I recently spoke to a class of undergraduates about the benefits, harms and politics of screening smokers for lung cancer using low-dose CT scans. Afterwards, a student asked how I felt about the Affordable Care Act's requirement that Medicare and private insurers cover U.S. Preventive Services Task Force "A" and "B" recommended screening tests and other preventive services without co-payments or deductibles, making them free at the point of care. I ...

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People suffering from chronic pain are often angry. They are trapped not only by an unpleasant sensation, but also by their limited treatment options. The experience can lead to feeling not only like there is no end in sight, but also as through there is no hope. So strong are the associated emotions that I often call this state of mind “the abyss.” All too often, when that frustration becomes too ...

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From MedPage Today:

  1. Striking a Nerve: Bungling the Cannabis Story. Correlation does not equal causation, and a single exam cannot show a trend over time. Basic stuff, right?
  2. 'Choosing Wisely' Lists Don't List Big Moneymakers. When America's joint surgeons were challenged to come up with a list of unnecessary procedures in their field, their selections shared one thing: none significantly impacted their incomes.

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Earlier this year, I completed a medical rotation in Africa. It was an amazing, eye-opening experience. While I expected it might be difficult to acquire newer, more expensive medications and procedures, I had anticipated that, given limited resources, there would be some rationale in deciding which medications and procedures would be available. I was deeply mistaken in this assumption. During my time abroad, I watched several patients with heart attacks pass ...

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Going to the doctor starts as a disconcerting experience: Getting naked, physically and emotionally; talking about your weight, your smoking, your divorce. You count on your doctor’s ear and her discretion. Often enough, a patient will apologize for taking my time or for crying or whatever. I remind them that this is what the exam room is for, this is what they pay me for. How far does this special relationship ...

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Hospital medicine has rapidly become one of the largest specialties in the United States. As the number of practicing hospital medicine doctors soars above the 30,000 mark and health care reform takes hold, the specialty finds itself at the forefront of American medicine. And for good reason. It is a young, dynamic, varied and flexible specialty that can be practiced in a number of different settings. Hospital medicine doctors are ...

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Doctor: “Phil, you have pneumonia.” Phil: “Oh noes. What shall I do?” Doctor: “Just take these red pills, here.” Phil: “Great! I feel better already! When can I go back to work?” Doctor: “I think in about 2 weeks. Or maybe 2 months. And actually, don’t take those red pills -- these blue ones are better. It could take a few years for you to get better, and I’ll be retired by then. Here, ...

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Next in a series. Beginning with a deep understanding of medical science and years of training and experience, the primary care physician (PCP) needs to delve deeply into the patient’s personal, family and social setting in order to fully understand the context and causes of the patient’s illness. The PCP also needs to know when it is important or even critical to call upon others with specific knowledge, techniques or ...

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Why you need to hear from miserable doctors Is being a physician a good gig, or not? In a piece that's gone viral, internist Daniela Drake writes a strongly-worded column in the Daily Beast about how miserable it is to be a physician:

To be sure many people with good intentions are working toward solving the healthcare crisis. But the answers they’ve come up with are driving up costs and driving ...

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In my transition from pure learner (i.e., the med student role) to teacher-learner (i.e., the attending), I’ve actually found myself focusing more on the learner than the teacher part of my dual existence.  Strong learning seems to be requisite to strong teaching, and I am realizing that succeeding on the next level requires some extra meta-cognition, that is, learning to learn in new ways. Learning to unlearn In med school, learners amass an ...

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From MedPage Today:

  1. Two HCV Drugs Stronger Than One. A combination of the two newest drugs approved for hepatitis C virus (HCV) suggests that a strength of one overcomes a weakness of the other.
  2. % of Type 2 Diabetes Left Undiagnosed Declines. A lower percentage of type 2 diabetes cases is going undiagnosed than was the case in the past couple of decades.

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A while ago, Atul Gawande, the noted surgeon-author, wrote a long piece in the New Yorker on why health care should look to a restaurant called the Cheesecake Factory for some guidance on how to standardize things. This was met with some derision by a number of physicians who pointed out, among other things, that the food at the Cheesecake Factory is not great and is loaded with calories. But I ...

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If you want to understand the world of professional board certification, it is important to understand the business and politics of testing professionals. Such testing is big business. So big in fact, that huge international media and education companies that trade on the New York Stock Exchange have been created to service this need. According to one article on Reuters from 2012, "the entire education sector, including college and mid-career training, represents nearly ...

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The janitor approached my office manager with a very worried expression.  "Uh, Brenda ..." he said, hesitantly. "Yes?" she replied, wondering what janitorial emergency was looming in her near future. "Uh ...well ... I was cleaning Dr. Lamberts' office yesterday and I noticed on his computer ..."  He cleared his throat nervously, "Uh ... his computer had something on it." "Something on his computer? You mean on top of the computer, or on ...

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Hegira: To take flight to escape.  To travel from a place of danger to a place of safety. “You have cancer.” You hear the words.  Your mind does not understand. “You have cancer.” Shock.  Distance.  Isolation.  Someone else.  A mistake.  A lie.  Bizarre, strange, you float above the room.  Everyone speaks; nothing is said. “You have cancer.” A fog-like curse, a venomous reality, a phantom idea.  A cold ghost foreign to the soul.  I must run. ...

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Barron Lerner thinks he understands doctor's motives.  In his recent article in the Atlantic he laments that physicians act on tradition and emotion over adopting new science.  In defense of his position, he sites the example of how cardiologists use angioplasty and coronary artery bypass to treat coronary disease. He states,

... cardiologists have been remarkably slow to abandon the old hypothesis, continuing to perform hundreds of thousands of bypass operations and ...

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Where I’m from, you can have someone killed for $5000.  I will do it for $1110. I’m a hand surgeon. I practice (or practiced, by the time you read this) in an area that is what we often refer to as “underserved.”   Rather, the area isn’t, but the people I treat are.  I work in a large urban referral center that has a very high proportion of Medicaid as well as ...

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From MedPage Today:

  1. A Different Take on .health Domains. Top level domains (TLD) like .doctor, .med, and .health will certainly provide for a memorable way to promote one's practice website as compared with what exists today in domain name choices.
  2. EMA Also Reviews Testosterone. The European Medicines Agency has initiated a review of testosterone therapies, joining the FDA in investigating potential cardiovascular side effects.

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It’s okay that you don’t remember me. My name is Shara, and I’m part of the surgical team. I’m checking to see how you’re doing after your surgery. Do you know where you are right now? Actually, you’re in the hospital. You had surgery a few hours ago, for a broken hip. You used to be able to walk before you broke it, so it was important to fix it as soon ...

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A recent ProPublica expose co-published with the Boston Globe typifies a growing gotcha genre of health journalism that portrays doctors as the enemy in a struggle for honesty and openness in medicine. These reports make unfounded leaps in their efforts to subject doctors to levels of skepticism once reserved for politicians and lawyers. They’re going to end up doing patients a disservice. For this particular hunting expedition ProPublica set its sights on ...

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