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Who’s responsible for polypharmacy in the elderly?

Medications

November 20, 2017

There’s a common affliction that’s rampant in my practice, but it’s not a gastrointestinal condition. It’s called polypharmacy, and it refers to patients who are receiving a pile of prescription and other medications. I see this daily in the office and in the hospital. It’s common enough to see patients who are receiving 10 or more medications, usually from 3 or 4 medical specialists.

Of course, every doctor feels that he …

Hospitals are struggling and the future is grim

Robert Pearl, MD

Health Policy

November 20, 2017

A strange thing happened last year in some the nation’s most established hospitals and health systems. Hundreds of millions of dollars in income suddenly disappeared.

This article, part two of a series that began with a look at primary care disruption, examines the economic struggles of inpatient facilities, the even harsher realities in front of them, and why hospitals are likely to aggravate, not address, health care’s rising …

Mental health problems in the transgender population

Anna Gorman

Conditions and Diseases

November 19, 2017

Diana Feliz Oliva, a 45-year-old transgender woman who grew up outside Fresno, Calif., remembers being bullied when she was younger and feeling confused about her gender identity. She was depressed and fearful about being found out, and she prayed every night for God to take her while she slept.

“I was living in turmoil,” said Oliva, who now works as health program manager in a clinic for transgender people at St. …

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How burnout is plaguing doctors and harming patients

Jay Desai, MD

Physician

November 19, 2017

The presidential symposium at this year’s Annual Meeting of the Child Neurology Society of America in early October in Kansas City raised many eyebrows. The first presentation of this symposium focused on burnout rates among neurologists around the country.

Many of my colleagues felt that this was an inappropriate choice, especially with so many trainees and young child neurologists in the audience. Typically, the presidential symposium at a conference of such …

The new battleground of prime time media, disease, and death

Jeffrey M. Levine, MD

Physician

November 19, 2017

I first noticed this phenomenon while watching the world news on a weekday after work. It was a commercial for a new diabetes medicine that showed overweight people dancing at a barbecue, cooking and enjoying life. How different this was from my day in the wound clinic, where I saw patient after patient with obesity, diabetes, and nonhealing wounds, as well as other dire medical complications.

So I tucked this image …

Eliminate the middlemen of private insurance companies

Mark P. Abrams, MD

Health Policy

November 19, 2017

It’s no doubt that the health care conundrum our nation is facing is fraught with high-risk hypotheses and their unpalatable consequences. Complicating this further is the business-minded nature of many lobbyists and policy-makers influencing our government’s decisions, including President Trump’s. This is particularly timely given the recent executive orders Mr. Trump has unilaterally implemented that both sides of the aisle are concerned about. As a physician with a top priority …

What I learned as a corrections physician

Robert J. Tilley, MD, MBA

Physician

November 18, 2017

As a corrections physician I frequently heard the question, “How can you take care of those people?” I understood what they were asking, after all, I was caring for people convicted of such crimes as murder, rape and child abuse.

And yet I had very little difficulty providing the same care to inmates that I provided to everyone else. In fact, the corrections environment was generally easier to work in and …

Involve plastic surgeons early in breast cancer treatment

Terry Myckatyn, MD

Conditions and Diseases

November 18, 2017

Women who lose part or all of one or both breasts due to breast cancer surgery may choose to have new breasts created with their own tissue — a process that also may or may not involve breast implants. A wide range of reconstruction procedures is available, including a variety of flaps and options to use either implants or what is known as autologous fat transfer.

Each surgery has its own …

Got real rights? Not when seeking health care.

John T. James, PhD and Michael F. Mascia, MD, MPH

Patient

November 18, 2017

Until genuine rights are extended to all patients, the ongoing health-care-reform saga perpetrated by Congress and executive leadership will continue to fail the American people. Many Americans have suffered and died because of a broken health-care-delivery system. One of us lost a 19-year old son due to lack of certain patient rights – specifically the right to evidence-based medicine and the right to a complete discharge plan from his hospital. …

MKSAP: 45-year-old man with type 2 diabetes mellitus

mksap

Conditions and Diseases

November 18, 2017

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

A 45-year-old man is evaluated during an annual routine health maintenance visit. History is notable for type 2 diabetes mellitus (diet controlled) diagnosed 3 months ago. Family history is significant for his father who developed end-stage kidney disease due to diabetes at age 68 years. He reports no symptoms and takes no …

This doctor gave flu vaccines to her patients. You won’t believe what happened next.

