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I will talk to my patients about smoking: Again and again

Conditions

January 16, 2013

Not everything that is faced can be changed. But nothing can be changed until it is faced.
– James Baldwin

She sits in the examination chair reeking of cigarette smoke. “I had a new sore under my tongue last week,” she tells me. “It was bad.”

A year ago, she finally developed a large throat cancer from her years of smoking and drinking. The cancer had spread to the neck lymph nodes and …

The problem of bouncy houses and the injuries they cause

Claire McCarthy, MD

Conditions

January 16, 2013

For around four years in a row, starting around 1996, my husband and I rented one of those inflatable bouncy houses for my son’s birthday party every August. We invited a whole bunch of his friends and cousins to bounce in it for a few hours (and let them play in the sprinkler and fed them cake). Nobody got hurt.

Which, in retrospect, …

Be the bad guy with good intentions

Shara Yurkiewicz

Education

January 14, 2013

“You’re not sorry.”

Within two days two different patients said this to me, each with hatred in his voice. Each time I was alone, each time I had known the patient for only a few minutes, and each time the rage was directed at me and only me.

For seven months, I had avoided being the bad guy. When a patient got upset, he accused my superiors, and I hid behind their …

Read more…

Be the bad guy with good intentions

Bed alarms don’t work and won’t reduce patient falls

Ken Covinsky, MD

Conditions

January 14, 2013

Many older patients fall in the hospital and these falls often lead to injury. Hospitals are under a lot of pressure to reduce falls. Generally, these falls happen when patients transfer such as when an older person tries to get out of bed or get up from a chair. While hospitalized, many patients are weak, dizzy, or confused, and they can be at risk of falling when ambulating …

Medical malpractice: Equating standard of care to best practice

Shadowfax, MD

Physician

January 8, 2013

I review a lot of cases in my professional life. Some of them are just ones that our QA group comes across in our practice. Some are cases related to our liability policy. Some are cases I’m sent for review, or educational cases I present. We see a lot of cases which could have been done better, or in which the …

The recipe for a great hospitalist program

Janice Boughton, MD

Physician

January 7, 2013

Internal medicine is the branch of medicine that deals with diseases of the internal organs in adults. It also involves dermatology, minor surgical procedures, general psychiatry and preventive care of well people. It is an excellent field, full of opportunities to think and feel and connect with people, mysteries to be solved and an endless variety of stuff to be learned. …

Your doctor has sold his practice: 6 tips for patients

Cary Presant, MD

Physician

January 3, 2013

The Affordable Care Act comes with the promise of a dramatic overhaul in what many see as a broken health care system. It promotes the potential for “better all around” – better care, easier access to hospitals, and affordable treatment. It also comes with a price. For one reason or another, the turbulence within the American health care system is causing doctors to shut down, downsizing or sell their practices …

How to deliver bad news to patients: 9 tips to do it better

Alex Lickerman, MD

Physician

January 2, 2013

My heart began pounding as I listened to the sound of the dial tone in my ear. After three rings a woman answered groggily and uncertainly, “H-hello?”

“Mrs. Peterson?” I asked. My voice trembled slightly. It was 2 a.m., and I’d awakened her from what I imagined had been a troubled sleep.

“Yes?”

“This is Dr. Lickerman. I’m calling from the hospital.” I paused. “I’m calling about your husband.”

There was silence. Then a breathless, “Yes?”

“Mrs. Peterson, …

Physicians can be better doctors by being patients

Kevin R. Campbell, MD

Physician

December 31, 2012

Physicians are terrible patients. That fact is one of the few absolutes in medicine. I can remember developing an acute appendicitis as a medical student. I remember the fear, the uncertainty and the discomfort. I can remember wanting someone who was in charge to spend a little time in my room explaining things to me. I can remember the embarrassment I felt when a group of 6 student nurses paraded …

Common criticisms of concierge medicine that deserve to be answered

Albert Fuchs, MD

Physician

December 30, 2012

The idea that patients are better off paying their doctor directly and using their insurance only for unaffordable catastrophes is gaining some traction. With implementation of the Affordable Care Act looming in 2014 many patients are looking at their doctor’s already crowded waiting room and wondering how their care will be impacted when their doctor is responsible for even more patients. And doctors who even now are swamped and frustrated …

4 bad reasons why medical students choose a specialty

Jessica Freedman, MD

Education

December 27, 2012

“I love the hours.”

