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Policy makers aren’t doctors, and why that’s a problem

Policy

July 25, 2011

Sometimes you just don’t want to be right. Over the past 5 years, I have seen an alarming pattern arise in my profession. Many of my patients have heard me talk about Soylent Green, an old Charleton Heston movie. The premise of the movie seems absurd. Can you imagine the government of the United States providing for all the needs of its people including healthcare, food, clothing, and even death?

David …

Why receptionists are integral to the health care team

Kevin Pho, MD

KevinMD

July 25, 2011

Health care is a team sport, and one of the most important members is the office receptionist.

Receptionists are often the first people patients see when the visit the clinic. And those first impressions count.

In a recent piece from the New York Times, Pauline Chen notes a study of the responsibilities of the medical receptionist, and finds they impact …

The secret in caring for the patient is to care for the patient

Jim deMaine, MD

Physician

July 24, 2011

Erik’s wife had warned him many times, “Stay off ladders dear, leave it to someone younger.” Erik though was a pretty spry 72 years old and had been cleaning the gutters for many years. He had a sturdy 25 foot extension ladder, had years of experience as an athlete, and wasn’t about to slow down for no good reason.

It was an unusually bright crisp November day in Seattle, when Erik …

Should medical students be introduced as Doctor?

Vineet Arora, MD

Education

July 22, 2011

I recently saw a post in Yahoo questions entitled, “Is it illegal for a medical student to introduce themselves as ‘Doctor’ before they have received their MD?”

One of the answers that was rated highly was “I think it is more unethical than illegal.” Clearly, if a student is deliberately misrepresenting themselves as a ‘doctor’, it is grounds for disciplinary action. More often than not, this misrepresentation …

The role of non-physician clinicians in primary care

Cedric Dark, MD, MPH

Physician

July 22, 2011

With sixteen million more Americans expected to gain health care coverage in the coming years as a result of the Affordable Care Act, access to actual health care providers may become more difficult. This may be especially true for patients with marginal coverage such as Medicaid.

The Kaiser Family Foundation recently explored the role of non-physician clinicians – specifically nurse practitioners (NPs) and physician assistants (PAs) …

Neurotransmitters and the side effects of antidepressants

Dheeraj Raina, MD

Meds

July 22, 2011

We certainly wish that antidepressants in particular, and all psychiatric medications in particular were free of side-effects. It would be a boon to our patients, and their families. Sadly, there is no such thing as a medication without any risk of side-effects. Even over-the-counter medications such as Tylenol, Benadryl an aspirin can have pretty serious side-effects.

Some side-effects of medications are related to dose — the higher the dose, the …

The benefits of successful patient self-management programs

Mark Novotny, MD

Physician

July 22, 2011

The emerging literature on chronic disease management suggests that successful programs rely on patient self management skills. Having been in the primary care role for 20 years, that initially seemed self evident and a bit “so what?” to me, thinking it meant that we just need to teach our patients a bit more in the primary care office.

However self-management skills refer to specific curricula of skills that can …

A model patient in physical exam class

Kate Land, MD

Education

July 21, 2011

In the New York Times article “18 Stethoscopes, 1 Heart Murmur and Many Missed Connections,” Madeline Drexler tells her story of being a model patient. Not like a model citizen cooperative and pleasant but, a person with a medically interesting finding who is asked to help teach medical students. These “patients” are examined by small hoards of inexperienced medical students who have little knowledge, little skill and varying degrees …

Read more…

A model patient in physical exam class

Advice to new interns from a nurse turned medical student

Albinoblackbear

Education

July 21, 2011

If you’re a new intern you are hopefully a little afraid of the new found responsibility in your life. I say “hopefully” because there is nothing more frightening in healthcare than someone who is “unconsciously incompetent.” That is, someone that doesn’t even realizethey have no idea what they are doing.

Before starting medical school I was an emergency nurse. As an RN, I had the opportunity to see many medical …

A medical student with anxiety and depression

Action Potential

Education

July 21, 2011

A strange thing happens on your first day of med school. Yesterday, you may have joked with old friends about upping your Paxil dose, but starting today, you are expected to be professional. And professional is suddenly a word that prevents you from being open with your new friends, a word that hints admitting to any real struggle could be a career-ending mistake.

I want to tell you that it isn’t, but the truth is, I’m …

Clinical competence, and whether a doctor is good, or not

Richard A. Foullon, MD

Physician

July 20, 2011

Is Dr. X a good doctor?

