angienadia, MD

Why monetary carrots and sticks are detrimental to health care

angienadia, MD

Physician

February 13, 2014

In describing why Cooper Union, a unique college that offers absolutely free education to students, would effectively die if it starts charging tuition, Kevin Slavin wrote:

For many of us, Cooper wasn’t even the cheapest way to go to school…So the question is: why did we go? We went not because of the financial value of free–that is, zero tuition–but rather, because of the academic value of free. At Cooper Union …

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Why monetary carrots and sticks are detrimental to health care

Building residency training from scratch: What would you do?

angienadia, MD

Education

January 25, 2013

Back in the day, legend has it that when space programs were just developed, NASA soon discovered that ball-point pens will not write in zero-gravity. Unfazed, NASA spent a large amount of money developing pens that will work in space, while the Russians simply used pencils.

It turns out that this legend is only half true, but the lesson remains – sometimes, we get bogged down trying to solve …

The only thing I had to do was to help Jerry and I failed

angienadia, MD

Physician

September 10, 2012

I have failed Jerry, and now I’m replaying every word I ever said in my head, over and over, the whole exercise consuming my being.

Jerry was not old. He just turned sixty, a good few decades of retirement awaiting him. Then, he was diagnosed with stage 4 esophageal cancer. It seemed that he had spent his entire life working up to that moment, only to be stolen away unjustly, by …

How we die should never be taken lightly

angienadia, MD

Physician

September 3, 2012

It was another day in the intensive care unit. The night was clean and calm, ventilators beeping their expected melody, and the laborers of medicine went about their night shifts uneventfully, including me sitting with the obnoxious admission pager attached to my hip. The smoothness of it all shattered when the beeper started screaming – I picked up the phone and soon the emergency room physician was on the line.

“We …

Heroic measures cannot cure how people want to live their lives

angienadia, MD

Physician

April 26, 2012

I was working in the Intensive Care Unit (ICU) the other day and as I counted, I found that more than half of the patients there, for lack of a better term, brought the condition upon themselves.

I sound harsh, but there was no better way to put it. I was taking care of Mrs. B, a 60-year-old lady with COPD who called EMS for shortness of breath. As EMS readied …

Useless thought experiments during medical school and residency

angienadia, MD

Physician

November 22, 2011

I recently admitted a patient with a pulmonary embolism. Before heparin drip was started, my attending ordered a hoard of eccentric, non-indicated hypercoagulable workup in the hope of avoiding the effect of heparin on these test results, including phosphatidylserine antibody and methylenetetrahydrofolate reductase DNA. I watched in horror as the nurse drew out approximately 13 tubes of blood, since each test needs its own tube.

On rounds, the attending of course …

What the death penalty has to do with medical errors

angienadia, MD

Patient

August 10, 2011

A fascinating, beautifully-written article on a death penalty granted to a most likely innocent man, with interesting details on fire dynamics and the history of the judicial system pertaining to the death penalty.

Reading about the system in place that should prevent an innocent man from being wrongfully executed reminds me of the supposed system that prevents medical errors from occurring – both are imperfect, with innocent victims falling through …

From the brink of hospice to awaiting a reading machine

angienadia, MD

Physician

July 11, 2011

It was a beautiful Monday morning in May. Yawning uncontrollably, I hopped into a Ford Hybrid with my attending and drove off to visit a patient who lived two hours away from our hospital. I woke up especially early that morning since we knew the commute would take many hours.

We drove past open fields and a few cows before pulling into a driveway of a lovely house with a cute …

Emergency medicine, we can do better

angienadia, MD

Physician

May 18, 2011

When someone gets sick, what are their options?

They can try to make an urgent appointment that day, but how many of your doctors actually offer that? Most people will have to wait for weeks, if not months, for a regular appointment. Even if you go to a walk-in clinic, the wait will likely be hours, and you’re not sure if clinics can take care of everything, so you head to …

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Emergency medicine, we can do better

New ACGME work hour regulations for interns: friend or foe?

angienadia, MD

Physician

May 5, 2011

On the night of October 4, 1984, a young girl named Libby Zion was admitted to New York Hospital in Manhattan for fever, agitation and strange jerking movements. No one knew that her death the next morning would, 27 years later, drastically change the quality of physician training, for better or worse.

When Libby was evaluated in the emergency room that night, neither the ER physician nor her family physician Dr. …

Welcome our new (doctor) computer overlords

angienadia, MD

Tech

March 4, 2011

In February, IBM supercomputer Watson won Jeopardy! against its two human opponents, Ken Jennings and Brad Rutter.

Watson’s victory rests on its power in speech recognition and the ability to understand colloquial human language used in game shows like Jeopardy!. The most interesting development of this story is that after Watson’s celebrated win on national television, IBM will partner with Nuance Communications to explore how Watson could help with medical diagnosis …

Medical care and airlines – should there be a difference?

angienadia, MD

Patient

January 3, 2011

A recent article by Pauline Chen features a group of primary care physicians at Tufts Medical Center in Boston, who have created a concierge practice that funnels income into the traditional general medical practice that sees less-advantaged patients.

Surveys (performed by the medical center itself) found that patients rated the quality of interactions with their doctors similarly regardless of their affiliation. The only significant differences in responses had to …

Patient safety suffers when doctors are forced to learn multiple EMRs

angienadia, MD

Tech

November 9, 2010

As a new intern at a well-endowed medical institution, I was disappointed despite the flurry of excitement that comes with orientation. I was disappointed despite the brand new privilege to save lives and relieve human sufferings. And the disappointment was made clear to me over the past two days.

What has happened in the past two days? As I will be working at two separate hospitals, for the past two days …

What motivates health care workers is needed to explain health care costs

angienadia, MD

Policy

September 21, 2010

As part of the new health care legislation, the government has instituted Medicare’s Physician Quality Reporting Initiative (PQRI) in an attempt to motivate health professionals to do the right thing.

According to the legislation, PQRI asks physicians to report how the care they furnish aligns with evidence-based clinical guidelines for a variety of medical conditions, such as diabetes or heart disease. In 2010, physicians who successfully report these measures will receive …

Why primary care is like air traffic control

angienadia, MD

Physician

August 18, 2010

Recently I had an interesting conversation with a few young doctors regarding the new health care reform that had been passed in the United States. One future specialist asked me why primary care doctors should receive more money than they have in the past.

And this is an important question that I think sheds light on the suboptimal state of our current health care system. It is important to specialists because …

angienadia, MD

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