One of the things I love about family medicine is that I get to care for people of all ages. I almost went into pediatrics, but the time I spend with older adults was too valuable to give up. Our elders have such great stories and knowledge to impart - it’s an honor to participate in their lives and share their experience.Since I first realized in residency training that Medicare ...
No one wants to die. Even people who want to go to heaven don't want to die to get there. And yet death is the destination we all share. No one has ever escaped it. And that is as it should be, because death is very likely the single best invention of life. It is life's change agent. It clears out the old to make way for the new. -Steve Jobs, ...
Everyone in the world is talking about “value-driven health care.” Or so it might seem if you pick up a medical journal or attend a lecture about health care here in Boston. “Maximizing value for patients” is on the tip of every administrator’s tongue and an interest in cost containment is de rigueur for young physicians who aspire to leadership positions in medicine. For those of us who are intimate with the ...
One morning this May, I woke up with a stiff neck. I applied hot and cold therapy all day and took an Advil before bed. By the end of that week, I was unable to comfortably move my head and I was feeling numbness down my left arm to my fingertips. I saw my doctor within 24 hours of calling his office. After a brief exam, he was sure of ...
Just the other day, I saw a 52 year old man in my office for what I thought was a routine prostate issue. I walked in the exam room, introduced myself and immediately knew his prostate was fine. His eye contact was non-existent. He was nervous and his handshake was clammy and brief. I see these patients everyday. Their prostates are just fine. It's their love life that's the issue. ...
There seems to be a deep, even innate, need on the part of many young men to actually, or vicariously, strike out at other people to cause pain and injury while striving to dominate.In 1996, I wrote an editorial entitled "Blunt Force Violence in America" describing "a modern continuum from street fights to barroom brawls to domestic child, spousal, and elder abuse, to ultimate fighting to extreme fighting, to ...
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.A 78-year-old woman who resides in a nursing home is seen for management of her diabetes mellitus. The patient's blood glucose log shows levels ranging between 40 and 400 mg/dL (2.2 and 22.2 mmol/L). She otherwise feels well. She has been on insulin for more ...
CNN recently posted an article titled "Doctors Going Broke." It described several cases of independent physicians who are near bankruptcy although they once were quite well off. For instance, the article detailed the case of Dr. William Pentz, a cardiologist in a small group practice, who had to borrow money last month to make payroll. He and the other cardiologists have cut their salaries in order to meet overhead. Dr. ...
Conflicts of interest in medical research are extremely common - one recent study found that 52% of the experts involved in developing clinical practice guidelines for the management of diabetes in the United States and Canada had a financial conflict of interest. Although doctors and researchers often declare financial conflicts of interests when they make presentations and publish papers, there are many who argue that declaring financial conflicts is no longer ...
In October 2011, the Centers for Disease Control and Prevention reported a 60% increase in “emergency department visits for sports– and recreation–related traumatic brain injuries, including concussions, among children and adolescents” over the past decade. That’s good news: as the CDC’s press release said, they believe the increase was due in part to “growing awareness among parents and coaches, and the public as a whole, about the need for individuals with a suspected ...
There is a healthy debate over whether a lab that created an extremely infectious version of influenza ought to publish the genetic sequence. The debate speaks to a larger problem: sometimes, medical advances do the world a disservice. The medical field could use some soul-searching, just as physicists did in the wake of the Manhattan Project.A few years ago, I read a neat research finding. In a pregnant woman, ...
This series is brought to you by MedPage Today.1. Last Patients on ICU Rounds Get Least Time. Clinical staff spent significantly less time with intensive care unit patients at the end of rounds as compared with the beginning.2. Women Suffer More ICD Complications. Women are at greater risk of complications and are less likely to receive appropriate shocks from their implantable cardioverter-defibrillators ...
As a follow-up to my post on why patients with implantable defibrillators should have access to their device’s data, I am going to talk about what your physician looks for when a device is interrogated. Many times this happens in silence or with few words, and some pushes of a button, when done in the office, and when done with remote patient management, is accomplished either automatically or with ...
It's amazing how quickly you can lose track of time as you power through the books. Once everything is setup -- coffee to the left, pens and highlighters to the right, Grooveshark playlist perfectly tuned -- you can suddenly look up and realize that three weeks have flown by and there are 123 multiple choice questions to be answered in the morning.Over the past year and a half I've learned ...
