One recent news item in the world of pharma is the less-than-enthusiastic response of an FDA panel to Boehringer-Ingelheim’s experimental “sexual desire for women” pill, flibanserin.I believe the quest for a “female Viagra” (an inaccurate parallel, by the way) is fundamentally misguided. Here’s why.There’s a big difference between sexual function and sexual desire. Viagra does something that a pill can, in fact, do – impacts a physiological process. Erectile dysfunction is, ...
August 2010
All Stories
Missed diagnosis in the ER, and the need to look
by 911Doc, MDWNL is doctor shorthand for "within normal limits". Saves a bunch of time when checking the boxes on the physical exam. The temptation is to write "WNL" whenever possible, and, therefore, it often ends up meaning "We Never Looked".A homeless gentleman presented to my ER a few months ago. He had been hit in the head with a beer bottle. He had a suturable laceration to his scalp ...
How to prevent and treat mosquito bites in children
Summer has already begun, and LeeAnn has already had enough of mosquitoes. She wants to know, “Does taking Vitamin B1 really help keep mosquitoes from biting? How much is safe for children?”I remember a trip to the Florida Everglades as a child with school—surrounded by mosquitoes, alligators, and miles of swamp, our teachers told us that mosquitoes are a vital part of the food chain, and ...
Fighting AIDS compelled this student to become a doctor
by Timothy DempseyOne thing changes everything.While this may be a poor paraphrase of the cheesy slogan ESPN used for the recently finished World Cup, in my life this statement has revealed itself as a universal truth. For me, one book changed everything. It would lead me into research labs, on a trip to disease-riddled Gaborone, Botswana, and pique my interest into an epidemic whose global ...
New osteoporosis screening guidelines from the USPSTF
by Todd NealePostmenopausal women of any age with a 10-year fracture risk equal to or greater than that of a 65-year-old woman and no other osteoporosis risk factors should be screened for the disease, according to draft guidelines from the U.S. Preventive Services Task Force (USPSTF).The 2002 USPSTF guidelines recommended routine screening only for women ages 65 and older, as well as women ages 60 to 64 with an increased ...
Colonoscopy and other screening options for colon cancer
It’s exceedingly uncommon for a healthy middle-aged man to walk into his doctor’s office and demand a colonoscopy. But even though he lacked a family history, Stanley Thornton, an African-American engineer who was then in his mid-40’s, wouldn’t take no for an answer.“I was concerned that African-Americans do get colorectal cancer earlier, and I said, ‘hey, let me lead by example,’” he said recently. “We argued about it for a ...
Can HSAs restore the doctor patient relationship?
by Charles W. Patterson, MDIs it possible that some do not understand that to promote Healthcare Savings Accounts is the most effective thing we could do to preserve traditional medical practice? In a true doctor-patient relationship only doctors and patients discuss the options agree to the treatments and handle the money. No third party touches any of these.If everyone had a HSA it would be just like the good old ...
Meaningful use letter for the hospital board and senior leaders
In January, I wrote a Do it Yourself presentation on meaningful use for folks to use with their Board and Senior leaders.Now that its August, there is a different kind of Do it Yourself document - a letter to your Board and Senior leaders outlining your plan and timeframe for certification, measurement of meaningful use, and collection of your stimulus funds. We cannot be completely certain about every detail, ...
Doctors need to confront end of life care
"Avoiding those twin traps of overtreatment and therapeutic nihilism"Recognize this phrase? It's from our Hippocratic Oath, the one I took, standing beside my newly assigned cadaver, in my second year of medical school."What Broke My Father's Heart", recently in the New York Times Magazine, is an exquisitely painful story of medicine and our Oath gone awry in the United States. I urge you to read it.End-of-life care is a ...
The Empowered Patient: Finding Dr. Right
An except from The Empowered Patient.by Elizabeth Cohen, MPHDid you ever see the Seinfeld episode where Elaine gets into trouble at the doctor’s office? While she’s waiting in the examining room, she sneaks a peek at her chart and notices that it says she’s “difficult.” When the doctor comes in, he whips the chart out of her hands.DOCTOR: You shouldn’t be reading that.ELAINE: ...
What cyberbullies have in common with their victims
by John GeverSo-called cyberbullies share many of the psychosocial features as their victims -- and in fact many bullies were also victims themselves, researchers from Finland said.A population-based cross-sectional study surveyed more than 2,000 seventh- and ninth-graders in two Finnish communities and found that cyberbullies had higher than average rates of self-perceived difficulties in life, headache, feeling unsafe at school, and perceiving teachers as uncaring, among other problems, reported Andre ...
Today’s new physicians are unable to improve patient safety
It has been 10 years since the landmark Institute of Medicine report "To Err is Human" uncovered disturbing deficiencies in the quality of our nation's medical care.Progress in correcting these deficiencies remains frustratingly slow, and it has become clear that achieving the quality and safety improvements we seek will require us to examine our approach to medical education.Although today's newly minted physicians are well prepared in the science of medicine ...
A primary care direct pay model that works
by Brian Forrest, MDWhen I started a cash-only, direct-pay practice nine years ago, my reasons were simple: spend more time with my patients, provide better care, and live a better life.I was uncomfortable signing insurance contracts that limited my ability to care for my patients. I was unwilling to sign an employment contract that required me to see a patient every 7.5 minutes, or lose ...
Laugh, Sing, and Eat Like a Pig: Facing death, with hope
An excerpt from Laugh, Sing, and Eat Like a Pig.
Last month Dave deBronkart, known on the internet as “e-Patient Dave,” released his first book, Laugh, Sing, and Eat Like a Pig: How an Empowered Patient Beat Stage IV Cancer (and what healthcare can learn from it) (www.LaughSingBook.com). It’s his personal cancer story – excerpts from the journal he ...
