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 Priscilla Chan may become the country’s most influential doctor
Who has the potential to be the most influential physician of our generation? It's Priscilla Chan, who not only recently graduated from...
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Confused about prostate cancer screening? Make a shared decision
In a widely anticipated move, the USPSTF officially recommended against prostate cancer screening in healthy men. Case closed, right? Hardly. The prostate...
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When it comes to doctors and social media, hospitals fail miserably
When it comes to medicine and social media, much of the attention is negative. Doctors losing their hospital privileges because of Facebook....
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Warren Buffett’s prostate cancer choices aren’t right for every man
A version of this column was published on April 24, 2012 in USA Today. There has been a recent uptick of elderly men...
Physician
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Why test recalls should not be considered cheating
I was appalled recently by the coverage of radiology “test recalls” by CNN, amplified by Dr. Gary Becker of the American Board...
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Why physicians are susceptible to hardball tactics
I was invited to a medical staff leadership conference sponsored by our hospital. A company specializing in training physician leaders ran the...
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How we deliver bad news is critical to how families deal with grief
As a cardiac electrophysiologist, I have had to discuss bad news with patients and families more times than I would like during...
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His father’s suffering had already been too great
He looked dead. The paramedics brought him down the hall toward one of my critical care beds, and for a moment I...
Patient
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How death can be a beautiful experience
I was honored to be part of a beautiful experience in late January of 2011. It was the death of my mother-in-law...
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What meaningful encouragement can be given to someone who is dying?
Theirs is a lonely journey; to be moving towards the separation and end of all things known and loved. Being with a...
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Health care journalists have tendencies similar to those of doctors
As a patient who was asked to speak at the Association of Health Care Journalists 2012 conference, I felt a bit covert....
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Adaptation can be painful, but it can also be a gift
Nothing will force you to live life on your own terms faster than almost losing it. In 2008, I was on fire....
Policy
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What should America’s health care vision be?
America has this paradox of excellent biomedical science, innovative drug manufacturers and entrepreneurial device developers along with outstanding providers but at the...
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Hospitals around the world aim to remain relevant to patients
"It was the best of times, it was the worst of times ..." So begins a story called A Tale of Two...
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Repairing the tear in health care’s safety net with social media
The nation’s “safety net” hospitals are designed to ensure that uninsured, lower income and indigent populations receive adequate medical care – a...
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Look to technology to reduce health costs
Technology to lower costs rather than accelerate them. Smart phones to increase physician and other providers’ productivity. Fewer primary care physicians but...
Tech
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When patient care becomes secondary to filling out the medical record
The policeman was two cars in front of me. I meandered down the road cautiously adjusting my speed a few ticks above...
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Doctors, use Google to get more patients in less than 7 minutes
Every month, hundreds of thousands of people look for a doctor on Google. As an amazing practitioner, your site deserves to be...
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The user interface for EHRs should be uniform
The first thing I noticed when I walked into the physician’s office were the tall cabinets filled with manila folders, tabbed with...
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EMR liability needs to go further than just the physician
This example of a disaster waiting to happen, in the form of an error-promoting CPOE, is a poster example of why the...
Social Media
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We need to see the potential harm of social media
Prior to 1794, farms across the world could only pick cotton as fast as humanly possible. In the late 18th century, Eli Whitney...
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Why social media may not be worth it for doctors
Social media in healthcare is all the rage these days. You can’t visit even one physician-oriented website without someone breathlessly advising you...
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Transparency defines social media success for doctors
Want to understand social media? Physicians wanting to learn about social media must learn transparency. We must learn transparency on a personal...
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How Twitter was used in a potential mass casualty scenario
It was my first ER shift in charge of the resuscitation area. Needless to say, my adrenaline and nerves were firing like...
