I had a patient once who wanted an exercise stress test even though he had neither symptoms nor risk factors to suggest the presence of coronary artery disease (such as chest pain with exertion). I argued vociferously against it. However, extenuating circumstances (not relevant here) prompted our mutual decision to go ahead with it anyway. To our surprise and dismay, it came …
Why doctors can’t screen patients for every disease
An elderly woman sent home from the hospital develops a life-threatening infection because she doesn’t understand the warning signs listed in the discharge instructions.
A man confused by an intake form in a doctor’s office reflexively writes “no” to every question because he doesn’t understand what is being asked.
A young mother pours a drug that is supposed to be taken by mouth into her baby’s ear, perforating the eardrum.
And a man in …
Poor health literacy linked with unnecessary health complications
I’m all for the values of social media, as evidenced by my frequent use of Twitter, Facebook, Youtube and LinkedIn.
Recently, I realized again the value of a telephone conversation. I was on the phone with someone who I consider a mentor, someone who has fiercely guided me through my journey into social media without knowing the power of what was being done. It was the best 20 minutes of …
Meaningful offline dialogue creates online inspiration
Here are the three most useful words for a doctor: “I don’t know.”
A close second would be “I’m not sure,” another three that have got me out of trouble more times than I can remember. The older I get, and more experience I have, the more useful it becomes.
Pattern recognition is essential in effective medical practice. So often patient complaints are vague and nondescript, and in the absence of physical …
The three most useful words for a doctor
According to one of the the guidelines set forth by the AMA about professionalism in social media, “When physicians see content posted by colleagues that appears unprofessional they have a responsibility to bring that content to the attention of the individual, so that he or she can remove it and/or take other appropriate actions.”
With that in mind, Bryan Vartabedian, who …
How doctors should professionally behave on Twitter
by Alex Smith, MD
I used to get Sports Illustrated, and my favorite column was titled, “This week’s sign that the apocalypse Is upon us.” Well, JAMA recently published the medical equivalent.
Sima and colleagues at Memorial Sloan Kettering used a population based dataset of patients with cancer to compare rates of cancer screening (mammography, PAP smears, PSA …
Cancer screening on autopilot in patients with advanced cancer
I love running.
I typically run 3-4 miles a day 5 to 6 days per week. It’s only about a half hour of time, and it’s well worth it. I get ‘in the zone’ when I run, and I can tune out the rest of the world and enjoy just being. It feels great physically and mentally each time. It’s helped me immensely to stave off the obesity issues that have …
A psychiatrist on the compulsion behind running and exercise
Part one of the three-part series, Let’s Pay Popular People More!
My patient only had 20 minutes to wait for the van headed to detox. The people who had worked to get him into a detox program already numbered in the double digits. Sam (not his real name) was the classic public inebriate — he woke on sidewalks with the shakes, vomited blood on a regular basis, had lost most of …
How basing physician pay on popularity marginalizes some patients
If you develop a swollen knee, please don’t consider it a normal occurrence.
If there was a clear cause, such as a fall to the knee, or some twisting injury to the knee, it’s likely that the cause is due to some mechanical damage. An easily recognized example would be a football or rugby player sustaining such an injury on the playing field. In that case, its typically serious and when …
Why you shouldn’t ignore a swollen knee
by George H. Northrup, PhD
No one becomes a mental health professional—in my case, a clinical psychologist—for the financial rewards.
With comparable (or less) education, far more lucrative careers exist in law, business, or other health care specialties. Psychotherapy tends to draw practitioners who are fascinated by the mysteries of the mind and who find satisfaction helping others in distress. Money has typically been a …
How managed care caused the mental health care crisis
Why does health care seem to lag behind other industries in innovation?
There’s a temptation to manufacture reasons that don’t necessarily explain why health care has not seen the kinds of revolutionary changes evident in industries from computing and telecommunications to music and retail? People routinely marvel at how easy it is to manage their bank account these days, but they don’t appreciate continuing to wait hours in their doctors’ offices, …
How medical students are key to innovating in medicine
Does physician denial of patient requests result in decreased patient satisfaction?
The short answer: No.
At least not in the context of a strong physician-patient relationship.
Many physicians have legitimate concerns about the prospects of having their salary or level reimbursement linked to patient satisfaction. I would too given the way most health …
How denying patient requests may not impact patient satisfaction
There’s been a movement afoot for several years now to quantify pain as the so-called “Fifth Vital Sign.” It all started as a well-intentioned effort to raise the level of awareness of inadequate pain control in many patients, but has gotten way out of hand.
The problem is that the word “sign” has a specific meaning in …
Why pain cannot be a vital sign
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Lying on the backboard, a frail little old lady moaned with discomfort.
She had fallen beside her bed in the nursing home and was then tightly bound by straps onto the backboard, a cervical collar pushing her chin up and holding her immobile. A person not familiar with modern medicine might think the ensemble looked like a torture device. Indeed, it can …
Why confused, weak elderly patients are subjected to aggressive care
Gary Schwitzer is Publisher of HealthNewsReview.org, where he and his team grade daily health news coverage. He works to improve health journalism with the goal of improving consumer knowledge and decision-making. He was the founding editor-in-chief of the MayoClinic.com site. While his guest lecture at Web Strategies for Health Communication was on health news reporting, I realized that his review criteria seemed equally applicable to any health content …
Improve health journalism to improve consumer knowledge and decisions
In the summer of 2001, I was preparing to begin my 19th year on the faculty of U.C. Davis School of Law. Then I got sick with what the doctors thought was an acute viral infection. I have yet to recover.
Being diagnosed with a chronic illness or condition can take a toll on your relationships, partly because all of the …
When chronic illness strikes: Tips on talking to family and close friends
Medical care in America isn’t doing so well when compared to other developed nations. Historically physicians did not want to take ownership of their patients’ problems. Patients have free will. They can “choose” to be non-adherent. They can choose to not take the medication the doctor prescribes — even if the one prescribed is $70 dollars a month when there is a $4 dollar Read more…
How physicians can take more responsibility in the care of patients
by Doctor D, MD
A teacher asks Doctor D about a diabetic teenager in his class: “His sugar readings are often over 400. His mom says this is normal. Can this be normal?”
What is normal?
a) A state of harmony within the body and mind that leads to health and well-being.
b) The typical or status quo for a person; the way things usually are.
c) WTF? There is no such …
What is normal for a teen with diabetes?
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 32-year-old man is evaluated in the emergency department for a 5-day history of worsening crampy abdominal pain and eight to ten loose bowel movements a day. The patient has a 5-year history of ulcerative colitis treated with azathioprine and topical mesalamine; before this episode, he …
MKSAP: 32-year-old man with crampy abdominal pain
When anyone brings up the idea of end of life care, you are thrown a political football. Yet, the failure to have these discussions with your loved ones creates an expensive and emotional mess.
I can’t tell you the number of times I’ve been sitting at a table with friends and this issue has surfaced with almost unanimous consent: they all want to …
End of life care requires individual family decisions
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