Listening to patients for the past two weeks, we learned quite a bit about what patients appreciated about their doctors and what had left them hurt and confused.The good:M., an elderly lady with a very close relationship with her primary care physician, said she had been to many bad doctors in her life. She knew right away that her current doctor ...
April 2011
All Stories
Becoming the official caregiver to your sick parent
I imagine the world as a vast, boundless frontier weathered by our swirling human emotions and complicated energies -- hurricanes of intense heartbreak and tornadoes of joyous, unbridled celebrations, with every weather pattern in between. Sunshine and rain included.If I could gather this world, foolishly believing that I could sweep my arms and hands through the unsuspecting air to collect a smaller, more-contained version of reality, I know with absolute ...
Maintaining private space when patients share trying times with you
Year: 1987Setting: Pitie-Salpetriere Hospital in Paris, France Position: Specialist in tropical diseasesI am a consultant in tropical diseases at the Pitie-Salpetriere Hospital in Paris in professor Marc Gentilini’s department, which has been receiving HIV/AIDS patients from all parts of the world since the onset of the pandemic.Indeed, in the early days most patients came from Haiti and Africa and were seen primarily in tropical disease ...
The FDA does not approve the uses of drugs
Many people believe that the Food and Drug Administration (FDA) of the United States approves uses of drugs. It does not.This confusion comes from insufficient clarity of language.The FDA does approve whether or not a prescription drug can be manufactured, marketed, and sold, the language on the label, and the claims of advertising.Drug manufacturers must use an elaborate, detailed, lengthy, and very ...
Treating patients with pre-diabetes: Weight loss and carbohydrate restriction
What physician has not stifled a groan when a patient presents with a chief complaint of "I just don't feel right, Doc."About this time last year, I had that "not quite right" feeling and vague, seemingly unrelated symptoms ... sweating, mid-morning headaches, and frequent feelings of hunger, which I was accustomed to satisfying with a muffin.Like most people -- patients and clinicians alike -- I ignored these subtle signals.One evening, ...
Overhauling America’s Healthcare Machine, an excerpt
An excerpt from Overhauling America’s Healthcare Machine: Stop the Bleeding and Save Trillions, published by Financial Times Press (2011). Reprinted with permission of FT Press, and imprint of Pearson. In recent years, more and more of the revenue collected by U.S. healthcare facilities ends up paying for costs that have nothing to do with providing actual healthcare goods and services: things such as administration, billing, documentation, and the cost ...
Medical student social media tips as an AAMC motivational story
I'd like to thank the Association of American Medical Colleges for profiling me
as one of their motivational stories. It's an honor.Here are some of the questions and topics I address:
- Please describe your typical work day and what it’s like to balance your career as a physician and a blogger.
- What advice do you have for medical school ...
Think about medical school tuition debt before becoming a doctor
Recently, I received a call from the son of some old friends. This 30-year-old man has been an elementary schoolteacher for the past few years and recently decided that he would like to go to medical school and eventually become a surgeon. He wanted to know what I thought of the idea.Suppressing the urge to tell him not to even consider ...
16 and Pregnant is increasing the awareness of teen pregnancy
Recently, I had the honor of moderating a discussion for the Sex::Tech 2011 Conference with the producers of MTVs 16 and Pregnant Morgan Freeman, Dia Sokol Savage and The National Campaign to Prevent Teen Pregnancy.I was fascinated by the responses of members in the audience as well as the reactions I read while monitoring the online live stream via Twitter. So what did I conclude?I concluded that the issue of teen pregnancy ...
FDA regulation, and off label use of atypical antipsychotic drugs
Abilify, Seroquel, Zyprexa, Risperal – these are among the atypical antipsychotics for which Americans paid $10 billion in 2008. $6 billion of that was for off-label use.The FDA only approves drugs when their safety and efficacy have been tested for specific conditions. For example, an antipsychotic might be approved for the treatment of schizophrenia. When it’s prescribed for anxiety or depression, that’s ...
How the reformulation of Oxycontin has affected patients
Having a healthy level of respect for opioids is critical for any physician. For those of us who prescribe or recommend this class of medicines on a daily basis, this statement rings all the more true.Recent events and research reinforce this reality."Oxycontin, Other Opioid Painkillers Tied to Higher Health Risks" was the title of a recent ...
Differential diagnosis and treating patients as individuals
I recently wrote about the importance of a differential diagnosis. Today I want to assume that you have a definitive diagnosis and discuss how we deal with that illness. First, some ground rules.There are hundreds of medical texts and unlimited amounts of information on Google that help define an illness. They all portray the “textbook” description of how the illness should present, what symptoms ...
What you need as a leader of your accountable care organization
The Michigan Medical Group Managers Association had a conference recently in Mt. Pleasant, MI. The theme of the conference was "Medical Management: Coaching Your Team to a Winning Season."Two speakers—Lloyd Carr, former head football coach of the University of Michigan Wolverines, and Lou Rabaut, partner of law firm Warner Norcross & Judd—both delivered excellent lessons on leadership. Several of the ...
Why does society frown on doctors earning a reasonable living?
Recently, while jogging through my community, I had the pleasure of bumping into a former colleague and his brother who were out for their daily five mile walk.Dr. G. had attended a local medical school, finished near the top of his class, and had gone on to do his internship and residency at the premier private hospital in Miami Beach, Florida. After completing his residency ...
Myths devalue the image of primary care
After an exciting and challenging day of caring for patients and teaching students, a third-year medical student on his family medicine rotation says to me, "I really like what you do, but I just cannot afford to go into family practice."I realized that by “afford,” he was referring not only to finances but also to the expectations of his parents, friends, and
Controlling health care costs requires shared sacrifice
To understand how hard it is going to be to control health care costs, one merely has to consider the outrage surrounding TSA's recent roll-out of "enhanced security" measures - measures which include 'enhanced pat downs' and full body scans.Videos of boys getting patted down personified the problem. But the upset and outrage and anger visible today will be nothing if ...
Rationing and limitations are inevitable in any health system
Healthcare is a limited commodity. It’s limitations are defined by the numbers of professionals supplying it and their physical limitations on the number of patients they’re able to treat, on availability of biomedical equipment and technology, on availability of physical space to safely provide medical care and, underlying all of these, on the funding for such.And so, not ...
Should doctors give more Oxycontin to chronic pain patients?
by Christopher, BAWe all know of the folly "Just Say No" as it just does not work. I disagree that a physician should ignore the requests of her or his patients, based solely on the perceivable abuse of the drug Oxycontin.This is an opiate that works wonders for patients in chronic pain situations, ...
Potassium iodide won’t protect you from nuclear reactor radioactive isotopes
Well, the nuclear crisis in Japan seems to be causing a run on potassium iodide (KI), and not just in Japan.If news reports are to be believed, people in many other regions (such as the west coast of the US and Canada) are stocking up, and some of these people may have already started dosing themselves.Don't do that. Don't ...
Caring for people is not always easy, but it is what makes us special
My mom is sick. Because of what can only be described as my crazy family dynamics I did not find out for 24 hours that she was taken by ambulance to the hospital in septic shock from pneumonia.She was hypotensive on arrival (not good) and pancytopenic (low white cell count, low hemoglobin, and low platelets – not good either). A CT scan showed multiple large, irregular lymph nodes in her ...
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....
