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How a doctor reviews cases for both plaintiff and defense attorneys

Physician

September 7, 2011

Early in my career, a local defense attorney working with my hospital would occasionally ask me to review a case in which another physician client of her firm was the defendant. As Medical Director of Evergreen Hospital Emergency Department, I was comfortable with hospital records, knowing where to look in a record for information – both recorded and not recorded – that either helps or hurts a case. I found …

Phil Mickelson’s psoriatic arthritis explained

Michele R. Berman, MD

Conditions

September 6, 2011

Golfer Phil Mickelson has had a rough year and a half. First, his wife and mother are diagnosed with breast cancer, and then he has a health scare of his own. Last year, after the US Open, Mickelson began to experience some troublesome symptoms.

In an interview with Extra’s AJ Calloway, Mickelson opened up about what was going on: “After the U.S. Open last year, I wasn’t able to …

10 ways to make a difference in the lives of your patients

Jan Gurley, MD

Physician

September 5, 2011

Most of us who write about health believe that knowledge can make a difference. But is the primary health issue facing us today a lack of knowledge? Or is it, instead, something I’d call the tenth-patient-of-the-day challenge?

Here’s what I mean: You pick up a chart and head to Exam Room B, reading as you speed-walk. Your patient’s blood sugar is running high again, she didn’t show at the smoking cessation …

Don’t always blame anesthesia for problems in the OR

Anesthesioboist T., MD

Physician

September 5, 2011

People blame anesthesia personnel for everything. You name it, they blame us for it. They call us by the umbrella name “Anesthesia” and if there’s a problem, it’s always “Anesthesia’s” fault.

Got into the room late? Blame Anesthesia. (Even though the anesthetist’s been sitting at the bedside for twenty minutes waiting for the surgeon or the nurses to be ready.)

Patient craving ice cream when she woke up? Must be Anesthesia’s fault.

No …

Heart valve repair without open surgery

Stephen C. Schimpff, MD

Conditions

September 2, 2011

A major innovation are the recent reports of success in replacing or repairing diseased or damaged aortic or mitral valves via catheter-based techniques instead of open surgery.

Mitral regurgitation is when the valve becomes unable to close tightly. Once the regurgitation becomes sufficiently severe to cause heart failure, the death rate reaches about 5% per year. Most such individuals are referred for cardiac surgery to either try to repair the valve, …

Read more…

Heart valve repair without open surgery

How medical students can prepare to be hospitalists

Happy Hospitalist, MD

Education

September 1, 2011

A second year medical student reader asked me to comment on what rotations to take in medical school to prepare for an internal medicine or hospitalist medicine career.

I am a second year medical student, very interested it practicing the art of Hospital Medicine, and I was wondering if you had any advice/comments on any specific electives to consider to help prepare me for an Internal Medicine residency.

Great question. As …

Medical students spending time in a nursing home as a patient

Marilyn Gugliucci, PhD

Education

August 31, 2011

An interview by Curaspan Health Group with Marilyn Gugliucci, PhD.

Every summer, a handful of medical students spends two weeks in a nursing home as a patient. That’s part of what’s been called “the life-altering education” established by Marilyn Gugliucci, Ph.D., the director of geriatrics education and research at the University of New England College of Osteopathic Medicine.

Gugliucci spoke with Curaspan Connections about the inspiration for her unique approach to elder-care …

Treating fungal laryngitis in patients with asthma

Christopher Chang, MD

Conditions

August 31, 2011

It is a big bummer to be an asthmatic. Not only is breathing a problem, but even the treatment for asthma can cause problems.

Take for example steroid inhalers like Advair, Symbicort, fluticasone, etc.

All asthma patients know to rinse their mouth out after inhaler use due to risk of oral thrush, but what about from the back of the mouth down to the vocal cords? This nether region can’t be …

Properly delete electronic medical records, or face fines

Pamela Wible, MD

Tech

August 30, 2011

Could a complete stranger receive your echocardiogram results in the mail?

Could a homeless guy in Boston end up with your labs in his shopping cart?

Is it possible that your medical records were sold on eBay?

Yes. Yes. And yes.

On February 24, 2011, Massachusetts General Hospital was fined $1 million dollars by the federal government when an employee inadvertently left a stack of papers on the subway. These documents contained the …

Consider half life during drug detoxification

Randall S. Bock, MD

Meds

August 30, 2011

A young man on my sobriety-based detox program (only after showing positive for opiates) admitted to heroin-usage, but hedged the matter saying it was “5 days ago.” His implicit presumption was that an isolated episode, days ago — compared to continuous, more recent, heroin-usage — would lessen the likelihood of his getting kicked off the program.

