Recent rules issued by the Accreditation Council for Graduate Medical Education (ACGME) for resident work hours have further limited the consecutive and total number of hours that medical trainees may work. These measures, originally created because of safety concerns, are intended to decrease the number of fatigue-related errors made by physicians in training. They have received broad support within the medical community.A recent story published by Mike Lillis in The ...
October 2010
All Stories
A physician’s worth doesn’t need a professional hierarchy
by Ruben J. Rucoba, MDHas it come to this? Do we really need, as a profession, to measure ourselves against others like a bunch of schoolboys? After reading Dr. Son’s article, “Does being a lawyer or journalist stack up with being a physician?”, I feel compelled to reply.As a practicing pediatrician, I, too, feel the nobility and privilege of my profession, and count myself lucky ...
Mobile health in developing countries
by Chad HyettCell phone adoption isn’t just a phenomenon in the developed world. Developing countries, such as China, India and Africa, are adopting mobile phones at a startling rate. Many predict that by 2013, 95 percent of the entire world will have cell phones. The technology has become cheap and the infrastructure widespread. Even if a village in Africa shares just one or two phones ...
How the Affordable Care Act helps Medicare
One of the more effective criticisms of the health reform law (Affordable Care Act, or ACA) is that it hurts Medicare. It also is wrong.Effective, in that it has been widely reported that seniors are more likely to express negative views of the ACA than other age groups. (Although the Kaiser Family Foundation's Drew Altman, citing the group's most recent tracking polls, writes that seniors' opposition to health ...
Drugs used to treat Parkinson’s disease can worsen impulsivity
Parkinson's disease (PD) commonly includes a variety of behavioral disturbances related to impulsivity. Impulse control problems noted in PD includes hypersexuality, compulsive shopping, compulsive eating and pathological gambling.These behavioral problems may be related to the pathophysiology of Parkinson's disease. However, drugs commonly used in Parkinson's disease appear to increase the risk for impulsive behavioral problems.Clinicians face a dilemma in drug-induced behavioral disturbances. The drugs that may be effective for treating ...
Technology can help your aging parents
One of the most difficult family decisions can be whether to move an aging parent(s) out of their own home and into assisted living or even a nursing home. I’ve seen families face this dilemma numerous times. (After my psychiatry residency, I completed a geriatric psychiatry fellowship and also spent the first few years in practice consulting at nursing homes.)Nobody wants to face this situation.In fact, I’ve seen repeated instances ...
A drug to treat hemophilia was polluted with hepatitis viruses and HIV
An excerpt from Doctor Guilt?by Everett Winslow Lovrien, MDThis is the story of a boy who had hemophilia, a bleeding disorder that resulted in pain, disability and death before adulthood. A new medicine was developed which brought an end to suffering and increased longevity in persons with hemophilia. The effect of the new medicine was like magic. It was a remarkable revolutionary advancement ...
Reduce medical malpractice and create a culture of patient safety
When I was a resident in internal medicine many years ago, I saw an elderly woman who came to the ER complaining of chest pain and shortness of breath. She had a history of heart disease. When I listened to her chest, the crackles I heard emanating from her wet lungs told me she had congestive heart failure. I treated her chest pain and gave her diuretics to help her get rid of the water that was making ...
Doctors working in an ambulatory care clinic
It would be difficult today to be connected to medicine as either a provider or a consumer and not be aware of the existence of free-standing ambulatory care centers.Their usual habitat is along a suburban commercial strip, and their presence is generally announced by a well-lit sign displaying a hyphenated medical name, corporate-logo style. The ambulatory care center, known to much of the public as the “walk-in clinic,” is less ...
Let Grandma go with dignity, and a family’s inability to do so
I can always use money. Regardless of what the public seems to think, doctors are generally not phenomenally wealthy.So I hate turning business away. But tonight I refused a hospital consult. Why would I do that?Because.The consult was for an 88-year old lady with advanced Alzheimer's Disease. Her sad life was reduced to lying in bed staring at the ceiling. The patient had been seen by 2 other neurologists during ...
