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When your child doesn’t poop: Solving the constipation death spiral

Conditions

September 27, 2014

Michelle wrote in: “We trained my 3-year-old son approximately 3 months ago, and it’s been great. He’s been having virtually no accidents. The problem is that he’s terrified of making ‘dirty’ on the toilet. He does it in his pamper at night when he’s sleeping. He’s very verbal about it, and tells me that he’s scared to let the dirty come out. It’s really difficult to deal with because there …

Emergency room doctors can safely use bedside ultrasound

Janice Boughton, MD

Physician

September 27, 2014

I have been following the progress of bedside ultrasound (using ultrasound as a diagnostic tool during my physical exam of patients) as it gets a foothold in standard medical practice since I first started learning to do it about 3 years ago. Every so often a study comes out which warms my heart as it proves that less (radiation, expense) is more in treating patients.

An article came out in the …

Vulnerability is a virtue in medicine

Michael Metzner

Education

September 26, 2014

Medical students are repeatedly taught the importance of the physician-patient relationship. We are told that to be a good doctor we must strive to exhibit compassion, empathy, respect, professionalism and confidence all while applying our medical knowledge to figure out a diagnosis and treatment plan. If you add in the pressure of doing this within a 15-minute visit, all while answering questions faster than an Internet search, it can get …

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Vulnerability is a virtue in medicine

How hospitals discourage doctors: A step by step guide

Richard Gunderman, MD, PhD

Physician

September 26, 2014

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Not accustomed to visiting hospital executive suites, I took my seat in the waiting room somewhat warily.

Seated across from me was a handsome man in a well-tailored three-piece suit, whose thoroughly professional appearance made me — in my rumpled white coat, sheaves of dog-eared paper bulging from both pockets — feel out of place.

Within a minute, an administrative secretary came out and …

An insider guide to reading your radiology report

Rourke Stay, MD

Conditions

September 26, 2014

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The simple truth is that radiology reports can be hard to read, especially for those without a medical background. The combination of advanced medical technology and the wonderful subtle intricacies of the human body often result in a final document that more closely resembles a William Faulkner novel (translation: difficult to understand!) than Dr. Seuss. The goal is to try to …

Health care fails to adopt technology. Here are 5 reasons why.

Robert Pearl, MD

Tech

September 25, 2014

Why do so many seemingly great technologies fail to penetrate the health care system?

I hope the following five answers shed some light on the realities of technology adoption in health care.

1. Many new technologies don’t address the real problem

Tech entrepreneurs often take a backward approach to invention. They start by discovering a nifty technology. Later, they figure out how people can use it.

This technique often teaches entrepreneurs a tough lesson: Technology …

A twisted argument against end-of-life care

James C. Salwitz, MD

Physician

September 25, 2014

“All your patients will die. Maybe not today, but someday. The defining fact of life is that it ends. Only a fool would dedicate their career to fighting something that can never be beaten. Therefore, a doctor’s task cannot be to fight death. A doctor’s task is to heal when possible and prevent suffering always. Our calling is to support life. Fighting death may deprive patients of the opportunity to …

Don’t spank your children. Do these 5 things instead.

Wendy Sue Swanson, MD

Conditions

September 24, 2014

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In my mind it’s no wonder the American Academy of Pediatrics has a statement against spanking. Spanking, in the simplest form, is the act of hitting a child, using physical force to try to get a different outcome. Thing is, spanking is an ineffective discipline tool in the long run and research shows it’s damaging to a child’s mental health. …

“I want to give up my son”: Is that child abuse?

Alberto Hazan, MD

Physician

September 24, 2014

The case

A thirty-five-year-old female presents to the emergency department on a weekend afternoon with the following chief complaint: “I want to give up custody of my son.”

The patient is well dressed — and so is her four-year-old son, who is sitting comfortably on the bed playing a video game on his mother’s cell phone.

According to the patient, she is a single mother with no support system. Her son’s father deserted …

Responding to a medical student in pain

Abigail Schildcrout, MD

Education

September 23, 2014

This evening, I read a post written by a woman who finds herself feeling alone, depressed, desperate, and afraid of losing herself as she goes through medical school.

This post is my response to that woman.

Dear colleague and friend,

You are not alone.

You are far from home. You are far from your family. You are far from the desert, the open …

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Responding to a medical student in pain

How do you know when a hypochondriac is really sick?

