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Tongue cancer in an elderly patient: Thinking of my grandmother

Conditions

December 17, 2014

Old age is no place for sissies.
-Bette Davis

“I want the surgery today!” She started to cry. “I’m ninety-four years old. I’ll accept any risk. Just take this thing out!”

She looked back and forth between the anesthesiologist and me. Her golf-ball sized tongue cancer had been growing over the past six months. It wasn’t changing from day-to-day, but it had increased over the course of the three weeks since we had …

How to introduce palliative care to patients

Robert Centor, MD

Physician

December 15, 2014

Did I tell you that I was a big fan of palliative care? Palliative care started around 15 years ago at the VA where I worked. We saw the service evolve. We saw how the palliative care approach improved the quality of both life and death.

Many physicians have not yet accepted or at least understood palliative care. Many physicians use some palliative care principles and believe palliative care is superfluous. …

She died thirsty! Ice chips matter when it comes to patient satisfaction.

David Klein, MD

Physician

December 15, 2014

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“My wife died uncomfortable and alone. She died thirsty!”

The man who spoke those words came in to the emergency room recently where I was working a shift. He was accompanied by his wife, a 70-year-old with high sugar, weakness, and nausea. The team worked to get her seen under the presumption that her diabetes needed control. Once she was brought back to …

Medicine is complex, but doctoring is viewed as being simple

Hans Duvefelt, MD

Physician

December 14, 2014

I keep six honest serving-men
(They taught me all I knew);
Their names are What and Why and When
And How and Where and Who.
– Rudyard Kipling

Medicine has become a very complex, multifaceted science, ranging from pharmacogenetics to psychoneurobiology. Doctoring, however, is increasingly viewed as so simple that you don’t actually have to be a doctor to know how it should be done.

What else could explain why IT people tell doctors what “workflows” …

A child psychiatrist: Whether I choose to be one or not

Greg Smith, MD

Physician

December 14, 2014

Dr. Kenneth Azar, a mentor of mine at the old Georgia Regional Psychiatric Hospital in Augusta, Georgia, told me something once that has always stuck with me.

He told me that in the early years of his practice, when he was living and working out in Idaho, that he was one of a very small handful of psychiatrists who served the whole state. If an adult with psychosis needed to be …

A doctor goes networking, and is horrified by what she finds

Abigail Schildcrout, MD

Physician

December 11, 2014

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I was invited to a “networking party.” I went. I was horrified by what transpired there. And disgusted. And felt blindsided. And angry. And blown away by the prevalence of what I couldn’t decide was greed, ignorance, or an unseemly combination of the two. And what magnified the intensity of my repulsion was the fact that a large proportion of the people involved have the …

Health care’s future: An interview with a hospital CEO

Trudy Lieberman

Policy

December 10, 2014

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Not long ago I interviewed Dr. Todd Sorensen, the CEO of Regional West Medical Center, a 184-bed facility serving a large swath of rural western Nebraska. I’ve known Dr. Sorensen since junior high school, and we’ve kept in touch over the years to discuss the health care system from his perspective as a physician and administrator and mine as a health …

A cardiologist undergoes knee surgery. Read what he learned.

Wes Fisher, MD

Physician

December 10, 2014

The phone rang one evening and a pleasant voice was on the other end. “Hi, my name is nurse so-and-so and I’m the educational coordinator for your upcoming knee surgery. Do you want to go to the patient orientation session?” she asked. “It’s very helpful to go over things before and after your surgery and to answer any questions you might …

Antibiotics during gynecological surgery: When are they necessary?

Jennifer Gunter, MD

Conditions

December 9, 2014

Preventing infection after surgery is very important as not only are these infections often uncomfortable and make you feel very sick, but they also increase the risk of more serious complications. For example, if you are less mobile because of an infection after surgery you are at higher risk for a blood clot or if you need a prolonged hospitalization because of an infection in your surgical wound you are …

The 80-20 rule: Apply Pareto’s principle to hospital medicine

Suneel Dhand, MD

Physician

December 9, 2014

There are certain universal laws that appear to govern the broader workings of the world around us. For those of you unfamiliar with Pareto’s principle, it’s a concept that was first applied in economics and then found to be a governing rule in a whole host of different arenas. It’s no understatement to say that understanding and acting upon this concept can be transformative, not just in your work but …

