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Advice for alternative medicine practitioners: Stay in your lane

HD, MD

Physician

November 5, 2017

Dear alternative medicine,

Hi, it’s HD again. You may remember me from the last time we entered the squared circle, “Endocrinology vs. Naturopathy: Steel Cage Death Match.” I had hoped that you might internalize a couple of the lessons I tried to teach you: “Know your assay” and “know your pre-test probability” — but, shocker, it didn’t happen. You regrouped, and you’ve come back more formidable than …

Using brain-computer interface technology in medical education

Daniel Gomez Ramos

Health Technology

November 5, 2017

Brain-computer interface (BCI) has been a topic of interest for several decades, and many discoveries have been made. The role of BCI has been monumental and significantly impactful in the field of medicine. It has been gaining much progress in recent decades with inventions such as the encephalophone, in which a person can create music with their thoughts alone, or a patient can move a cursor icon on a monitor …

How you design your schedule has far-reaching consequences

Bruce Hough, MD

Physician

November 5, 2017

“Doctor, how would you like your schedule template?”

As a hematology/oncology physician in a non-profit hospital group, I am reimbursed by wRVU. This is the standard mechanism of reimbursement for large multispecialty groups and academic centers. In this scenario, the more wRVUs you make, the more you get paid. However, there are only so many hours in the day. One of the first decisions each doctor makes when joining a group …

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Why quality reports for hospitals and doctors are interesting but flawed

Mark Kelley, MD

Health Policy

November 5, 2017

Every patient eventually asks the same question: “How can I find the best hospitals and doctors?”

The solution might seem easy, since we live in a world where information is readily available on the Internet. In a few clicks we can shop for goods, review consumer products, market ourselves on social media, and complete financial transactions instantly. You would think that health care, which accounts for 17 percent of the GDP, …

When a diet is changed, a behavior is changed first

Michel Accad, MD

Physician

November 4, 2017

Here’s the typical story we come across every day:

Jack was overweight and had a terrible cardio-metabolic profile. Jack changed his diet: He eliminated X, Y, Z and added more A, B, and C. He’s now lost 30 pounds, and he feels fantastic. His numbers are also perfect: His HDL is through the roof, his LDL is undetectable, and his A1c is smack in the normal range.

Todd was overweight and had …

Why positive role models are essential in medical education

Robert Centor, MD

Medical Education

November 4, 2017

In the 70s when I trained, we had no add-on curricula; we had no milestones; we had little interference from governing bodies. What we did have were role models.

In the current century, when I talk with students and residents (and I do that very often) they talk about what they see or do not see from their attending physicians and fellow residents. The carefully constructed curricula result from excellent intentions, …

I am the “same-same but different”

Dr. Saqib Noor

Physician

November 4, 2017

Phnom Penh is changing at an incalculable rate. It is evolving so quickly that even from my last visit four years ago, I barely recognize the streets I once shuffled my well-worn sandals through. Now, the streets of my old neighborhood are proudly adorned with a new facade of artistic, stylish restaurants and a collection of boutique coffee shops. Bigger buildings and prime real estate positions are now occupied by …

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I am the “same-same but different”

MKSAP: 35-year-old man with upper abdominal discomfort

mksap

Conditions and Diseases

November 4, 2017

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

A 35-year-old man is evaluated for a 2-month history of upper abdominal discomfort after eating. He has recently returned from working in a rural area of a developing country. He takes no medications. There is no family history of esophageal or gastric cancer.

On physical examination, vital signs are normal. BMI is 40. …

Is assembly line surgery better for the patient?

Thomas D. Guastavino, MD

Physician

November 3, 2017

A friend of mine recently underwent a total knee replacement. Although he did well and was pain-free, he did say that he felt he was on an assembly line. I asked him what he meant. As he was talking, I flashed back 30 years, back to a time when by today’s standards I would be considered a “good old country orthopedist.”

Thirty years ago, I moved to a small community to …

Most of the documentation physicians perform don’t help patients

Michael Kirsch, MD

Physician

November 3, 2017

Let me post a question that neither I nor readers can answer: How much of what I do during the course of a day directly benefits patients?

Perhaps, I don’t want to really know as I would be dismayed at how much of my effort benefits no one. Ask a nurse who works on a hospital ward, how much of his or her effort is directly applied to patient care. I would …

Our laws don’t do enough to protect our health data

Sharona Hoffman, JD

Health Policy

November 3, 2017

Have you ever wondered why your computer often shows you ads that seem tailor-made for your interests? The answer is big data. By combing through extremely large datasets, analysts can reveal patterns in your behavior.

