by Shawn VuongIncoming medical students, I know you're excited about medical school. I was in your same exact position about 2 years ago to the day. Every day I went to sleep and thought about how cool medical school was going to be, how much cool stuff I was going to learn, and how much my life was going to change.I asked myself many questions. Am I going ...
July 2010
All Stories
Obesity should not require specialists to manage
Medical school trains us to deal with a wide range of medical problems.No matter what our current practice or specialty, at some point during medical school we will have had to study and demonstrate our knowledge and competency in dealing with common disorders like diabetes, hypertension, depression, chronic pain and countless other ailments. In addition, we will have spent hours poring over much rarer disorders, conditions that many of us ...
Certified stroke centers and ischemic stroke treatment realities
by John FauberTime is brain. Every minute wasted seeking treatment is measured in neuronal death, which is why stroke specialists were early supporters of certified stroke centers. Getting a stroke patient to the right center -- a center that could administer clot-busting therapy quickly, and safely -- was considered the surest way to "save brain."That was the concept behind the certified ...
The way we practice primary care doesn’t make sense
You've probably had the experience of going to see a primary care physician and wondering about the many aspects of that visit that just didn't make sense.Why is it so important for me to arrive on time when, in reality, I won't be called back until half an hour (or more) later? What's the point of waiting for another 20 minutes in a chilly examining room for the doctor ...
The art of medicine and whether computers can replace doctors
My medical school at the University of Utah developed a clever computer program in the late 80s that was meant to both educate medical students and assist in the treatment of patients.For several years the tech geeks at the school had collected an immense database of information from all the patient admissions at the hospital—presenting symptoms, exam findings, tests, and final diagnoses. They took all this data and crunched ...
Preventing postop infections need to be implemented as a package
by Kristina FioreMeasures designed to prevent postoperative infections work if measured as a package, but looked at individually they provide no improvement, researchers found.When analyzing the six components of the Surgical Care Improvement Project (SCIP) on an all-or-nothing basis, there was a 15% reduced risk of infection, according to Jonah J. Stulberg, MD, PhD, MPH, of Case Medical Center in Cleveland, and colleagues.But the three core infection prevention measures taken ...
Sometimes more expensive care is better treatment
by James Gaulte, MDA recent publication in the publication Health Affairs has evoked comments and some concern from advocates of comparative effectiveness research and admirers of the Dartmouth Atlas.A survey of "consumers" found a level of skepticism that is alarming to those folks who are in the business of claiming to know what aspects of medical care should be offered.The idea that more care and more costly care gives inferior ...
Patient safety requires doctors report incompetent physicians
Recently, JAMA published a study concluding that doctors are hesitant to report incompetent physicians or those who were impaired.According to the article,
more than a third of docs don't think they're responsible for reporting those who aren't fit to practice, according to the results just published in JAMA. And only 69 percent of the docs who knew about an impaired or incompetent colleague reported them.To those who advocate that the medical ...
How seniors will accept cuts in Medicare from health reform
Everybody knows politics is a balancing act. One must balance promises against reality.For example, how does government keep Medicare intact for seniors while cutting $500 billion out of Medicare when government has no track record of cutting entitlement spending?And how one do it without losing the vote of seniors, who hold the key to the balance of power?The Obama administration and the Democrats hope to keep power by winning the ...
Are antidepressant drugs better than placebo for depression?
by James Baker, MDClinical psychologist Irving Kirsch is selling a new book in which he argues that anti-depressants aren't much better than placebo. He bases his claim on sophisticated statistical studies he has done that combine the results of antidepressant research trials from over the years.The scary part is that he had to use the freedom of information act to get a hold of some of the studies.His ...
What doctors think about drug and device marketing
by Charles BankheadIncreased emphasis on conflicts of interest has yet to sway physicians' generally positive attitudes toward drug and device manufacturers' marketing activities, a survey of almost 600 attending physicians and trainees showed.More than 70% of respondents saw nothing inappropriate about attending sponsored lunches, and 25% had no problems with accepting large gifts from industry representatives, according to an article in the June issue of Archives of Surgery.Surgeons, trainees, and ...
Defensive medicine forces residents to use test oriented care
A recent article in US News and World Report, Most U.S. Physicians Practicing Defensive Medicine, claims that physicians are ordering more tests and escalating the work-up of sick patients, all in the name of defensive medicine.Is it true? Absolutely.It is especially true in the emergency department, where we have one shot to get things right, or else. Ironically, by practicing defensive medicine we are not ...
The Apple Genius Bar could learn some bedside manner
by Rahul Parikh, MDMy life is wired by Steve Jobs and Apple. When I was a kid, my first computer was an Apple IIc, followed by Macintosh Plus for college. In residency, I used a Newton for a while to take notes on patients. I have a MacBook, an iPod (I’ve actually had 3 and my wife has had 2), an iPhone, iPhone 3gs; an iPhone ...
Chronic illness needs to be managed at home, not at the hospital
“You know, what Mr. HD really needs is for his mom or somebody to chain herself to him…” [the ICU team laughs] …"But seriously, he needs to be watched over, he needs to be talked to. He needs someone to give him his medications, someone to take him to his appointments, someone to take care of him. With that somebody he can live for years to come. Without that somebody ...
Parents who want genetic testing for their children
by Kristina FioreMore than a third of parents who have been tested for genetic breast cancer risk say they'd support similar testing for their children -- despite scant evidence of any benefit for young people, researchers have found.In interviews with 246 parents who were tested for the BRCA1/2 mutation, 37% supported testing minors, compared with 55% who opposed screening, according to Angela R. Bradbury, MD, of Fox Chase Cancer Center ...
