People often seem to think that members of the medical world are excessively preoccupied with, defined according to, and ruled by a status-oriented system.That may have been an accurate perception a generation ago, but I've seen enough surgeons sweeping O.R. floors, attending physicians socializing with interns, and doctors having deep conversations with custodians to believe that "medical people" have matured a little past the old caste systems that governed the ...
August 2010
All Stories
Medical blog posts of the week, ending August 6, 2010
Here are the top posts from this past week, based on the number of times they were viewed.1. Non-clinical physician job starting salaries2. Doctors hiring scribes because of electronic medical records3. Pay specialists less to save primary care4. Notes in the chart are helping patients less5. Create a family practice mystique in medical school
Academic medical centers need better conflict of interest policies
by John GeverAcademic medical centers need comprehensive policies to manage their physicians' relationships with industry and other commercial interests, according to the Association of American Medical Colleges (AAMC).Disclosure of such relationships -- both to patients and to their institutions -- should be more detailed than is currently the case at many medical schools, an AAMC task force recommended in a new report.In particular, significant potential conflicts should be reported annually ...
Healthcare costs need to be discussed with patients in the exam room
Why don't patients and their doctors talk about healthcare costs?Choose the best answer:A. The doctor doesn't bring it up. B. Patients are too embarassed to say cost is a concern. C. Patients assume docs can't do anything to address the cost. D. Doctors don't have sufficient knowledge to discuss costs. E. All of the aboveCorrect answer: EDoctors don't bring up the cost of prescriptions or testing with their patients.In a study from the Archives ...
Is migraine pain comparable to torture?
by Diana E. LeeLast year, People published an interview with Cindy McCain, wife of U.S. Senator John McCain of Arizona.She revealed she has dealt with excruciating migraine attacks for about 15 years, including during her husband's presidential campaign. Though she has never discussed them publicly before, she has chosen to talk about her situation now to help bring awareness to this disabling condition and all the people going through what ...
Does surgery prevent knee osteoarthritis?
by John GeverSurgery for torn knee ligaments and meniscal cartilage may have improved patients' short-term outcomes, but it did not seem to prevent the eventual development of osteoarthritis, researchers said.A study that followed 326 patients for a mean of 10 years found that radiographic findings shortly after the initial knee injury strongly predicted the long-term clinical course, with no significant difference seen between those who did and did not have ...
Will patients embrace Health 2.0?
Someone going by the name "Darthmed" recently posted a comment that stopped me in my tracks:
… The remaining 95% of “patients” out there are not motivated to become informed, or invest the time/energy/money in using any of these tools. These are the folks that know that fast food isn’t healthy, but are just too tired to choose differently. Some (emphasis on some) will do a standard Google search when they ...
Testosterone and when should low levels be treated in older men
I've been interested in the role of testosterone in physical performance, depression and aging for many years. While at the University of Iowa, I was involved in research to detect testosterone doping, the psychological effects of testosterone and the potential for testosterone to alleviate depression in older men.One of the difficult questions facing clinicians is when is testosterone too low in older men.One problem with answering this question is the ...
3 tips to stick with an exercise program
How many times have you started a new exercise program and been determined that this time would be different? You’d actually keep it up. You wouldn’t quit. But, a few weeks or months later, you’re back to your old ways. You’re busy, and you have lots of “legitimate” excuses for skipping a fitness routine.I think most people who have tried to make regular exercise a part of their lives have ...
Patients will skip care with higher deductibles and copays
The Wall Street Journal reported that overall medical use fell as patients had fewer doctor office visits, lab testing, and maintenance medications possibly due to the recession or as a result of consumer driven healthcare in the way of higher deductibles and copays.This is very worrisome. Certainly patients should have some financial responsibility for their care, but skimping on care will only result in Americans not becoming healthier, but sicker. ...
