As a kid I had allergies and asthma.Because of this, for several years, my mother wrote a note excusing me from the 600 meter run in elementary school. My father took me to weekly allergy shots. At times I had eczema on my forearms and eyes, and according to my allergist, whose notes I later read, I had moderate allergic shiners (also known as dark circles under my eyes). My ...
2010
All Stories
Will medical school as we know it exist in a decade?
A century ago in the U.S., the American Medical Association (AMA) created the Council of Medical Education (CME) to evaluate the standard of medical education.In 1908, the committee recruited the Carnegie Foundation to survey the 155 medical schools operating at the time in order to see whether they met the standard of medical education set by the CME. The Carnegie Foundation in turn asked Abraham Flexner, a professional educator, to ...
Lifelong lessons from the Code of Medical Ethics
The American Medical Association was founded in 1846 for a number of reasons, including to create a Code of Medical Ethics.It did, and the Code is alive in 2010.I believe that all medical students should memorize these bedrock principles -- a little like many did the Boy Scout Oath and Law.And, I believe that all physicians should follow them scrupulously, lifelong.The Principles are:I. A physician shall be dedicated to providing ...
Heart attack symptoms in women, in their own words
Having a heart attack felt nothing like I thought it would feel. For one thing, unlike sudden cardiac arrrest, in which the heart stops beating and you stop breathing, during my heart attack (myocardial infarction), my heart continued beating, and I was conscious throughout despite horrific symptoms – so how could I possibly be having a heart attack?Like most women I know, I thought very little about heart disease, even ...
Adding tiotropium (Spiriva) to an inhaled steroid a mistake?
There is a lot of press about a study recently published in the New England Journal of Medicine that shows that adding tiotropium (Spiriva) to an inhaled steroid might have benefit in asthmatic patients. This study is creating a lot of buzz due to recent concerns of ICS/LABA safety and might prompt doctors and patients to start switching (some already have before this study came out). However, this ...
A mandate for vaccines in California
The California pertussis epidemic is on track to be the biggest in the state since 1958. As of mid-June, there were 910 confirmed cases, some 600 more suspected cases and five deaths, all in infants younger than 3 months. There’s also this: California is one of a handful of states that does not require the tetanus-diphtheria and acellular pertussis booster for middle school entry.Why doesn’t California have a ...
Take responsibility for your own health
An excerpt from More Health Less Care: How to Take Charge of Your Medical Care and Write Your Own Personal Prescription for Lifelong Health.Bob Baker is a patient of Dr. Lisa Martin. Bob works as an engineer for a Fortune 500 company that holds major commercial and Department of Defense contracts. He’s 45 years old and happily married with two college-age children. Bob’s lifestyle is stressful. He travels ...
Hospital meals make it difficult to control blood sugars
My mom doesn’t take any diabetes medicine. She keeps her blood sugars normal through a combination of common sense and careful carbohydrate consumption.A few months ago, she had to be hospitalized for what she calls a “minor procedure.” The procedure went fine, but not the food. The first meal they brought her consisted of breaded fish (frozen), mashed potatoes (instant), corn (canned), a dinner roll (frozen), and tea (2 sugar ...
Should surgeons tell patients how much sleep they had?
In a recent New England Journal of Medicine, a perspective piece on what to do with fatigued surgeons is generating debate.The issue of work-hour restrictions has been a controversial issue when it comes to doctors in training, something that I wrote about earlier in the year in USA Today. But once doctors graduate and practice in the real world, there are no rules.As summarized in the WSJ's Health Blog, ...
Health care economics and the relationship between doctor and patient
I used to practice pediatrics. It has been several years since I decided to leave medicine, but people still ask me about it, and I find myself offering neat explanations between gulps of coffee. Of course, the full truth is much more complicated. The full truth has as much to do with our health care system and our culture as it does with me.My journey in pediatrics was not entirely ...
Your attention deficit disorder may be an anxiety disorder
Are you one of those people who simply cannot concentrate for long enough? Do you find that no sooner than you start doing something, that your attention is scattered all over the place? Do you find that you log onto your computer and within minutes are surfing every possible tangential site that you find?Your problem may not be a problem with your attention. In fact, it may be that the ...
How American physicians should be paid
How do you think American physicians should be paid?I think many of the current methods are insane. Case in point:In the 1980s, during a meeting of the board of trustees of the American Medical Association, I experienced sudden unexpected unilateral loss of hearing. You might say that was lucky. But I was scared and went right to my ENT's office.He looked in my ear and extracted a large wad of ...
Tips to find a good psychiatrist
Seems like a simple enough question: How do you find a psychiatrist?It's not that easy to answer. There are all sorts of psychiatrists who do all sorts of things (therapy, not therapy, specific forms of therapy like psychoanalysis or CBT), and then there's the overriding insurance question. Not to mention location, location, location.We've talked before about insurance, and if you haven't read Why Shrinks Don't Take Your Insurance, ...
Why an EMR doesn’t necessarily deliver better patient care
Regular readers of this blog know that the mere introduction of an electronic medical record doesn't necessarily guarantee better patient care.There are multiple reasons for that, including the fact that many systems are archaic in nature, counter-intuitive, and doctors are forced to learn multiple systems.Yesterday, the WSJ's Health Blog posted a study showing that hospitals with an EMR don't necessarily have better quality measures.Shocker.According Rand Corp.,
trying to ...
CT scans and x-rays draw patients into risk and overutilization
Many patients erroneously believe that x-rays and CAT scans have no risk.In their minds, they are non-invasive studies that can cause no harm. Since there are no incisions or anesthesia, they regard the experience as having the same risk as taking a family photograph. How wrong they are. In my mind the danger from non-invasive radiology studies may surpass the risk of hard core medical treatment. True, radiology tests won’t ...
