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

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:

[Azithromycin] can cause …

Read more…

Azithromycin and long QT syndrome: Facts from a cardiologist

Watching my grandfather pass away changed my life

Shraddha Dalwadi

Education

May 4, 2013

Watching my grandfather pass away changed my life. It wasn’t sudden and it shouldn’t have been unexpected. Yet it seemed unnatural, mysterious, and incredibly uncomfortable. I can still remember receiving the phone call from the hospital, my mother letting out a distraught cry that my grandfather was no more. My initial reaction was shock and confusion: I just couldn’t understand what had happened. Looking back, he had been under intensive …

Why family medicine was the best choice for me

Anoop Raman, MD, MBA

Education

May 3, 2013

When I came to medical school, I was certain I wanted to do primary care. Despite the forces that steer many of us off the path – how many times have we heard, “but you’re too smart to do primary care!”? – after three years of medical school, I was still committed to primary care.

But I struggled with which type of program would be best for me. I applied to both …

A high calcium diet and calcium supplementation: Is it bad for you?

Janice Boughton, MD

Meds

April 30, 2013

An article from Sweden was recently published showing that in a very large group of women, over 60,000 of them, followed for 19 years as part of an also very interesting study of the effectiveness of mammograms, women who get more calcium, in their diet or as supplements, had a higher risk of dying of anything, but especially of heart attacks. It is …

That slippery bowel wants to be everywhere

Sid Schwab, MD

Physician

April 29, 2013

Next in a continuing series.

Inside the belly, everything is slippery. The peritoneum is a glistening layer of self-moistening plastic wrap, enveloping the surfaces of all the organs, and the inner aspect of the abdominal wall. Undisturbed, the intestines coil and slither, reptilian. Watching waves of peristalsis makes me smile: there’s something always entertaining about those moving contractions, following one upon another, gurgling, surprisingly tight bands of tension moving …

The ethical shortcomings of selling supplements

Lucy Hornstein, MD

Meds

April 28, 2013

A crunchy friend of mine on Facebook re-posted something from an even crunchier friend of hers who was shocked to find that many naturopaths sell supplements. Actually, she feels that selling them is okay; so is prescribing them. But selling what they prescribe apparently tips her ethics meter over into “unacceptable”.

As I read her screed against the ND who conducted a cursory history and exam before checking off $750 worth …

Practical advice for the parent of a pre-med

Suzanne M. Miller, MD

Education

April 27, 2013

For over a decade, I have advised pre-meds on how to maximize their chances of getting into medical school. During this time, as I witnessed thousands of anxiety-ridden pre-meds wade doggedly through the murky waters of medical school admissions, I have noticed pre-med difficulties often pale in comparison to those of pre-meds parents. It’s often much easier to be the athlete on the field than the coach on the sidelines. …

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