by Rishi Manchanda, MD, MPH
Mr. M walked into the community clinic where I work with a portable oxygen tank in tow. At 62, he’s gaunt and winded, battling a disease that is progressively scarring his lungs. Every breath is a fight. Instead of the clear flow of air, I hear the sound of velcro ripping when I place my stethoscope on his chest. In medicine, his …
How Medicaid is under political attack
Recently it was announced that Dr. Jack Kevorkian (also known as Dr. Death) died — ironically, not by suicide.
As a psychiatrist, one of the things I consider part of my job description is suicide prevention. Although many consider Dr. Kevorkian a civil rights activist for assisted suicide, I believe that there was a severe lack of ethics in his medical practice.
From everything I’ve read in the media (and I …
Doctor Kevorkian dead, but not by suicide
If nothing else, this post illustrates that surgeons are not that great with the whole bedside manner thing. I would like to think I’m an exception … but I still am a surgeon.
I make a point of communication with my patient. Obviously if he is a child, I use the same measure of effort in communicating with the parents. But few things irritate me more than some …
A surgeon makes it a point to directly communicate with the patient
I am all for breastfeeding. Without doubt, breast milk is incredible stuff. And it’s free. Who complains about free?
Nevertheless, somewhere along the way, the campaign for breastfeeding has spun out of control. The topic has morphed into yet another competition in the arena of parenthood. Mothers boast about breastfeeding. Mothers compare how long they nurse. Mothers compare how much milk can be pumped in one sitting. Mothers are made …
Let’s stop the war between breastfeeding and formula feeding
Although the famous clip from Jerry Maguire is about a sports agent trying to negotiate a new contract for an entitled egotistical football player, every time I see it, it reminds me of work. Put a white coat on Tom Cruise, and transplant them from a shower room to an exam room, and it becomes a pretty accurate portrait of my daily conversations with patients.
In fact, when I was on …
How medicine can be like a scene in Jerry Maguire
by Francine Gaillour, MD
A piercing and entertaining article in Harvard Business Review online, “People Are Not Cogs,” by Nilofer Merchant, author of The New How, offers keen insights worth considering by healthcare executives and physician leaders.
Merchant makes some incisive points about how industry has traditionally measured productivity and hence factored in the value of the individuals on the production line:
In spite of a forest’s worth …
Physicians are not cogs: How we can be great in healthcare
by Mona Mangat, MD
“We take our children to pediatricians for medical care — not moral judgment, not privacy intrusions.”
This quote by an NRA lobbyist troubles me. The statement reveals degradation in a sacred relationship – the physician-patient relationship.
This sentiment was prompted by a Florida pediatrician that refused to continue seeing a child after the parents refused to answer whether they kept firearms in the home. Governor …
Docs vs Glocks, and the slippery slope of HB 155
As undergraduate premedical students, we learned about narrative medicine by chance in a New York Times article titled “Learning to Listen.”
After exploring the research of Dr. Rita Charon, we were both drawn to the new field and what it had to offer us as future medical professionals. The Times article explains, “Through literature, [Dr. Charon] learned how stories are built and told, and translated that …
Narrative medicine means more effective healthcare
How and when do new medical technologies become the standard of care?
A recent study showed that the use of CT scans in hospital emergency departments rose sixteen percent between 1995 and 2007.
Looks a bit like a medieval torture doughnut.
The only thing that surprises me about this is that it’s not more.
Way more.
I remember the first time I actually ordered a CT scan on a patient all by myself, in …
Before getting a CT scan, ask your doctor if its really needed
At some point, the novelty of a new baby wears off.
Waking up at two in the morning loses some of its appeal. Parents often tell me that their baby does not sleep well. I tell them how they can get their child to sleep through the night in just three nights. I explain that learning to sleep is a training process, either …
How a pediatrician advises parents on sleep training their children
There are many more individuals with end stage kidney failure, heart failure, chronic lung disease, or liver failure who would benefit from a transplanted kidney, heart, lung or liver than are available. Similarly, there are many people with unstable, difficult to control diabetes that could benefit from a ready source of pancreatic insulin-producing islet cells.
Today the only option for more organs available for transplant …
Can xenotransplantation help with the organ shortage?
by Alison McKnight
We are surrounded by technology. No matter where you go, you will find technology rearing its face, whether ugly and ungodly or tempting and beautiful. These advances have brought both good and evil to many professions, especially healthcare.
Twenty years ago, you would not have found signs instructing people to turn off their cell phones in physician offices. Now these signs litter both …
How technology intersects with medicine and its impact on patients
This past Presidents’ Day, I thought it would be a good idea to talk briefly about the role that smallpox played in the life of our first president and it’s important role in the American Revolution. For those who would like to learn about this in greater detail, I would highly recommend the book, Pox Americana: The Great Smallpox Epidemic of 1775-82, written by Elizabeth A. Fenn.
In 1751, when George …
A history of smallpox in America
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My patient, whom I’ll call Jane, had a neurologic disorder that prevented her from emptying her bladder properly.
She required a permanent urinary foley catheter to help her urinate. Jane landed back at the hospital with yet another urinary tract infection – her third in one month. She had pus draining from her catheter and was infected with a multi-drug resistant strain of the bacteria Proteus. Our lab ran tests (sensitivities) …
Insurance companies cutting corners puts patients at risk
This past summer, I had a few parents complain to me about our staff. The parents wanted to let me know that they were treated nicely by the staff, but they had noticed things from the employees that they didn’t appreciate. They mentioned that the staff seemed annoyed and irritated, even bored at times and a bit disingenuous.
I wanted to investigate the issue before I reprimanded the staff. Things …
Physicians and their staff need to put on a consistent show
MRI overuse and misuse really make me angry.
Did you know that a growing number of doctors don’t even read the tests themselves? Another shocking aspect of this industry is that some doctors will order an MRI because it’s quicker than doing a full examination. Rushing to an MRI can oftentimes erase clinical correlation, that is, connecting the dots between pain and what the MRI shows.
MRI is unnecessarily overused. In …
MRI overuse is widespread, and dangerous to patients
I like to poke fun at real estate agents (please, forgive me if you are one, it is all in good fun).
My experience has been that, despite what I describe as my preferences, they always end up showing me what they have, even if it does not bear the remotest resemblance to what I need. This holds true for politicians, with this cardinal rule: always answer the question you want …
How physicians derive evidence for their practices needs to change
This is a message that should resonate loud and clear with providers, institutions or members of the healthcare enterprise world who are ruminating over the upsides — and potential downsides — of a wide reaching, multiple digital property: social media presence.
As Ted Eytan found out when he questioned the (anonymous) physicians on Sermo, many physicians are simply not interested in establishing an online presence.
“Risk” is the overwhelming variable they’re …
Social media ROI for one practicing physician
The USDA has recently released it’s new concept, the food plate, to replace the iconic food pyramid it introduced in 1992 (and modified in 2005).
At its release, Agriculture Secretary Tom Vilsack criticized the food pyramid for being “too complex to serve as a quick and easy guide for American families” – I completely agree, and have always felt this way. The food pyramid was the …
More healthy eating tips to add to the USDA food plate
Children are getting fatter because they are not allowed to run around and play. This comes from parents wanting to wrap kids in cotton wool — also known as helicopter parenting.
There is a new push to get children to walk to school. This is something which previous generations just did but has largely disappeared over the last 25 years. There are many reasons for this but one of them …
Why children are getting fatter
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