As a kid I had allergies and asthma.Because of this, for several years, my mother wrote a note excusing me from the 600 meter run in elementary school. My father took me to weekly allergy shots. At times I had eczema on my forearms and eyes, and according to my allergist, whose notes I later read, I had moderate allergic shiners (also known as dark circles under my eyes). My ...
December 2010
All Stories
Will medical school as we know it exist in a decade?
A century ago in the U.S., the American Medical Association (AMA) created the Council of Medical Education (CME) to evaluate the standard of medical education.In 1908, the committee recruited the Carnegie Foundation to survey the 155 medical schools operating at the time in order to see whether they met the standard of medical education set by the CME. The Carnegie Foundation in turn asked Abraham Flexner, a professional educator, to ...
Lifelong lessons from the Code of Medical Ethics
The American Medical Association was founded in 1846 for a number of reasons, including to create a Code of Medical Ethics.It did, and the Code is alive in 2010.I believe that all medical students should memorize these bedrock principles -- a little like many did the Boy Scout Oath and Law.And, I believe that all physicians should follow them scrupulously, lifelong.The Principles are:I. A physician shall be dedicated to providing ...
Heart attack symptoms in women, in their own words
Having a heart attack felt nothing like I thought it would feel. For one thing, unlike sudden cardiac arrrest, in which the heart stops beating and you stop breathing, during my heart attack (myocardial infarction), my heart continued beating, and I was conscious throughout despite horrific symptoms – so how could I possibly be having a heart attack?Like most women I know, I thought very little about heart disease, even ...
Adding tiotropium (Spiriva) to an inhaled steroid a mistake?
There is a lot of press about a study recently published in the New England Journal of Medicine that shows that adding tiotropium (Spiriva) to an inhaled steroid might have benefit in asthmatic patients. This study is creating a lot of buzz due to recent concerns of ICS/LABA safety and might prompt doctors and patients to start switching (some already have before this study came out). However, this ...
A mandate for vaccines in California
The California pertussis epidemic is on track to be the biggest in the state since 1958. As of mid-June, there were 910 confirmed cases, some 600 more suspected cases and five deaths, all in infants younger than 3 months. There’s also this: California is one of a handful of states that does not require the tetanus-diphtheria and acellular pertussis booster for middle school entry.Why doesn’t California have a ...
Take responsibility for your own health
An excerpt from More Health Less Care: How to Take Charge of Your Medical Care and Write Your Own Personal Prescription for Lifelong Health.Bob Baker is a patient of Dr. Lisa Martin. Bob works as an engineer for a Fortune 500 company that holds major commercial and Department of Defense contracts. He’s 45 years old and happily married with two college-age children. Bob’s lifestyle is stressful. He travels ...
Hospital meals make it difficult to control blood sugars
My mom doesn’t take any diabetes medicine. She keeps her blood sugars normal through a combination of common sense and careful carbohydrate consumption.A few months ago, she had to be hospitalized for what she calls a “minor procedure.” The procedure went fine, but not the food. The first meal they brought her consisted of breaded fish (frozen), mashed potatoes (instant), corn (canned), a dinner roll (frozen), and tea (2 sugar ...
Should surgeons tell patients how much sleep they had?
In a recent New England Journal of Medicine, a perspective piece on what to do with fatigued surgeons is generating debate.The issue of work-hour restrictions has been a controversial issue when it comes to doctors in training, something that I wrote about earlier in the year in USA Today. But once doctors graduate and practice in the real world, there are no rules.As summarized in the WSJ's Health Blog, ...
Health care economics and the relationship between doctor and patient
I used to practice pediatrics. It has been several years since I decided to leave medicine, but people still ask me about it, and I find myself offering neat explanations between gulps of coffee. Of course, the full truth is much more complicated. The full truth has as much to do with our health care system and our culture as it does with me.My journey in pediatrics was not entirely ...
Your attention deficit disorder may be an anxiety disorder
Are you one of those people who simply cannot concentrate for long enough? Do you find that no sooner than you start doing something, that your attention is scattered all over the place? Do you find that you log onto your computer and within minutes are surfing every possible tangential site that you find?Your problem may not be a problem with your attention. In fact, it may be that the ...
How American physicians should be paid
How do you think American physicians should be paid?I think many of the current methods are insane. Case in point:In the 1980s, during a meeting of the board of trustees of the American Medical Association, I experienced sudden unexpected unilateral loss of hearing. You might say that was lucky. But I was scared and went right to my ENT's office.He looked in my ear and extracted a large wad of ...
Tips to find a good psychiatrist
Seems like a simple enough question: How do you find a psychiatrist?It's not that easy to answer. There are all sorts of psychiatrists who do all sorts of things (therapy, not therapy, specific forms of therapy like psychoanalysis or CBT), and then there's the overriding insurance question. Not to mention location, location, location.We've talked before about insurance, and if you haven't read Why Shrinks Don't Take Your Insurance, ...
Why an EMR doesn’t necessarily deliver better patient care
Regular readers of this blog know that the mere introduction of an electronic medical record doesn't necessarily guarantee better patient care.There are multiple reasons for that, including the fact that many systems are archaic in nature, counter-intuitive, and doctors are forced to learn multiple systems.Yesterday, the WSJ's Health Blog posted a study showing that hospitals with an EMR don't necessarily have better quality measures.Shocker.According Rand Corp.,
trying to ...
CT scans and x-rays draw patients into risk and overutilization
Many patients erroneously believe that x-rays and CAT scans have no risk.In their minds, they are non-invasive studies that can cause no harm. Since there are no incisions or anesthesia, they regard the experience as having the same risk as taking a family photograph. How wrong they are. In my mind the danger from non-invasive radiology studies may surpass the risk of hard core medical treatment. True, radiology tests won’t ...
How false positives can kill patients
I've written in the past that more medicine and tests do not necessarily reflect better care.There is no test that is 100% specific or sensitive. That means tests may be positive, when, in fact, there is no disease ("false positive"), or tests may be negative in the presence of disease ("false negative").It's the latter that often gets the most media attention, often trumpeted as missed diagnoses, but false positives ...
Are chaperones a hindrance to patient privacy?
Chaperones are increasingly recommended for routine use in Western medicine. There are semi-official recommendations in both the UK and USA. The AMA has long had this.The rationale for using chaperones is twofold. In theory their primary purpose is to protect, comfort and assist the patient. In reality though, the usual purpose is to protect the physician against claims of sexual assault or harassment.Preferably, chaperones should be real professionals, ideally ...
Reduce phone calls in your medical practice
A physician approached me at the end of a talk on optimizing practice efficiency and improving service to patients and said, "I dream of an office with no phones."Do you have days where the phones are ringing off the hook? Or the phone message forms in your in-box seem to be reproducing? Maybe it's been one of those days when you can never get your nurse's help because she's been ...
Responsibility, respect and relationships are important for patients
At the risk of dating myself, I recall a time when “The Three Rs” summed up American education. In case you aren’t familiar with this phrase, it stands for "Reading, ‘Riting, and ‘Rithmetic."I think it’s high time we develop “Three Rs” for patients. Right now, Patient World is ruled by “E” words such as “empowered” and “engaged,” with “empowered” the big one. I think “empowered” is turning into a label, ...
Patient complaints do not fit the primary care office visit
Primary care physicians often have to see patients with a litany of issues. Often within a span of a 15-minute office visit.This places the doctor in the middle of a tension -- spend more time with the patient to address all of the concerns, but risk the wrath of patients scheduled afterwards, who are then forced to wait.And, in some cases, it's simply impossible to adequately address every patient question ...
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....
