I know what you’re thinking, punk. You’re thinking “did he fire six shots or only five?” Now to tell you the truth I forgot myself in all this excitement. But being this is a .44 Magnum, the most powerful handgun in the world and will blow you head clean off, you’ve gotta ask yourself a question: “Do I feel lucky?” Well, do ya, punk?
– Harry Callahan (played by Clint …
Who do you want reading your EKG?
October 1st was a special day. The Affordable Care Act (ACA) also commonly known as Obamacare became official. The federal government shut down because Republicans and Democrats disagreed around Obamacare funding. Most importantly, October 1st was when I could finally read Malcolm Gladwell’s new book David and Goliath.
Gladwell ponders why do underdogs succeed when we least expect them to? Is it possible that advantages a Goliath has can be a disadvantage? …
David and Goliath lessons for doctors and our health system
Is there a patient who goes through a hospitalization who does not have stories to tell about the obstacles, errors and indignities that they endured? I just wonder sometimes.
A family relative was hospitalized this week with a stroke at a hospital a few hours from me — and his experience left me demoralized about medicine.
Joe (not his real name) is an 82-year-old grandfather, father, husband and one of a kind. …
Improve health care by seeing through the patient’s eyes
Ms. A was a sweet older lady with a bad heart who was transferred all the way from Montana in order to get expedited workup for cardiac (heart-related) surgery.
Her story of her symptoms and disease course was the story told by hundreds of patients seen at any given hospital every year. It started with a few weeks of chest discomfort while walking, followed by a day of chest pain, nausea, …
What to do after you make a medical error
We all know that physician-patient communication is important. Poor communication, not deficient clinical skill, is the primary driver of malpractice suits; conversely, good clinical communication alone can improve patient outcomes. For example, patients of physicians with superior communication skills have been shown to have superior blood pressure control. Fortunately, physicians generally recognize the significance of good communication, and often take the time to ensure that it happens. Yet there …
Use visual aids to teach patients and improve decision making
I used to think medicine would get easier over time. It makes sense, right? You see patterns, you learn how treatments work, and you just get to know stuff. Experience should make it easier to diagnose and treat.
That’s not been the case for me. In fact, it’s closer to the opposite. In the exam room, as I look up to the patient from my stool, and before I stand at …
The hubris of medicine has to end
Folks must think than all doctors know all things medical. I know this is true by the questions that I have been asked over the years. While my expertise spans hemorrhoids to heartburn, I am routinely queried on medical issues well beyond the specialty of gastroenterology. When I can’t answer questions about a new medicine for hypertension or if an MRI of …
Does your doctor know ACLS? Does it matter?
As Americans we spend more money on healthcare per capita than any other nation in the world. We have the latest medical innovations and for decades have been able to provide cutting edge therapy without regard to cost. However, as a profession, doctors are not doing nearly enough when it comes to prevention of disease. Certainly, costs will be reduced if we are able to prevent chronic illness and associated …
The powerful effects of culture and lifestyle on health
Here is an edited email I received from an athletic colleague:
John,
A 50 year-old male healthy athlete has the new problem of occasional periods of premature beats. She (or he, doesn’t matter) has visited the doctor and an ECG shows PVCs, or premature ventricular contractions. Otherwise the history, exam, ECG, ECHO and electrolytes are normal.
What’s up with PVCs? Why? Could they be 1) consequence of (chronic) exercise or 2) related in …
How a heart rhythm specialist approaches PVCs
A few weeks ago I was following an online discussion conducted by a widely followed health site.
During the discussion, they had a physician who was giving out wellness advice to users via Twitter.
That physician had one tweet in particular that terrified me.
As the above screenshot shows, one tweet mentioned that when in doubt regarding …
Why you shouldn’t give medical advice on Twitter
Medicine is about balancing risk and benefit. Certainly, as healthcare providers, we attempt to provide the best care for our patients based on available evidence. Physicians often are seen as shepherds, helping to guide patients through disease and therapy. As I have mentioned in previous blogs, ultimately medicine will be personalized and tailored to one’s particular genetic make-up. However, the need for a clear discussion of treatment options …
We must change how we discuss procedures with our patients
I first picked up an ultrasound transducer 17 months ago, at an emergency medicine ultrasound course at Harvard University. I had just barely heard about using ultrasound as a clinical tool and was vaguely interested. The course was 3 days long and cost a little under $700 and changed my life forever and made me a better doctor.
Emergency physicians have embraced the …
Bedside ultrasound tips for the general internist
With the announcement that the FDA granted 510(k) approval for the AliveCor EKG case for the iPhone 4/4S, the device became available to “licensed U.S. medical professionals and prescribed patients to record, display, store, and transfer single-channel electrocardiogram (ECG) rhythms.”
While this sounds nice, how, exactly, does one become a prescribed patient? Once a doctor prescribes such a device, what are his responsibilities? Does …
The legal risks of prescribing the AliveCor ECG
Full Code. Do not resuscitate. Do not intubate.
Ask anyone without a personal or family history of a hospitalization on the implication of these terms and you’d likely get a blank stare in response.
Unfortunately, this incomprehension often rings true with those who need to know it most: the hospitalized patients themselves.
Many clinical reports (see here and here) have demonstrated that most physicians are not only inadequate in discussing code status with …
5 essential concepts to know about code status
A recent meta-analysis published in the American Journal of Clinical Nutrition suggests that coenzyme Q10 is of benefit in congestive heart failure. For those who like the idea that food and nutrients can be excellent medicine, this paper is interesting at the very least. But there is a case to be made that it is far more than that. There is a case to be made …
The resurrection of coenzyme Q10: It’s all about the money
Radiolab recently aired a show called “The Bitter End” that discusses the end-of-life care preferences of physicians and non-physicians. Physicians are much more likely to decline “heroic” measures, such as CPR, mechanical ventilation, feeding tubes, etc. This comes as a surprise to the hosts and, presumably, to other non-physicians. It’s a good show. I recommend it. (Full disclosure: I like Radiolab.)
In the show, Ken Murray argues that …
Why physicians tend to decline CPR and other heroic measures
I live in Louisville, KY, which is the epicenter for heart disease in the United States. My state ranks 49th out of 50 states for heart attack mortality. This is a complex issue with many contributing factors, including access to care, patient education, health insurance, cooperation between EMS and hospitals, among others. The thing is: heart disease is our number one …
Allowing EMTs to perform an ECG should not be controversial
I’ve been thinking lately about all the great advances in medicine over the years. There have been lots of them. And despite everything you’ve heard about looming cuts in healthcare, I have no doubt that the hits will keep on coming. Since I seem to be on this Top 5 thing lately, I figured I would continue this ride and rank my top 10 medical advances over the years. There …
10 advances that have changed medicine forever
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 59-year-old man is evaluated for recently discovered spontaneous hypokalemia and hypertension. The patient had normal blood pressure at a visit 1 year ago. He has no symptoms and takes no medications.
On physical examination, temperature is 36.9 °C (98.4 °F), blood pressure is 148/96 mm Hg, pulse rate is 58/min, respiration rate is 18/min, …
MKSAP: 59-year-old man is evaluated for hypokalemia and hypertension
We can’t, of course, plan the way we’re going to die (with the obvious exception of suicide). We can, however, live in such a way that reduces the likelihood of our dying from certain diseases. Which is why it’s now almost universally accepted that we should exercise regularly, not smoke, drink only in moderation (if at all), avoid too much fat in our diet (and now probably too much carbohydrate), …
What is the best disease from which to die?
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