The problem of conflicting professional medical guidelines

Physician
June 5, 2012

Guidelines for care increasingly help guide medical decision-making. If you’ve followed top health news over the past several years you’ve read conflicting statements about the utility of various medical procedures and tests. As a general internist I’ve devoured these reports with particular interest trying to wade through bias to formulate views that I believe will be of most benefit to my patients.

Recently I put together a talk about recommendations for …

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Using Advair to treat postinfectious cough

Meds
June 3, 2012

I am not a huge baseball fan to begin with, and when I am, I root for the Nationals.  Thus, I pay little attention to the New York Yankees, and was not aware that Yankee player Mark Teixeira had been suffering from a cough for the past month until it the story from the New York Times came through one of my Twitter feeds. According to the story: “Mark Teixeira had …

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How to get started on Twitter: A primer for doctors

Social media
June 3, 2012

So you’ve decided to take the plunge (or at least, dip your toes) into the Twitterverse.  Congratulations! Welcome to a vibrant interactive community.  You’ll find plenty of different personalities here and lots of opinions.  But if you are like I was back in January 2011, you currently have no idea how to actually use Twitter, let alone how a physician might want to use it.

There are plenty of places to …

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How doctors handle fear will determine their ability to give care

Physician
June 1, 2012

There was a night when I was in training that all the decisions, disasters and chaos, which are the practice of medicine, caught up to me.  In those dark hours, I felt practically despondent.  What I had seen left me in tears and overwhelmed by the tasks in front of me.

At that moment a wise attending physician took a moment to sit with me.  Rather than tell me how wonderful …

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Are the poor more likely to sue their doctors?

Policy
May 26, 2012

Many physicians, including myself, have the misconception that the indigent patient is more likely to be litigious than those patients with greater financial resources.  A well-organized study that was reported in Clinical Orthopeaedics and Related Research reported that socioeconomically disadvantaged patients tend to sue physicians less often than their more affluent patients.

Dr. Ramon Jimenez and his colleagues at the Monterey Orthopaedic and Sports Medicine Institute and his team demonstrated that patients …

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A medical student’s first patient interview

Education
May 25, 2012

“Um—Hi there, I’m a, uh, you know.  Medical student. First year. For, you know, the Patient-Doctor—err, Patient-Physician course—”

The nurse smiled and turned to a woman of shorter stature with bony, scrunched- up shoulders. “Mary, do you want this first year to interview you?”

Mary was about to set foot in the lounge when she heard this. She let out a sigh and faced me. Her eyes looked worn; I could tell …

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Patients are our best teachers

Physician
May 23, 2012

There are some patients we doctors never forget. They linger in our memories for various reasons. Often, it is their serious or unusual medical condition that stays with us. On other occasions, it is a zany or unique personality that we recall, even years later. Rarely, when the doctor-patient relationship becomes injured, then the patient may become unforgettable.

I remember a particular patient from 20 years ago for a very different …

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How medical school changed me

Education
May 22, 2012

I have been thinking a lot over the last few weeks about all the many ways that the experience of medical school has changed me.

The most obvious is knowledge. I’ve drunk from the proverbial “firehose” of information that we experience in medical school, and apparently enough of the facts stuck with me to pass all my exams, and secure myself a residency program back in my home state of California. …

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Struggling with the idea of leaving for medical school

Education
May 21, 2012

The lines of text on my laptop screen blurred together as I lost focus.  I knew there was at least one error on my medical school re-application I would regret later on.  My eyes scanned the familiar body of words but failed to connect the information to my brain.  Frustrated, I closed the application and shut my computer off.

My bedroom door abruptly swung open, revealing my mother with the phone …

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How we deliver bad news is critical to how families deal with grief

Physician
May 20, 2012

As a cardiac electrophysiologist, I have had to discuss bad news with patients and families more times than I would like during my career.  How a physician goes about this process can make an enormous impact in the lives of those affected by the news that must be delivered.

Precious little time is devoted to teaching this essential communication skill in the training of physicians today.  I can remember back to …

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Medical school and residency aren’t places for human growth

Physician
May 18, 2012

The end of my residency and beginning of my practice was the most wrenching experience of my life.  I was woefully prepared for the transition.  Full disclaimer: I was trained many years ago when residencies were acknowledged brutal demeaning processes.  Things have changed considerably, but the psychological passage I endured still holds.