Male hormone treatment and testosterone replacement concerns
One of my medical school professors was an internationally renowned subspecialist, whose ward occupied the entire top floor of the medical tower at Academy Hospital in Uppsala.He had cadres of residents working for him, and for two glorious months I rotated through his ward as part of my internal medicine training in medical school.One thing that stands out in my memory, to this day, from those two months is how ...
Sharing medical records with patients can save lives
Regina Holliday’s husband, Fred, age 39, died of cancer in June 2009 leaving his wife, and his two young, beautiful children behind. During their journey through the healthcare system to try to get Fred the help he needed, too many hurdles were put in their way. Their story makes you want to scream.Among the horrors of their journey was the fact that Fred was transferred ...
Video games are linked with attention problems in children
by Michael SmithIt's not just TV -- video games are also associated with an increased risk of attention problems in children, researchers said.A large study found that children who spent more than three hours in front of a computer or television screen -- whether playing video games or watching TV -- were significantly more likely to have attention problems, according to Edward Swing, MS, of Iowa State University in Ames, ...
Reducing hospital re-admissions and bouncebacks isn’t easy
In their most recent piece at Slate, emergency physicians Zachary F. Meisel and Jesse M. Pines tackle the issue of bouncebacks. That is, the re-admission of recently discharged hospitalized patients.They bring up good some good points, and point out that, until recently, hospitals really didn't have any incentive to reduce bouncebacks:
... hospitals have never had a compelling reason to try to prevent bouncebacks. Hospitals are typically paid a flat sum ...
10 EMR don’ts when choosing electronic medical record
So, you've decided to move forward and get an EMR for your practice, but studies and reports of EMR implementation failures are adding to your anxiety levels.You've probably read scores of rules on how to go about the task -- some of them in this column. But today I want to share with you some important things you shouldn't do.Medical groups of all sizes and specialties across the country make ...
Facebook and physician professionalism
by Walter van den Broek, MD, PhDDo Facebook and other social networking services damage the profession of physicians or the public trust in this profession?So far, no systematic research into this topic has been published. However several cases were presented in the media resulting in disciplinary measures. On social networking sites patients may learn information about their doctors that compromises the professional relationship. Threats to ...
Kevin Pho, MD
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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....
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Radiologists who cheat on their board exams: Who’s to blame?
In a widely circulated CNN article, many radiologists have been found to cheat on their board exams: "Doctors around the country taking an...
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Doctors: Don’t be ashamed about going bankrupt
Are doctors really going broke? According to this piece from CNN Money, some are: "Doctors list shrinking insurance reimbursements, changing regulations, rising...
Physician
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Patients will understand an honest mistake if the doctor tells the truth
It was 1976 and I was a junior resident in urology at Baylor College of Medicine in Houston, Texas. I was assigned...
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Diagnosing an illness is an art
Diagnosis is the foundation on which all care and treatments rest. If the diagnosis is wrong, most probably so is the treatment. ...
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Physicians have a natural role as advocates
As physicians, we are often called upon to be advocates for our patients. Sometimes they have no other person to turn to....
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Our society expends huge sums on futile care
Mike was a runner, outdoors-man, and fitness nut. This was not so much as for health reasons as for "feeling good", but...
Patient
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How will the Baby Boomers age and die?
I love listening to life stories. As a hospice chaplain, I loved sitting with our patients and their loved ones engaging in...
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Patient engagement is the holy grail of health care
For health care professionals, patient engagement is the holy grail of health care. It is the key to patient adherence – a...
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Why do doctors delay hospice referrals?
This is a response to Deb Discenza's article requesting a one page informational sheet informing a patient about hospice or palliative care. This would...
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How touch can calm patients
So, Megen at Not Nurse Ratched wrote post recently about therapeutic presence. The following passage really caught my attention: "Question is: are...
Policy
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A lack of incentive for medical schools to train primary care doctors
A social media movement is happening before our eyes with action starting to take shape. The #occupyhealthcare movement has begun within to...
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What should be the stated aim of health care in America?
The triple aim of health care, as defined by the Center for Medicare and Medicaid Services (CMS) is: improving the experience of care, bettering...
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How Moneyball applies to healthcare
The storyline is familiar. An organization is challenged to achieve better results without spending more money. An executive is committed to obtaining...
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The problem of insurance gaps in cancer patients
Why are cancer organizations waiting until it starts to rain before they suggest buying an umbrella? “Join my Medicare Advantage plan and...
Tech
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Repetition is the curse of the doctor-patient engagement
How many times as a doctor do you ask the same questions over and over again as part of the routine process...
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Why the prognosis of patients is difficult
Many clinical decisions in older persons are dependent on life expectancy. For example, as life expectancy declines, cancer screening is likely to...
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Innovative technologies can markedly enhance safety
“To Err Is Human” is the title of the now famous book from the Institute of Medicine on patient safety published about...
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Google knows more about certain diseases than physicians ever will
Professor Gunter Dueck, is a calm and eloquent german mathematician who’s also the CTO of IBM Germany. He studied mathematics and philosophy...
Social Media
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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...
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5 ways doctors can benefit from professional connections
Looking ahead to the next several months, I’ve found myself frequently wondering how many physicians will make this their year to take...
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Twitter Is my third office location
The physician’s decision to first dive into social media can be stress-inducing. Issues of time management, maintaining professionalism, and determining a return...
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The impact of social media on a physician assistant
The impact of social media on medicine could arguably be compared to the impact of the industrial revolution on the human condition....
