I was listening to the news on my way to work recently, and heard a story about the review conducted after the well-publicized security breach at the White House. Like many people, I was shocked when the story of the fence-jumper first broke. How was it possible that some guy with a knife managed to get over the fence, cross the lawn, enter the White House and get deep into the ...

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It is well known that Medicare expenditures threaten the financial solvency of the U.S. government. And it is pretty well agreed upon that some of our Medicare spending goes towards wasteful medical care. But which medical care is wasteful and how much is such care costing us?  A study in JAMA Internal Medicine provides a sneak peek at answers to these important questions. The research, led by Aaron Schwartz, a graduate student ...

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It was a Friday morning, in the wee hours. I had come in to the hospital early to get caught up on the ever-present computer work. As I got a quick cup of tea, a young surgeon I’d seen around the operating room came in. He’d clearly been up most of the night. We exchanged a few pleasantries. And then he cut to the chase: “Don’t you help docs with burnout?” Surprised that ...

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Check. The administrator's voice wavered as I picked up the phone.  He was calling about the nursing home patient that I admitted the day before.  While normally forthright, I could feel the discomfort in his tone as he danced around the issue.  The patient's insurer had called.  Apparently they made an "arrangement" with the mega-ACO owned by the latest consolidation of Goliath health systems.  They wanted my patient transferred to another ...

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I walk out of the patient room.  My eyes stare at the computer screen.  I’m behind, way behind.  I roll my head on my neck.  My neck feels tense, and I have a headache.  It’s been a long week.  I need a vacation.  Hurry up, click-click-click this computer, I think to myself.  Dammit, is this EMR really freezing up again? I look up.  A man walks out of a patient room ...

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Top stories in health and medicine, November 26, 2014From MedPage Today:

  1. USPSTF: Routine Vitamin D Screening Unsupported. There is not enough evidence that vitamin D screening is beneficial in routine practice and therefore it can't be recommended, according to the U.S. Preventive Services Task Force.
  2. SLE Patients See Good Outcomes in Blood Cancers. Risk of hematologic malignancy may be increased ...

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In recent months, Silicon Valley has surpassed Hollywood as America’s home for high-profile split ups. Last month, computer security giant Symantec announced its intentions to split in two. And three days before that, HP announced plans to divide up into parts. In September, eBay announced its intention to spin off PayPal. With enough twists and turns to fill a screenplay, the tech industry’s recent split-up saga raises a couple of ...

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Much has been made about physicians’ tendencies to interrupt patients. Studies have shown that patients are permitted 12 to 18 seconds of talk time before they are redirected (or interrupted) by their doctor. This leads to patients feeling that the physician didn’t listen or didn’t care. I believe that there is a way to solve the problem without wasting time or being rude. I have used this technique with great ...

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We need to start skin cancer prevention with our children The numbers about skin cancer incidence and costs in the United States are worse than anyone expected. That's the message that comes from a report published recently in the American Journal of Preventive Medicine on research from the Centers For Disease Control and Prevention, the Agency for Healthcare Research and Quality and the National Cancer Institute. The researchers took a look at the number of skin cancers ...

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Andy was new to me. He told me he had seen several doctors over the past few years for various pains in his right arm. Some months ago, he had right shoulder pain that went away on its own, but for the past few weeks, he had pain in the middle of his upper arm. Last year he had tennis elbow and forearm pain for many months. A slender, middle aged man, ...

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We have heard ad nauseum that the data collection mandated by Medicare and Medicaid is to improve quality of care. Significant taxpayer dollars have been expended as bonuses in the name of PQRS (Physician Quality Reporting System). With all this investment and mandating, one would assume that the PQRS must be highly indicative of better quality of patient care, right? Not so fast. Two recent reports demonstrate how ineffective this program is and how much ...

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I spent this past week worrying that my in-laws were going to divorce me. For sure. No getting out of it this time. I do not keep a neat house. There are piles everywhere. Piles of books. Piles of papers. Piles of clean-but-unfolded laundry. Piles of mail. Piles of music. Piles (believe it or not) of instruments. Piles of shoes. Piles of coats (it’s cold these days, but varying degrees of ...

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Top stories in health and medicine, November 25, 2014From MedPage Today:

  1. FDA Advisers Tackle Epidural Steroid Shots. An FDA advisory committee is meeting Monday and Tuesday to discuss adverse neurologic effects following the use of epidural steroid injections for pain management.
  2. FDA Stiffens Warning on Power Morcellators. The FDA has warned against using power morcellators during hysterectomy or treatment of ...

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Ezekiel Emanuel wrote an article for the Atlantic on "Why I Hope to Die at 75: An argument that society and families -- and you -- will be better off if nature takes its course swiftly and promptly."  As an oncologist and ethicist, he says he speaks for himself but implies not so subtlety that avoiding our declining years may be in our best interest -- and that it ...

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A few days before I wrote this, a patient had a complication in my office. I have discussed previously the distinction between a complication, which is a blameless event, and a negligent act. In my experience, most lawsuits are initiated against complications or adverse medical outcomes, neither of which are the result of medical negligence. This is the basis for my strong belief that the current medical malpractice system ...

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I think it’s fair to say Jonathan Gruber will not be offered the role of Pinocchio. Although intelligence agencies, in search of the truth serum, might have an interest in the ingredients of what he drinks. Please put away the pitchforks. Gruber deserves credit for honesty and bipartisanship. Plus a complete rejection of Disneyland economics. If you’re looking for transparency, the other face of honesty, Gruber is ground zero. Stupidity, though, was ...

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I understand that for some, digital health still might be a bitter pill, but the promise of techno-medical mumbo jumbo is bold and transformative. That being said, in my opinion, the “secret sauce” to digital health might be a bit outside the conventional “drug development” methodology -- both in logistics and psychology. Therefore, I thought it would be fun to take a page out of IBM’s Watson playbook. IBM recently used “cognitive ...

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The costs of fertility preservation in cancer treatment I have fertility on my mind -- and it’s definitely not personal. And it’s really fertility preservation that has me thinking. I recently completed the manuscript of my 10th book -- a text for oncology care providers about the provision of psychosocial care to young adults with cancer . Writing the book was at times frustrating due to the paucity of research and ...

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I recently began a rotation at the hospital as one of the night float interns. As part of this responsibility, I manage the care for approximately fifty patients each night. Day after day, I perform the same routine in preparation for the night ahead: Grab my stethoscope and pager, claim one of the code pagers, pick up a time sheet to fill in the nightly team to-do’s and mentally prepare ...

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Top stories in health and medicine, November 24, 2014From MedPage Today:

  1. Does an IUD and Family History Boost RA Risk? Current use of an intrauterine device (IUD) was associated with an important biomarker of future rheumatoid arthritis risk among women with a family history of the disease.
  2. Pricey Generics Draw Senate Scrutiny. Robert Frankil, RPh, was dismayed when a customer ...

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