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Obamacare covers screening colonoscopies, with a catch

Conditions

October 25, 2013

“An ounce of prevention” we all know is good medicine. An example is colonoscopy. It was time for mine so after some lengthy procrastination I called and set up an appointment which I soon found a perfectly good reason to postpone for a few weeks. A common occurrence. The government wants me (and you) to not procrastinate, at least not because of the cost. The Affordable Care Act (or Obamacare) …

David and Goliath lessons for doctors and our health system

Davis Liu, MD

Physician

October 24, 2013

October 1st was a special day. The Affordable Care Act (ACA) also commonly known as Obamacare became official. The federal government shut down because Republicans and Democrats disagreed around Obamacare funding. Most importantly, October 1st was when I could finally read Malcolm Gladwell’s new book David and Goliath.

Gladwell ponders why do underdogs succeed when we least expect them to? Is it possible that advantages a Goliath has can be a disadvantage? …

What’s the best way to keep up with medical literature?

Paul Bergl, MD

Education

October 23, 2013

As a resident, probably the most common piece of feedback one receives is, “Read more and expand your clinical knowledge base.” This critique is a standard and generic piece of feedback to encourage the younger generation to never quit in the endless pursuit of knowledge. As our erudite attendings know, medical knowledge always evolves and often reverses course. Thus, the trainee is reminded to establish the habit of keeping up …

A new tagline for direct primary care

Rob Lamberts, MD

Physician

October 21, 2013

He seemed a bit grumpy when he came into the office. I am used to the picture: male in his early to mid-forties, with wife by his side leading him into the office to “finally get taken care of” by the doctor. Usually the woman has a disgusted expression on her face as he looks like a boy forced to spend his afternoon in a fabric store with his mother. …

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A new tagline for direct primary care

What an old doctor taught me about palliative care

Monica Williams-Murphy, MD

Physician

October 19, 2013

Many years ago when I was a “young” doctor, moonlighting in the ER of a tiny country town, I had an experience that challenged my training. You see, most young, new doctors often think their training and knowledge is superior to that of “old” doctors, which is often malarkey. A wise and sage old doctor in this tiny country town taught me an important lesson on where and how one …

Why doctors need to be more like Malcolm Gladwell

Kevin Pho, MD

KevinMD

October 17, 2013

In case you haven’t heard, Malcolm Gladwell recently released his book, David and Goliath. I’m just about finished reading it.

Just as interesting as the book are its reviews. In a recent post from Slate, Gladwell himself responds to the criticism. He freely admits that his books should not be held as pinnacles of academic rigor, but should be considered “intellectual adventures stories.”

He further elaborates on the power …

Not all adverse events are preventable

Skeptical Scalpel, MD

Physician

October 16, 2013

Medical errors are a real problem. I won’t deny that.

It was bad enough when the often-quoted Institute of Medicine figure that 98,000 deaths per year in the US are caused by medical errors was in vogue, but now a paper in the Journal of Patient Safety states that adverse medical events result in 210,000 to 400,000 deaths per year and 10 to 20 times those numbers of serious …

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Not all adverse events are preventable

Patient engagement is the blockbuster drug of the century

Dave Chase

Policy

October 16, 2013

Historically, the “do more, bill more” fee-for-service model of healthcare measured success by increased billings. In the fee-for-value era, we need a new framework for assessing healthcare results. Quality indicators are logical but they are mostly geared towards measuring actions taken. We can borrow a concept from the energy sector for an additional metric. We need a concept for removing waste and unnecessary care that could be inspired by a concept …

Hostile dependency: The real reason for physician burnout

Wes Fisher, MD

Physician

October 14, 2013

A piece recently appeared in the New York Times entitled “Who Will Heal the Doctors?”

The piece is written by Donald Borstein and I encourage all to read it. Mr. Bornstein offers a solution to the doctor burnout problem in health care, a course called “The Healers Art,” now being promoted in US medical schools that uses “mindfulness” as his means of creating compassionate, caring doctors as a way forward.

I should say …

Applying to medical school: The fuss about extracurricular activities

Alexa Mieses

Education

October 13, 2013

An excerpt from The Heartbeat of Success: A Med Student’s Guide to Med School Admissions.