A particularly sensitive type of big data is medical big data. Medical big data can consist of electronic health records, insurance claims, information entered by patients into websites such as PatientsLikeMe and more. …

One nurse for 4,000 pupils isn’t the healthiest arrangement

Ana B. Ibarra

Health Policy

November 3, 2017

During a 15-minute recess, the elementary school students trooped from the playground toward nurse Catherin Crofton’s office — one with a bloody nose, a second with a scraped knee and a third with a headache.

Kids quickly filled a row of chairs. Staffers brought paper towels for the bleeders and tried to comfort the crying.

“We’re here for first aid, emergency, counseling,” said Crofton of the Mount Diablo Unified School District. “There …

Never forget to consider the number needed to treat

Hans Duvefelt, MD

Conditions and Diseases

November 3, 2017

How would you like to double your chances of winning the lottery? Just buy two tickets!

Statistically, this is true, but is that a reason to spend more money on something that most likely offers no return on investment?

Yet, in medical research, study after study shows impressive improvement in relative risk for this, that and the other intervention but a small or even negligible effect on absolute risk.

For example, I just …

“My mom is a doctor; my dad is a dad.”

Jennifer Lycette, MD

Physician

November 2, 2017

So stated one of our children in their autobiography assignment for school. I kept reading, curious what would come next.

“My dad usually stays home and cleans up, and takes care of the pets.”

I thought for a moment. “That’s very good, honey, but do you think you could write something else about Dad?” I suggested. “He does other stuff too, add some more nice things.”

“OK, how about … ‘And he takes …

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“My mom is a doctor; my dad is a dad.”

Why the cell-free fetal DNA test is a game-changer

Danielle Jones, MD

Conditions and Diseases

November 2, 2017

As a practicing OB/GYN, I feel lucky to be working in a field so full of promise and with space for advancement of medical technology. Although prospects of improved fetal imaging, cervical cancer prevention, and techniques of minimally invasive surgery are game-changing, new discoveries in the genetics arena of our field strike me as simply incredible.

Prenatal genetic testing has only been reasonably available to mothers since about 1970, and at …

Seeds, popcorn, and nuts in diverticulitis: fact and fiction

Frederick Gandolfo, MD

Conditions and Diseases

November 2, 2017

Diverticulitis is a common and sometimes serious problem that affects several hundred thousand people each year. Diverticulitis is the condition where small outpouchings or “pockets” in the wall of the large intestine called diverticula become inflamed and infected, and typically presents as a constant lower abdominal pain, associated with fever or chills, and often bloating or constipation symptoms. Despite becoming even more common in recent years, not much is understood …

Why physicians should be their own brand

Suneel Dhand, MD

Physician

November 2, 2017

Health care in America and the practice of medicine has undergone a sea change over the last couple of decades. It used to be about Dr. Johnson’s office around the corner that would serve you and your whole family. Nowadays, it’s about mega-specialty groups and large health care conglomerates. It’s about mergers and hostile corporate takeovers. Statistics now suggest that over 50 percent of physicians are employed rather …

Technology is not friendly to the elderly

Janice Boughton, MD

Health Technology

November 2, 2017

In about 1990 we got our first computer. I say “we” because my husband and I shared a desktop which I used infrequently. I mostly used it for word processing, and the Internet was very young. At the turn of the millennium, my children were using computers, and they were limited to 1 hour of computer time a day, which was on a shared desktop. By 2001, I was communicating …

Better paid, better utilized physicians can transform the VA

Suvas Vajracharya, PhD

Health Policy

November 2, 2017

It’s a tale of two health systems: the VA and Kaiser Permanente.

The U.S. Department of Veterans Affairs, Veterans Health Administration (VA) is a mission-driven health organization, serving our nation’s veterans. A patient population of 8.9 million, led by David Shulkin, MD. An early leader in health technology adoption. The VA has faced serious issues; however: long patient wait times (deadly long in some cases) and high physician turnover rates.

Kaiser Permanente …

Is too much insurance a problem?

Joseph Bentivegna, MD

Health Policy

November 1, 2017

I’ve discovered a new condition called “Cadillac Health Care Syndrome.” Those afflicted are relatively healthy people who have numerous diagnoses, take multiple medications and have frequent surgical procedures because they have excellent health insurance with little to no out-of-pocket expenses. Risk factors include early retirement, lack of hobbies, jobs with paid sick days, excessive television watching and overuse of the Internet to investigate symptoms.

It has been widely assumed that better …

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Is too much insurance a problem?

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