So there was a neurosurgeon who called a plumber for a house visit.The plumber arrived and after spending an hour bestowed the neurosurgeon a bill of $500. The surgeon was stunned; he said, “Even I don’t charge this much after a surgery." The plumber stood up, gave him a sly look and said, "well that is why I am a plumber now; I used to be a neurosurgeon."I mention this ...
November 2010
All Stories
Suspicious withdrawal of a publication from an academic journal
The official ESC journal Europace publishes an online case report by Dr. Martin Hudec about the extremely rare and spectacular failure of a recently implanted Biotronik 340 VR-T ICD in a 46-year-old man. The battery of the device apparently overheated, causing the device to malfunction and leading to severe internal burning.On Wednesday, October 6, US electrophysiologist Westby Fisher summarizes the Europace article on his blog and reprints several extremely gruesome pictures ...
Patients adjusting their medications and controlling blood pressure
We are no longer surprised when a patient is asked if they take their blood pressure medicines every day, and we are told "it depends."Yes, it can be amusing to hear how one member of a couple decides that they know more than their physician, and makes decisions based on home blood pressure measurements. Sample quotes may include “she thinks she is a doctor”, or “I decide what to give ...
Travelers with medical conditions fear increased TSA security procedures
by Brian LoewTravelers with medical conditions hope that the TSA pat-down incidents involving bladder cancer survivor Thomas “Tom” Sawyer, at Detroit Metro Airport, and to breast cancer survivor Cathy Bossi, at Dulles Airport, are isolated incidents. But these reports are already creating a chilling effect on air travel for people with medical conditions and disabilities.This group of travelers could benefit the most from holiday ...
The reassurance of a CT scan in the emergency department
There's little question that CT scans are on the rise, especially in the emergency department.A recent paper from Radiology put a number to the increased frequency of the test, concluding,
CT, a radiology tool that once took nine days to finish, was used 16.2 million times in 2007 to diagnose headaches, stomach aches, back pain, chest pain and the like. That was a huge increase from 1995 when it was ...
Testicular self exam sung to Michael Jackson
ZDoggMD, who previously recorded the brilliant Safe Sex Song, recently released Manhood in the Mirror.The importance of the testicular self-exam sung to Michael Jackson. Awesome.width="430" height="266" classid="clsid:d27cdb6e-ae6d-11cf-96b8-444553540000" codebase="http://download.macromedia.com/pub/shockwave/cabs/flash/swflash.cab#version=6,0,40,0">
Living with cancer is different from living after cancer
This is a topic close to home.My wife was diagnosed with stage 3C cancer of the ovary a bit over a year ago. She was a chemotherapy superstar, had few complications, and has been in remission since her treatment finished last October. Still we know her chances of a cure are fairly low.Understanding statistics is a mixed blessing. Even though her chances of this cancer never recurring are pretty low, ...
Bedside manner may need to include cost of care discussions
by Dennis GraceFor years, if you asked for a recommendation for a physician, the answer included some mention of bedside manner.I mean, we’re human beings first and patients second, so we think it’s great that she’s a brilliant doctor, but is she pleasant? Is she respectful and patient? Nobody wants to work with a know-it-all, especially one who gets to hear about our bowel movements ...
The malpractice system doesn’t improve patient safety
There has been significant media attention on a New England Journal of Medicine case report where a surgeon, Massachusetts General Hospital's David Ring, described how he operated on the wrong hand of a patient.Here's a summary of the case:
Ring, along with colleagues at Massachusetts General and Harvard Medical School, detailed the series of missteps that led to the wrong operation in the patient whose ring finger on her ...
Antibiotics need to become controlled substances and regulated
Antibiotics for viral infections are a big pet peeve of mine. No. Make that a huge pet peeve.Some doctors prescribe antibiotics for coughs and stuffy noses because the patients want them. If you’re one of those patients who think that antibiotics make your coughs go away, or clear up your stuffy noses, or somehow make your sinus headaches vanish, or if you’re a doctor who prescribes antibiotics for these symptoms, ...
