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4 complaints of physician employees and 1 solution to fix them

Physician

June 30, 2013

Medscape published an article titled, 4 Top Complaints of Employed Doctors, and it was a very interesting read. Turns out the things employed physicians complain about are basically that they are employees.

Let me lay out these employed physicians gripes for you with a little detail so you will see what I mean. I will finish this article with a solid way to address all of them. These …

A surgeon deconstructs bowel surgery

Sid Schwab, MD

Conditions

June 29, 2013

Next in a continuing series.

Let’s make it easy on ourselves. I haven’t yet established why — other than liking the particular operation — we’re removing this nice person’s colon. So since our patient has agreed to remain exposed and to do so for all to see, I declare s/he has diverticulitis. (Were it cancer, the operation would be largely the same, taking a bit more out.) Most likely …

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A surgeon deconstructs bowel surgery

Why EMR companies don’t care about usability

David Do, MD

Tech

June 26, 2013

I overheard nurses praising the pilot of a new technology with the promise of improving communication, safety, and saving on healthcare spending. The innovation: two-way texting. That’s one of the many indicators that hospitals are stuck the technological stone age.

Imagine how many eyes light up when you offer providers fewer logins, autopopulating forms, and uncluttered menus. There’s an assumption that technology, in the context of healthcare, has to be bad …

When a child can’t feel his poops

Roy Benaroch, MD

Conditions

June 26, 2013

Kathy wrote about her son: “What can cause a 9-year-old boy to poop in his pants occasionally and not feel it? He was completely potty trained at age three. I have found dirty underwear and poop on the bathroom floor–and it just concerns me that he is unaware of it. It has been suggested at checkups that he may be constipated. My mother suggests he may simply not be paying …

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When a child can’t feel his poops

Should doctors be available to patients around the clock?

Kevin R. Campbell, MD

Physician

June 25, 2013

Nothing exemplifies more the complete lack of understanding of the issues surrounding our healthcare system than an article that appeared in the New York Times recently.

Author Jane Brody’s piece attempts to address issues with the astronomical costs and misuses of emergency department (ED) visits in the US today. While I agree that ED visits for routine issues are a waste of resources and money, her suggestion that physicians should …

Using Google Docs to manage patients more efficiently

Avanthi Jayaweera

Education

June 25, 2013

During my sophomore year of college as a pre-med, I volunteered at the front desk of a free clinic, where it was typical to see patients waiting sometimes for more than two hours. At first I figured it was just because some patients took longer to examine than others. It wasn’t until I got certified as a nurse’s aide and started working in the medical department at the same clinic …

A pediatrician’s approach to dehydration in children

Christopher Johnson, MD

Conditions

June 24, 2013

Our bodies are mostly water — about 60% water, in fact. This varies a little with age and sex, but it is a good rough estimate. Of that 60% water, about a third of it is outside the body’s cells, so-called extracellular fluid, and two thirds of it is inside the body’s cells, so-called intracellular fluid. The easiest way to remember this is the “60/40/20″ rule: total body water is …

How a heart rhythm specialist approaches PVCs

John Mandrola, MD

Conditions

June 23, 2013

Here is an edited email I received from an athletic colleague:

John,

A 50 year-old male healthy athlete has the new problem of occasional periods of premature beats. She (or he, doesn’t matter) has visited the doctor and an ECG shows PVCs, or premature ventricular contractions. Otherwise the history, exam, ECG, ECHO and electrolytes are normal.

What’s up with PVCs? Why? Could they be 1) consequence of (chronic) exercise or 2) related in …

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How a heart rhythm specialist approaches PVCs

Every doctor can learn from a medical coder

Jessica Jou

Education

June 23, 2013

Mrs. B was washing dishes in the kitchen when she heard a thump where her twelve-month-old son was asleep. She ran to him and found her son had fallen from a chair (code: e884.2). He was crying (code: 780.92) and visibly shaken, but did not have overt signs of bleeding, bruising, or trauma. She picked him up and immediately brought him to the emergency room.

There, he was triaged by the …

A hospital transfer may not always be a good thing

Colin Son, MD

Physician

June 20, 2013

Injury to the brain continues to be a unique thing in medicine. These injuries are scary and unfamiliar to many health care providers. There is a finality to them. Their consequences are hidden a little bit; the asystole is easy to figure in the emergency room but the suppression and brain death isn’t something so easily recognized.

