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The problem with an anti-medication bias

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

How do we fix the high blood pressure problem?

Robert Pearl, MD

Conditions

May 28, 2014

It’s a leading cause of death and disability in the U.S., leading to hundreds of thousands of preventable heart attacks, strokes and failed kidneys each year. About one-third of all American adults have it, according to the Centers for Disease Control, and it costs the nation about $50 billion annually to treat it and its complications.

“It” is high blood pressure, also known as hypertension. It is a symptomless, silent killer.

There are …

Can doctors ever work together with insurance companies?

Natalie Azar, MD

Physician

May 28, 2014

Recently, I had what I’d call a true banner day in my office. One late afternoon, after I had finished seeing patients, I had started in on that iniquitous pile of paperwork that awaits all of us doctors after office hours. As usual, I was finding the task alternately arduous (can my patient comfortably carry five-to-ten pounds for five-to-ten minutes?), rewarding (the patient does not have lupus), and monotonous (there …

Is medical school just for rich kids?

Pamela Wible, MD

Education

May 26, 2014

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This letter was received and edited for clarity by Pamela Wible, MD.

Dear Dr. Wible,

This will be my last email to you because I am giving up on my dream of being a doctor.

I’ve contacted so many colleges and medical schools hoping to find one that would help me become a doctor for my tribe. Today, I finally got a response from the …

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Is medical school just for rich kids?

Ignaz Semmelweis and the lessons of fear and medical innovation

Alberto Hazan, MD

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

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