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James Reason and the foundation of patient safety

Physician

June 18, 2012

Professor James Reason is the intellectual father of the patient safety field. I remember reading his book Managing the Risks of Organizational Accidents in 1999 and having the same feeling that I had when I first donned eyeglasses: I saw my world anew, in sharper focus.

Reason’s “Swiss cheese” model, in particular – which holds that most errors in complex organizations are caused not so much by …

Marcus Welby, MD is still relevant today

Hans Duvefelt, MD

Physician

June 17, 2012

The year is 2012. A 58-year-old veteran Family Physician who has just finished a day with more human heartaches than clinical triumphs settles down among the pillows with his wife in front of his MacBook to watch a movie, delivered wirelessly over the Internet:

“The year is 1969. A 62-year-old veteran general practitioner who has just seen his health threaten to fail him, speaks passionately to a group of doctors about …

Does it matter if your doctor is board certified or board eligible?

Christopher Johnson, MD

Physician

June 16, 2012

Does your doctor have something on the wall that starts with “American Board of … “?

The terms “board certified” and “board eligible” are confusing to people not in the medical profession. It doesn’t help that more than a few doctors blur the distinctions to their own benefit. This post gives you a brief rundown of the distinctions at stake.

The first thing to understand is that anybody who has graduated from …

Clinician researchers meet the physician scientists

Vinay Prasad, MD

Physician

June 15, 2012

Recently our department of medicine grand rounds was on the subject of asthma. It began with a clinical vignette about a child with asthma, lasting three minutes, and, was followed by 47 more of intracellular cascades. The talk was like many others this year, and the speaker, who was introduced as a physician scientist, lived up to the part.

As someone who works in an academic hospital, I know many physician-scientists. …

Is there a harm to not seeing drug reps?

Matthew Mintz, MD

Meds

June 10, 2012

Now more than ever, the growing consensus among many is that doctors should avoid seeing pharmaceutical sales representatives, otherwise known as drug reps. A position statement from the AAMC, the head organization of all US medical schools and residency programs, recommends that all academic health centers avoid having drug reps on their campuses, hospital and clinics. Many medical institutions including the VA and Kaiser have also enacted similar policies banning …

What can be done for children with migraine headaches?

Mark W. Green, MD

Conditions

June 9, 2012

Recently, as I finished up a visit with one of my patients who has migraine, she asked me the following: “My 10 year old daughter gets headaches. Is it possible that she has migraines too? I had headaches as a child and was always told it was nothing to worry about, but now I have headaches several times a month. Is there anything I can do to prevent this from …

What does an ACO mean in small town America?

Robert Provenzano, MD

Policy

June 9, 2012

At the end of long days I often stand gazing out my window at the beautiful, timeless Rocky Mountains in Colorado Springs and am taken by their sense of permanence. I recently returned from Nampa, Idaho, where I presented hospital Grand Rounds on Accountable Care Organizations.

The parallels between the timeless mountains and the physicians I met in Nampa struck me. Strange, you say? Maybe, but I am accustomed to the …

My pediatrician inspired me to become a physician

Reflex Hammer

Education

June 7, 2012

I recently learned the sorry news that my childhood pediatrician has died. Not only was he my pediatrician, but he was also my father’s pediatrician. Our family became rather close to him over the years.

He came from a different generation of doctors, one that made house calls, that served in wars abroad, and that learned how to diagnose patients in the days before MRIs and CT scans. Even though I …

Hide your health insurance status and pay cash instead

Dike Drummond, MD

Physician

June 6, 2012

It always has broken my heart to see a person bankrupted by the costs of their healthcare. I remember my outrage when I first learned the only people who pay full price for their medical procedures are the ones paying cash. Insurance companies use their market muscle and patient volumes to negotiate discounts for their patients that have always been unavailable to the uninsured, individual healthcare consumer.

If you have been …

Is the daily blood draw in the hospital truly necessary?

Ioana Baiu, MD

Conditions

June 5, 2012

One of the most memorable discussions regarding the cost of care was at 4:45AM during surgical morning rounds.

