Why are you, Dr. Jones, licensed to practice medicine by the state of New Jersey? And, if you live in Ewing Township, right across the Delaware River from Yardley, Pa., why can’t you practice medicine in Yardley?
In these United States, each of us physicians must obtain and retain a license in each state in which one practices.
Since we may have gone to a medical school in any state, or even …
The American Medical Association was founded in 1846 for a number of reasons, including to create a Code of Medical Ethics.
It did, and the Code is alive in 2010.
I believe that all medical students should memorize these bedrock principles — a little like many did the Boy Scout Oath and Law.
And, I believe that all physicians should follow them scrupulously, lifelong.
The Principles are:
I. A physician shall be dedicated to providing …
How do you think American physicians should be paid?
I think many of the current methods are insane. Case in point:
In the 1980s, during a meeting of the board of trustees of the American Medical Association, I experienced sudden unexpected unilateral loss of hearing. You might say that was lucky. But I was scared and went right to my ENT’s office.
He looked in my ear and extracted a large wad of …
Ethyl alcohol kills large numbers of Americans every day (about 200), almost all legally.
Tobacco kills large numbers of Americans every day (about 1,200), almost all legally.
Americans also use many illegal psychoactive drugs and some of these also kill, but the numbers are much smaller. We don’t know what the effect on American mortality figures would be if these illegal psychoactive drugs were legalized or decriminalized, but it is a topic …
Do nurses want to be doctors? Of course many do.
And I say, if you want to be a doctor, go to medical school. I say that as a red-blooded, licensed, board-certified, AMA card carrying, guild mentality, protectionist physician.
But I am also a citizen, a patient, a taxpayer, a public health professional, and a member of the Institute of Medicine (IOM) of the National Academy of Sciences.
The IOM has recently issued …
Doctor, did you eat your fruits and veggies today?
Two servings of fruit and three servings of vegetables each and every day?
If you did not, how can you expect your patients, for whom you are supposed to set an example, to do so?
The Healthy People 2010 program of the Department of Health and Human Services set as a goal that 75% of Americans would consume two or more servings a day …
How many murders did you have in your hospital last year? Did they involve sporadic or serial killers?
What? You don’t know? You really haven’t thought that much about it?
I’m not surprised.
Chances are you might have had some murders but they were not discovered. I’m not only talking about the angry patient or family member who brings a gun to the ER or a patient room to seek revenge for a …
Cancer is a really bad diagnosis and I hope I never get one. But I was taught a long time ago that if I had to get a cancer, a papillary carcinoma of the thyroid would be a good one to get.
An article in the World Journal of Surgery in June 2010, selected as highly credible by McMaster PLUS, bears that out.
Long-term follow-up really is the best way to learn …
Stop pushing screening mammograms now.
One by one, the big-time screening tests for dread diseases, begun with good intentions, the best science known at the time, and a mass public health campaign, bite the dust.
Real science, that of statistically and clinically valid outcomes over time, obviously takes time to be realized. It also takes unbiased scientists and physicians with minimal conflicts of interest to study, deduce, report and then take the …
How are we going to solve the drug problem? The answer is we aren’t.
Psychoactive drug abuse is as old as recorded history. As long as drugs are available and humans are frail, there will be drug abuse and drug abusers.
The main point for medicine is to follow Hippocrates. First, do no harm.
So many of our drug laws, intended to do good, actually do more harm than good. Witness marijuana.
Will California …
Doctor, why did you behave the way you behaved last night?
Frankly, I don’t really care how you behaved last night as a person, although you should. I do realize that the Christian religion states that “I am my brother’s keeper.” I do care about your welfare, but I am not that strong a believer as to make your personal life my personal business.
But, if it were your professional behavior, I …
We at the Los Angeles County/USC Medical Center are generally credited with having created the “Panic Value” or “Critical Value” laboratory reporting system in 1969.
A Panic or Critical Value is a laboratory finding at such variance with normal as to be life-threatening if something is not done quickly, and for which there is a corrective action that can be taken.
We determined that it was the laboratory’s responsibility to recognize such …
A couple of centuries ago, when I was a graduate student in biochemistry and later a med tech, we thought about a lab test as a CBC or a blood sugar that produces a numerical result. Period.
Later, I learned and wrote that there were at least nine separate vital steps in the performance of a laboratory test and that the analysis that produces a result was important but that so …
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First, a disclosure. I am President and Board Chair of the not-for-profit Lundberg Institute in California, which is dedicated to Archie Cochrane.
What would happen if we in American healthcare actually followed the teachings of the revered Archie Cochrane? I’m sorry. You don’t know what those teachings are? … and you don’t even know who Archie Cochrane was? Oh my …
Click www.lundberginstitute.org, no registration required, and then click to …
So you want not to be decimated by a malpractice lawsuit? I understand that, and I agree. Here are eight ways to elude that destiny.
Way number 1. Don’t do malpractice.
Way number 2. Care deeply about your patients; and let them know by your actions that you really do care.
Way number 3. Communicate diligently with your patients so that you and they are on the same page and understand together what …
To screen or not to screen? That is not the question.
The question is not whether to screen, it is why, what, where, when, how, and how much, how often, and at what cost for what benefit.
Patients and physicians must and do screen. The issue is cautious appropriateness. Self-screening by patients is easy, free, and fundamentally harmless. Look at your skin for potential melanomas, be alert to warning symptoms of a …
Why do physicians order lab tests? As reported in JAMA some years ago from a survey of hundreds of resident physicians at the Los Angeles County/University of Southern California Medical Center, the traditional reasons are: diagnosis 37%, monitoring 33%, screening 32%, previous abnormal result 12%, prognosis 7%, education 2%, and medicolegal (at this large public hospital) only 1%. Okay, that all makes some sense.
In order to confirm these findings, I …
You probably saw the July press reports: balmy tropical breezes, azure surf, cerebral plaques and tangles, and new criteria for Alzheimer’s.
Who could deny an opportunity to spend some time at the best non-oil-spoiled beaches for those who toil at the benches and bedsides for Alzheimer’s victims — and on taxpayer money yet.
It seems to me like, just as human hip and knee joints and premolars and molars are not preprogrammed …
There is no Alternative Medicine.
Thus sprach Phil Fontanarosa and me in a 1998 JAMA editorial in the famous theme issue dedicated to Complementary and Alternative Medicine.
So I went to Mr. Google in 2010 and entered … Alternative Medicine … and clicked — 41,200,000 results; entered Complementary and Alternative Medicine, click — 3,210,000 results; entered CAM, click — 191,000,000 results, but that’s not fair; CAM can stand for many unrelated topics.
Let’s …
Should consumers have easy, direct access to genetic tests? So asked a recent survey on MedPage Today. After nearly 1,000 people voted, the tally was: Yes 37%; No 30%; it depends on the test 32%.
Of course this survey is “unscientific,” meaning anyone who sees it may (or may not) vote so there is obvious selection bias. Nonetheless, since the number voting is hefty, it is worth looking at.
I am impressed …
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