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Saying no to your oncologist is sometimes the right thing to do

Physician

December 11, 2011

Cancer is a dreadful disease. Just dreadful. Make no mistake: I have tremendous respect for the awesome doctors who treat patients afflicted with it day after day. Still, paradoxically, I can’t help but notice that some of them have just as hard a time as do other doctors with caring for patients at the end of their lives. I believe a large part of their difficulty stems from the ridiculously …

MKSAP: 42-year-old woman with lymphadenopathy, fatigue, and edema

mksap

Conditions

December 10, 2011

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

A 42-year-old woman is evaluated for a 3-month history of progressive cervical lymphadenopathy, fatigue, night sweats, bilateral lower-extremity and abdominal wall edema, and a 4.5-kg (10.0-lb) weight gain. History is significant for three episodes of weight gain and facial and lower-extremity edema lasting 4 weeks in …

The difference between a child psychologist and child psychiatrist

Roy Michael Stefanik, DO

Physician

December 8, 2011

What exactly is the difference between a child psychologist and child psychiatrist? The two terms are frequently mistakenly interchanged, but the requirements for the two are considerably different.

To become a child psychologist, many programs require that you get an undergraduate degree in psychology, although some graduate programs will only require that you take the prerequisite sciences courses (biology, physical and social sciences, statistics, mathematics, etc.) before applying for the graduate …

Young doctors don’t see value in primary care careers

John Schumann, MD

Physician

December 5, 2011

In my new role as one of the directors of an internal medicine training program, I help select new interns out of medical school for the three year training stint of residency.

At the end of residency, many graduates go on to subspecialty fellowships, another two to four year period of intensive training in fields like cardiology, nephrology, critical care etc.

For those that don’t choose a subspecialty, one choice remains: traditional …

Are doctors given more responsibility than they can handle?

Nagarathna Manjappa, MD

Physician

December 5, 2011

Doctors inevitably come into spotlight, being at the front end of health care delivery. Sometimes seen as guardian angels restoring health and life, other times, greedy minds sucking resources while they carelessly harm and kill patients to fill their wallets. After experiencing, observing, and hearing from others like me, I wonder if doctors are given more responsibility than they can handle, often attributed more aura than they deserve and frequently …

Why rheumatology is sexy

Ronan Kavanagh, MD

Physician

December 2, 2011

Although as a medical student rheumatology was always associated with an air of mystery and complexity to me – factors which might have aroused a younger me had they been associated with a member of the opposite sex – the specialty didn’t catch my eye at all as an undergraduate. To a medical student cruising for medical action in the 1980′s, rheumatology wouldn’t have got as far as a first …

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Why rheumatology is sexy

Impersonal care from the new generation of physicians

Norman Silverman, MD

Physician

December 1, 2011

Historically, American physicians and surgeons were fiercely independent practitioners, who owned their own practices, worked long days and maybe longer nights, made a good income, but saw little of their families. They trained in a male-dominated world in “residency,” so named originally because their extended 120 hour/week work schedule demanded them living in dormitory type residence adjacent to the hospital.

They developed long-standing professional commitment to their patients that superceded time …

I eat lunch with drug company representatives and I’m proud of it

Stewart Segal, MD

Meds

December 1, 2011

Today, I want to review another article I wrote in last year. That article started with a confession: “I confessed that I ate lunch with a representative of a pharmaceutical company.”

I must now confess that I often eat lunch with representatives of pharmaceutical companies and I’m proud of it. At this stage of my career, I can well afford my own lunch. I could sit quietly and relax over a cup …

The art of Alzheimer’s disease

Michael Chorney

Physician

November 30, 2011

Physicians are not trained to interpret paintings, and most patients do not have a lifetime of artwork to analyze. However, a rare opportunity for both to occur is at the Museum of Modern Art’s exhibition de Kooning: A Retrospective.

Wilem de Kooning, regarded as one of the most prolific American artists of the twentieth century, grounded himself in the Abstract Expression movement. The AbEx movement is widely associated and recognized with …

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The art of Alzheimer’s disease

Problems with the Multiple-Mini Interview for medical school

Reflex Hammer

Education

November 28, 2011

Some medical schools have altered their admissions process by replacing the traditional applicant interview with the Multiple-Mini Interview (MMI). MMI resembles speed-dating: applicants rotate through numerous interview stations, where they act out scenarios and solve puzzles, sometimes alone and sometimes in groups. A July New York Times article presented a good overview of MMI, as implemented by Virginia Tech Carillon.