They’re what you might imagine, along with polytrauma, as poster child conditions for tertiarization …

The reality of medicine’s inherently unequal power dynamic

Abraar Karan, MD

Education

June 20, 2013

As part of the first-year curriculum, medical students at the David Geffen School of Medicine at UCLA are required to attend chaplain rounds at local hospitals during which they accompany chaplains to offer spiritual care to patients. This is designed to encourage students to empathize with patients who are enduring difficult end-of-life issues and is part of a ubiquitous and important theme that inundates almost every medical student across the …

The problem with a negative BRCA test

Jan Gurley, MD

Conditions

June 19, 2013

There is nothing so horrifying as when your doctor is too nice to you. During my first mammogram at Kaiser Permanente, I knew I had cancer before they even told me because of the hushed voices, the pats on my shoulder, and the way, suddenly, no one cared how much time was being spent on my visit. When that happens to you before the diagnosis is official, there is nothing …

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The problem with a negative BRCA test

Thanks for the compliment, but I’m not a nurse

Megan S. Lemay, MD

Physician

June 17, 2013

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Let’s get one thing clear from the start: I love nurses. My grandmother was a nurse’s aide. My aunt is a nurse. My mother is a nurse. Nurses have been by my side for the most frightening and important experiences in my life (in the hospital and out). However, I’m not a nurse. I’m a doctor. And when someone calls me …

Should medical resident training be limited to 40 hours per week?

Skeptical Scalpel, MD

Education

June 16, 2013

Dr. Sam Ko says resident work hours should be limited to 40 per week. Via Twitter, I warned him that I would rebut his assertion.

Without any data or references except a tangential one, he bases his opinion on four premises.

1. Residents will be happier and nicer to patients because they will be less stressed. There is no proof that this is so. In fact, a recent Read more…

Should medical resident training be limited to 40 hours per week?

What if doctors worked for free?

Hans Duvefelt, MD

Policy

June 15, 2013

Today I am going to write about how the US could save up to 10% on its healthcare bill.

The US spends more on health care than any other nation, $8,500 per person per year. Multiply that by 300 million people and try to grasp the vast sum of $2,5 trillion.

A lot of changes are taking place with the intent to save healthcare dollars. So far, many of those changes have …

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What if doctors worked for free?

When can you override an advance directive?

Eric Widera, MD

Physician

June 14, 2013

An 85-year-old woman with moderate Alzheimer’s disease who enjoys walking in her nursing home’s garden with her walker has fallen and broken her hip. An advance directive signed by the patient states a preference for “comfort measures only,” and specifically states that she does not want to be transferred to the hospital. The physician believes that surgery would provide long-term pain relief and the chance to maintain some mobility.

What do …

Quality, cost, and value in health care: How to solve the puzzle

Robert Wachter, MD

Policy

June 14, 2013

I sometimes explain to medical students that they are entering a profession being transformed, like coal to diamonds, under the pressure of a new mandate.

“The world is going to push us, relentlessly and without mercy, to deliver the highest quality, safest, most satisfying care at the lowest cost,” I’ll say gravely, trying to get their attention.

“What exactly were you trying to do before?” some have asked, in that wonderful way …

Reflection after attending an Alcoholics Anonymous meeting

Robert Spencer, MD

Education

June 13, 2013

I’m two weeks into my psychiatry clerkship, sitting quietly in the back of a crowded Alcoholics Anonymous meeting and watching a middle-aged man discuss his past struggles with alcoholism. He starts with his difficult childhood, describing his abusive father. When he was eleven years old, his parents divorced. Soon after, he resorted to alcohol as an escape from his loneliness, drinking to “fit in” and impress his friends at social gatherings. As …

How to stop medical students from becoming jaded

Robert Centor, MD

Education

June 12, 2013

Recent research suggests that medical students lose empathy during the third (the main clinical year) of school.

Talking with end of the year third year students might make you think differently. Understanding the psychological changes that likely occur during the third year should make you think differently.

Medicine seems easy during the pre-clinical years. You get smokers to stop and prevent COPD and coronary artery disease. Patients just need to listen to …

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