5 ways how doctors can round with nurses

Val Jones, MD

Physician

December 7, 2014

Whenever possible I make a point of rounding on patients with their nurses present. I rely on nurses to be my eyes and ears when I’m not at the bedside. I need their input to confirm patient self-reports of everything from bowel and bladder habits to pain control, not to mention catching early warning signs of infection, mental status changes, or …

Stay human in medicine: Lessons from The House of God

Stephen Bergman, MD

Physician

December 7, 2014

In 1978, under the pseudonym Samuel Shem, psychiatrist Stephen Bergman published “The House of God,” an iconic novel drawn from his medical internship in Boston in the early 1970s. Earlier this year, Dr. Bergman spoke at the commencement of the New York University School of Medicine. With his permission, the following is adapted from those remarks.

I began writing The House of God as a catharsis, to make sense of what seemed like the worst year of my life.

These are …

Why does treating heart attacks cost so much money?

Janice Boughton, MD

Physician

December 7, 2014

An article from the JAMA has been gnawing at my consciousness for the last couple of weeks. Dr. Prashant Kaul and colleagues out of the University of North Carolina reviewed records from hospitals in the state of California from 2008 through 2011, looking for patients who had been hospitalized with heart attacks. Specifically, they were looking for patients with ST elevation …

After a miscarriage: Answers to your difficult questions

Brian Enggano, MD

Conditions

December 6, 2014

I chose to become an OB/GYN because I love delivering babies and bringing joy to expectant parents. It is by far the most rewarding part of my job. Seeing the sense of pride on a new dad’s face, the joyful tears in a happy mother’s eyes, or the inquisitive look of a young big brother or sister is priceless and makes my “job” feel more like a privilege. Bringing a new …

The last house call: Turning off the defibrillator

James Ong, MD

Physician

December 5, 2014

Standing in front of my patient’s home, I reach out to ring the bell. On the other side of the door live a man and his wife, who have been waiting patiently for my arrival. I hesitate for a moment before pressing the button.

As I wait uneasily for the door to open, I think to myself that this is the first time I make a house call on my patient …

After residency: I’m scared to practice outpatient medicine

Rebecca Crow, DO

Education

December 3, 2014

As a graduating senior resident I’m scared to practice outpatient medicine. In a community of patients and physicians crying out for primary care doctors, what are we doing at a training level to foster and promote confidence and independence at doing this?

Many bright eyed freshly graduated medical school students enter residency understanding the need and embodying the hope of pursing outpatient …

Why teaching anatomically correct words matters

Natasha Burgert, MD

Physician

December 2, 2014

As a doc, I need to take care of the whole child. I do this with respect for every kiddo; and with their parent’s consent, presence, and permission. Sometimes the job includes discussing or examining a child’s genitals.

In the past, it was not thought of as appropriate to allow children to speak openly about sensitive anatomical areas (“private parts.”) Growing up as kids, we may have …

Two patient result letters: Which one did this physician send?

Lucy Hornstein, MD

Physician

December 2, 2014

Middle-aged lady, twenty pounds overweight.

Doing everything I can, doctor. Everything imaginable. Diet: I eat practically nothing. Exercise: all the time! Weight Watchers doesn’t work. Jenny Craig, South Beach, the Zone; I’ve tried it all. Nothing works. Have to lose weight. Have to lose weight.

Yada, yada, yada.

Oh look: A few years back I diagnosed you as hypothyroid and gave you some Synthroid. …

Medicare’s perverse incentive to keep patients on dialysis

Natasha Deonarain, MD, MBA

Policy

December 2, 2014

One of the most subtle deceptions hidden inside the cracks of our sick care system is the lie told to doctors: that health is our primary goal for our patients.

I began to understand this paradox clearly when I listened to my friend’s anguish.

She’s been working as a full-time medical assistant in a busy nephrology practice, supporting two sometimes three full-time sub-specialty doctors. The practice is located in a small town …

Medicare will pay for care coordination. Should doctors take the money?

Richard Hodach, MD, PhD

Policy

December 1, 2014

CMS recently announced it would begin next January to pay physicians for care coordination activities. It’s about time. As physicians have been saying for some time, any payment system that hopes to encourage value (better patient outcomes) has to start by paying physicians to coordinate the care of their patients. When physicians follow up on referrals or communicate with patients outside of the office, healthoutcomes improve, costs shrink and the patient …

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