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The ethical shortcomings of selling supplements

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. …

Treating the enemy still requires respect and professionalism

Ryan Gray, MD

Physician

April 26, 2013

A city is free. A town is celebrating.

I sat and watched the local news station announce that the second suspect in the 2013 Boston Marathon bombings had been taken into custody and was being transported to a nearby hospital.

I am relieved. And thankful.

Then I wonder. I wonder about the hospital that this suspect is being transferred to, and I wonder about my colleagues. What are the nurses, the doctors, and …

How my geriatric practice works

Leslie Kernisan, MD, MPH

Physician

April 22, 2013

A little over a year ago, I found myself burning out and realized that my worklife was unsustainable.

I’d been working at an FQHC clinic, and had become the site’s medical director a few months before. I was practicing as a primary care doc, trying to improve our clinical workflows, problem-solving around the new e-prescribing system, helping plan the agency’s transition from paper charts to electronic charts, and working on our …

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How my geriatric practice works

As an oncologist, I hate running late

James C. Salwitz, MD

Physician

April 22, 2013

Yesterday I had office hours: 26 patients at 15-minute intervals, followed by 3 new patients for one-hour visits, interspersed with 4 emergencies and 33 phone calls. An active normal day. However, the 1:30, 1:45, 2:00 patients all arrived at 2:15 and suddenly I was looking at an afternoon that would run deeply into eve. I really hate it when patients are late.

Now, I have to admit this is a unique …

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As an oncologist, I hate running late

Radiation therapy: Don’t let me talk you into it

Miranda Fielding, MD

Physician

April 20, 2013

When I was young and foolish and just starting out in my career, I found it very hard to take “no” for an answer. If a patient needed radiation therapy, and he or she didn’t want to have it, I did my very best to talk that patient into it. I have always been a very persuasive person—if I didn’t get the go ahead on the first formal consultation, there …

The locked inpatient psychiatry unit: What’s it really like?

Arjune Rama, MD

Physician

April 19, 2013

As I walk onto any one of the locked psychiatric units at our hospital I am immediately struck by the hum of intense activity. It’s like the startling feeling of stepping out of an air-conditioned apartment into the steamy height of a New Haven summer. Across from the nurses’ station, a psychologist interviews a patient retelling the story of constant childhood molestation as rivulets of mascara run down her cheeks. …

Anesthesiologists are victims of their own success

Karen S. Sibert, MD

Physician

April 18, 2013

New research just out in the journal Psychology and Aging says pessimists live longer and healthier lives. If this is true, then contemplating the future of anesthesiology ought to make us immortal, because our professional prospects don’t look bright. As we teach residents to do what we’ve always done, shouldn’t we ask ourselves honestly if we’re training them for a future that doesn’t exist?

Especially here in California, it seems …

So your partner wants to remove your pubic hair

Jennifer Gunter, MD

Physician

April 16, 2013

A divorced friend of mine who recently started dating was shocked to find that the complete absence of female pubic hair seemed to be an expectation among her potential partners. I’m not surprised, when I was in the dating pool a couple of years back there were men who actually listed full clamscaping required among the personal attributes they were seeking in a girlfriend (and here I was looking for …

The rise of ultimatums in medicine: Do they work?

Katie Noorbakhsh, MD

Physician

April 15, 2013

Has anyone else noticed the growing presence of ultimatums in medicine today?

The New England Journal of Medicine published a discussion of the ethics of not hiring smokers. My hospital adopted this policy six months ago, and they are not alone. There is a tobacco blood test that new employees have to pass. If they fail, they can look for a job elsewhere. I do not know the exact details, but …

8 surprising thoughts about patient wait times

Adam Banks

Physician

April 14, 2013

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Every one of us feels a high level of anxiety when we are made to wait. In grocery stores, we jockey back and forth to the line we perceive is moving the fastest and easily get frustrated when we choose the “wrong” line. When driving, we will swerve across multiple lanes of traffic to avoid a line at a toll booth or …

The patient experience can be dehumanizing

Joyce Ho, MD

Physician

April 12, 2013

Being a clinical student is not a walk in the park. When we get together for “Reflections on Clerkship” days every two months in our small groups, students let the floodgates open about the hardships they have been facing on rotations. I am no exception. Transitioning to a strict schedule in the hierarchical world of academic medicine has been no small feat. In fact I was planning earlier this morning …

The male gynecologist: Tips to connect with female patients

Suzanne Hall, MD

Physician

April 12, 2013

With all due respect to the many caring, compassionate, and skilled male OB/GYN physicians out there, we’d be amiss in ignoring the research showing a near majority of younger women preferring a female gynecologist. Some call this reverse discrimination in gynecology. I’d more simply call it patient preference. The bigger question is, “Where does this leave the male gynecologist?”, especially in a current marketing climate promoting the “female only” OB/GYN …

Increasing the role of nurse practitioners in the inpatient setting

Gene Uzawa Dorio, MD

Physician

April 12, 2013

We are fortunate in our country to have the best medical technology in the world. Unfortunately, delivery of this technology, reflected in a worldwide healthcare ranking of 37th, is a disservice to the American people and must be rectified especially when Cuba is ranked 39th.

As provisions of the Affordable Care Act are put in place, a daunting factor is the shortage of doctors who will be needed to provide this …

Beauty in surgery: Traction and counter-traction

Sid Schwab, MD

Physician

April 11, 2013

Next in a continuing series.

Traction and counter-traction: along with maintaining excellent exposure, that is one of the fundamental principles of operating. It’s Newtonian: equal and opposite. In nearly all forms of surgical dissection, there’s a need for some pull in the opposing direction: tissues that are a little stretched-out, that are under some tension, fall open more easily when dissected. Plus, it’s a form of stabilization, another obligatory …

Roger Ebert did not lose his battle with cancer

Michael A. Wosnick, PhD

Conditions

April 11, 2013

Roger-Ebert_612x451

I was very saddened to learn of the death of Roger Ebert. I, like so many around the world, was impressed and inspired at how he handled himself in the aftermath of his cancer surgery years ago that left him disabled and disfigured and unable to eat, drink or speak. And yet, despite his struggles he remained a dominant force in film …

A memorable introduction to the family

StorytellERdoc, MD

Physician

April 10, 2013

Although I rarely get sick with the numerous strains of “bugs” that seem to go around our community this time of year, the week prior to my return to work for my next scheduled string of four shifts was spent mainly in bed, coughing and aching and whining about how miserable I felt. Fully recovered, though, I was excited to return to the emergency department to do my fair share …

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A memorable introduction to the family

The real reason to be cautious about Z-Paks and azithromycin

Albert Fuchs, MD

Meds

April 10, 2013

The FDA issued a warning about the antibiotic azithromycin (Zithromax). The media stories have some patients terrified and some of them are calling me convinced that azithromycin is poison, a reliable agent for suicide.

What’s the hubbub about?

Azithromycin is in a family of antibiotics called macrolides, which also includes erythromycin and clarithromycin (Biaxin). Erythromycin and clarithromycin have long been known to very rarely cause fatal abnormal heart rhythms. It …

Doctors and nurse practitioners: We’re failing the reality test

Yul Ejnes, MD

Physician

April 9, 2013

A guest column by the American College of Physicians, exclusive to KevinMD.com.

Over the past several months, I have covered some controversial topics, such as electronic health records and the overuse of diagnostic testing. For this month’s column, I will address a less provocative topic: the role of non-physician providers …

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