Hold onto your hats. I am about to enter dangerous territory. I am about to suggest maybe doctors should profit from dispensing medications from their office to offset declining reimbursements and rising expenses by using prescriptions as a source of ancillary revenues.Why dangerous? For a number of reasons.One, physicians still grapple with the perception that it is improper for a physician to make money from ...
January 2011
All Stories
What health reform compromise could look like
While the rhetoric around health reform has been incendiary from day one, in policy terms, a compromise between Democrats and Republicans using the outline of the Affordable Care Act (ACA) has always been available. The two primary problems with the health care system are costs and lack of coverage. The ACA does pretty well on the second, and is a start on the first, but much ...
Alternative medicine and osteopathic medical education
by Tayson DeLengocky, DOThere has been a growing public interest in complementary and alternative medicine (CAM) in recent years. Osteopathic manipulative therapy, a form of physical manipulation of the body for improvement of health and body function, has been designated as complementary and alternative medicine (CAM) by the National Institutes of Health (NIH).According to data reported in 2007 by the National Institutes of Health’s ...
Using failure as motivation for medical residents
Dear Dr. Brandt,
As a second year medical student, I know that my peers and I all struggle with what we view as "failure" at some point or another. I imagine this problem doesn’t stop (... ever), especially since medicine seems to attract people who hold themselves to extremely high, if not impossible, standards. If you’re looking for topics, I wonder if you might have some insight to offer on how ...
What is a concussion, and what does it mean for the child?
When it comes to football season, it’s time to think about sports injuries. We frequently have children admitted to the PICU (or to what we call the intermediate or step-down unit) for observation, typically overnight, who have struck their head. They have had concussions. What is a concussion, and what does it mean for the child?The term itself is centuries old, but even thirty-five years ago, when I was in ...
Statin use and its effects on venous thromboembolism
In 2003 in the BMJ, Wald and Law and a supporting editorial by then editor Richard Smith, proposed that 80% of heart attacks and strokes could be prevented by widespread use of a six drug polypill. The six ingredients were a statin, three low-dose antihypertensives (a thiazide, an ACE inhibitor and a beta blocker), folic acid, and aspirin.Although there was a lot of derision at that time and there has ...
Obesity and the crossroads between relative health and medical illness
At the end of a busy afternoon, Mrs. MJ was exactly the kind of case I needed.Two of my patients had come in late but needed to be seen and another was acutely short of breath and refusing to be admitted to the hospital. The chaos had put me almost an hour behind schedule, and I still had to return to the wards to round on my cancer patients. Fortunately ...
Blogs encouraging suicides in the gay community
Are reblogs encouraging suicides in the gay community?Recently, we’ve seen numerous young gay people take their lives. Tumblr went purple and spread the word with 29,294 reblogs. The photo above has 17,300 reblogs. Obama even made an "It gets better" video with 704,000 views.Is the blogosphere contributing and encouraging this recent suicide epidemic? Are we reblogging the stories of these “martyrs” without actually thinking about what we’re doing in ...
How the vaccine and autism scare was a fraud to make money
Most parents and all pediatricians are aware of the 1998 study published in The Lancet by Dr. Andrew Wakefield that mentioned a causal link between measles, mumps, rubella (MMR) vaccine and the increased incidence of childhood autism. It shook the medical community and created an international movement of parents questioning the extensive combination of immunizations that are given to children. Could these immunizations be the cause of the increase in ...
Legal tobacco and illegal marijuana are historical accidents costing billions
"What do you think of medical marijuana?" my mother, who has never smoked a thing in her life, of the tobacco or cannabis variety, asked me one day as we drove through beautiful upstate New York woods. We had just passed a sign saying "We will destroy your crops," with a marijuana leaf beneath. "It has its place," I said. "No reason to be against it." "But isn’t marijuana a ...
Kind and thoughtful words from a fellow physician colleague
I was sitting on one of the hospital's nursing units having a difficult telephone conversation. Anyone working nearby could have easily discerned the situation from my end of the call.Patient's family member wants to keep aggressive care going for a comatose, terminally ill family member against the best advice of the medical team.Having never had to make such a decision in my own life, I am left to imagine how ...
Do satisfaction scores really measure quality care?
by William Sullivan, DO, JDDoes patient satisfaction matter? The answer is a resounding "yes."In fact, as the director of an emergency department, feedback from dissatisfied patients has provided both me and our group with an early warning about several physicians who were not performing up to our standards. Studies show a clear correlation between decreased patient satisfaction and increased medical malpractice risk, so meeting our patients’ needs is not only ...