Surviving a potentially fatal injury and the fragility of life
You are now out of the Gray Zone, and you are now a member of an exclusive club.But membership to this club comes at a steep price. Membership is not offered, it is not dependent on your income, title nor your social status. Membership is granted simply by surviving or living with a grave or potentially fatal illness or injury and realizing just how fragile life is and how quickly ...
Is the critical value reporting system truly life saving?
We at the Los Angeles County/USC Medical Center are generally credited with having created the "Panic Value" or "Critical Value" laboratory reporting system in 1969.A Panic or Critical Value is a laboratory finding at such variance with normal as to be life-threatening if something is not done quickly, and for which there is a corrective action that can be taken.We determined that it was the laboratory's responsibility to recognize such ...
Controversy about NSAIDs and heart health
by Marianna Rakovitsky, RPhRecently there has been a lot of controversy about the use of NSAIDs and heart health.NSAIDs are medications for pain and inflammation. Many of them are sold over the counter and they are used by millions of people for various aches and pains as well as for more serious chronic conditions such as arthritis. Aspirin is technically an NSAID, but its effects ...
A sweet and tender moment between a mother and daughter
I had been running late on another busy summer day. The type of day where you gain one step and lose two. Meetings and paperwork had filled up another summer morning. Baseball games, swimming practices, and soccer scrimmages had filled up another summer afternoon. And for this particular summer evening, I was scheduled to work an odd emergency room shift from eight p.m. to four a.m.While driving to work, I ...
Common throat problems that sleep apnea sufferers face
If you wake up every morning needing to hack up lots of thick mucous, or have throat pain, hoarseness, or a chronic cough, you’re not alone. You may think it’s the beginning of a cold, but a cold doesn’t continue for weeks to months without progressing into the full-blown viral symptoms.Instead, these symptoms are the beginnings of the most common throat problem sleep apnea sufferers face. And as I explain ...
How working in the White House breaks down your body
by Keith Humphreys, PhDWhen my friend Paul Costello left the Carter Administration, he wrote a funny New York Times article suggesting a special course for departing staffers:
There ought to be an "outward bound" course for White House employees facing exile. Must we face this cruel and unusual punishment cold turkey?Maybe people were tougher back then - I personally would have collapsed five minutes into the first day of the ...
10 top medical blog posts, September 2010
Here are the top posts from this past month, based on the number of times they were viewed.1. Medical school is hard, and other medical student thoughts. Some reflections on my first semester of medical school.2. Physicians love their work but are frustrated. Many physicians describe themselves as at the breaking point.3. 10 cancer signs women shouldn’t ignore. If you’re relatively young and healthy, gynecologic cancers probably ...
Advice for a second year medical student
A rising second year medical student read some of my posts and wrote me a kind note asking if I would write something for students. I taught students and ran surgical clerkships at community teaching hospitals for my entire career until about 19 months ago.I also was prompted to address this subject after reading a recent New York Times story about a new admissions policy at Mt. Sinai ...
How a tyranny of health is bad for both patients and physicians
Something happened to the public perception of health and medicine in the 1970s. People began to adopt — and financial interests and the media began to profit from – “healthy lifestyles.”This was not without consequences.• Americans became increasingly preoccupied with diet, exercise, and health habits.• There was a big uptick in the use of alternative “medicine” and stress reduction practices – acupuncture, chiropractic, herbalism, naturopathy, nutritional therapies, yoga, massage, biofeedback.• ...
MKSAP: A 70-year-old man with a history of a systolic murmur presents with exertional dyspnea
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 70-year-old man with a history of a systolic murmur presents for further assessment of exertional dyspnea. He has had dyspnea his entire life, but has noted a recent deterioration in his exercise capacity. He has no other medical conditions and is ...
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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Improve patient safety to improve healthcare quality
It has taken 13 years for us to revisit the issues in To Err Is Human, the 1999 landmark government report that...
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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...
Tech
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New classes of devices to diet and exercise
For many celebrities, their livelihoods depend on their physical appearance and they rely on armies of personal assistants, schedulers, stylists, trainers and...
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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...
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....