I think my process of becoming a surgeon was fairly typical, with the exception that there was no one …

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The malpractice risk of volunteer medical coverage at sporting events

Physician
May 16, 2012

From Outside Online, an article about how physicians are increasingly hesitant to provide volunteer medical coverage at athletic events:

“Last year, 13 Americans died during running races, and another eight while competing in triathlons. While those numbers might seem troubling, the deaths are attributable mostly to the booming popularity of endurance sports—13 million Americans enter running races each year, and 2.3 million compete in triathlons. But the rising participation and the …

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What does a perfect pediatrics practice look like?

Physician
May 15, 2012

I had a phenomenal day in clinic yesterday. Imperfect for sure but inspiring, connected, and busy. I felt useful and like anybody else, that feels so good to me. Productivity can be defined in various ways and yesterday I fulfilled my personal definition. I wrote an email to a friend and cardiologist this morning where I said, “But I must say, it’s a sincere fortune to be a doctor some days. Yesterday …

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Where you have your mammogram, and who reads it, matter

Conditions
May 15, 2012

I’ve received several inquiries from women living in various regions of the country, asking how they should choose where to go for their mammogram, and if it really matters.  I cannot emphasize this enough:  It matters!  Here are a few tips to help your search:

The most basic requirement is whether a facility is accredited under the MQSA (Mammography Quality Standards Act).  The accrediting body for most states is the ACR …

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Go ahead, let patients buy prescription drugs over the counter

Meds
May 14, 2012

The FDA is deciding whether to allow patients to purchase prescription medications over the counter for many common ailments.

This idea is controversial.

On one hand, deregulation would remove one of the largest barriers to receiving treatment for some conditions – the doctor’s visit. If no doctor’s visit is necessary to receive necessary blood pressure medications or diabetes medications, then patients don’t have to wait for an appointment and the patient/government …

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Tips to improve your patient satisfaction scores

Physician
May 14, 2012

Recently I was asked, “How can I improve my Press Ganey scores?”  Presently this question applies mostly to hospitals as CMS is requiring hospitals to use the HCAHPS as a part of their quality reporting. Press Ganey can manage the HCAHPS for hospitals.  Few physicians or physician groups presently survey patients for satisfaction; they should begin thinking about doing so in the near future as it seems likely that CMS …

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Are smokers to blame for the damage they do to their bodies?

Conditions
May 12, 2012

He had yellow nails, leather neck, stained teeth and a deep cough. He wheezed slightly, breathed too quickly and occasionally sprinkled the white handkerchief red. No surprise his ticket to my office was a lung mass to match. We talked about tests, treatment and prognosis.  About the future, probably short.  Devastated, he was not surprised.  He was reaping the reward of 30 smoking years.  He sadly admitted, “I knew better, …

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The unholy alliance between Big Pharma and the medical profession

Meds
May 12, 2012

An excerpt from The Truth About Statins.

Like all physicians, I’ve had interactions with pharmaceutical companies. Shortly after I went into private practice in Rhode Island in 1977, I received a telephone call from a drug company representative. He offered me an all-expense-paid weeklong trip to Germany to attend a medical conference. I was taken aback, knowing that the cost of such a trip would run to thousands of dollars. I …

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Primary care requires more than knowledge

Physician
May 11, 2012

“You are too smart to do primary care.”

I have heard this far too many times, directed at me and at others seeking career advice.  There are many reasons for the shortage of primary care doctors in the U.S., but at least part of it is this.  Smart, capable, successful trainees are discouraged from choosing primary care.  It is perceived as a less prestigious pathway than specializing.

The knowledge base of primary …

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Tips for adjusting to life after residency

Education
May 11, 2012

The more I talk to new physicians who are transitioning into practice, the more I realize how many substantial life and career shifts occur post-residency.

I experienced these changes myself several years ago, but it’s taken me a while to fully process them and realize how they’ve affected my life.

In fact, it would be safe to say that I experienced a complete 180 after graduating from residency. I know other new …

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