September 2010

All Stories

Why answering a cell phone during an office visit is a problem

by | in Patient | 19 responses

Here is an unfortunate, but almost daily not-so-secret occurrence in my practice:I am in the midst of an intricate follow-up visit with a rather complicated patient with diabetes, high cholesterol, and high blood pressure. I am feeling as though I am a CIA agent in a rather mission impossible assignment: she is here for lab results, is complaining of low back pain, and presents with an elevated blood pressure of ...

Patient Protection and Affordable Care Act individual mandate controversy

by | in Policy | one response

The individual mandate is the single most controversial feature of the Patient Protection and Affordable Care Act. Everyone who can afford coverage—unless an undocumented immigrant or exempted on religious grounds—is required to have it or pay a penalty of $695 or 2.5 percent of income.The rationale is straightforward: without a mandate, many people would wait until they needed care before buying insurance, driving up premiums for those with ongoing coverage, ...

Is it the doctor’s fault if an obese patient cannot lose weight?

by | in Patient | 32 responses

I need help.  In dealing with obesity as a medical problem, that is.I am pretty solid at arrhythmia management, but as an obesity doctor, not so much.  If I was the teacher, and my obese patients were the students, I would surely be fired for poor student test performance. At least, if the core measure was the patient's BMI.If a student does poorly on an achievement test, is it the student's ...

DTC advertising, and its history with the FDA

by | in Meds | 2 responses

Advertising is everywhere.That should come as no surprise to anyone who has lived in modern America. It is impossible to turn on the television, ride the subway, or even sort through the daily mail without coming across an ad for a new car, a soft drink, or the latest digital toy. These advertisements have only one goal: to entice you to buy their products. This is harmless enough when these ...

Do all people with disturbing behavior have a psychiatric illness?

by | in Conditions | 3 responses

“Hey Doc, this guy needs some help.”I’ve heard that statement from countless correctional officers over the years. Its meaning is very simple: Someone is exhibiting thoughts or behaviors that the officers find disturbing and “not normal.”I appreciate the officers expressing concern. Without their input I often would not be aware of cases where I might be able to be of assistance.But, one of the questions that always pops into my ...

Are Alzheimer’s disease screening tests ready for the public?

by | in Conditions | 3 responses

In April, an independent panel established by the National Institutes of Health came to the disheartening conclusion that currently, there is nothing to prevent or delay the progress of Alzheimer’s disease in those of us who are destined to join the 5 million Americans currently suffering from this dreaded ailment.The panel  found that: “Although numerous interventions have been suggested to delay Alzheimer’s disease, the evidence is inadequate to conclude that ...

Radiation risks of CT scans need to be taught to patients

by | in Physician | 7 responses

Radiation is emitted in various forms. Recently, CT scan radiation has preoccupied (or “absorbed”) the attention of the public and media. As explained: “X rays, γ rays, and neutron beams are considered ionizing radiation. Ionizing radiation may break molecules into pieces, creating ionic free radicals that can be very damaging to tissue.”

For this reason, it is imperative that the use of radiation is only by highly trained ...

Mayo Clinic Center for Health Care Social Media disses physicians

by | in Potpourri | 35 responses

The Mayo Clinic has always been at the forefront of the social media and health care intersection, and is the first institution to have an official Center for Social Media.When they recently announced the invited first 13 members of their Advisory Board for the Mayo Clinic Center for Health Care Social Media, the first thing I noticed that there were zero physicians, and few with clinical experience.What a slap ...

For autism, vaccination is the simple answer that is tragically wrong

by | in Conditions | 2 responses

It is a curious fact, seldom remarked upon, that all diseases purportedly caused by vaccination share certain common characteristics. Chief among these characteristics is that the cause of the disease purportedly caused by vaccination is presently unknown.Vaccine rejectionists never claim that a particular vaccine causes heart disease, gall bladder disease, bone abnormalities or any of the myriad diseases for which causes are already known. Vaccine rejectionists always insist that vaccines ...

Triage pathways make patients feel disconnected from their doctors

by | in Physician | 14 responses

There are things we (the providers) do to health care that are hurtful. We make protocols and rules that divide us from our patients. Protocols that sometimes make patients feel alone, distant, and disconnected from their doctors. I don’t mean algorithms of care (safe, standardized ways of how and why to treat pneumonia, for example), I mean clinic rules for helping patients schedule and get in to see doctors appropriately.Triage ...

There is no alternative medicine, only unproven medicine

by | in Conditions | 28 responses

There is no Alternative Medicine.Thus sprach Phil Fontanarosa and me in a 1998 JAMA editorial in the famous theme issue dedicated to Complementary and Alternative Medicine.So I went to Mr. Google in 2010 and entered ... Alternative Medicine ... and clicked -- 41,200,000 results; entered Complementary and Alternative Medicine, click -- 3,210,000 results; entered CAM, click -- 191,000,000 results, but that's not fair; CAM can stand for many unrelated topics.Let's ...

Chronic prostatitis is a public health problem

in Conditions | 5 responses

by Arnon Krongrad, MDDavid was afraid. After years of peregrinations with pain, he had exhausted all the options. David knew he wasn’t crazy. The problem was the doctors: They had no more treatments for chronic prostatitis. The doctors did not want to see him.Chronic prostatitis is a public health problem. Contrasted with fibromyalgia, autism, and breast cancer, however, nobody talks about it. President ...

Powerful examples of using the iPad on the wards

by | in Tech | 6 responses

I recently completed a two week tour of duty on the wards in July with new residents, interns, and students.Attending (serving as the supervising doctor for the team of residents, interns and students) in July can be challenging, but also one of the most rewarding clinical experiences as a faculty member.  The interns and residents are eager to learn and your teaching may have a more lasting impact as the residents ...

Goals when starting medicine and how some have been disillusioned

by | in Physician | 7 responses

When I went into medicine, I had clear goals in mind. Helping people. A stable income to provide for a family. I grew up under the spotlight of my father, who is a neonatologist, and lived in awe of his work. I remember being in restaurants with my dad - people would come up to him reverently and sing his praises (to his obvious embarrassment).Talk about their son or daughter ...

Business reasons to get compliant with HIPAA

by | in Physician | no responses

In addition to providing those incentive dollars for meaningful use of a certified EHR, the Health Information Technology for Economic and Clinical Health Act (HITECH) significantly strengthened aspects of the HIPAA security rule, including the penalties imposed under HHS and the Office of Civil Rights.If you are a "Covered Entity" (CE) or "Business Associate" (BA) it's time to get serious, the deadline to be fully compliant with these final HIPAA ...

Can scientific knowledge overcome uncontrollable food behavior?

by | in Conditions | 7 responses

I’ve struggled almost my whole life with food. During my late teens I was obsessed with dieting and calorie-counting, which turned into compulsive eating and a powerful addiction to sugary, fatty foods in my 20’s and 30’s – even though I had both a medical degree and a degree in dietetics (human nutrition).Obviously, having scientific knowledge about food and health isn’t enough to help someone control their uncontrollable behavior around ...

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