Best Doc in a magazine, the inside story
You've seen it, somewhere.Every city in America, and likely the world, has a local magazine. And once a year, that magazine publishes a "Best Docs" issue, usually listing 10 doctors from each specialty who they consider the best of the best.Dr. Grumpy, for the record, is not biased against this. I've been named a "Best Doc" in my field several times.And I know most of the other neurologists on the ...
Paying cash to doctors affects the treatment plan
If we really want to find out how to damn near perfectly manage any medical problem as efficiently and cost-effectively as possible, we should be studying how doctors manage the medical problems of the cash-paying doctors they see in their own practice.Read part one here.My visit with Dr. Grubman was fairly simple. We discussed allergy shots and how they could possibly help significantly with my dust allergy. Since ...
Hearing loss from iPods and other MP3 players
by Crystal PhendiPod users beware. Listening to an MP3 player for even an hour can induce short-term hearing loss, researchers affirmed.Compared with controls, hearing deterioration among MP3 users was 3.97 to 4.40 times more likely when listening to pop/rock music through earbud headphones at different output levels, found Hannah Keppler, MS, of Ghent University in Ghent, Belgium, and colleagues.Listening to an iPod with over-the-ear headphones also boosted the odds of ...
Good medicine sometimes makes patients unhappy
As physicians, we all strive to practice good medicine. Good medicine means evidence based medicine in the patient’s best interests. In the ideal world this will make patients happy and satisfied. If you are getting the best treatment for your condition you should be happy, right?In the real world, though, keeping patients or their families’ happy and practicing good medicine might not be possible at the same time. This is ...
Costs of communication on email, Facebook and Twitter
Email, Twitter, Facebook, MySpace, YouTube, Delicious, Digg, LinkedIn, blogs (of course), and scores of others—all part of the new and wonderful ways we can now connect with one another electronically, each with its own culture and unique set of rules.In one sense, the planet has never been more interconnected. And yet, this interconnectedness, while wonderful, hasn’t come without cost.IsolationMuch has been written about the dangers of Internet addiction. From pornography ...
Kevin Pho, MD
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How patient satisfaction can kill
Patient satisfaction is all the rage. Medicare is beginning to tie patient satisfaction scores with hospital reimbursement, and doctors across the country...
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How I approach ovarian cancer screening with patients
Ovarian cancer screening clearly touches a nerve. No one doubts that ovarian cancer is a devastating diagnosis, often found when the disease...
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Why more primary care doctors are referring patients to specialists
According to a recent study from the Archives of Internal Medicine, primary care physicians are referring more patients to specialists than ever...
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Should Google censor anti-vaccine claims?
One of the reasons there is such a movement against vaccines is the democratization of information, perpetuated by search engines like Google....
Physician
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The analogy between baseball hierarchy and medical systems
From age six through high school, I played baseball. Playing baseball ended, rather abruptly it seemed, when I went to college, but...
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Saving patients from Internet health information
Lately, I get the feeling that I’m doing something wrong. I’m supposed to form a partnership with my patients. My patients are...
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Understanding what patient centered care really means
There was nothing the professor despised more then the syrup that oozed out of his partner's lips when dealing with patients. He...
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A letter of thanks to my organ donor
I have tried to write a letter of thanks but don't know what to say or even how to begin. I don't...
Patient
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Why patient engagement is reciprocal
It is said that "turn around is fair play." So if providers (physicians, hospitals and other health care professionals) expect patients to...
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Question the price of drugs and medical procedures
Hypertension was the trigger that forced medical cost awareness to the forefront. My doctor decided that with my rise in blood pressure...
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In love there is a life giving force
Here is a toast to the miracle of love. Not to the romantic, chocolate, dance club nightlife type of love. Not warm...
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How to get ready for death
No one wants to die. Even people who want to go to heaven don't want to die to get there. And yet...
Policy
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America has a medical care system not a health care system
As Americans we believe we have the best healthcare system in the world. But think again, it’s really not the truth. We...
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Reading between the lines of breast cancer treatment studies
Between the Susan G. Komen-Planned Parenthood debate and the study on treatments released by the Journal of the American Medical Association recently,...
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Why are labor and deliveries closing?
Labor and deliveries are slowly closing across the United States: California, Pennsylvania, and Ohio. In regional areas where there have been no...
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America has a health care paradox
We have a real paradox in American healthcare. On the one hand we have exceptionally well educated and well trained providers who...
Tech
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Why physicians don’t want patients to have their cardiac device data
There is a groundswell of discussion concerning patients demanding to have direct access to data derived from their implantable defibrillators and pacemakers....
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Impersonal communication on the Internet fuels cyberbullying
In the old days, bullying used to consist of name calling or physical aggression from someone in a position of power over...
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Health IT and doctors: A framework for successful partnerships
We are on the front lines of the healthcare revolution along side our patients and our colleagues in technology. We have firsthand...
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Break out of the prison of the American health care delivery system
Speaker after speaker at the recent Care Innovations Summit in Washington, DC concluded that increasing the quality and decreasing the per-capita cost...
Social Media
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Why doctors should embrace Google+
Lots of pressure out there for you to be on Facebook and Twitter, right? The ultimate question, though, is how are you...
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Using Twitter to deliver health improvement messages
I have decided to spam for public health. Phone calls, text messaging, and even apps have been shown to help improve health...
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Addressing comments on your medical practice’s Facebook page
Does your medical practice allow anybody to post links and comments on your Facebook page? The short answer is yes. We do....
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The Internet is where patients go for pre-visit consultations
As a physician, technology cannot replace you, but it can make you more efficient and effective. This was the message from Richard...