As you might expect, schools that have adopted MMI (UCLA and …

I will never be the physician that my father was

Aaron E. Carroll, MD

Physician

November 25, 2011

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Let me start by saying that I love my father dearly. We have an excellent relationship, and talk regularly. So there’s no bitterness in this post, nor any desire to engage in armchair psychology.

My father, now retired, was a general and thoracic surgeon, who was triple-boarded in critical care, and ran a trauma unit in inner-city Philadelphia. He was in private …

Unsupervised anesthesia care by a nurse anesthetist is a threat to patient safety

Karen S. Sibert, MD

Physician

November 17, 2011

No matter how quickly you tried to switch the television channel lately, you probably couldn’t escape the trial of Dr. Conrad Murray or avoid hearing about propofol, an anesthesia drug that can be fatally easy to use.

What you may not have heard is that the American people just dodged a serious threat to their anesthesia care, and most don’t know how near a miss it was.

The Centers for Medicare and …

Simple tips to improve your blood pressure checks

Dr. Charles

Conditions

November 13, 2011

A recent study confirmed that the doctor’s office may be one of the worst places to determine if your blood pressure is under control. The automatic rise in tension many people experience when they are being scrutinized contributes to artificially high blood pressure readings. Although many times the only way improve one’s blood pressure is through treatment (such as medication, a low salt diet, and weight loss), other times …

Billing an established patient visit as a consultation

Ryan Madanick, MD

Physician

November 13, 2011

Until recently, there was a financial difference between performing a “consultation” and a “new patient visit” for office visits (Medicare stopped paying for consultations at a higher rate than new patient visits in 2010).

In specialists’ offices, patients often got billed for the more expensive “consults” when in fact the visit was not a consultation at all. Let’s just use this understanding as the brief background for what I’m about to say.

I …

Why do non-profit hospitals compete with each other?

Joe Ketcherside, MD

Policy

November 13, 2011

While we are talking about things that drive health care costs up, this one has bothered me since I was in practice years ago. I am a believer in competition, I think it forces us to be creative and provide better, cheaper, more efficient products and services.

But there is the mindset of leadership at play as well. Are we competing to provide better patient services to improve patient care, or …

The new definition for a medical emergency

Myles Riner, MD

Policy

November 9, 2011

The recent budget crisis in many state Medicaid programs has led the directors of these health care programs for the poor to cast about for ways to cut their costs, and many have landed on a ‘solution’ that puts lives at risk and undermine the financial viability of an emergency care safety net that is already severely underfunded and overwhelmed. Some 21 states use a variation of the old definition …

Let’s stop degree creep in health care

Sharon Bahrych, PA-C, MPH

Physician

November 8, 2011

How long ago was it that we were all content with having the physician have a MD or DO title after their name, the clinic or hospital floor nurse having a RN after her name, the pharmacist having RPh after their name?

Now unless the pharmacist has PharmD after their name they can’t be a pharmacist. And for the nurse, unless they have RN, BSN or RN, MSN after their name …

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Let’s stop degree creep in health care

Treating Adele’s vocal cord hemorrhage

Christopher Chang, MD

Conditions

November 6, 2011

Before going any further, the title to a Los Angeles Times story was “Adele to have surgery to treat vocal cord hemorrhage. What is it?”

I sincerely hope that whomever her surgeon is knows not to perform surgery when the vocal cord is in the middle of a hemorrhage. You do the surgery when the hemorrhage is gone and the culprit blood vessel is left behind which likely is the reason …

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Treating Adele’s vocal cord hemorrhage

Neuropsychologists in the evaluation of ADHD

Dominic A. Carone, PhD

Conditions

November 6, 2011

Recently, the media has reported that the American Academy of Pediatrics (AAP) has broadened its 2000-2001 guidelines for the diagnosis of and treatment of ADHD. While the prior guidelines focused on children from ages 6 to 12, the new guidelines cover ages 4 to 18. The story is being covered by the media with lead-ins such as saying that AAP is “expanding the age range for diagnosis and treatment.”

This is …

What happened to the art of medicine?

Sharon Bahrych, PA-C, MPH

Physician

November 2, 2011

During our medical training we are taught to use evidence based medicine. This means using the most up to date scientific research data that has been analyzed and accepted as fact. But does this mean every patient we see fits into the evidence based medicine algorithm that we have been taught to use?

I hope not. For this would mean we would only be following half of medicine. The art of …

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What happened to the art of medicine?