I just finished reading George’s recent post on Evelyn Lauder, who recently passed away from ovarian cancer, and am still stirred by the passing of Patrick Swayze from pancreatic cancer and Elizabeth Edwards from metastatic breast cancer. There’s a reason I am a surgeon, and not a medical oncologist. Death has this bleak sadness about it, that eternal optimists ...
The orders came indirectly from the government.Reduce hospital re-admissions. Cut costs.So, the hospital contacted the local hospice-palliative care center and asked for help. Of course, overwhelmed with work and understaffed, the project was handed off to me.My task sounded simple. Create a palliative care program at the nursing home. But as I gathered for the first meeting with the administrator, social worker, and clinical staff, I knew there would be ...
This series is brought to you by MedPage Today.1. Fighters Need Padded Gear to Cut Head Injury. Rotational head injuries in fighting sports can be minimized if participants wear padded boxing gloves and headgear rather lighter protective gear or no protection at all.2. Heart Failure, Fractures Linked. Heart failure appears to be associated with a greater risk of major osteoporotic fractures, independent ...
I’m reluctant to write a post about ADHD. It just seems like treacherous ground. Judging by comments I’ve read online and in magazines, and my own personal experience, expressing an opinion about this diagnosis—or just about anything in child psychiatry—will be met with criticism from one side or another. But after reading L. Alan Sroufe’s article (“Ritalin Gone Wild”) in the New York Times, I feel compelled to write.If ...
One of the things that I like most about my job is engaging with ACP’s physician leadership—the internal medicine doctors who dedicate enormous amounts of time, at great personal sacrifice, to represent the interests of our members and their patients.One of the things that I like least is when an ACP member (or non-member physician) caustically dismisses their efforts, usually because they disagree with some aspects of ACP policy. It ...
I recently wrote that "diagnosis is job number one." In sports, there are times when two teams share the number one position. Each team competes to make it to the championship; and, ultimately, one team has to lose its top ranking.In medicine, care and diagnosis share the number one spot, working together toward a common goal: to promote health. Some would say that, without care, the diagnosis is worthless. Certainly, ...
Ovarian cancer screening clearly touches a nerve. No one doubts that ovarian cancer is a devastating diagnosis, often found when the disease...
According to a recent study from the Archives of Internal Medicine, primary care physicians are referring more patients to specialists than ever...
One of the reasons there is such a movement against vaccines is the democratization of information, perpetuated by search engines like Google....
In a widely circulated CNN article, many radiologists have been found to cheat on their board exams: "Doctors around the country taking an...
One of the things I love about family medicine is that I get to care for people of all ages. I almost...
I just finished reading George’s recent post on Evelyn Lauder, who recently passed away from ovarian cancer, and am still stirred by...
The orders came indirectly from the government. Reduce hospital re-admissions. Cut costs. So, the hospital contacted the local hospice-palliative care center and...
I recently wrote that "diagnosis is job number one." In sports, there are times when two teams share the number one position. ...
No one wants to die. Even people who want to go to heaven don't want to die to get there. And yet...
One morning this May, I woke up with a stiff neck. I applied hot and cold therapy all day and took an...
Visiting someone who is dying or critically ill is an experience many of us will have in the course of our lives....
I found a recent Associated Press article on an aspect of the new health care law that many of us may have...
Everyone in the world is talking about “value-driven health care.” Or so it might seem if you pick up a medical journal...
CNN recently posted an article titled "Doctors Going Broke." It described several cases of independent physicians who are near bankruptcy although they once...
One of the things that I like most about my job is engaging with ACP’s physician leadership—the internal medicine doctors who dedicate...
I’m sure Ezekiel Emanuel hates being referred to as Rahm Emanuel’s brother, so I won’t describe him as such. After working as...
As a follow-up to my post on why patients with implantable defibrillators should have access to their device’s data, I am going...
A recent article in the Wall Street Journal reviewed the emerging role of email in healthcare, arguing that doctors should more aggressively...
Paul Conslato, MD, director of clinical affairs for Lancaster General Medical Group, recently was quoted in the PAMED Better Health Network eZine...
Don’t get me wrong, EMRs (electronic medical records) are inevitable. Over the long-run they are almost certainly good for physicians, patients and...
As a physician, technology cannot replace you, but it can make you more efficient and effective. This was the message from Richard...
Looking ahead to the next several months, I’ve found myself frequently wondering how many physicians will make this their year to take...
The physician’s decision to first dive into social media can be stress-inducing. Issues of time management, maintaining professionalism, and determining a return...
The impact of social media on medicine could arguably be compared to the impact of the industrial revolution on the human condition....