Lucy Hornstein, MD

Physician

September 22, 2014

I have a patient who is a full blown sufferer of health anxiety. He firmly believes he has full-blown AIDS after a single extramarital sexual contact (non-genital) one month prior with a woman not known to have HIV. (Reality check: The other person didn’t have HIV, the specific contact as described was ridiculously unlikely to have transmitted the virus had it been present, and AIDS takes months to years to develop …

Deactivating a pacemaker: Is it euthanasia?

Eric Widera, MD

Conditions

September 18, 2014

“He’d feel okay about not replacing the pacemaker’s battery when it ran down, he said. But turning it off, he said, would be ‘too active.’ Later he would tell me that it would have been “like putting a pillow over your father’s head.”

These are the words of Katy Butler in her book Knocking on Heaven’s Door – The Path to a Better Way of Death in which she writes about her …

Abortion or ectopic pregnancy? When politicians confuse medical terms.

Jennifer Gunter, MD

Conditions

September 17, 2014

Wendy Davis, gubernatorial candidate for Texas, has a new memoir Forgetting to Be Afraid. In it she describes terminating two pregnancies. One termination appears to have been in the second trimester for fetal indications and the other she describes as an ectopic pregnancy. She writes, “The only medical option was to have surgery to terminate the pregnancy and remove the affected fallopian tube — which …

The worst-case scenario: When patient satisfaction goes too far

Suneel Dhand, MD

Physician

September 15, 2014

Everyone involved in health care, and particularly hospital care, has witnessed a sea change over the last decade. Things that were never even thought about, let alone formally taught to frontline doctors and nurses, have now come to the forefront.

Chief among these is the drive towards improving patient satisfaction and delivering a more optimal hospital experience. True, a large part of this is due to federal incentives and tying reimbursements …

5 things people get wrong about Canada’s health system

Kathleen O’Grady and Noralou Roos, PhD

Policy

September 14, 2014

The Canadian health care system is often held up as an example to model or to avoid at all costs in the debates on health care in America, and elsewhere. Yet there are a startling number of misconceptions — on both sides of the partisan divide — about how the Canadian health system actually works, often from experts who should know better. Here are the facts.

1. Doctors are self-employed, not …

What is a gomer? And why should you know about it?

Admin

Video

September 12, 2014

Ever wonder what a “gomer” is? While certainly passé and unprofessional, does it shed light into the frustrations both doctors and patients have with end-of-life care? Emergency physician and author Brian Goldman explains the origins and use of such medical slang in his book, The Secret Language of Doctors.

What is a gomer? And why should you know about it?

Value-based care: Bad for doctors, bad for patients?

Margalit Gur-Arie

Policy

September 11, 2014

Value-based health care is antithetic to patient-centered care. Value-based health care is also diametrically opposed to excellence, transparency and competitive markets. And value-based health care is a shrewdly selected and disingenuously applied misnomer. Value-based pricing is not a health-care innovation. Value-based pricing is why a plastic cup filled with tepid beer costs $8 at the ballpark, why a pack of gum …

What’s it like to be an oncologist? This is just one day.

James C. Salwitz, MD

Physician

September 10, 2014

7:00 a.m. Lights on.

Coffee, black and a banana. Paperwork. 27 patient visits, 3 emergencies, 35 phone calls. Lots of computer time. Some laughs and a few tears. Paperwork. Last family meeting. Coffee, black. In between: Thursday.

Was not completely successful in explaining to my frantic patient with the multi-page lab printout, how the problem was not that her tests were bad, but that the computer had used the wrong “normal” range …

Appreciate your NICU nurse: A letter from a neonatologist

Sue Hall, MD

Physician

September 7, 2014

Dear NICU nurse,

I couldn’t have done what I do without you, and the time to thank you publicly for all the ways you have helped me is more than overdue.

Thank you for teaching me how to handle 500 grammers when I was a medical student and had no clue. This showed me your tolerance and good nature.

Thank you for speaking up …

Want to become a doctor? 5 criteria you should consider.

Robert Centor, MD

Education

September 4, 2014

While running several times over the past week, I have thought carefully about our profession. I cannot imagine having chosen any other profession than medicine, nor any specialty other than internal medicine.

But that is me, is it you?

A medical tweeter than everyone should follow @medicalaxioms had these tweets recently: