An excerpt from What Will Happen to Me?by Howard Zehr and Lorraine Stutzman AmstutzChildren need time to adjust to the separation caused by having a parent in prison. But it takes more than time. As we have heard in their voices, children also need to make sense of what has happened to them and to their parent or parents. Because of this, they have many ...
February 2011
All Stories
Radiation treatment errors with Intensity-Modulated Radiation Therapy (IMRT)
In a recent series of articles in the New York Times, Walt Bogdanich uncovered an alarming series of radiation treatment errors associated with implementation of new computerized treatment technologies such as Intensity-Modulated Radiation Therapy (IMRT).Based on this article, reporting hundreds of cases, some of them fatal, it appears that a variety of causes are associated with errors, including inadequate training of physicists and radiation therapists, difficulty physically validating ...
Does a physician need an MBA degree?
There's a great blog post on Harvard Business Review titled, "Does an Entrepreneur Need an MBA?" I'm now enrolled in business school and I'm pursuing an MBA. I don't consider myself a traditional entrepreneur, but I've started a few things here and there. Someday, I may take a big risk and start a "real" company, but for now I'm comfortable bootstrapping my way through a few little ventures.The ...
A stent anecdote from a former FDA Associate Commissioner
by Peter J. PittsAs the saying goes, the plural of anecdote isn't data. That is unless the anecdote supports your theory. Here’s a personal anecdote -- a story of how the system works.Being adopted, I have no family history, so when I suffered through some late night chest pains I figured I’d better act on the warning signals. I called my GP and got a same-day consultation, resulting in a next-day referral ...
Bioethics and bedside communication in daily patient interaction
by Zakari Tata, MDBiomedical ethics and bedside communication is currently taught to medical students in a classroom mainly in the first two years. In residency it is not usually given a lot of attention. This is leading to a situation where a very basic part of daily patient interaction is not addressed. This leads to many complex problems in the hospital that lead to moral dilemmas and conflicts.The idea needs ...
Why is there a gender gap in physician salaries?
Some research studies just contain too many revelations to not share with the world. The Health Affairs study on the pay gap between newly-trained male and female physicians is just such a study, demonstrating conclusively that:1. The gender gap in physician salaries is not related to specialty choice or work hours. No matter where women are choosing to work (solo practice vs. hospital, city vs. rural), which specialty they choose ...
Can posting ER wait times be dangerous to patients?
You've probably experienced that age-old ritual of cooling your heels in an ER waiting room hoping that it won't be too many hours before a nurse lets you inside the sliding doors.Simon Bradley tweeted this to my Twitter Account @WCBADoctorBrian: "My buddy had a deep laceration between the thumb and the index finger - a full layer of skin. Took 10 hours at (name of hospital withheld), fastest in town."A ...
Kids with allergies can die in school
Like many other parents of kids with allergies, I was very dismayed to see this article, titled, Allergic boy, 7, suffers two heart attacks after teacher hands him chocolate nut in class, last week. It seems a boy of 7 was accidentally given a chocolate candy containing a hazelnut, to which he is allergic. After biting into the candy, he realized immediately that he shouldn't have it and ...
Food is an essential part of a doctor’s success strategy
Nutrition fascinates me - I've been studying it for over twenty years and have a university degree in Dietetics. These days I'm particularly interested in the secrets of high-performance eating; the busier and bigger my life gets, the more I need to be on the ball. Food is an essential part of my success strategy. Put another way: if I didn't know how to eat right for my brain, I'd ...
Confidence in a student’s ability to become a competent physician
by Timothy DempseyLooking in the mirror before heading out the door for my first patient encounter, I slouched. Something looked off. I had on my new, absurdly short white coat complemented nicely by the equally as new black stethoscope draped around my neck; yet the way I looked wasn’t the problem. It was the way I felt. No matter how well I dressed the part ...
Why the time is right for collaborative care
by John MooneyA recent study conducted by Dove Press Patient Intelligence Journal asked this question of patients: “Have you ever asked your physician to prescribe something different than the original recommendation?” Thirty-four percent of the respondents indicated that in fact they had. Perhaps even more interesting: of that 34 percent, 69 percent of the doctors agreed to prescribe the alternative drug when asked. Why is this important? The health ...
Alternatives to NSAIDs, pros and cons
by Marianna Rakovitsky, RPhRecently, I have talked about the concerns with the use of NSAIDs and their effects on the heart. All medications carry a risk of adverse effects. NSAIDs are usually very effective in controlling pain especially muscle and bone pain, but they also carry a potential risk of side effects such as stomach and kidney problems, increased risk of bleeding and adverse effects ...
Can President Obama and the GOP agree on improving health reform?
Everything seems to be pointing toward two years of partisan and ideological confrontations over health reform. The leadership of an emboldened Republican party has made it clear that it will use its newfound House majority to seek to "repeal and replace" the Affordable Care Act (ACA), and if that doesn't work, to "defund" it. Huge GOP gains in statehouses make it likely that more states will resist implementation. Meanwhile, President ...
Ethics of the individual mandate
by Raymond Raad, MD, MPHThere is a remarkable inconsistency between the ethics of medical practice and the discussion about the health care reform law passed this past March, especially the individual mandate.In medicine, it is considered unethical to force a patient to do something against his will. Patients are allowed to disagree with their doctors and to decide for themselves whether they want to heed their advice. Patients are even ...
Should doctors give marriage advice?
Doctors have no trouble or compunction giving these good pieces of advice:
- stop smoking
- lose weight
- eat less saturated fat
- wash your hands
- vaccinate
- schedule your mammogram
- get a colonoscopy
Change health behavior with a gentle nudge
Gentle nudges is a concept termed recently to describe a micro-choice movement that is beginning to carve out a sizable niche in the healthcare start-up space, and is gaining a lot of well deserved national attention. The secret ingredient relates to the power of a gentle nudge; verbal, text or otherwise to accomplish a change in the behavior of the person who receives the nudge. We are just starting to ...
USA Today op-ed: Violence against doctors and nurses due health care dysfunction
My latest column was published this morning in USA Today: Violence is symptom of health care dysfunction.
I discuss the disturbing trend of violence against health care workers. Here's an excerpt:
Violence is most common in psychiatric facilities and emergency departments, but can also be seen in waiting rooms, long-term care facilities and critical care units. Nurses are the most frequent ...
The threat of malpractice means doctors cannot acknowledge their fallibility
An excerpt from The Color of Atmosphere: One Doctor’s Journey In and Out of Medicine (Chelsea Green Publishing, 2011).We all make mistakes. To err is human—unless you are a doctor. This is a lesson that began in med school. If something went wrong, someone else was to blame. Attending physicians blamed the residents, who blamed the interns, who blamed whomever else was within range—med student, nurse, patient. We gave ...
Patient-physician relationships in medical malpractice
I recently read a post from Jan Gurley, MD on here on KevinMD.com.Her opinion is that medical malpractice lawsuits are a “crap-shoot”; she notes that “malpractice lawsuits fail when it comes to medical errors-in both directions. People who’ve suffered from errors both don’t sue, and lose suits, in the same percentages that people who sued have no suffered from errors.”Assuming that information is correct for purposes of this ...
Treating a patient in a small town versus a big city
I usually work two or three shifts a month at a small, rural hospital about two hours from where I live. Why? Mainly, the small hospital is less than ten miles from my childhood home, where my widowed father still resides, and thus provides me an opportunity to catch up with Dad as well as four of my siblings and their families, all who live within five miles of Dad.I ...
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....
