February 2010

All Stories

A nurse practitioner is valuable in hospice and palliative care

in Patient | 11 responses

by Patrice VillarsRecently, a physician colleague expressed her concern about signing routine hospice admission orders for her elderly patient with end stage heart failure. The routine ‘as needed’ (PRN) orders included phenobarbital, pentobarbital, haloperidol, lorazepam, and morphine. “The hospice nurses know more about this than I do, don’t they?” she said.Yesterday, a longtime palliative care nurse told me she didn’t want to put her mother with end stage heart ...

A beautiful Valentine’s Day patient story

by | in Patient | 3 responses

“I’ll be back in a little while, Hon’. Will you be okay without me?” the frail old woman asked of her husband. She was standing at the front door and breathing heavily.“I’ll be fine,” her husband replied from his wheelchair. His voice sounded as weak as his body looked – emaciated, scaly, and full of cancer. “I’m sorry I can’t come with you.”The woman opened the front door. A gust ...

How patient comments will affect your physician practice

in Physician | 14 responses

Originally published in HCPLive.comby Owen Dahl and Altamash Rahman“Her MA is very rude, uncompassionate. Dr. ABCD doesn’t return phone calls. They’re not helpful and not good with following up with the care plan for patients. We’re new seeing this doctor, but will never go back. I would not recommend this practice at all!!!!!!”How patient comments will affect your physician practiceHow would you handle a comment like this ...

The Haiti earthquake and its broken health infrastructure

by | in Physician | no responses

Dr. Barth Green co-founded Project Medishare, which has worked in Haiti for two decades. He led the first team of U.S. physicians to Port-au-Prince after the earthquake and, together with the University of Miami’s Global Institute, spearheaded the development of a 240-bed tent hospital that is now the country’s largest functioning urgent care hospital. His group is working with the U.S. government to establish Haiti’s first rehabilitation hospital. Green ...

Why cancer screening is not a black or white decision

by | in Conditions | 13 responses

Last month I saw a 65 year-old woman with a mass in her kidney in clinic for follow up. She had recently transferred her medical care to our clinic after her insurance changed.She came with a few medical problems including high blood pressure, tobacco use and arthritis — diseases which are the bread and butter of primary care medicine — but she also came with a history of a mass ...

How patient satisfaction scores can affect physicians

by | in Physician | 5 responses

I am very blessed. The hospital where I practice, while concerned with patient satisfaction, does not worship at its altar.That is, so far our administrators seem to understand that people will occasionally be angry or unsatisfied, and that such dissatisfaction is within the realm of real life. We still have people storm out of the emergency department, prattling on about lawyers and lawsuits, promising to go to another hospital in ...

Condoms don’t work all the time, and here’s why

in Patient | no responses

Originally published in MedPage Todayby Chris Emery, MedPage Today Contributing WriterCondoms dont work all the time, and heres why Condoms that don't fit properly are more likely to break, slip off, and decrease the pleasure of both partners during sex, which may discourage their use and undermine their public health benefits, a survey found.Ill-fitting condoms were reported by 44.7% of the men polled. They were more likely than ...

How hospitals can lose money by relying on hospitalists

in Physician | 12 responses

Are hospitals victims of hospitalists' success?Interesting observation from cardiologist Dr. Wes, writing in Better Health. He notes that hospitalist services are so busy that they are limited in the number of patients they see. That's similar to the caps many medicine programs have on their residents.Who, then, takes care of the patient?It won't be the primary care doctor, who has divorced himself from inpatient care (besides, as ...

Can doctors learn medicine from physician lounges?

in Physician | 3 responses

by Vineet Arora MDI just finished rotating at a community hospital where one of the most interesting things I’ve enjoyed is stopping by the Doctor’s Lounge. I can always count on a getting coffee there and hearing some good conversation – doctors asking for input on interesting cases, laughing, sharing stories, both personal and professional, and catching up on each other’s busy lives. In fact, I ran into an old ...

