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Before getting a CT scan, ask your doctor if its really needed

Conditions

June 15, 2011

How and when do new medical technologies become the standard of care?

A recent study showed that the use of CT scans in hospital emergency departments rose sixteen percent between 1995 and 2007.

Looks a bit like a medieval torture doughnut.

The only thing that surprises me about this is that it’s not more.

Way more.

I remember the first time I actually ordered a CT scan on a patient all by myself, in …

A history of smallpox in America

Michele R. Berman, MD

Conditions

June 14, 2011

This past Presidents’ Day, I thought it would be a good idea to talk briefly about the role that smallpox played in the life of our first president and it’s important role in the American Revolution. For those who would like to learn about this in greater detail, I would highly recommend the book, Pox Americana: The Great Smallpox Epidemic of 1775-82, written by Elizabeth A. Fenn.

In 1751, when George …

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A history of smallpox in America

MRI overuse is widespread, and dangerous to patients

Angry Orthopod, MD

Physician

June 13, 2011

MRI overuse and misuse really make me angry.

Did you know that a growing number of doctors don’t even read the tests themselves? Another shocking aspect of this industry is that some doctors will order an MRI because it’s quicker than doing a full examination. Rushing to an MRI can oftentimes erase clinical correlation, that is, connecting the dots between pain and what the MRI shows.

MRI is unnecessarily overused. In …

Doctors don’t take snow days

Anesthesioboist T., MD

Physician

June 12, 2011

Editor’s note: This post was originally written this past winter.

Boston had another blizzard today. I was really worried about this one. It was supposed to snow hard, about three inches an hour from 3 a.m. to 12 p.m. with poor visibility, impassable roads, etc. I’ve driven home in snow like that, and I find it terrifying. Your car won’t do what you want it to, and worse, other people can’t …

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Doctors don’t take snow days

The Golden Moment in medical malpractice

Kathleen Clark, PhD

Physician

June 12, 2011

As Kevin Pho pointed out in his piece, “How malpractice hurts doctors and their future patients,” physicians who have been through trial are often never quite the same.

Physicians who have been sued in medical malpractice case are often referred to as the “Second Victim,” a term that says it all. When a mistake is made and a patient is injured, the physician also suffers, often in silence and …

ABIM Maintenance of Certification (MOC) internal medicine exam tips

Kevin Pho, MD

KevinMD

June 10, 2011

This past spring, I took the American Board of Internal Medicine (ABIM) Maintenance of Certification (MOC) exam.

7 weeks later, I received my results. Thankfully, I passed.

This was not entirely a surprise, as the pass rate for first-time test takers was 88%. But it definitely requires some studying. It’s not a gimmie.

Considering that I last took my board exam in …

A doctor’s letter to a patient with newly diagnosed cancer

Dr. Martin Young

Physician

June 9, 2011

Dear “Robin,”

Nothing in my career in medicine has prepared me for being a friend to someone with such a terrible disease. As a doctor I dispense advice on a daily basis, but those interactions remain strangely impersonal. With you, cancer has invaded our inner circle, and we all share your shock and despair.

No one can know exactly what it feels like …

Prices should be readily available to save hospitals money

Happy Hospitalist, MD

Physician

June 9, 2011

Hospital costs are out of control. We have an aging population living longer with more complicated presentation of disease. We have an insurance driven platform instead of a health driven accountability. The long term sustainability of that architecture is one of guaranteed insolvency.

One way or another hospitals are going to find their lifeline cut off. Medicaid is bankrupt. Hospital profit margins …

What it means to be sick as a medical student

Jessica Gold

Education

June 8, 2011

For the first time since I have been in medical training, I got sick.

Not just the kind of sick where its a cold, or you know that its stress, but the kind of sick that does not go away and randomly comes up just to make you mad when you just want to have fun (like …

Cultural attitudes influence the benefit from stem cell therapy

Stephen C. Schimpff, MD

Meds

June 8, 2011

Embryonic stem cells are present after a fertilized egg divides for two or three days. They have the seemingly miraculous ability to turn into any of the tissue types in the body—whether brain neurons, beating heart cells, bone, or pancreatic islet cells. It is important to understand just where these cells come from.