Being a doctor, I often hear this question being asked. More often than not, the response that I hear is a rather clear cut one, “oh yes, Dr. X is a great doctor,” or “oh no, Dr. X is not a good doctor,” making me wonder what such a definite response is based upon. Is it based on actual facts? Is it based on …

Do non-compliant patients really sue their doctors?

Jock Hoffman

Physician

July 14, 2011

The non-compliant patient who sues his physician for an adverse clinical outcome is a storied malpractice bogeyman. After failing to follow a screening regimen, show for appointments, undergo recommended tests, make health-related lifestyle changes, or take their medications, these patients (now plaintiffs) have the audacity to blame the doctors and nurses for not being adequately clear or assertive.

Are they real?

Yes and no. Not every “difficult” patient is a potential …

Women in medicine: Gender, mentors and role models

Katherine Ellington

Physician

July 13, 2011

We are living a new era where the progress for the civil rights of women is undeniable, yet Facebook COO Sheryl Sandberg points out in her compelling TED presentation:

“We still live in a world where some women don’t have [civil rights]. But all that aside, we still have … a real problem … women are not making it to the top of any profession …

The professional status of physicians is at risk

Richard A. Foullon, MD

Physician

July 12, 2011

According to Wikipedia, up to the beginning of the 19th century there had been only 3 occupations that were considered to be professions, Divinity, Medicine and Law.

A profession is considered a trade or occupation that transforms itself through “the development of formal qualifications based upon education, apprenticeship, and examinations, the emergence of regulatory bodies with powers to admit, discipline members, and enforce adherence to an ethical code of practice.”

Professionals are …

Death is inevitable, but it is almost always seen as tragic

Rob Lamberts, MD

Physician

July 4, 2011

Everyone liked him. Though his later years (the only ones in which I knew him) took away his ability to do most things, and though he was in great pain every day, it was easy to see the mischief in his eyes. The subtle humor was still there, coming out of a man who was weak, in pain, dying.

She lived for him. She was always telling me of his pain, …

Sometimes the treatment is worse than the disease

Hans Duvefelt, MD

Conditions

June 30, 2011

To do nothing is sometimes a good remedy.
-Hippocrates

Edna Frost is 88 years old, a slender, slow-talking woman with a dry sense of humor and a blood pressure that’s all over the place. At best, she runs ten points higher than any of her previous doctors wanted to put up with. At worst, she flirts with systolics over 200, but that doesn’t seem to be a common occurrence.

Edna has been my …

Pharmacies selling prescription information to data mining companies

David Harlow

Meds

June 30, 2011

Walgreens is being sued by customers who are not happy that their prescription information – even though it has been de-identified – is being sold by Walgreens to data-mining companies.

The data privacy and security concerns surrounding the transfer of de-identified data are significant. To “de-identify” what is otherwise protected health information under HIPAA, some outfits will simply strip data of 18 types of identifiers listed in federal …

The decision point psychiatrists faced with psychotherapy

Daniel J. Carlat, MD

Physician

June 29, 2011

There’s been plenty of buzz about a recent New York Times story, “Talk Doesn’t Pay, So Psychiatry Turns Instead to Drug Therapy” by Gardiner Harris. The story is essentially a profile of Dr. Donald Levin, a 68 year old psychiatrist who has a private practice in Doylestown, Pa.

It is a poignant example of a common situation in psychiatry. Older psychiatrists were trained during a time when there …

Why doctors shouldn’t leave their emotions behind

Michael A. Zadeh, MD

Physician

June 28, 2011

Part of the reason I became a physician was because I got tired of watching those close to me as they suffered through illness and eventually died, while I stood helplessly by, unable to do a thing.

Throughout my training I watched as my mentors interacted with their patients, displaying a political correctness matched with just enough outward emotion so that there was no telling the difference between the good news and the bad.

“Don’t …

The challenge of pre-authorization for an elective procedure

Kevin

Policy

June 27, 2011

by Grayson Wheatley, MD

It was supposed to be a routine office visit for my patient.

Unexpectedly, it turned into a real-world health economics lesson for me, the treating physician. The old adage “listen to your patients; they will always give you the answer” became exceedingly true in this case, even when it dealt with an issue beyond a medical diagnosis, such as lack of transparency …

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