As a medical provider, while seeing a husband and wife, or a couple, regardless of gender, one comes across several situations that may be considered difficult to handle and that require a good deal of tact and confidentiality.
This is the case with seeing a husband and wife or (couple), together, for an examination. Ultimately, it depends on the rapport that the couple shares. If they …
A physician seeing the husband and wife together
Authors of a recent study from the Archives of Internal Medicine are unlikely to endear themselves to specialists.
As reported by Reuters, and provocatively titled, Do specialist doctors make too much money?, the study gives a per-hour breakdown of how much doctors make.
I think this is a good approach, since annual salary figures do not account for the number of hours doctors work — and in the case of primary …
Specialist and primary care pay per hour
In downtown Los Angeles recently, two very different celebrations went on within walking distance of each other.
On West Temple Street, at the beautiful and contemporary Cathedral of Our Lady of the Angels—a structure with no right angles in its adobe-colored walls—Catholic Mass was offered throughout the morning, in both English and Spanish. Five blocks south, at the stunningly refurbished Millennium Biltmore Hotel on Grand Avenue, the Council for Secular Humanism, …
Religious coping in dying patients
A guest column by the American Medical Association, exclusive to KevinMD.com.
As physicians, we prioritize the health of others often at the expense of our own health. Our patients’ health is our priority and why we chose the profession of medicine. The International Conference on Physician Health, held earlier this month in Chicago, gave physicians the opportunity to make their health a priority and provided them with tools to make …
AMA makes physician health a priority
An excerpt from Doctor Guilt?
by Everett Winslow Lovrien, MD
This is the story of a boy who had hemophilia, a bleeding disorder that resulted in pain, disability and death before adulthood. A new medicine was developed which brought an end to suffering and increased longevity in persons with hemophilia. The effect of the new medicine was like magic. It was a remarkable revolutionary advancement …
A drug to treat hemophilia was polluted with hepatitis viruses and HIV
You are now out of the Gray Zone, and you are now a member of an exclusive club.
But membership to this club comes at a steep price. Membership is not offered, it is not dependent on your income, title nor your social status. Membership is granted simply by surviving or living with a grave or potentially fatal illness or injury and realizing just how fragile life is and how quickly …
Surviving a potentially fatal injury and the fragility of life
Something happened to the public perception of health and medicine in the 1970s. People began to adopt — and financial interests and the media began to profit from – “healthy lifestyles.”
This was not without consequences.
• Americans became increasingly preoccupied with diet, exercise, and health habits.
• There was a big uptick in the use of alternative “medicine” and stress reduction practices – acupuncture, chiropractic, herbalism, naturopathy, nutritional therapies, yoga, massage, biofeedback.
• …
How a tyranny of health is bad for both patients and physicians
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 70-year-old man with a history of a systolic murmur presents for further assessment of exertional dyspnea. He has had dyspnea his entire life, but has noted a recent deterioration in his exercise capacity. He has no other medical conditions and is on …
MKSAP: A 70-year-old man with a history of a systolic murmur presents with exertional dyspnea
What does your breast type say about your cancer risk? Quite a bit, actually.
Whether you have large, small or lumpy breasts, self-awareness is very important. Getting to know how your breasts look and feel can help you recognize possible red flags.
Large vs. small breasts
When it comes to cancer risk, size really doesn’t matter. But, size can affect your mammogram and clinical breast exam.
For example, women with large breasts may need …
Breast cancer and understanding your breast type
by Arnon Krongrad, MD
The noose was loose on its neck. At first I worried, but then I relaxed. This was a bottle of pomegranate juice, the antioxidant superpower. As the billboard implied, it could cheat death. Perhaps if I consumed pomegranate juice, I could cheat death.
Last week, the Federal Trade Commission charged POM Wonderful, LLC, makers of pomegranate products, with deceptive advertising. …
Finasteride, fruit, and the matter of prostate health
The rise of the e-Patient movement has the potential to change the practice of medicine, in my opinion, for the better. e-Patients demand to be taken seriously, to be “equipped, enabled, empowered, engaged, equals, and emancipated.”
My recent post on KevinMD.com suggested the need for e-Doctors as well, in response to the growth of the e-Patient movement.
So how do you become an e-Doctor? I believe you, and I, need to be equally …
I don’t think there is anything nobler than being a physician. In it’s most prime form it is service to life’s most basic needs.
Certainly there are professions and lives with similar dedication. But lawyers and journalist I can’t reasonably place amongst them. This from someone who favors liberty and transparency in society above most else; certainly things that lawyers and journalists can help foster.
And yet, for all the respect thrown …
Does being a lawyer or journalist stack up with being a physician?
“How many staffers should we have per doctor?” was the opening question in a recent column. We looked at the impact of staff on provider productivity and ultimately practice profitability as an approach to address that question.
In that piece, we focused primarily on clinical staff, but in this column, we’ll dig even deeper into medical practice operations, looking at the way a practice utilizes nonclinical support staff for traditionally …
How medical practice operations impacts productivity and profitability
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“What does it take to be good at something in which failure is so easy, so effortless?” asks Atul Gawande in his book, Better. For medical students who will soon have responsibility over people’s lives, it’s a daunting question. It draws out our fears of messing up and making mistakes. Of getting a lower grade than our peers on a Structure Function exam. Of answering a question incorrectly and embarrassing …
How to foster a cycle of excellence in medicine
One of the simultaneously most enjoyable and exasperating aspects of being an infectious disease specialist is the large volume of “curbside” consultations we get from colleagues.
For example, here’s this week’s tally — and it’s only Tuesday — done from memory and without systematically keeping track of emails, pages, phone calls, etc.:
Why specialists don’t do more curbside consults
Interesting article recently from Health Affairs about the clinical equivalence between the care provided by anesthesiologists and CRNAs. The article concludes by advocating that CRNAs be given permission to practice anesthesiology without physician supervision. It’s more cost effective. And there is no compromise to the quality of care delivered to patients.
We recommend CMS return to its original intention of allowing nurse anesthetists to work independently of surgeon or …
Should CRNAs practice anesthesiology without physician supervision?
by Krupali Tejura, MD
A fellow physician called me with a consult this afternoon.
He described the case as a 60 year old who had stridor (difficulty breathing) for the past week and was admitted to the hospital recently. A CT scan showed lymph nodes in his neck which was compressing the trachea, and other scans didn’t show much better. A biopsy was done but the final results were …
Cake with a terminal cancer patient
I was a third-year medical student in the first week of my obstetrics rotation. The obstetrics program was known to be high-pressure, its residents among the best. Mostly women, they were a hard-core group–smart, efficient, motivated–and they scared the heck out of us medical students.
I remember the day clearly: Not only was I on call, but I was assigned to the chief resident’s team. I felt petrified.
We’d started morning rounds …
The day that medicine broke her and destroyed her innocence
An excerpt from Unhinged: The trouble with psychiatry- a doctor’s revelations about a profession in crisis. Copyright © 2010 Daniel Carlat. Excerpted with permission by Free Press, a Division of Simon & Schuster, Inc.
My own education in pharmaceutical marketing began during my second year of residency at Massachusetts General Hospital.
Suddenly, I noticed that Paxil bagels began appearing everywhere. I first saw them in the break room of …
Why drug companies lavish doctors and how they price their drugs
Let’s say you develop some heart problem and get sent to me for an evaluation. You show up to the office, check in, get ushered into an exam room, then you wait and wait and wait. When I finally come into the room I seem terse, impatient and rushed, and you end up visiting with me for less than 5 minutes. I provide you with a diagnosis, order a couple …
Finding a doctor using ratings is a sound idea, but poorly executed
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