A single mom juggling two jobs and four kids may be right in thinking her life is complicated - but it is certainly not complex - at least not in the scientific sense of the word.In medicine we also differentiate between procedures that are complicated (difficult, requiring skill) and complex (no clear solutions, unknown and incalculable risks, unpredictable outcome).The best description of complexity was the “simplified” one I found in ...
August 2010
All Stories
Contract pregnancy ethics and moral issues
An excerpt from Why Some Things Should Not Be for Sale: The Moral Limits of Markets.by Debra Satz
Sometimes what critics of pregnancy contracts have in mind is not the effect of such contracts on the relationship between reproductive labor and a woman’s sense of self, but their effect on her views (and ours) of the mother-fetus and mother-child bond.
On this view, ...
Treating vitamin D deficiency requires caution
Vitamin D seems to be all the rage in medicine these days. A family physician colleague commented to me recently that the laboratory test for vitamin D deficiency is becoming the most frequently ordered test in his practice.This clinical bandwagon is likely a response to data from multiple recent studies that found low vitamin D levels in the majority of children and adults of all ages. While vitamin D has ...
Statins for heart disease and stroke, and debunking statin myths
There is no class of medications in the history of the world that has been better studied that statins.This class of drugs is more properly termed HMG CoA reductase (3-hydroxy-3-methyl-glutaryl co-enzyme A reductase) inhibitors, but with a name like that a terser nickname is almost mandatory (the name statin comes from the suffix of the members of this class: lovastatin, pravastatin, etc.).Simply ...
For women with endometriosis, motherhood is elusive
by Lone HummelshojEarlier this year, we finished a month dedicated to women and mothers. In the U.S., we celebrated "National Women's Health Week" and before it Mother's Day. One study suggested Americans would spend a total of $14.6 billion in May alone to honor our mothers. And we should honor our mothers!However, for millions of women with endometriosis, motherhood is elusive. In fact, an estimated ...
Assumptions in medicine can inhibit care
Assumptions are ubiquitous. Neither patients nor physicians are exempt. Sometimes they are justified, other times entirely misguided.Webster’s defines "assume" as "to take as granted or true." The cliché’s have probably always existed: Doctors are greedy and paid too much, and are uncaring. Some patients believe doctors do care and that their doctor actually likes them. That’s an assumption too. Some assumptions are newer. Patients assume doctors will substitute their prescription ...
How drug companies sell psychiatrists on their drugs
An excerpt from Unhinged: The trouble with psychiatry- a doctor’s revelations about a profession in crisis. Copyright © 2010 Daniel Carlat. Excerpted with permission by Free Press, a Division of Simon & Schuster, Inc.In 1993, the FDA approved Neurontin for the treatment of epilepsy. This should have been a cause for celebration at Warner-Lambert, the drug company that introduced it, but the celebration was muted. The FDA had ...
Checks and balances in health reform
What follows are ten thoughts on checks and balances in health reform.I am writing from Oak Ridge, Tennessee, where I am attending a high school class reunion. My son Spencer, a nationally known poet and a candidate for the Episcopal priesthood, is with me. He is checking on my past, and I am trying to provide balance so he can understand his father's legacy.There ...
Medicalization increases treatment and can harm patients
by James Baker, MD“Medicalization” is the process of turning problems into diagnoses and people into patients.According to Dr. Gilbert Welch, “It encourages more of us to be anxious about our health and undermines our confidence in our own bodies. It leads people to have too much treatment — and some of them are harmed by it.”“Alcohol dependence” and “attention deficit hyperactivity disorder (ADHD)” are among the issues that ...
Converting from paper chart to an EMR: Keep daily use in mind
Maybe you've been assuming that when it comes time to go live on your EMR, you'll simply scan each patient's old paper chart into the electronic system.Maybe you haven't given it much thought because you're focusing on the change in your work flow when you start to use the EMR to document patient encounters.Well, it's time to pay attention to the transfer, because the conversion of the paper chart can ...