Those used in science are …

What will be your legacy as a physician?

Francine Gaillour, MD

Physician

June 6, 2011

I’ve heard some physicians wonder out loud if their career has been “wasted” – either because they were on a path that wasn’t a good fit or they spent years focusing on accumulating and worrying rather than on contributing and enjoying. The question is one of personal value: Am I measuring up? And by whose metrics?

How do you measure the value of your physician career? Dollars earned? Lives saved? Honors …

How to minimize the costs of surgery

Christopher Chang, MD

Policy

June 5, 2011

Surgery is expensive, there are no doubts about that. However, there are a few things a patient without insurance who desires surgery can do to minimize the costs as much as possible. Before going into cost-cutting measures, you first need to understand where the costs come from.

In rank order, the costs of surgery come from (highest to lowest):

Hospital Charges …
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How to minimize the costs of surgery

5 easy steps to become a better medical student

Aaron George, DO

Education

June 1, 2011

I recently had quite a long conversation with a college senior that was just accepted into medical school for this coming fall.

As a rising fourth year medical student myself, I would like to think that I have navigated the waters of academia and figured out both efficient paths to success and avoidance of roadblocks and setbacks. …

Pain control in a patient with rib fractures and a spinal cord transsection

Ralph Gordon, MD

Physician

June 1, 2011

When I was called to see the patient after a motorcycle accident I expected the worst. The patient sustained a thoracic spine injury with cord transsection at T5 level as well as significant chest wall injury on the right side.

Multiple ribs were broken; some with a significant displacement. Managing patients with a significant chest wall trauma could be a nightmare. Pain control is only one of the challenges.

Practical advice for medical students starting clinical rotations

Mary L. Brandt, MD

Education

June 1, 2011

Here’s some advice to think about before starting clinical rotations during the third year of medical school.

Don’t sit in the back of the plane

The basic sciences are important to learn the vocabulary and grammar of medicine. Clinical rotations are different – it’s where you actually learn to be a physician. If you use the analogy of learning to fly, …

The legal issues of doctors and chiropractors working together

Kevin

Physician

June 1, 2011

by Jeffrey L. Cohen and Albert R. Meyer

Chiropractors and medical doctors (or D.O.s) have had a long and somewhat complex relationship.

Though they approach healthcare issues differently, there are many instances where they share care or even work together. Such “M.D./D.C.” relationships are legally complex, but often prove to be rewarding in many respects. Properly constructing the arrangements is critical, especially since government regulators and payers tend …

What happened inside the hospital during the Joplin, MO tornado

Kevin J. Kikta, DO

Physician

May 31, 2011

joplin hospital tornado

Dr. Kevin Kikta was one of two emergency physicians on duty at St. John’s Regional Medical Center in Joplin, MO on Sunday, May 22, 2011, when an EF-5 tornado struck the hospital.

You never know that it will be the most important day of your life until the day is over. The day started like any other day for me: …

Should doctors be addressed by their first name?

Jennifer Middleton, MD

Physician

May 29, 2011

I was sitting next to a resident in the preceptor room yesterday. He was calling a patient to discuss lab results, and introduced himself on the phone by his first name and last name … but not with “Doctor.” (e.g., “Hi, this is John Smith from the Family Health Center.”)

I occasionally see the residents’ patients for urgent visits. When I ask them who their regular PCP is at the office, …

Why doctors can’t screen patients for every disease

Alex Lickerman, MD

Physician

May 26, 2011

I had a patient once who wanted an exercise stress test even though he had neither symptoms nor risk factors to suggest the presence of coronary artery disease (such as chest pain with exertion). I argued vociferously against it. However, extenuating circumstances (not relevant here) prompted our mutual decision to go ahead with it anyway. To our surprise and dismay, it came …

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