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Estimating a patient’s age-clinical implications

Neil Baum, MD

Physician

June 22, 2014

As a medical student I was in awe when a professor looked at a patient’s hands or nail beds and described their medical condition without taking a history. I was also enthralled by a TED talk by the best selling author, Abraham Verghese, where he described a lesson that Arthur Conan Doyle, author of Sherlock Holmes, learned as a medical student at the medical school in Edinburgh, Scotland from the famous physician …

A prayer by a physician

Afshine Ash Emrani, MD

Physician

June 21, 2014

When I first met Ralph, he was 82-years-old. He suffered from shortness of breath which started when his wife of 56 years was diagnosed with a rare bone cancer. Upon further investigation, I diagnosed him with a weak heart and a very tight aortic valve which required immediate surgery. Ralph made it; his wife died. Today, twelve years later, he brings me treasures from his metal detecting hobby on the …

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A prayer by a physician

The problem with vendor management systems to solve staffing shortages

Val Jones, MD

Physician

June 20, 2014

In an effort to save on human resources costs, some hospitals have decided to make locum tenens* doctors and nurses line items in a supply list. Next to IV tubing, liquid nutritional supplements and anti-bacterial wipes you’ll find slots for nurses, surgeons, and hospitalist positions.

This depressing commoditization of professional staffing is a new trend in health care promoted by software companies promising to solve staffing shortages with vendor management systems (VMS). In …

Patient sensors: 5 differences between the consumer and health care market

David Lee Scher, MD

Tech

June 17, 2014

The technology industry has been buzzing of late because of the big players entering the wearable sensor market. We are very familiar with Misfit and Nike’s Fitbit for some time. Others investing into the sector include Intel, Microsoft, Apple and Samsung.

There is no doubt that the inertia for fitness trackers is undergoing modulation. This is a result of both a dampening of the initial “wow” factor by consumers and a maturation of the market. Recalls of …

Be personable and make a huge difference in a patient’s recovery

Ira Nash, MD

Physician

June 17, 2014

I have long been a fan of the Case Records of the Massachusetts General Hospital, which is published weekly in the New England Journal of Medicine. For many years, I made a point of recommending them to medical students and internal medicine residents as a model of concise yet comprehensive case presentations.

No wasted words, no missing information, and none of the filler that trainees often added when they presented cases, such …

Reasons why your wait time at the doctor’s office is so long

Justin Smith, MD

Physician

June 16, 2014

Painful wait times at the doctor’s office. It’s an old story with few exceptions.

As a dad, I have to deal with many of the same issues of parenting that you deal with: sleepless nights , fevers and holding my kids down for shots (my wife did it once, I think, then she promptly retired from this job). However, waiting at the pediatrician is not something I have to do. So, I can’t truly empathize …

The outrage over how much hospital administrators make

Janice Boughton, MD

Policy

June 11, 2014

I recently read the New York Times article on the ridiculous amount that insurance company executives and hospital administrators make. So the reason that American health care is so expensive is not because doctors earn too much, or drug companies charge too much or device manufacturers are making ever more expensive devices with ever expanded indications. Except that it is all of that and more.

Hospital administrators and insurance company executives do …

5 ways to improve the healing environment of hospitals

Suneel Dhand, MD

Physician

June 10, 2014

The very basic definition of a hospital is a place of healing and recovery. Health care is in a tumultuous state of flux at the moment, with the universal drive for quality improvement and the need to reign in costs. These issues, along with the desire to enhance our patients’ satisfaction and overall health care experience, were barely even talked about a decade ago. Now, they are all the buzz …

5 controversies surrounding the Affordable Care Act

Lawrence D. Brown, PhD

Policy

June 8, 2014

The continued implementation of the Affordable Care Act (ACA) in 2014 will be as controversial as in previous years.

Here are five main areas of concern:

1. The individual mandate. By what right does the federal government “force” its citizens to buy a product they may not want? The Supreme Court upheld the mandate in 2012, but that does not end the matter. Partly — perhaps largely — because the ACA sets …

The truth about admissions from the emergency department

Shadowfax, MD

Physician

June 8, 2014

I would like to explain why Michael Kirsch’s article, “Why the ER admits too many patients,” is wrong, in all the myriad ways, in his contention that emergency physicians (EPs) admit too many patients because of improper motivations. Note that I am not going to argue that EPs don’t admit too many patients — that’s a legitimate discussion to have and there may be some merit …

The problem with an anti-medication bias

Albert Fuchs, MD

Meds

June 6, 2014

“I don’t like taking medicines.”