Is his story of “no heroin [ingestion] in the last five days,” likely, the whole …

The expensive progression of pill crushing technology

Gina, RN

Meds

August 29, 2011

We have to crush pills sometimes. Either the patient (through aversion or physical limitation from stroke) can’t swallow whole pills so we crush them and put them in applesauce, or the patient gets their pills through a tube, so we crush them and dissolve them in water.

When I started nursing, we had a mortar and pestle.

Anyway, this is what we used …

The ethics of being on a pharmaceutical advisory board

David B. Nash, MD, MBA

Meds

August 27, 2011

While diligently perusing a stack of unread journals, a piece in the July 25, 2011 issue of Modern Healthcare caught my attention.

Titled “What’s the Agenda?” this special report deftly navigated the murky waters of “physician participation on advisory boards” and managed to present an accurate appraisal of the issues.

Here is a brief recap.

Back in the days before “medical ethics” issues were commonplace, pharmaceutical and medical device manufacturers were accustomed …

Navigating the path of contradictory medical opinions

Ralph Gordon, MD

Conditions

August 24, 2011

With the advancement in healthcare and technology we are able to greatly extend the life expectancy of the population. For the healthcare provider that means that more elderly patients and patients with multiple chronic medical conditions are being admitted to the hospital. Some “complex” patients require a multidisciplinary approach with the involvement of multiple consultants.

As a primary attending physician for the patient you often have to deal with contradictory …

How medical residents should spend their time off

Mary L. Brandt, MD

Education

August 24, 2011

Here’s the scenario. It’s Friday evening. You’ll be back at work on Sunday. You’re sleep deprived because you are a resident. You haven’t spent any quality time with your significant other, friends or family because you haven’t had any real time off. Next week has plenty of call and it would really help if you planned out good food for the week and cooked something. And, by the way, …

It’s possible to have fun during medical school

Eric Lu

Education

August 22, 2011

Before I start second year of medical school, I wanted to take this time to reflect on my first year in medical school and use these lessons to ground me as I begin a new school year.

When people ask me how first year was, my first answer is that it was a lot of fun. That usually comes off as a surprise. Don’t get me wrong, there were definitely …

Practices have failed to analyze the clinical content of their EHR

Ron Sterling

Tech

August 20, 2011

Clinical content refers to the various checklists, documents, and forms that address an area of medicine when using an EHR. For example, a pediatric practice would be interested in documentation tools for a newborn visit. Not all EHRs have clinical content for all areas of medicine. For example, some EHRs have clinical content for internal medicine, but lack the details needed for dermatology or cardiology.

A disturbing number of practices …

MKSAP: 89-year-old woman is evaluated for dizziness

mksap

Conditions

August 20, 2011

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

An 89-year-old woman is evaluated for dizziness that she has had for the past year, mainly while standing and ambulating. The dizziness is described as a sense of unsteadiness. The symptoms can last for minutes to hours, and she has at least 4 to 5 episodes …

What do tonsils do and why would we take them out?

Christopher Johnson, MD

Conditions

August 19, 2011

There are some important new recommendations about tonsillectomy — taking out the tonsils — as a treatment for recurrent strep throats.

Some of us can recall a time when getting your tonsils out was one of the rites of passage of childhood. Usually a related procedure is added — an adenoidectomy, removing the adenoids as well. It’s called a T&A in the medical world, and it’s one of the …

Female doctors and the physician shortage

Darrell E. White, MD

Physician

August 13, 2011

Someone has gone and rained the facts down on what is generally considered a feel–good story in American medicine, the dramatic increase in female doctors in America.

In response to Dr. Herbert Parde’s “The Coming Doctor Shortage” article in the Wall Street Journal, Dr. Curtis Markel pointed out that there is a difference between the raw, gross number of physicians in America, and the effective number of practicing physicians. Not only …

Why doctors should accept protocol medicine

Stephen C. Schimpff, MD

Policy

August 13, 2011

We hear that doctors do not like “protocol medicine” – they do not want to follow a “cookbook” when every patient is different. It is not a good understanding of the issues.

Some years ago when I worked in a branch of he National Cancer Institute and then the University of Maryland Cancer Center, we admitted many patients with acute leukemia. The treatment approach including the necessary special tests to …

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