Elisabeth Poorman, MD

Physician

November 17, 2017

Flu season is upon us, and with it a chance to test out my persuasion skills on a deeply skeptical public.

Consider this recent patient of mine, a young man in college who came in for an ankle sprain. “While you’re here, why not get a flu shot?” I asked.

He looked at me as if I were a car mechanic offering a few more add-ons to his maintenance exam.

“Oh, I don’t …

Physician wellness programs are lipstick on a pig

Linda Drozdowicz, MD

Physician

November 17, 2017

Here it comes — another email about “physician wellness,” advertising mindfulness training, an ice cream social, or a volunteer day. As a psychiatrist, I can attest to the importance of tending to one’s own mental and physical health in order to strive for wellness. However, the trend of implementing physician wellness programs throughout the U.S. is nothing more than putting proverbial lipstick on a pig. Or, stated differently, this may …

Here’s why we don’t care about our health

Jim Schroeder, PhD

Physician

November 17, 2017

A little ways back, I was at a gathering of friends and family and was in the kitchen setting out a dish of black bean and quinoa dip. Suddenly, I heard someone from behind me exclaim: “What is that? If that’s something healthy, I am not eating it.”

Although somewhat intended as a joke, there was no doubt a truthfulness to what was said, just as exists in similar comments which …

Prescribe exercise like you prescribe medicine

Nicole L. Stout, DPT

Conditions and Diseases

November 17, 2017

We have all seen and heard the story: a patient who is overweight and has heart problems (or arthritis, diabetes, low back pain or any number of other chronic conditions) is told by their doctor that they need to exercise.

The patient agrees, “Yes, I really will try to start an exercise program.”

Six months later, the patient is back in the doctor’s office, and the conversation goes something like this:

“Well, I …

There’s a problem with ERAS

Julia Blanter

Medical Education

November 17, 2017

Interview season is upon us, and with the excitement of those dings from ERAS comes twenty tons of added stresses. Being in the new age of lightning speed communication via phones, tablets, laptops, etc., we no longer have use for invitations via snail mail. For obvious reasons, this makes for a much more effective process. However, giving thousands of high-strung Type A applicants the ability to respond to an invite …

Read more…

There’s a problem with ERAS

Maybe the reason patients don’t understand us is because we don’t speak in plain English

Peter F. Nichol, MD, PhD

Physician

November 17, 2017

Recently, I was challenged by the mother of a trauma patient. She had read about traumatic spleen injuries online and was concerned about the risk a hematoma presented and wanted the ultrasound to look at the hematoma. I found myself floundering around trying to explain how this study was unnecessary. In frustration, I turned to my nurse practitioner and said, “Heather, can you translate for me?”

This is a common problem. …

The one job robots can never take away from doctors

Jeffrey Cannon

Medical Education

November 16, 2017

Robots read EKGs. Computers interpret chest X-rays. Algorithms decide which treatment a patient gets.

I asked myself this question this morning, “What job can I do as a doctor that cannot be done by a computer or a robot?” And one of the first things I said to myself was, “Comfort a human.”

But I dwelt on this for a moment and found it’s not quite true. Because computers and robots can …

We need to accept our failure as doctors

Samer Bou Karroum, MD

Physician

November 16, 2017

Why do we want to become doctors? What was our main motivation that we have written in our motivation letters and repeated in our interviews? Regardless of the specific incident or the general motivation, it can be all summarized in one sentence: We are here to save lives. After all, this is what the physicians do, isn’t it?

Preventing deaths is actually hinted to by the original Hippocratic Oath, written between …

Do yourself a favor: Leave the country and see how health care is abroad

Craig Bowron, MD and Peter Melchert, MD

Physician

November 16, 2017

Here’s some advice for your career in health care: Leave the country as soon as possible.

This has nothing to do with the president’s attempts to euthanize the Affordable Care Act. Or with EMRs, Medicare reimbursements, or the burnout surveys you get from your employer, who also sends emails aimed at getting you to work faster and more efficiently.

It’s none of that. You need to leave the country, just for a …

Understanding physician burnout: It’s a perplexity

Maiysha Clairborne, MD

Physician

November 16, 2017

When looking at why we as an industry have been largely unsuccessful in combating the epidemic of burnout that is plaguing our community, we must deal with our approach to solutions.

One of the biggest things to distinguish about burnout is that it’s not a problem to be solved. It’s not a diagnosis to be made, and it’s not a condition to be treated. Burnout is a perplexity; a vicious cycle …

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