All physicians hear some form of this opinion very frequently. Even more frequently, patients don’t state this view outright but rely on it to completely subvert their doctor’s plans.

When I was new to practice such an utterance would shock and confuse me.

“I don’t want to take any medicines,” a patient would declare.

“That’s fine,” I would reassure my interlocutor. “It’s a free country. No one is going …

Why the ER admits too many patients

Michael Kirsch, MD

Physician

June 6, 2014

Every player in the medical arena has found itself challenged by conflicts where one’s self-interest competes can skew what should be pure advice. This issue is not restricted to the medical universe. Every one of us has to navigate through similar circumstances throughout the journey of life. If an attorney, for example, is paid by the hour, then there is an incentive for the legal task to take longer than …

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Why the ER admits too many patients

What paying it forward in health care looks like

Peter Pronovost, MD, PhD

Physician

June 4, 2014

The doughnut shop I pass on my drive to the hospital isn’t the kind of place where you might expect to see outpourings of random kindness. It sits in the shadow of a raised highway, a few doors down from a bail bond business and a block away from a prison complex that resembles a medieval castle.

One Sunday before Valentine’s Day, the line to get served there was long, checkered …

A requiem for handwritten admitting orders

Janice Boughton, MD

Physician

June 4, 2014

When I first learned to take care of patients in the hospital, as a third-year medical student, we used a mnemonic to help us remember what to order when a patient was first admitted. Patients would come in to the hospital from a doctor’s office or from the emergency room and the nurses needed a set of orders to know what to do for the patient. The mnemonic we used …

Should junk foods carry warning labels?

David L. Katz, MD

Physician

June 3, 2014

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There is, of course, stuff we can chew and swallow that isn’t food. Play-Doh comes to mind. As does Silly Putty.

My thoughts turned to those substances, among others, when my friends at Time magazine asked me recently to opine on the suggestion that junk foods should carry warning labels. My first inclination was: No, that’s too much. But then it dawned on me: Is anything that …

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Should junk foods carry warning labels?

The health care industrial complex is stronger than ever

Wes Fisher, MD

Physician

May 30, 2014

Irontriangle

Walking to the 2014 Heart Rhythm Society (HRS) Scientific Sessions recently, I couldn’t help but marvel how beautiful San Francisco was. The weather was perfect, the streets bustling, the quaint shops and eateries doing brisk business in a very hip metropolitan city with a distinctive West Coast vibe. As I walked up to the Moscone Conference Center, I was struck by …

My favorite patient died last night

Miranda Fielding, MD

Physician

May 30, 2014

to live in this world

you must be able
to do three things
to love what is mortal;
to hold it

against your bones knowing
your own life depends on it;
and, when the time comes to let it go,
to let it go
-Mary Oliver, New and Selected Poems, Vol. 1

As a parent, you are not supposed to have a favorite child, and since some of us physicians feel a strange but kindred protectiveness for our patients, likewise we …

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My favorite patient died last night

Physicians are noncompliant too

Elaine Khoong, MD

Physician

May 30, 2014

Patient noncompliance.

I wasn’t very familiar with this term until I started my clinical rotations. But after just the first week, I started noticing that health care providers throw this phrase around all time.

We particularly like using it as an excuse. Why did this diabetic patient require a foot amputation? Why does this patient come in monthly with congestive heart failure exacerbation? Why did this patient suffer a stroke? It’s often …

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Physicians are noncompliant too

The salaries of health executives: What can doctors do?

Kevin R. Campbell, MD

Policy

May 29, 2014

Health care reform is a reality. The ACA and its associated mandates have forever changed the landscape of medicine in the U.S. today. The Obama administration touts the goals of reform as providing affordable, cost effective, high quality care for all Americans. Certainly these are noble and lofty goals: But have we completely missed the mark?

Today, many remain uninsured and the majority that have signed up for the exchanges are simply …

Managing unhappy patients after surgery

Sid Schwab, MD

Physician

May 29, 2014

The idea behind surgery is a really simple one: You come to me with a specific problem, I fix it, you go away happy. And when you come back, you’re still happy. What’s so wrong with that? If I wanted to be miserable, I’d have gone into primary care.

When a surgeon screws up, his/her role is clear: Admit it, make it better, or as good as possible, and stick with …

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Managing unhappy patients after surgery