What’s all the fuss about extracurricular activities? Isn’t doing well in your coursework and on the MCAT enough to get into medical school? Nope. Extracurricular activities and employment are opportunities to explore your interests, become …

A medical short story: High five

Glenn Gray, MD

Physician

October 12, 2013

An excerpt from The Little Boy Inside and Other Stories.

“Hey Altman,” the chief resident says.

We’re in a small group outside a patient’s room. I look up.

“One of the high-fivers needs a central line over on Two North.”

High-fiver. Another code word from the secret language of medicine. High-five means HIV, positive …

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A medical short story: High five

Reinventing the pain scale in the emergency department

Rob Brandt, MD

Conditions

October 12, 2013

All people are gifted. As an emergency room physician, I see a wide variety of gifts, such as yodeling, knitting, and swearing (mostly swearing). One gift I rarely see is math. As a whole, the U.S. sucks at math. When compared with other nations, the U.S. ranks 32nd in math (though first in confidence). Despite this, we expect mathematical coherency …

Medical students may find themselves without a job

Christy Duan

Education

October 12, 2013

“Well, if medicine doesn’t work out, you can always fall back on waiting tables,” I joked with my waiter, who, like me, happens to be a medical student. We were bonding over completing our first year of medical school — he, in Detroit, and myself, in the Bronx. He liked waiting tables and decided to work during his last summer of …

What do we do with the extreme elderly?

Janice Boughton, MD

Physician

October 10, 2013

A 100-year-old woman is brought to the emergency room by a concerned friend because she can no longer get out of bed to get food or go to the bathroom. Other than being unwashed and a little confused, she is fine. Her electrolytes are pristine, her electrocardiogram the definition of normal, her blood count and chest x-ray perfectly mirror the expected physiology for her age. Even her urinalysis is normal. …

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What do we do with the extreme elderly?

Radiation from x-rays and living in Denver: They’re not the same

Jennifer Gunter, MD

Conditions

October 9, 2013

My kids were at the dentist this weekend for their routine cleaning and check ups (yes, Saturday hours!) when the hygienist mentioned x-rays. I smiled and mentioned I’d rather discuss the need with the dentist after his exam. This isn’t a dental x-ray thing, this is what I do for every test that involves ionizing radiation.

My son, Oliver, has had more radiation than most people will have. Ever. In fact, …

Being a good medical student doesn’t mean you’ll be a good doctor

Amy Faith Ho, MD

Education

October 6, 2013

There is a saying that you enter medical school wanting to help people but exit it wanting to help yourself. It may be a cynical view, but a realistic one. The criteria for being a good medical student are far different from being a good doctor. Medical education may be breeding a legion of self-serving, grade-grubbing, SOAP-note spewing machines rather than …

The OR is not a good place for a prank

Skeptical Scalpel, MD

Social media

October 2, 2013

An anesthesiologist at a California hospital pasted stickers simulating a mustache and teardrops on the face of a hospital employee while she was having surgery on a finger.

According to the Los Angeles Times, the doctor said, “I thought she would think this is funny and she would appreciate it.”

And if that wasn’t bad enough, a “nursing attendant” took a photograph.

The patient, who said she had to quit her job …

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The OR is not a good place for a prank

4 myths and truths about milk

Naline Lai, MD and Julie Kardos, MD

Conditions

October 2, 2013

We’ve heard some interesting things about cow’s milk over the years. I am going to share with you four myths about milk that I continue to hear from my patients’ parents.

Myth #1: Don’t give milk to a child with a fever; the milk will curdle (or some other variant).

Truth: As long as your child is not vomiting, milk is a perfectly acceptable …

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4 myths and truths about milk

Why solutions to mental health continue to evade us

Edwin Leap, MD

Physician

October 1, 2013

Another tragedy, another tragic series of errors, another avalanche of debriefings and politicization, and in Washington, DC, there are 12 more dead. What can we say about this? It seems that the standard commentary fails. Aaron Alexis was not an angry white man, nor a conservative. He carried no assault rifle and he had a secret security clearance. He doesn’t seem to have been motivated by race. He was a …

How nurses can help contain health care costs

September Wallingford, RN

Policy

September 30, 2013

Due to ever increasing health care costs, stakeholders in the health care system rely heavily upon front-line workers to assist in containing costs to help make health care more affordable. Since nursing is the largest sector of front-line workers, the field has an opportunity to greatly impact cost containment. Currently, there are 2.7 million nurses in the workforce, with an expected growth rate of 26% over the next decade; however, …

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