The medical system Donald Berwick prefers in the United States
by James Gaulte, MDApart from some apparently radically contradictory expressed views on patient "centeredness" and patients being in control, the newly appointed head of CMS, Dr. Donald Berwick, has made it clear what sort of medical system he would have for the United States.What he wants is well explained in this commentary from National Review Online as is the authors' reasoning ...
Fix the July Effect for incoming interns and residents
According to an article published in the Journal of General Internal Medicine, counties with teaching medical hospitals experienced a 10% increase in fatal medication errors as compared to counties without teaching medical hospitals.First, what is the July Effect? It represents an entire transition in the hospital, during which medical students become interns, interns become senior residents, and second or third-year residents become chief residents. ...
Tamoxifen for breast cancer prevention is not routinely used
Cancer prevention is built around screening. In screening, the hope is to catch cancer at an earlier stage than it would be found otherwise and increase options for treatment and chances of cure. In some cases, screening prevents cancer — for example, when a precancerous polyp is removed from the colon during colonoscopy — but generally it is aimed at early detection.What if instead we could prevent cancer from developing ...
Burnout in doctors and stressed physicians hurt patients
The following op-ed was published on July 18th, 2010 in USA Today.A new patient recently said he was referred to me after his last doctor had left medicine. His old doctor always looked unhappy and burned out, he noted.Burnout affects more than half of doctors, according to researchers at the University of Rochester School of Medicine. Beyond mere job dissatisfaction, these doctors are emotionally exhausted to the point ...
Doctors are often preferred to market a drug to other physicians
An excerpt from White Coat, Black Hat.by Carl ElliottA few years ago a small group of first-year medical students at the University of Minnesota spoke to me about a lecture on erectile dysfunction that had just been given by a member of the urology department.The doctor’s PowerPoint slides had a large, watermarked logo in the corner. At one point during the lecture a ...
Implementing patient centered medical home pilot projects
by Robert Graham, MDAs the nation works to reinvigorate primary care, a lot is riding on the medical home.Some see it as an answer to a fragmented health care system that is not responsive to patients’ needs for coordinated, comprehensive care. Others have invested in it as a vehicle to improve both the quality of care and control costs. While we work to address ...
Bureaucrats determine the business model of a doctor’s practice
Dr. Marcus Conant, among the first AIDS specialists in San Francisco, who for decades had one of the world’s largest private practices for patients with AIDS and HIV, has left town and moved to Manhattan.He has been a physician for nearly 50 years, but like many doctors, in the past decade he has become increasingly frustrated with insurance challenges that made running a private practice unnecessarily complicated and a financial ...
Applying the minimally invasive concept to patient management
Every time you subject the patient to an invasive procedure you take the risk of causing complication. I have done hundreds if not thousands of procedures which makes me even more aware of the risk I take every time I stick a needle or cut into the patient. We can do everything possible to enhance the safety, yet we cannot completely eradicate the risk of adverse events.With the recent progress ...
Positive reinforcement can motivate preventive behaviors
Eating right, exercising, avoiding the sun or using sunscreen, moderating alcohol consumption, abstaining from tobacco use, getting mammograms, Pap smears, colonoscopies—almost every measure we’re asked to take to safeguard our future health is difficult. It’s a strange paradox that we have to work in some way, to expend energy, and experience discomfort of some kind in order to gain benefit in life.Wouldn’t it be nice if the most pleasurable things ...
Why OpenNotes and access to the medical chart is important
Have you ever read what your physicians and nurses have written in your medical chart? If not, would you want to?
The OpenNotes project is a recently launched observational research study that involves 100 primary care doctors and about 25,000 patients. Lead author Dr. Tom Delbacoa, a primary care physician at the Beth Israel Deaconess Medical Center, poses the research question succinctly: “After a year, will the patients and doctors still want to continue sharing notes?”
In the study, ... 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...