“I want to be just like Dr. Smith. He has a sweet practice.”“I want to make a ton of money.”

“I want to make a ton of money.”

These are some bad reasons why medical students choose a specialty. Most medical students decide what specialty to pursue when they are in their mid to late 20s. While we all think …

Primary care doctors may no longer be needed

Doug Olson, MD

Physician

December 24, 2012

As a primary care doctor, my days are busy. Seeing patient after patient, I try to provide the most patient-centric, evidence based care that I can. But if I read anything about healthcare reform, it will tell me that 80-85% of the patients I see can be seen by a nurse practitioner or a physician’s assistant. So why did I train for an extra 3-4 years as a doctor, incur …

The insanity of pain management in the ER

William Jantsch, MD

Physician

December 23, 2012

One of medicine’s ethical traditions is to relieve suffering whenever possible. I believe in this, and try to treat all of my patients as I myself would want to be treated under similar circumstances.

My dilemma is, even after practicing medicine for over 30 years, the definition of a “suffering patient” has become a moving target.

On the one hand, I hear arguments primarily from governmental agencies that presume to “advocate for …

What doctors can learn from working at Starbucks

Linda Pourmassina, MD

Physician

December 21, 2012

She sat in her crisp, white coat, probably not much older than I am now, leaning back with all of the assurance of someone who recently completed a cardiology fellowship, newly hired by the academic medical center to which I was applying for residency. One of the first of many interviews for me, the conversation was anything but smooth. She clearly …

The transition from resident to attending physician

Dawn Baker, MD

Education

December 19, 2012

The patient had arrived for a urology procedure with a blood glucose in the 400’s. He suffered from a recent stomach bug and had gotten off schedule with administration of his meds. While his GI symptoms had subsided, he was feeling crappy overall. I decided to cancel his case and went about initiating treatment to get his blood sugar under control. When I informed the urologist of my findings and …

Please don’t wear perfume to the doctor’s office

Jennifer Middleton, MD

Conditions

December 17, 2012

Along with about 8.4% of the US population, I have asthma. To promote good doctor-patient communication, I can’t sit too far away from you. To perform a high-quality physical examination, I must enter into your personal space. Several minutes of inhaling that strong scent, however, can cause me to have trouble breathing.

I’ve never been brave enough to bring this up before, …

Tips to examine the eardrum of the squirming, angry child

Roy Benaroch, MD

Conditions

December 14, 2012

Let me tell you a secret. Examining eardrums in a squirming, angry child is really difficult—if not impossible. If the doc in your screaming, struggling child’s ear for a half-second, it’s unlikely that anything useful was seen.

Sometimes, it is just impossible to get a decent exam. But there are ways that parents (and doctors!) can help at least increase the chance …

MKSAP: 42-year-old with pain and swelling of the knee

mksap

Conditions

December 9, 2012

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

A 42-year-old woman is evaluated for recurring pain and swelling of the left knee and right ankle that began 5 months ago. At that time, she also had an episode of conjunctivitis as well as dysuria, both of which resolved spontaneously. The joint pain and …

Doctors: How to improve your workplace relationship with nurses

Brian J. Secemsky, MD

Physician

December 7, 2012

Accepting a promotion in the workplace is never easy task. One must take on a higher level of responsibility, carry out new job objectives, and must quickly form new working relationships with colleagues at the office.

Taking on the role as a newly-branded doctor after years of being a medical student is no different in this aspect from becoming a junior partner …

My experience with a scribe in the emergency department

Shadowfax, MD

Physician

December 6, 2012

I have a lovely pen. It’s a Mont Blanc Meisterstück fountain pen. My group bought it for me on my tenth anniversary as a partner in our emergency medicine practice.

It’s a luxury I would never have paid for myself, though I have loved and used fountain pens since I was in college. Ironically, about the time I got it, the window …

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