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What really happens in a morbidity and mortality conference

Education

May 17, 2013

If you’ve read my reviews of the new medical TV show Monday Mornings, you’ll know I’ve been critical of many things about it. I was particularly disappointed with the way the show handled one of its central themes: the morbidity and mortality (M&M) conference.

I thought it might be useful to tell you how most real M&M conferences are run. M&M conferences generally take place at hospitals with residency training …

How I would end the war between nurse practitioners and doctors

Kevin Pho, MD

KevinMD

May 16, 2013

One of the more contentious topics on my site is the scope of practice for non-physician providers, such as nurse practitioners. This echos the debate on the national stage where leaders of physician organizations, who want to protect their scope of practice, conflict with those of nurse practitioners’, who want to perform the tasks that physicians traditionally have.

Simply Google “nurse practitioner” on this site, for instance, and you’ll see …

Did Mike Huckabee foreshadow his journey back to obesity?

Barbara Berkeley, MD

Conditions

May 15, 2013

Ah, the addictive power of modern food. Never underestimate it.

On a recent trip to New York I happened to be flipping through the channels on my in-flight TV when I ran across Mike Huckabee doing an interview on Fox News. I was surprised to see that he had gained his weight back. The former governor of Arkansas and presidential candidate had staked quite a bit on the success of his …

What is the role of the physician in today’s health care system?

Hans Duvefelt, MD

Physician

May 15, 2013

I used to be a stickler for time. One of my first blog posts was about how it felt to go to work without my wristwatch.

I also used to be very particular about knowing the purpose of each visit, partly to help me manage my time, and partly to help me feel prepared and in control of the visit.

I often questioned why my colleagues’ patients would sometimes end up in …

The controversy over DSM-5 and the cataclysm in mental health

Suzanne Koven, MD

Conditions

May 14, 2013

Here’s a joke I love: A man goes to an old-school psychiatrist who, at the first session, administers some Rorschach tests.

“Just tell me the first thing that comes to mind,” the doctor instructs the patient as he shows him the ink blots.

“Sex,” answers the patient.

“I see,” says the doctor. “And this one?”

“Sex.”

“And this one?”

“Sex again.”

“Well,” says the doctor, “I see we will have to work on your obsession with sex.”

“Me??” …

Doctor owned hospitals: Are the rich getting richer?

John Schumann, MD

Policy

May 14, 2013

It was bound to happen.

By “it,” I mean that the small group of specialty hospitals (usually orthopedic or cardiology-focused) across that country that are owned by doctors were going to have their “See! We Told ‘ya so!” moment.

Doctor-owned hospitals. How many are there? Two hundred and thirty-eight of them in the whole country (out of more than five thousand)–somewhere between four and five percent of the total in the U.S. (numbers courtesy …

The medical model versus the nursing model: A difference in philosophy

Shirie Leng, MD

Physician

May 13, 2013

I recently blogged about the question of what the difference is between a doctor and a nurse, now that advanced practice nurses can do so many of the same things physicians do. As both a nurse and a doctor I thought maybe I could wade into that quagmire. In that post I suggested that the real difference is one of ultimate responsibility. A reader pointed out that this …

It’s not hard to do surgery, it’s hard to get to do surgery

Ara Feinstein, MD, MPH

Education

May 13, 2013

boards

We were instructed not to knock, that the examiners would invite us in when they were ready. Even under the bright lights and unforgiving atmosphere of an operating room emergency, I couldn’t recall being this nervous. Yet today, in the dimly lit hallway of a three-star hotel, my hands trembled without a bleeding patient or sharp instrument anywhere nearby. I glanced left …

How to effectively follow a patient’s multiple medical problems

Leslie Kernisan, MD, MPH

Physician

May 13, 2013

How to effectively keep tabs on a patient’s multiple medical problems? And how to do so without losing sight of the whole person?

The first question is the one I wrote about in a recent blog post. The second was the theme of many of the responses and also LinkedIn.

I love this second question; it’s an issue that’s always been of interest to me. Plus it’s especially relevant in geriatrics, where …

3 steps physicians use to become an expert and avoid mediocrity

Richard Winters, MD, MBA

Physician

May 12, 2013

violin2

As I sit on this old wooden pew, I rock side-to-side to ensure that blood flows to each part of my bottom. We’ve been at this rented church for 75 minutes listening to the sounds of my daughter’s violin class recital and now it’s time for the last piece.