Optimization of the new PCMH neighborhood
by Matt AdamsonThere are a number of care models now being explored to improve the manner in which healthcare can be delivered. Let’s take a quick look at a few of the well known options:Accountable Care Organization (ACO): The ACO model has the ability to provide, and manage with patients, the continuum of care across different institutional settings, including at least ambulatory (outpatient) and inpatient ...
Caregiving and living with those who have mental illness
Your mother has been up all night.She has Alzheimer's Disease and now it has progressed to that inevitable stage of the dementing process where she is paranoid, agitated, and confused. She fidgets and paces and walks all day. She gets out of bed multiple times each night. She has gone out the door into the back yard and tried to escape to the street, wearing only her night clothes. Sometimes ...
How much we should try to help patients who do not want our help?
I recently completed a long stretch of night shifts in the emergency department. I have done a myriad of things – spent over twenty minutes trying to convince a patient to take a pill that she needed to treat her psychosis, sutured a facial laceration for a young gentleman who kept insisting that he wanted to leave AMA (against medical advice) and just place a ...
How surgery is a team sport, and in awe of neurosurgery
I recently finished my 10 weeks in Internal Medicine and have moved on to 1 week each of Ophthalmology, Neurosurgery, Anesthesiology, and Otolaryngology. This week: brain surgery. (Tomorrow, the world.)In 3rd grade, I wrote “I want to be a brain surgen [sic].” Ever since, it’s been a goal of mine to be a neurosurgeon. Well, until college ... when other interests and the anticipated reality of a 7+ year residency ...
Saying Goodbye: How families can find renewal through loss, an excerpt
An excerpt from Saying Goodbye: How Families Can Find Renewal Through Loss. Published by arrangement with Berkley, a member of Penguin Group (USA), Inc. Copyright(c)2011.by Barbara Okun, PhD and Joseph Nowinski, PhDOne of the first tasks facing families upon receiving a diagnosis is to learn more about the illness or disorder that faces them. There are many ways to do this: by visiting Internet web ...
Mischaracterizations by the popular media of medical conditions
by Joyce GraffMedical dramas can play powerful roles in increasing awareness of rare diseases, but it's critical that the diseases are portrayed accurately. Mischaracterizations by the popular media of medical conditions, particularly rare ones, can be very demeaning to people afflicted with those conditions, and can affect how people look at them in the workplace or at school.The TV show, Grey's Anatomy recently broadcast the first ...
Intubating the combative patient
How many times have I been asked by the trauma surgeons to see a trauma patient for respiratory failure? The reason for intubation and ventilatory support – being combative and non-cooperative.Intubating, sedating and sometimes even paralyzing a combative patient is an established practice. Combative patients are dangerous to themselves and to the medical staff. Clinical and radiological evaluation of these patients is difficult as well. Asking “What is hurting, Sir” ...
Doctors play a role in helping people through transitions with rituals
When I was an intern in internal medicine, I admitted a patient to my service with pancreatic cancer.Pancreatic cancer is a bad one; back then, only ten percent of patients with it would be alive within five years after being diagnosed. My patient was a farmer in the full bloom of late middle-age health when he began rapidly losing weight. An abdominal CT scan ordered by his primary care physician ...
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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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...
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I learned the value of listening to the patient
William Osler famously said (among other things): “Listen to the patient. He is telling you the diagnosis.” I was doing my obstetrical...
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Repeated experiences of shaming are not good for a young child
The little boy, who looked to be about two, darted away in a fit of giggles. His young mother, who seemed thoroughly...
Patient
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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...
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How I became a hospice volunteer
People often ask me how I became a hospice volunteer. For the record, nobody is more surprised than I am. You know...
Policy
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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...
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The problem of insurance gaps in cancer patients
Why are cancer organizations waiting until it starts to rain before they suggest buying an umbrella? “Join my Medicare Advantage plan and...
Tech
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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...
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Google knows more about certain diseases than physicians ever will
Professor Gunter Dueck, is a calm and eloquent german mathematician who’s also the CTO of IBM Germany. He studied mathematics and philosophy...
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Robotics can revolutionize the delivery of medical care
Robotics has the potential to revolutionize the delivery of healthcare. It can help extend the delivery of information, expertise and clinical care...
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....
