Caregivers have the power to prevent medical error

Patient
July 10, 2018

What if it is your parent? Your spouse? Your child?

Imagine supporting a loved one through a journey of serious illness. You go to all the appointments, know all the medications, almost feel the aches and pains as if they were our own. You repeat the same thing over and over again to one doctor after another making sure nothing slips through the cracks. Did somebody write this down? Isn’t this …

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Caregivers have the power to prevent medical error

If Facebook knows me better than my spouse, why does my doctor know so little?

Health Technology
July 10, 2018

A few months ago, I was on call and admitted a 65-year-old man to the intensive care unit for a flare of his chronic obstructive pulmonary disease (COPD). Although he had only gotten to the point of being unable to speak full sentences between gasps for breath for only a few days, his story started two months earlier when he had gradually started retaining water and getting more short of …

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If Facebook knows me better than my spouse, why does my doctor know so little?

Crying when a patient suffers a devastating loss

Physician
July 10, 2018

I was a second-year resident, doing a 24-hour shift on maternity care. I’d spent some arduous nights on call with my attending physician, Dr. Campbell. Now, we sat at the nursing station, joking about what this one might bring.

“You must be a black cloud,” she teased, accusing me of being one of those unfortunate residents who seem to attract medical emergencies. I laughingly protested, but in fact, these quiet nights …

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Crying when a patient suffers a devastating loss

3 steps for doctors to move into the next level of career growth

Physician
July 10, 2018

In medicine, this is the time when one season ends and another begins. New doctors graduate from medical school. They are excited and, at the same time, scared as they enter into residency training. Interns become residents. Senior residents celebrate moving into attending positions or look forward to subspecialty training in fellowship programs. It’s the excitement of completion combined with the uncertainty of charting a new course in medicine. Each …

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3 steps for doctors to move into the next level of career growth

The freedom to admit someone because it was the right thing to do

Physician
July 10, 2018

The most high-powered rotation in my medical school was endocrinology. There, you got to see things most doctors never come close to diagnosing themselves. Uppsala University’s Akademiska Hospital served as a referral center for the Swedish population north of Uppsala, an area the size and shape of California.

Back in the seventies, laboratory testing wasn’t as sophisticated as it is now. We didn’t have CT scanners even at the major hospitals, …

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The freedom to admit someone because it was the right thing to do

It’s time we think about health care differently

Health Policy
July 9, 2018

Before the invention of the stethoscope, doctors routinely laid their ears on chests of patients to check how they were doing. Homemade concoctions, essentially placebos, often made people feel better. Doctors visited homes of patients who would later pay them whatever they could afford. Local apothecaries sold morphine, a derivative of opium, to reduce pain. Medicine for its part was a nascent science – most of today’s diseases were yet …

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It’s time we think about health care differently

Sleeping with your baby: Mainstream media gets it wrong

Conditions and Diseases
July 9, 2018

Recently, a journalist with NPR asked her audience if sleeping with your baby is as dangerous as doctors say.  In short, yes, it is very dangerous.

In the article, Michaeleen Doucleff repeatedly trivializes the danger of parents co-sleeping with their baby.  She uses anthropological evidence to reassure parents that sleeping with their infant is safe if parents don’t drink, smoke, or use illicit drugs.   She makes light …

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Sleeping with your baby: Mainstream media gets it wrong

The hidden issues of the “dancing doctor”

Physician
July 9, 2018

Over the last month, a dermatologist practicing in Georgia known as the “dancing doctor” was suspended by the Georgia Medical Board, which said she posed a “threat to public health, safety, and welfare.” At least ten patients have sued this physician with complications including disfigurement and brain damage, and reportedly there are another 100 former patients who …

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The hidden issues of the “dancing doctor”

What I wish my family had known about medical residency

Physician
July 9, 2018
YouTube video

I sometimes get messages from people who have lost physician colleagues and loved ones to suicide. It’s the specifics of these stories that wound me: a note left for an unexpected person; an insignificant fight at sign-out that in retrospect is full of meaning; the white coat that a woman wore when she jumped to her death. Each of these lives is complex, and each of these deaths …

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What I wish my family had known about medical residency

Come see for yourself why medicine rarely runs on time

Physician
July 8, 2018

“Sorry, I’m running late … sorry, to keep you waiting.” How many times a day do I say that? Sometimes it is every time I walk into a patient’s room as if it is a normal greeting. Sometimes patients respond with: “Oh, you aren’t late” or “I haven’t been waiting long.” I can be so obsessed with not being late that I don’t realize I’m actually running on time! But …