A high school student with a large tattoo of a stanza on her left …

Is this Fisher Price sleeper safe for infants?

Roy Benaroch, MD

Physician

May 12, 2013

R6070_d_1

You might think a thing sold by a huge manufacturer of children’s toys and furniture as a “sleeper” would a safe, appropriate place for a baby to sleep. It is, after all, called a “sleeper.” But it is not a safe place for your baby to sleep.

The Fisher Price Newborn Rock ‘n Play Sleeper is a sling-shaped baby holder sort of gizmo, …

Prescribing antibiotics: It’s time to draw a hard line

Wesley Nickens, MD

Meds

May 11, 2013

This is a call to arms to my fellow providers to protect our patients from themselves and our willingness to comply with their requests. We live and practice in a society filled with fear of medications and their side effects. People will not take blood pressure, cholesterol, or diabetic medication because of the side effects they have heard or read about.

However, these same patients will take antibiotics every day of …

How to know if your toddler has autism

Naline Lai, MD and Julie Kardos, MD

Conditions

May 11, 2013

About half of all children in the United States with an autistic spectrum disorder are diagnosed at age five or older, according to a May 2012 NCHS (National Center for Health Statistics) data brief. However, many parents are suspicious much sooner. As part of autism awareness month, we bring you clues into toddler development that can alert you to a potential issue.

Pediatricians often use a questionnaire called the M-CHAT (Modified …

Read more…

How to know if your toddler has autism

Is medicine a profession or a commodity?

Gene Uzawa Dorio, MD

Physician

May 9, 2013

Over the past twenty years, Wall Street business has covertly taken over the medical profession while doctors have been distracted by a deluge of procedural, financial, and legal paperwork. A strategic plan was launched to extract exorbitant profit benefiting business, and is now mainstream without challenge from our profession nor the public.

Legal boardrooms were abuzz in the 1990s as a blueprint assault was made against organized medicine, redirecting a profession into a …

The big impact of small changes for DSM-5 ADHD diagnosis

Dr. David Shaffer

Conditions

May 8, 2013

As chairman of the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5) Work Group on Attention Deficit Hyperactivity Disorder (ADHD) and Disruptive Behavior Disorders, I read the article on ADHD that appeared on the front page of The New York Times on April 1, 2013, with interest and also dismay, which was shared by my colleagues in the work group. We recognize the effort involved …

A radiologist reflects on indeterminate findings

Paul Dorio, MD

Physician

May 7, 2013

Radiologists care about their patients, even though most diagnostic radiologists don’t meet and greet their patients the same way direct-care clinicians do.

Some people have the erroneous perspective that radiologists and pathologists don’t care about the welfare of their patients. It is possible for us to understand that view if we look at radiologists and pathologists as isolated workers who work …

5 critical elements of patient-centric care

David Lee Scher, MD

Tech

May 7, 2013

I would like now to delve into what I consider critical elements of patient-centric care. They all involve technology to various extents.

1. There must be buy-in from providers. I am including payers, healthcare systems as well as clinical providers in this category. While I realize that much of healthcare is devoted to satisfying legal and regulatory mandates, there is great opportunity to improve the care experience (and dare I say …

Female feticide: The ethical issues of ultrasound in India and China

Janice Boughton, MD

Physician

May 6, 2013

The use of ultrasound has had a large impact on health care in resource poor countries. This article details some of the research that has been done overseas to look at the impact on bedside ultrasound by caregivers to deliver more appropriate care for injured and ill patients in Africa, Asia and Mexico.

Using an ultrasound to determine how dehydrated a child …

The problem with leaping into a gluten-free diet

Sophie M. Balzora, MD

Conditions

May 5, 2013

In recent times, it seems as though every newspaper or magazine with a dedicated health section has a focus on the perils of gluten and the benefits that come along with adhering to a gluten-free diet. Or better yet, each week brings a new celebrity touting the dangers of gluten, and how it is an unhealthy ingredient that should be avoided religiously. Is this truly sound advice?

As a practicing academic …

Azithromycin and long QT syndrome: Facts from a cardiologist

John Mandrola, MD

Meds

May 4, 2013

Text message: “John, This cough and congestion is killing me. It’s turning thick and green. Can you write me a Z-pak? It always works for me.”

If you write a blog on medical decision-making and heart rhythm matters, it seems an incredible omission not to opine on the FDA warning concerning the commonly used antibiotic azithromycin (the drug in a Z-pak). Quoting directly from the FDA warning: