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Everyone should have a pleasant mammogram experience

Physician

February 12, 2014

This morning I went for my annual mammogram. It’s not something I generally look forward to. In fact, I mildly dread it.

In my personal experience, mammograms have ranged from quite uncomfortable to downright painful. And then there’s the general unpleasantness of standing topless in a cold room. The first time I had this screening imaging study done, the plate pressed so hard into my sternum that I was almost in …

5 truths about fevers in children

Melissa Arca, MD

Conditions

February 10, 2014

shutterstock_84129244

The flu, RSV, colds, croup, strep throat, ear infections. They all have one thing in common: they can cause fevers. And as any parent can attest to, it’s often the fever itself that freaks us out more than anything and prompts many parents to call their child’s pediatrician or hustle them off to the emergency room.

Fever is clearly not a parent’s …

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5 truths about fevers in children

What is the main cause of the primary care crisis?

Stephen C. Schimpff, MD

Policy

February 10, 2014

Next in a series.

Primary care physicians (PCPs) have too little time per patient which means too many referrals to specialists, too little time listening and thinking, no time to delve into the stress or emotional causes of many symptoms and substantial frustration by PCP and patient alike.

Previously in this continuing series on primary care, I described a patient with a straight forward if unusual symptom who was bounced …

Shotgun medicine: An arrow is often better

Jennifer Adaeze Anyaegbunam

Education

February 5, 2014

During my internal medicine rotation, the medical students had the opportunity to attend intern morning report, an interactive teaching session where attending physicians walk the interns through a patient’s story, starting from the moment they hit the door of the emergency room to the final stages of diagnosis and treatment.

After discussing the patient’s symptoms, complaints and past medical history, the attendings always ask the group to think carefully about the …

4 reasons why hospitals can be very dangerous places to be

Robert Pearl, MD

Physician

February 3, 2014

Hospitals are commonly thought of as the safest place to be for sick people.

Patients have around-the-clock access to skilled care teams. Their vital signs are continuously monitored. A physician stops by every morning to check on them.

While it all sounds safe, a hospital can be a very dangerous place to be. Here are four frightening risks hospitals pose, along with their causes and some easy-to-implement solutions that could save hundreds …

5 ways to improve the adoption of medical apps

David Lee Scher, MD

Tech

February 3, 2014

Before the adoption of new technologies which will undoubtedly improve health care (as it has the retail and finance sectors), it must be introduced in ways which are digestible, scalable, and subject to rapid iteration.

Is mobile technology different from the adoption of any other change in health care delivery? I think not. The culture of care certainly requires change as care models are changing. The point of care is shifting to the home, professionals …

Are you a victim of patient profiling?

Pamela Wible, MD

Physician

February 3, 2014

patient profiling

Ever felt misjudged by a doctor? Or treated unfairly by a clinic or hospital? You may be a victim of patient profiling.

Patient profiling is the practice of regarding particular patients as more likely to have certain behaviors or illnesses based on their appearance, race, gender, financial status, or other observable characteristics. Profiling disproportionately impacts patients with chronic pain, mental illness, the …

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Are you a victim of patient profiling?

What is a high risk patient?

Fred N. Pelzman, MD

Physician

February 2, 2014

“What’s a high-risk patient?” asked our newly hired care coordinator.

Interesting question, and, as you would expect, one without an easy answer.

One of our patient-centered medical home certifying agencies was performing an audit for recertification, and requested information on our high-risk patient registry, including how patients were identified and assigned to the registry.

When you ask doctors or any other providers, we all know one when we see …

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What is a high risk patient?

Treating post-viral coughs: This too shall pass

Emily Gibson, MD

Conditions

February 1, 2014

‘Tis the season to be coughing …

It no longer takes an epidemiologist looking at absenteeism rates in schools to predict the start of influenza season. For several years now there have been sophisticated models using search engine terms to monitor increasing incidence of febrile cough illness in regions of the world.

Or just ask a primary care clinic what its waiting room sounds like these days. A chorus of coughs, high, low, dry, …

When patients write to doctors, and what it means

Miranda Fielding, MD

Physician

January 31, 2014

Where I come from, when most people refer to the Good Book, they are referring to the Bible. This is not true for my father, because to him, the Good Books are something else entirely.