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Come see for yourself why medicine rarely runs on time

To give good value, Medicaid needs help

Health Policy
July 8, 2018

Medicaid — the program that provides funding for adults, seniors (along with Medicare), children and people who are blind or disabled who can’t pay for their own health care — is expensive. It is painfully expensive. The program, along with CHIP (the Children’s Health Insurance Program), marketplace subsidies and Medicare is responsible for 25 percent of the federal budget. Total Medicaid costs in 2016 were …

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To give good value, Medicaid needs help

8 things I would tell my younger self

Medical Education
July 8, 2018

Young, aspiring doctors are the Iron Youth of this generation. In Erich Maria Remarque’s All Quiet on the Western Front, young German soldiers are called the Iron Youth as part of a campaign to generate enthusiasm for fighting in the war; these soldiers soon realize the true horrors of war and its lasting impact on the psyche. The analogy is not necessarily to compare residency to war but to highlight …

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8 things I would tell my younger self

Political polarization is harming America’s health

Health Policy
July 8, 2018

On May 15, President Trump attempted to kill not just two, but three birds with one tweet, simultaneously denouncing the Media and the Mueller investigation, and crowing about his approval ratings. “Can you believe that with all of the made up, unsourced stories I get from the Fake News Media, together with the $10,000,000 Russian Witch Hunt (there is no Collusion), I now have my best …

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Political polarization is harming America’s health

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Which of these patients should get a liver transplant?

Conditions and Diseases
July 7, 2018

People with liver failure and cirrhosis die every year because there are not enough livers available. Who should receive the treasured life-saving organ? There is an organ allocation system in place, which has evolved over time, which ranks patients who need liver transplants. Without such a system, there would be confusion and chaos. How can we fairly determine who should receive the next available liver? What criteria should move a …

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Which of these patients should get a liver transplant?

Don’t worry, medical students don’t judge

Medical Education
July 7, 2018

Everybody gets nervous at the doctor’s office. Physicians ask all sorts of personal questions about what people eat, how much they drink, and how things are at home. Even questions that would seem completely harmless in another context — such as how work is going, or what hobbies a person enjoys — seem surrounded by hidden meaning and purpose. After all, who doesn’t want to “pass” their annual checkup?

Part of …

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Don’t worry, medical students don’t judge

Close the gender pay gap in medicine

Health Policy
July 7, 2018

On June 10, 1963, the Equal Pay Act was signed into law by President John F. Kennedy, amending the previous Fair Labor Standards Act.  Under this law, pay disparities between men and women were clearly prohibited. More than fifty-five years later, women are still fighting to be paid the same as men holding the same jobs.

Gender pay disparities exist among all professions. Not only does a pay gap exist …

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Close the gender pay gap in medicine

MKSAP: 68-year-old man with heart failure

Conditions and Diseases
July 7, 2018

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

A 68-year-old man is evaluated at a follow-up appointment. He has a 7-year history of heart failure secondary to ischemic cardiomyopathy. Over the past 6 months, he has had three hospitalizations for exacerbations of his heart failure. He currently has exertional dyspnea while getting dressed, and his maximal activity level is limited to riding to …

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MKSAP: 68-year-old man with heart failure

Address physician well-being as we would any other disease

Physician
July 6, 2018

I lost a friend this month. She was a surgeon; she was one of us.

We lost her.

So did her patients. All the ones she helped. The ones she saved.

So did her hospital, her nurses, her techs.

So did her family. All the love, coming to a screeching halt.

Another friend lost. Another brilliant healer in medicine — gone. Another one I will now refer to as “she was …” when I talk …

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Address physician well-being as we would any other disease

Why guns should be tracked and studied

Health Policy
July 6, 2018

A relative taught me to drive in a burgundy Lincoln Town Car in an empty Long Island parking lot in the 1980s. After emphasizing the need to practice driving in reverse, he also warned: “A car is a weapon. You can kill someone, or get killed, in an instant.” I am a safer driver (forwards and backwards) thanks to his warning.

This relative had purchased several handguns over the years. He …

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Why guns should be tracked and studied

How today’s EMRs are like self-driving cars

Health Technology
July 6, 2018

Drivers are distracted klutzes and computers could obviously do better. Self-driving cars will make all of us safer on he road.

Doctors have spotty knowledge and keep illegible records. EMRs with decision support will improve the quality of healthcare.

The parallels are obvious. And so far the outcomes are disappointing on both fronts of our new war against human error.

I remember vividly flunking my first driving test in Sweden. It was early …

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How today’s EMRs are like self-driving cars

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