Randomized controlled clinical trials and the Human Genome Project
First, relevant disclosures: I work half-time as editor-at-large at MedPage Today in Little Falls, N.J., and I work half-time as editor-in-chief of Cancer Commons from CollabRx in Palo Alto.Many of you know that I was the editor at JAMA for 17 years and at Medscape for 10 years. You also know that I have been a strong advocate for evidence-based medicine (EBM) for decades and have trumpeted the large randomized ...
Laughter and humor heals the soul in life’s most difficult times
by Charles BankheadMy oldest sister died recently. She spent the last three years of her life in a nursing home, trying to hold on to reality and her dignity as her mind and body betrayed her.Barely five feet tall, my sister Peggy had a big heart and a vibrant personality that made her seem much taller. I have a lot of fond memories of her, many of which involve her ...
MKSAP: A 35-year-old man with red eye and acute eye pain
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. 
A 35-year-old man is evaluated for red eye and acute onset of right eye pain. He wears contact lenses daily. Fluorescein staining is positive for corneal abrasion without a dendritic, or branching, pattern. He is instructed to stop wearing the contact ...
Will Medicare really lose physicians because of the SGR?
For years, physicians have argued that the specter of annual cuts in Medicare will cause many of them to leave the program, or at the very least, to limit how many new Medicare patients they will accept in their practices. Yet, for the most part, measures of seniors' access show that the vast majority enjoy good access to care.For instance, in May of this year, the Medicare Payment Advisory Commission ...
Attribution error in a patient with colon cancer
Zahia Esber, ACP Associate Member, who practices at McKenzie-Willamette Medical Center in Eugene, Ore., told us about a case of a 71-year-old obese woman whose mental status deteriorated rapidly while in the hospital.The patient had undergone a sigmoid resection in December 2009 for colon cancer. At that time, her mental status was intact. Three weeks after surgery, she returned to the hospital because of nausea and anorexia. She told the ...
Metastatic cancer and the matching walkers
They made a regal couple, the elderly man and woman sitting in Room 19. She was the patient, he the supportive husband. She sat in the treatment cot while he sat in a chair pulled near her bedside. Together, they greeted me with their warm smiles as I walked into their room.They both had full heads of healthy, silvery hair that shimmered from the overhead fluorescent bulbs. Their eyes were ...
Commercial CME funding and the rise of medical errors
While the percentage of commercial support for continuing medical education (CME) has continued to drastically drop over the past few years (29% decrease from 2007 to 2009), recent data, which show an epidemic of medication errors in hospitals, make this decrease even more troublesome.
At a time when 30 million more patients will flood our hospitals, do we really need to ...
8 reasons why healthcare costs are rising
In early June, 2010, MedPage Today posted a survey question asking readers to identify the primary driver of rising healthcare costs.More than 1,200 readers responded by answering: 24%, Increased insurance premiums; 22%, New technology; 22%, Malpractice costs; 12%, Drug costs; 3% Increased physician payment; Other -- 16%.I voted "Other." This survey, like most, misses the main point. It is the decisions of patients and physicians that are the principal drivers ...
How developing countries use foreign health aid matters
Year: 1994Setting: Port Moresby General Hospital, Papua New Guinea Position: Chief medical officer for Chevron Oil Co.The wife of an expatriate employee has injured her arm and, suspecting that she has fractured her left elbow, I accompany her to the Port Moresby hospital for further evaluation. The building looks good and new. In fact, it was recently donated to Papua New Guinea by the Japanese government.While waiting for the X-rays, I ...
Doctors ignore social factors when making a patient diagnosis
A recent study from the Annals of Internal Medicine found that doctors often discounted a patient's social situation when making a medical diagnosis.Lead researcher Saul Weiner "arranged to send actors playing patients into physicians' offices and discovered that errors occurred in 78 percent of cases when socioeconomic concerns were a significant factor."Evan Falchuk, commenting on the results, provides some context:
It’s hard to expect even the most ...
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....
