I’ve always had a tough relationship with cigarettes and the people who love them. As a lung doctor I hate cigarettes, and I hate that patients I see everyday continue to use them. But I also understand that vilifying smokers seems to be in vogue right now. I figure that if someone does something that is not considered socially palatable, and that does them harm, even as they strive to …
Should doctors stop prescribing inhalers for smokers?
When I was a kid, my parents used to avoid giving me Coca-Cola after lunch. Not because they were overly concerned about my health. (If they had been, my mom wouldn’t have given me milkshakes when I watched Kung Fu Theater every Sunday afternoon. But that is a different story). The reason was that I would have really severe problems falling asleep about a quarter of the time. I would …
Restless legs syndrome in children: How the kids see it
In a word, yes.
And this is a difficult concept for many doctors to get because we have long been taught that the gold standard is culture.
Let’s back up a little. These are the symptoms of a bladder infection: needing to empty your bladder a lot (urinary frequency), when you gotta go, you gotta go (urgency), pain just over the pubic bone, blood in the urine, burning when you empty your …
Can I still have a bladder infection with a negative urine culture?
By now most of us have heard of a nurse practitioner. But what exactly is a nurse practitioner? What can they do? How can they be incorporated into a medical practice?
A nurse practitioner is a registered nurse who has completed graduate-level education and advanced practice training. Nurse practitioners can see a wide range of patients, both well and sick, and perform many in-office procedures. Prescribing medications, ordering and interpreting tests, …
These are the reasons why nurse practitioners are special
As all of us know, there is a long, long tradition in our culture of disciplining or punishing children using physical means. “Spare the rod and spoil the child,” as the old saying goes. That explicit wording, by the way, does not come from the Bible, as most people think. Rather, it comes from a seventeenth century satirical poem by Samuel Butler. Still, The belief that …
Does spanking control a child’s bad behavior?
Medicine has gone down Alice in Wonderland’s rabbit hole. Looking at the size of practices today, it seems like some of them have taken red pills and the rest have taken blue ones: most of them are getting bigger and bigger and bigger, while some are getting smaller and smaller. As the giant practices gobble up their competition to become ever more gargantuan, others are shrinking down into micropractices.
Everyone has …
Practices are getting larger to provide micropractice service
When I was a kid, my pediatrician was a friend of my parents who practiced out of a first floor office in his home across the street from ours. He was a wonderful man and doctor, I’m sure, but I was terrified of him because I associated him with the injections he gave me periodically. Even when he and his wife came to our house for dinner I hid–just in …
When the fear of needles paralyzes medical care
Something that has been on my mind recently is obesity, specifically obesity in doctors. This may be because we cover obesity in a high percentage of our stories (1 in 3 Americans is obese, after all) or because I recently discovered that I gained ten pounds since moving to New York City. Either way, after watching Dr. Snyderman speak her mind on national television about how obese leaders are unfit …
Would you accept obesity advice from a fat doctor?
Everybody has a shadow. Although as a small child you may have tried, you cannot separate yourself from your shadow no matter what you do. Electronic medical records may be the first tiny step on the road to attaching yet another indivisible part to your persona, a “panoramic, high-definition, relatively comprehensive view of a patient that doctors can use to assess and manage disease”, and this, in the words of …
Striking the balance between the public good and patient privacy
Many elderly patients get admitted to the hospital with profound weakness due to their acute and chronic medical conditions. Many of them will leave the hospital with profound weakness from their acute and chronic medical conditions (and unfortunately without a palliative care consult). In many situations, these patients will be too weak to take care of themselves. They will need extra help with their activities of daily living either from …
Any doctor can make the decision for mental capacity
And issue of Newsweek quotes me as saying, “A lot of our weight-loss recommendations are unethical because we shouldn’t be saying lose weight when there is no chance people will keep it off.“
This quote appears in the context of a lengthy article by Daniel Heimpel that examines whether or not the obesity epidemic is being oversold.
While I personally do not think that the obesity epidemic is being oversold, I do …
Why weight loss advice may be unethical
It was another day in the intensive care unit. The night was clean and calm, ventilators beeping their expected melody, and the laborers of medicine went about their night shifts uneventfully, including me sitting with the obnoxious admission pager attached to my hip. The smoothness of it all shattered when the beeper started screaming – I picked up the phone and soon the emergency room physician was on the line.
“We …
How we die should never be taken lightly
We’re not going for sympathy here. Doctors as a whole enjoy less sympathy than many other professional groups (members of Congress enjoy the least, I would think), and that’s probably appropriate. They have high incomes and many prerogatives and rank highly in esteem polls as individuals, if not as a group. It’s not where they are that is causing the grieving, it is where they are coming from.
Let’s deal with …
Why doctors complain: A history of physician income
Many doctors are now getting into movie production and making videos that are loaded onto YouTube. These videos are effective in attracting new patients and educating your existing patients. There are a few guidelines that you can use to create an effective script for each of your videos. These scripts can be loaded onto your computer in a PowerPoint format and will serve as poor man’s teleprompter to assist in …
How to create YouTube videos for patient education
I’ve talked to hundreds of people about the health care options and decisions they face at the end of life. It’s a challenging time and understandably many have little knowledge, while others have misconceptions, and some have bitter disagreements.
Here’s a basic primer for two common approaches: hospice and palliative care.
Hospice care
Two myths about hospice care are prevalent. First, many people believe hospice is provided in a place like a hospital. …
Hospice care and palliative care: What’s the difference?
A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com.
As an anesthesiologist and pain physician, I understand the complexity of pain management procedures required for chronic pain disease. Chronic pain is a disease like others such as hypertension and cardiac disease. Several interventional pain procedures can be dangerous, even in the hands of the most …
Only trained physicians should provide interventional pain services
“The question” comes in several forms: “Doc, what stage is my cancer?” “What is my prognosis?” “Can it be cured?” “Am I going to die?” “Have long have I got?” These tough honest words require courage. “The question” superficially asks for a simple answer. Time to live. However, in the real world of life and death, these questions and therefore the answers are far more complex and subtle.
Years ago we …
How long do I have? The question of prognosis has no simple answer
Would you rather your physician be an astute diagnostician or a compassionate and empathic practitioner? Of course, we want our physicians to be blends of these qualities. We want it all. We want them to be chimeras of Drs. House and Welby. But, is this possible?
I can’t say. I suspect that it is easier to cultivate soft bedside manners than it is to teach medical acumen, although the latter was …
Choose your doctor: Astute diagnostician or empathic practitioner?
Flavored water. Water with electrolytes. Tonic water. Sparkling water. Seltzer.
Grocery shelves are packed with so-called water options. But not every drink that bills itself as water is the real deal.
Many drinks labeled as water are loaded with sugar and empty calories. Even though these drinks have ‘water’ in their name, drinking them regularly may cause weight gain and may increase your risk of obesity.
And, that’s bad news because maintaining a …
6 tips for choosing the right water drink
The names of things often greatly affect our perception. In end of life lexicon, there is a movement underway to change the name of the medical order DNR (do not resuscitate) to AND (allow natural death). No change in the medical reality of what occurs, but a radical change in our emotional reaction to the each term.
DNR: “They withholding a medical intervention” (evoking negative feelings).
AND: “They are giving care that …
Artificial death extension: It means that I actually care
Get free updates delivered free to your inbox.