As usual, the interns would present the overnight events of their patients to the chief resident and a plan for the day would be agreed upon. These morning rounds were particularly intense: in addition to the 30 patients that an intern had to manage solo over night, the brutal hours that the surgical …

The problem of conflicting professional medical guidelines

Juliet K. Mavromatis, MD

Physician

June 5, 2012

Guidelines for care increasingly help guide medical decision-making. If you’ve followed top health news over the past several years you’ve read conflicting statements about the utility of various medical procedures and tests. As a general internist I’ve devoured these reports with particular interest trying to wade through bias to formulate views that I believe will be of most benefit to my patients.

Recently I put together a talk about recommendations for …

Using Advair to treat postinfectious cough

Matthew Mintz, MD

Meds

June 3, 2012

I am not a huge baseball fan to begin with, and when I am, I root for the Nationals. Thus, I pay little attention to the New York Yankees, and was not aware that Yankee player Mark Teixeira had been suffering from a cough for the past month until it the story from the New York Times came through one of my Twitter feeds. According to the story: “Mark Teixeira had …

How doctors handle fear will determine their ability to give care

James C. Salwitz, MD

Physician

June 1, 2012

There was a night when I was in training that all the decisions, disasters and chaos, which are the practice of medicine, caught up to me. In those dark hours, I felt practically despondent. What I had seen left me in tears and overwhelmed by the tasks in front of me.

At that moment a wise attending physician took a moment to sit with me. Rather than tell me how wonderful …

Are the poor more likely to sue their doctors?

Neil Baum, MD

Policy

May 26, 2012

Many physicians, including myself, have the misconception that the indigent patient is more likely to be litigious than those patients with greater financial resources. A well-organized study that was reported in Clinical Orthopeaedics and Related Research reported that socioeconomically disadvantaged patients tend to sue physicians less often than their more affluent patients.

Dr. Ramon Jimenez and his colleagues at the Monterey Orthopaedic and Sports Medicine Institute and his team demonstrated that patients …

A medical student’s first patient interview

Charles Casassa

Education

May 25, 2012

“Um—Hi there, I’m a, uh, you know. Medical student. First year. For, you know, the Patient-Doctor—err, Patient-Physician course—”

The nurse smiled and turned to a woman of shorter stature with bony, scrunched- up shoulders. “Mary, do you want this first year to interview you?”

Mary was about to set foot in the lounge when she heard this. She let out a sigh and faced me. Her eyes looked worn; I could tell …

Patients are our best teachers

Michael Kirsch, MD

Physician

May 23, 2012

There are some patients we doctors never forget. They linger in our memories for various reasons. Often, it is their serious or unusual medical condition that stays with us. On other occasions, it is a zany or unique personality that we recall, even years later. Rarely, when the doctor-patient relationship becomes injured, then the patient may become unforgettable.

I remember a particular patient from 20 years ago for a very different …

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Patients are our best teachers

How medical school changed me

Matthew Gibson, MD

Education

May 22, 2012

I have been thinking a lot over the last few weeks about all the many ways that the experience of medical school has changed me.

The most obvious is knowledge. I’ve drunk from the proverbial “firehose” of information that we experience in medical school, and apparently enough of the facts stuck with me to pass all my exams, and secure myself a residency program back in my home state of California. …

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How medical school changed me

Struggling with the idea of leaving for medical school

Imraan Allarakhia

Education

May 21, 2012

The lines of text on my laptop screen blurred together as I lost focus. I knew there was at least one error on my medical school re-application I would regret later on. My eyes scanned the familiar body of words but failed to connect the information to my brain. Frustrated, I closed the application and shut my computer off.

My bedroom door abruptly swung open, revealing my mother with the phone …

How we deliver bad news is critical to how families deal with grief

Kevin R. Campbell, MD

Physician

May 20, 2012

As a cardiac electrophysiologist, I have had to discuss bad news with patients and families more times than I would like during my career. How a physician goes about this process can make an enormous impact in the lives of those affected by the news that must be delivered.

Precious little time is devoted to teaching this essential communication skill in the training of physicians today. I can remember back to …