When anyone brings up the idea of end of life care, you are thrown a political football. Yet, the failure to have these discussions with your loved ones creates an expensive and emotional mess.I can't tell you the number of times I've been sitting at a table with friends and this issue has surfaced with almost unanimous consent: they all want to ...
May 2011
All Stories
The difficult road to becoming a doctor
On May 15, 2011, 147 students embarked on their careers as doctors as they graduated from the University of Pennsylvania School of Medicine. One student, Jenny Rowland, who will pursue a career in Radiology and continue her training at Penn, shared her personal thoughts and emotions as she prepared to graduate.by Jenny Rowland, MDI’m not a typical PennMed student.I’m 31 years old, and I ...
Cancer will always be a part of a patient’s identity
So, you've cut off your breast(s) and poisoned and radiated your body. You've hit all your medical milestones - surgery, chemo, herceptin. You've recovered and the hair on your legs has grown back to plague you, and you have gotten back to a normal life. Work, jobs, family. Shaving.Yet you are changed. You didn't expect this, but each time you get dressed or undressed, you can't help but notice your mastectomy ...
Pay attention to the color and smell of your urine
Most of us are uncomfortable talking about our waste products, urine and feces. However, changes in the color and odor may signify disease that can be treated or prevented. This article will review causes of discoloration of urine and when there is a change in the odor of urine.For hundreds of years doctors have looked at urine as a barometer of what is happening in the body. The urine can ...
Going through Netter’s to teach medical students pelvic anatomy
I recently had the opportunity to go to the anatomy lab and help the first years go through the pelvic anatomy. What a blast! There is nothing like dissecting a cadaver to tune up one’s surgical anatomy skills, and helping young eager medical students through it is a great experience.Prior to going into the lab, I spent many hours going through Netter’s atlas to brush up on the anatomy so ...
The power of music at a hospital in Haiti
by Mariana Perroni, MDThe following post was written on February 27, 2010, while working as a volunteer in a field hospital in Haiti. It was called Love a Child Recovery Center and it was run by us (Albert Einstein Hospital - São Paulo - Brazil), Harvard Medical School and University of Chicago Medical School. We ...
How patients can handle bad medical news
When bad medical news hits, the blow can be devastating.Shock is almost always the first thing people feel, followed by anger, fear and often a profound sense of sadness.At times like these it came be extremely difficult to collect your thoughts and decide what to do next. Your head is likely to flood with questions that arrive at various moments – in the middle of the night, in the shower, ...
Using Glee for teachable moments to teens
I am a “Gleek.” I admit it. A Gleek is a self-described lover of Fox’s show, Glee. The show features a diverse group of teens who are in the school’s show choir. Glee focuses on the lives of these teens, in and out of school, while emphasizing certain storyline elements with entertaining Broadway musical-type performances.The show itself, however, is not the point of this post. Last week was an unexpected ...
The science of getting into medical school
An excerpt from Med School Admissions Secrets.by Jason SpearsThere are currently 134 allopathic medical schools in the United States and you need to select approximately 20 schools.You are not going to randomly pick, instead there is a system to getting into medical school.The first step is ranking schools in the following manner:
- Top-tier/Dream Schools
- Competitive Schools
- Safety Schools
How a specialty pharmacy denies a physician his medication
Holy crap.My medication did not arrive today.How can this possible be happening? Do they not know this medication is not optional?Let me recap. I called over a week ago for a refill. I am only allowed (by my insurance) to use the (non-local) specialty pharmacy that they own for this medication. They told me my medication would arrive yesterday, which was the day after I’d use my last ...
Our future health depends on the success of hospital medicine
Over the past few years I have talked with many hospitalists. I know many hospitalist leaders and have many hard working hospitalists.Most classic general internists have viewed the hospitalist movement with skepticism. Many outpatient internists express jealousy over the salaries and work hours of most hospitalists.But here is what most non-hospitalists do not understand. In most hospitals in this country hospitalists ...
Belimumab (Benlysta) to treat systemic lupus erythematosus (SLE)
Genomics promises to fundamentally change much of medical care. But the ultimate value of this new understanding of basic human biology will in many cases come with fits and starts. The saga of belimumab (Benlysta) and Human Genome Sciences (HGS) is illustrative.Systemic lupus erythematosus (SLE) occurs in somewhere between 300,000 and 4 million Americans according to the ...
Navigating any health care facility requires sophisticated literacy skills
by Rima Rudd, ScDWe take the written word for granted.Signs and billboards are everywhere – offering directional information, alerts, warnings, and advertisements. Streets, public squares, buildings, agencies, and institutions are numbered and named. We are surrounded by the written word in public locations and within public and private institutions. Individual entrances and even elevators in some large buildings carry names. The lobby, the inside ...
How real life medicine is less glamorous than residency
"Code Blue ICU ... Code Blue ICU"I was greeted by the PA system as I walked into the hospital this morning. A shiver ran down my spine as I quickened my pace . The days of running to codes are long gone. But since I have a patient In the ICU I was curious and just a little bit worried.As I walked through the sliding doors I passed the room ...
How the quality of the scientific literature impacts the evidence
by Tom Lang and George Lundberg, MDA not-so-obvious truth is that evidence-based medicine is literature-based medicine.That is, the quality of the scientific literature directly affects the quality of the evidence.Quality, in turn, depends in large measure on reporting research completely and accurately.In response to ample evidence that such quality is often missing from the literature, dozens of reporting guidelines, such as the CONSORT Statement for reporting randomized trials, ...
Direct primary care and the Marcus Welby vision of primary care
The insurance middleman has taken a toll on the family doctor. New practice models plan to change that. Physicians in Seattle, Silicon Valley and Boston are proving what the rest of the world already knows. When you have a high function primary care system, there's less money spent and better health outcomes.Before House, M.D., ...
Practice variation from the perspective of an e-patient
One of our purposes e-Patients.net is to help people develop e-patient skills, so they can be more effectively engaged in their care. One aspect is shared decision making. A related topic, is understanding the challenges of pathology and diagnosis. Both posts teach about being better informed partners for our healthcare professionals.I’ve recently learned of an another topic, which I’m sure many of you know: practice ...
Emergency medicine, we can do better
When someone gets sick, what are their options?They can try to make an urgent appointment that day, but how many of your doctors actually offer that? Most people will have to wait for weeks, if not months, for a regular appointment. Even if you go to a walk-in clinic, the wait will likely be hours, and you're not sure if clinics can take care of everything, so you head to ...
Medical school starts with anatomy lab
When does medical school officially begin? Is it when you are given your white coat? When you sit through your first orientation activity? When you listen to your first lecture? Or when someone first mistakes you for a doctor?While medical school commencement is truly is an amalgam of all of these things, the answer to this question is ...
Pros and cons of cloud based or web based EMR systems
As if medical practices don’t have enough to worry about with EMR implementation, now they have to decide what kind of EMR system to get: a client-server-based system or a web-based system. The former is the kind that most of us are familiar with. You purchase a computer server, buy a license for the EMR software, install said software on your server, ...
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....
