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Ignaz Semmelweis and the lessons of fear and medical innovation

Physician

May 25, 2014

The man who saved more lives than any other physician (in the history of humanity combined) died in a mental institution — unrecognized and shunned by the medical community. He was beaten by guards and died a miserable death. Dr. Ignaz Semmelweis was a Hungarian obstetrician practicing in the mid-1800s, years before Louis Pasteur came up with his germ theory and Joseph Lister popularized hand washing.

While working as an assistant …

The art of writing a good consultation letter to another physician

Merry Jennifer Markham, MD

Physician

May 25, 2014

I received a fax recently, from the office of another hematologist-oncologist, at another academic medical center. Attached to the fax cover page, with my name and fax number scribbled in slanted script, was a five-page consultation report on one of my patients. That oncologist — I’ll call him Dr. Z — had seen and evaluated my patient to provide a second opinion on the patient’s diagnosis and treatment.

The lengthy report …

Breaking down the language barrier in medicine

Chiduzie Madubata, MD

Physician

May 24, 2014

When one hears the words “language barrier,” it usually brings up images of a person who is in another country of which the national language is not his own. If you have visited a foreign country without fully knowing the primary language, you can start to feel out of place fairly quickly. Despite one’s best efforts to navigate the country, a part of the cultural experience is lost without knowing …

How many patients can a primary care physician care for?

Stephen C. Schimpff, MD

Physician

May 23, 2014

Next in a series.

How many patients can a primary care physician (PCP) reasonably care for? I have been interviewing PCPs: Here are some of their thoughts when asked this question.

Responses were widely divergent ranging from about 300 to 3,000 or even more. Yet many are clearly conflicted. Some say they can manage about 2,000 with little difficulty — but then observe elsewhere in the conversation that they have no …

Psychiatric hospitals need meaningful use incentives

Edmund Billings, MD

Tech

May 22, 2014

Imagine you go to work one day and your boss says all employees will be evaluated based on the performance of a new set of job skills that require additional training and, perhaps, new computer hardware and software. The boss also announces that some employees will be reimbursed for the cost of acquiring these skills and tools. You aren’t among this privileged group.

In government, this is called an unfunded …

Physician suicide etiquette: What to do when your doctor dies suddenly

Pamela Wible, MD

Physician

May 19, 2014

physician suicide

An obstetrician is found dead in his bathtub. Gunshot wound to the head. An anesthesiologist dies of an overdose in a hospital closet. A family doctor is hit by a train. He’s decapitated. An internist at a medical conference jumps from his hotel balcony to his death. All true stories.

What are patients to do?

When they call for appointments, patients are …

When we torture our patients

Shoa L. Clarke, MD, PhD

Physician

May 18, 2014

Today, a patient attacked me. A nurse got kicked. Another punched. I was gouged to the point that blood was drawn. The patient was neither intoxicated nor psychotic. Rather, she was a meek 92-year-old grandmother, and she was terrified. It took five of us to hold her down, as she summoned the strength of a woman fighting for her life.

Linda is an elderly woman with moderate dementia. She is blind …

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When we torture our patients

Being a nurse is the noblest profession

Angelo Falcone, MD

Physician

May 16, 2014

It was recently Nurses Week in early May and there were a lot of adulations being offered on social media and throughout hospitals regarding the appreciation we have for those among us who have chosen to be on the “front lines” of caring for us when ill or injured.

As an emergency physician I could speak about the many times a nurse has grabbed me and pulled me into a room …

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Being a nurse is the noblest profession

Health care quality can be surprisingly subjective

Lucy Hornstein, MD

Policy

May 14, 2014

Round and round and round we go yet again. The system is broken. Do something. Health care reform!

“Pay for performance” morphs into “measure (and pay) for quality.” The big problem is that no one has bothered to actually define the term, maybe because everyone assumes they know what it means — and that everyone else agrees with them. Wrong.

Quality is very much in the eye of the beholder, and …

How to design a better hospital

Suneel Dhand, MD

Physician

May 13, 2014

Let’s face it. A hospital is a place where nobody wants to be. By it’s very nature, it is somewhere scary and not too nice. Those of us who work every day in hospitals can easily forget this fact: Those who we serve would rather be anywhere else (and so they should). Think of all the things our patients would rather be doing — enjoying a leisurely afternoon with the …

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How to design a better hospital

Why do I only get 10 minutes with my doctor?