Electronic health records (EHR) to improve medication compliance
A recent report in the Annals of Internal Medicine on the characteristics of prescriptions that are abandoned at the pharmacy raise the question of (1) how to ensure that people actually pick up their prescriptions, and (2) how to make sure that people actually take the medications that are prescribed.What role does modern Electronic Health Record (EHR) technology play in this question?A study by the non-profit ...
How your medical practice can manage vendor relationships
by Rosemarie Nelson, MSEveryone is trying to "do more with less" and concerns about the economy add fuel to that fire! But, when done with purpose and thoughtfulness, you can manage vendor relationships so that you'll deliver successful negotiations that will get the most bang for the buck for any medical practice, small or large, multispecialty or single specialty.Preparation and setting objectives well before contract ...
Scribes lead to unintended consequences from electronic medical records
Recently, Dr. Scot Silverstein over at Health Care Renewal published this update to the ongoing story of electronic medical records that are so simple, intuitive and easy to use that doctors and hospitals everywhere are being forced to hire "scribes" to run them.We'd looked at the resurgence of scribes in a previous post, and Dr. Silverstein's article seems to confirm that the phenomenon is is here to ...
Paying for access to medical journals
I’m not sure about the validity of this study: Free Access to U.S. Research Papers Could Yield $1 Billion in Benefits.Quantifying how much money will be saved by increased efficiency due to open access seems like fuzzy math at best. However, we do need better access to medical journal articles. As a researcher, I’ve constantly fought the battle against firewalled journals. I am fortunate to be part of ...
Shifts and making switches in the ER
Everyone one knows ER docs work shifts. Many places though have each doc doing a set schedule. Such as 1 day, 1 evening, 1 overnight or one week with days, one with evenings, and one with nights.Others, like my hospital, it is a mass jumble. We work all sorts of random shifts at random times, so long as it evens out at the end of the 6 week block that ...
Working at the student care center in college
For five years I worked at GlassHospital’s Student Care Center.I don't get no respect, neither.One of the great things about GlassHospital is that it sits on the campus of a well-known and fairly well-respected former Big Ten university.Like all colleges and universities, our place acts in loco parentis to the students that grace its campus. This means responsibility for our students’ health and well-being.I loved working at the Student Care ...
Medical blog posts of the week, ending November 28, 2010
Here are the top posts from this past week, based on the number of times they were viewed.1. Why EHRs aren’t meaningful to doctors and hospitals. Electronic health record (EHR) advocates in Washington don’t seem to get it.2. Cardiothoracic surgery has a shortage of surgeons. The specialty’s big time claim to fame, the CABG (coronary artery bypass graft), surgery was on a huge decline.3. Breast cancer transforms ...
Colds teach the immune system how to fight future viruses
Viral upper respiratory illnesses, or common colds, are by far the most frequent illness I see in my office.It is called the common cold because it is, well, common. I typically can make the diagnosis with a high degree of certainty based on the pattern and the timing of the symptoms. Deciphering cold symptoms and knowing when to worry is what a pediatrician does more often than anything else, and ...
Ethics of placebo in cancer treatment clinical trials
The New York Times recently ran an article tackling a complex ethical dilemma in cancer care: the withholding of treatment in clinical trials. Because I was treated in 3 clinical trials in the 1990s, the topic is close to my heart.Scientists have advanced the treatment of disease using the scientific method. By that, I mean they have tested a theory using rigorous methods that give a reliable and reproducible answer. This ...
Travel tips for a panic free vacation
by Stephen R. Blumberg, PhDIf you are like many Americans, you are planning or getting ready to take a summer vacation. Sounds very exciting. Aruba. A cross-country jaunt. Or a short trip overnight to the coast!What is exciting for the panic-free community can be agony for a panic sufferer. Why?The core fear is being trapped far from safetyWhether it is traveling on a cruise ship, airplane, highway driving, ...
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....