How false positives can kill patients
I've written in the past that more medicine and tests do not necessarily reflect better care.There is no test that is 100% specific or sensitive. That means tests may be positive, when, in fact, there is no disease ("false positive"), or tests may be negative in the presence of disease ("false negative").It's the latter that often gets the most media attention, often trumpeted as missed diagnoses, but false positives ...
Are chaperones a hindrance to patient privacy?
Chaperones are increasingly recommended for routine use in Western medicine. There are semi-official recommendations in both the UK and USA. The AMA has long had this.The rationale for using chaperones is twofold. In theory their primary purpose is to protect, comfort and assist the patient. In reality though, the usual purpose is to protect the physician against claims of sexual assault or harassment.Preferably, chaperones should be real professionals, ideally ...
Reduce phone calls in your medical practice
A physician approached me at the end of a talk on optimizing practice efficiency and improving service to patients and said, "I dream of an office with no phones."Do you have days where the phones are ringing off the hook? Or the phone message forms in your in-box seem to be reproducing? Maybe it's been one of those days when you can never get your nurse's help because she's been ...
Responsibility, respect and relationships are important for patients
At the risk of dating myself, I recall a time when “The Three Rs” summed up American education. In case you aren’t familiar with this phrase, it stands for "Reading, ‘Riting, and ‘Rithmetic."I think it’s high time we develop “Three Rs” for patients. Right now, Patient World is ruled by “E” words such as “empowered” and “engaged,” with “empowered” the big one. I think “empowered” is turning into a label, ...
Patient complaints do not fit the primary care office visit
Primary care physicians often have to see patients with a litany of issues. Often within a span of a 15-minute office visit.This places the doctor in the middle of a tension -- spend more time with the patient to address all of the concerns, but risk the wrath of patients scheduled afterwards, who are then forced to wait.And, in some cases, it's simply impossible to adequately address every patient question ...
Kevin Pho, MD
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Why Priscilla Chan may become the country’s most influential doctor
Who has the potential to be the most influential physician of our generation? It's Priscilla Chan, who not only recently graduated from...
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Confused about prostate cancer screening? Make a shared decision
In a widely anticipated move, the USPSTF officially recommended against prostate cancer screening in healthy men. Case closed, right? Hardly. The prostate...
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When it comes to doctors and social media, hospitals fail miserably
When it comes to medicine and social media, much of the attention is negative. Doctors losing their hospital privileges because of Facebook....
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Warren Buffett’s prostate cancer choices aren’t right for every man
A version of this column was published on April 24, 2012 in USA Today. There has been a recent uptick of elderly men...
Physician
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Why test recalls should not be considered cheating
I was appalled recently by the coverage of radiology “test recalls” by CNN, amplified by Dr. Gary Becker of the American Board...
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Why physicians are susceptible to hardball tactics
I was invited to a medical staff leadership conference sponsored by our hospital. A company specializing in training physician leaders ran the...
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How we deliver bad news is critical to how families deal with grief
As a cardiac electrophysiologist, I have had to discuss bad news with patients and families more times than I would like during...
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His father’s suffering had already been too great
He looked dead. The paramedics brought him down the hall toward one of my critical care beds, and for a moment I...
Patient
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How death can be a beautiful experience
I was honored to be part of a beautiful experience in late January of 2011. It was the death of my mother-in-law...
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What meaningful encouragement can be given to someone who is dying?
Theirs is a lonely journey; to be moving towards the separation and end of all things known and loved. Being with a...
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Health care journalists have tendencies similar to those of doctors
As a patient who was asked to speak at the Association of Health Care Journalists 2012 conference, I felt a bit covert....
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Adaptation can be painful, but it can also be a gift
Nothing will force you to live life on your own terms faster than almost losing it. In 2008, I was on fire....
Policy
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What should America’s health care vision be?
America has this paradox of excellent biomedical science, innovative drug manufacturers and entrepreneurial device developers along with outstanding providers but at the...
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Hospitals around the world aim to remain relevant to patients
"It was the best of times, it was the worst of times ..." So begins a story called A Tale of Two...
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Repairing the tear in health care’s safety net with social media
The nation’s “safety net” hospitals are designed to ensure that uninsured, lower income and indigent populations receive adequate medical care – a...
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Look to technology to reduce health costs
Technology to lower costs rather than accelerate them. Smart phones to increase physician and other providers’ productivity. Fewer primary care physicians but...
Tech
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When patient care becomes secondary to filling out the medical record
The policeman was two cars in front of me. I meandered down the road cautiously adjusting my speed a few ticks above...
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Doctors, use Google to get more patients in less than 7 minutes
Every month, hundreds of thousands of people look for a doctor on Google. As an amazing practitioner, your site deserves to be...
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The user interface for EHRs should be uniform
The first thing I noticed when I walked into the physician’s office were the tall cabinets filled with manila folders, tabbed with...
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EMR liability needs to go further than just the physician
This example of a disaster waiting to happen, in the form of an error-promoting CPOE, is a poster example of why the...
Social Media
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We need to see the potential harm of social media
Prior to 1794, farms across the world could only pick cotton as fast as humanly possible. In the late 18th century, Eli Whitney...
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Why social media may not be worth it for doctors
Social media in healthcare is all the rage these days. You can’t visit even one physician-oriented website without someone breathlessly advising you...
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Transparency defines social media success for doctors
Want to understand social media? Physicians wanting to learn about social media must learn transparency. We must learn transparency on a personal...
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How Twitter was used in a potential mass casualty scenario
It was my first ER shift in charge of the resuscitation area. Needless to say, my adrenaline and nerves were firing like...