He describes a scene early in his career as a plastic surgeon, when he had taken his doting mother to see his new office. Coincidentally, a lovely thank you note had just arrived from one of …

Use Justin Bieber as a teaching moment for kids

Wendy Sue Swanson, MD

Conditions

January 31, 2014

justin-bieber-mugshot

Justin Bieber was arrested recently in Florida for a DUI. The smirk on his face is a bit misplaced. While it’s no longer a surprise when we hear about a celebrity’s challenge with drugs and alcohol, Bieber serves up a perfect moment for education. I mean this kid (he’s 19-years-old) really could have killed himself last night. Thank goodness he’s …

Refusing the flu shot: Respecting the patient’s right to choose

Jennifer Adaeze Anyaegbunam

Conditions

January 29, 2014

I’ve spent the past four weeks learning about primary care on my family medicine rotation. A significant portion of patient care in this setting is focused on health maintenance or disease prevention. Physicians can provide their patients with evidence-based recommendations for various screening tests and vaccinations, but it is ultimately up to the patient to decide what services he or she will receive.

According to the Centers for Disease Control and …

Mohs surgery is vilified, physicians again fail to respond effectively

Joyce Ho, MD

Conditions

January 29, 2014

An article published in the New York Times last weekend has been circulating widely on the Internet, and I feel that more than ever, physician voices are needed to reach the public and counter certain misconceptions put forth by the media.

The article, “Patients’ Costs Skyrocket; Specialists’ Incomes Soar,” charts the growth of specialist incomes in the past decade, using the case of a patient from Arkansas who had a …

The transition from chief resident to attending

Akhil Narang, MD

Education

January 28, 2014

During my year as a chief resident, I have the privilege to attend on the general medicine service for 8 weeks. I recently completed 4 weeks and, as expected, found myself in an entirely new realm of patient care and accountability. I would be remiss without recalling a few of the pivotal lessons and poignant moments that stand out.

Transitioning from resident to attending inevitably results in greater scrutiny. Despite my best …

The toxicity of Medicaid

Edwin Leap, MD

Physician

January 28, 2014

I have noticed over the years that physicians who write about medicine, particularly for the general public, are limited to very specific discussions. For instance, it is perfectly acceptable to write about the plight of the poor and uninsured. It is always reasonable to advocate for a single payer system. It is perfectly acceptable to discuss how one downsized in order to make less and “give back” more. And it …

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The toxicity of Medicaid

Does your joint replacement have a warranty?

Brian Hatten, MD

Physician

January 26, 2014

Should joint replacement manufactures provide a warranty for their products? It seems pretty logical since most consumer products come with some sort of warranty these days. Basic warranties are almost universally provided and the market for extended warranties is increasingly popular.

Take for instance my recent upgrade to the new iPhone 5s. At the time of purchase, the AT&T store suggested their extended …

Why psychiatrists don’t take insurance

Dinah Miller, MD

Physician

January 25, 2014

In 2007, I wrote a post called “Why Shrinks Don’t Take Insurance.” The post is a bit dated, the CPT codes have changed since then, and the reasons to not take insurance have increased. Many other doctors don’t take insurance now, though psychiatry remains the number one specialty where doctors don’t participate in health insurance plans. This is an updated version of that same post.

Many psychiatrists in private practice don’t …

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Why psychiatrists don’t take insurance

When should you use antibiotics in hospice care?

Alex Smith, MD

Physician

January 23, 2014

Case 1: You have a 94-year-old woman with multiple medical problems in hospice who develops a fever (subjectively hot to the touch), shortness of breath, and a cough producing yellow sputum. Her daughter asks if she can be treated with antibiotics “to make her feel better.” The patient is not well enough to make decisions, but in earlier conversations had stated a goal of remaining comfortable at home, while also …

Board certification: Valid indefinitely is no longer rings true

Ira Nash, MD

Physician

January 23, 2014

I trained in internal medicine and cardiology at the tail end of the era of lifetime board certification by the American Board of Internal Medicine. In fact, my timing was perfect — I was “boarded” in medicine in 1987, and in cardiovascular disease in 1989, which (I am pretty sure) were, respectively, the last years that the ABIM offered certificates without an expiration date in those disciplines.

Late last year, I …