Value doctors as listeners to prevent primary care burn out

by | in Physician | 2 responses

A recent editorial in the Boston Globe addressed the dearth of primary care physicians. The piece concluded: “Federal funding for new residency slots should follow reforms that address the underlying reasons - principally money - that lead doctors to choose to specialize.”Money is certainly important. But there is another obstacle to attracting primary care doctors that is more subtle, though perhaps equally important. Consider the following story.Recently I had ...

Never events in hospitals depend on patient risk

in Policy | 9 responses

Originally published in MedPage Todayby John Gever, MedPage Today Senior EditorOccurrence of some so-called "never events" in hospitals may depend partly on unmodifiable risk factors such as patient characteristics, undermining the rationale for denying Medicare payment for their treatment, researchers said.Never events in hospitals depend on patient risk Analysis of some 890,000 surgeries performed in 1,368 hospitals showed that patient age and pre-existing conditions such as weight ...

Conscience prevents doctors from dropping Medicare

in Policy | 22 responses

There's lots of talk about primary care doctors threatening to refuse Medicare and Medicaid patients. As some commenters point out, "If you don't like the system, just drop out."Why, then, do so many doctors continue to see patients on Medicare and Medicaid?Two words. Duty and conscience.Primary care doctor Rob Lamberts has an excellent post on this, entitled, Good conscience is bad business. He notes how Medicare (and ...

How doctors can improve patient interactions

in Patient | 13 responses

by Lockup DocPhysicians learn a lot about many different topics, both in medical training and in practice. However, there are some life lessons that we never learn as well as when we become patients ourselves.When I was 13 or 14 years old, I regularly interacted with 2 different physicians with disparate interpersonal styles. Little did I know then that these seemingly meaningless encounters would indelibly shape my own beliefs about ...

Atul Gawande’s The Checklist Manifesto reviewed

by | in Physician | 7 responses

Every now and then, I read and enjoy a book, but only later fully appreciate it as its lessons and insights slowly become apparent. Judging by the number of times I’ve said, “That reminds me of Gawande’s observations about ___” over the past month, The Checklist Manifesto is one such book.In this short, deceptively simple volume, Atul (who I count as both friend and inspiration) discusses the history ...

Why being President of the United States is a health hazard

in Patient | no responses

Originally published in MedPage Todayby Liz O'BrienExactly whom are we honoring on Presidents (or is it President's) Day?A. George Washington B. George Washington and Abraham Lincoln C. All presidentsWhy being President of the United States is a health hazard The answer is more complicated than you'd ever expect. Probably A is most correct, but if it were up to me, I'd pick C.Certainly every one of these 43 men has earned the ...

How pediatricians should handle families who refuse vaccines

in Conditions | 6 responses

How pediatricians deal with families who refuse to vaccinate their kids is a contentious issue.There are some offices, for instance, that flat out refuse to treat kids who parents say "no" to vaccines. But is taking such a hard line wise?A recent piece from the Wall Street Journal looks at the issue. According to the former chairman of the American Academy of Pediatrics' bio-ethics committee, "the vast ...

Is Google Android or the iPhone the future of mobile smartphones?

in Tech | 6 responses

by Felasfa Wodajo, MDOver the last few months, a great deal of time has been expended on the “hot competition” between Apple and Google in relation to smart phones.Much of this interest probably had to do with a partially imagined story of a once close friendship between Apple and Google, founded on their mutual enmity of Microsoft, now fractured on the rocks of competition and greed. While the truth probably ...

Some hospitals tube feed patients with advanced dementia

in Physician | one response

Originally published in MedPage Todayby John Gever, MedPage Today Senior EditorTube-feeding patients with advanced dementia -- a practice whose effectiveness has been questioned by two widely cited literature reviews -- is most common in larger hospitals and those run for profit, researchers said.Some hospitals tube feed patients with advanced dementia The odds of a feeding-tube insertion in a hospitalized patient with advanced dementia were about 50% greater ...

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