Stephen C. Schimpff, MD

Physician

May 12, 2014

Next in a series.

Good question. You call for an appointment and are told it will be about 20 days. You arrive on time only to sit in the apt named waiting room for 40 minutes. Finally you get to see your primary care doctor (PCP). You begin to explain why you came in but are interrupted within about 23 seconds even though it would have only taken you about …

Why the quality measures used in health care are deeply flawed

Karen S. Sibert, MD

Physician

May 12, 2014

Nobody stands up to argue against quality and value in health care. You might as well argue against motherhood, or puppies. Yet many physicians are inherently skeptical of definitions of “quality” that are imposed from above, whether by outside evaluators like The Joint Commission, or (worse) by the government.

There’s good reason for skepticism. Some of the “evidence” behind “evidence-based medicine” has turned out to be flawed, tainted by financial conflict …

Medical school drug testing is a moral and scientific failure

Anonymous

Education

May 11, 2014

Before the 1980s, drug testing was uncommon. It was widely viewed as an invasion of privacy and an infringement on fourth amendment rights. Today, a medical student is likely to be drug tested before entering medical school, before clinical rotations, and/or before residency. If preventing drug use among medical students is the goal of these tests, they have failed miserably. Urinalysis drug tests are ineffective. But more importantly, they are …

The relatively low compensation of infectious disease specialists

Paul Sax, MD

Physician

May 9, 2014

MD-Compensation-Report

Now a median of $174,000 per year is hardly chump change, so I don’t expect much in the way of sympathy on these data. On the other hand, someone has to to be last, and note that our income hasn’t increased a bit since the last time I commented on this survey three years ago.

So it’s worth taking a few moments listing …

The risks of being a physician advocate

Amol Utrankar

Policy

May 9, 2014

As a future doctor, I believe that digital dialogue affords medicine a powerful responsibility to educate and engage. I believe physicians have a responsibility, as daily witnesses to the gaps and failures of public policy, to advocate for social justice and policy reform. I believe that medicine should extend beyond the proximate effects of illness and injury to address their root social etiologies.

I’ve always held these beliefs with firm conviction. …

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The risks of being a physician advocate

Pay me like a French doctor. You know you want to.

Kevin Pho, MD

KevinMD

May 8, 2014

cost of medical school

Whenever new physician salary data is released, reporters and policy experts often compare doctor salaries in the United States to those of other countries: most notably, France.

And on cue, Vox’s Sarah Kliff — normally an excellent health care writer, by the way — is uncharacteristically lazy in framing physician salaries through a biased lens.

After presenting the data, …

When patients secretly record their doctor visits

Deep Ramachandran, MD

Physician

May 5, 2014

“Doctor, can I record this conversation?”

It’s happened to me a couple of times already. But the question above was never asked. Rather I was informed later on that my conversation with a patient or family was recorded without my knowledge. Smartphones have made it all too easy for patients to secretly record conversations with their health care providers. Simply hit a button, lay it innocently down by your side in …

To medical students: We’re all in the same boat

Serena Zhou-Talbert, MD, MPH

Education

May 4, 2014

I am an imposter in a white coat. I’m not sure if anyone knows yet, I hope I am good at hiding it. It’s a well-kept secret amongst all medical students. In the hospital, I am at the bottom. I know the least and have the least power. Most patients don’t realize this and look up to me like I’m an all-knowing, wise muse or something of that nature. Sometimes, …

Table manners for physicians: 30 tips for better dining etiquette

Karen Hickman

Physician

May 2, 2014

A few years ago I was engaged by the director of a residency program in my community to teach the program residents table manners. Now, you may wonder why medical residents need to know how to navigate a dining table gracefully. But good table manners are a must for professionals in any arena.

The director of the program stated that she felt some …

Why doesn’t everyone have a pocket ultrasound machine?

Janice Boughton, MD

Tech

May 1, 2014

For about 2 years now a tiny ultrasound machine has been part of my standard physical exam tools as I take care of patients in the hospital and in the outpatient clinic. In November 2011, I first picked up an ultrasound transducer in a continuing medical education course on bedside ultrasound for emergency physicians. I am an internist, not an emergency physician, …

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