Can you properly examine and treat a 400lb patient in your office setting? How about a four-year-old in your ED? A deaf woman in Labor and Delivery? An 82-year-old in the endoscopy clinic? Do patients who present with challenges beyond their immediate health issues increase your risk for a diagnostic or treatment error?Once-accepted practices, e.g., jerry-rigging adult medical equipment for a toddler, guesstimating the weight of a patient who exceeds ...
August 2011
All Stories
Does acupuncture work for headaches?
One interesting therapy for headaches, which generates a lot of questions from patients, is acupuncture. Acupuncture is a traditional Chinese therapy which has been around for centuries but only came around to wide spread use in the West (United States and Europe) in the 20th Century.There are many misconceptions about acupuncture. One question I get regularly is “Do you think acupuncture works?” This is a difficult question to answer because ...
Making life meaningful despite a debilitating disease
I worked with Joe over a year ago and now he returned to see me with a new problem. He had just been diagnosed with a rare degenerative disorder that would eventually rob him of the use of his limbs as his muscles weakened over time. Joe wanted to talk about how he could prepare himself for this decline.Joe is in his sixties and has worked in high tech for ...
Hurricane tips that patients and health professionals should know
If you’ve seen the news recently, you know that emergencies can happen unexpectedly in communities just like yours, to people like you. We’ve seen tornado outbreaks, river floods and flash floods, historic earthquakes, tsunamis, and even water main breaks and power outages in U.S. cities affecting millions of people for days at a time and now Hurricane Irene is coming. Health care professionals should be ready too.I was never concerned ...
Talk to your patients before sending them home from the ED
So you’re not having a heart attack like your wife thought. That’s the good news. But what is wrong, what did cause that pain, and what should you do from here on out?That’s the purpose of discharge instructions, and it’s not enough for the ED staff to just print out some forms, say “sign here,” and send you on your way.What constitutes good discharge instructions, and why are they critical ...
How much physician guidance do patients want with medical decisions?
As access to medical information has become more common, patients are gaining empowerment in their medical care.And rightly so. Gone are the days where medical decisions are paternalistic in nature, with the physician leading, and the patient following. Today, an ideal medical decision has input from both patient and provider.But, have we gone too far the other way?In ...
Why specialists should join primary care to end the RUC
The old doctors know. The practice of medicine has changed in a very basic way over the last 20 years. Physician relationships have lost their civility and have been replaced by a level of tension that takes the fun out of collegial interactions. I remember my first year of family medicine as the only doctor in Weeping Water, Nebraska. My personal medical community had gone from an entire medical ...
Will patients trust sociable humanoid robots?
Within in five years primary care providers will begin being replaced by sociable humanoid robots, avatars, and computer programs. Within ten years you will no longer hear any complaints about medical students choosing specialty residencies over family practice because the role of the physician will be completely redefined to complement a rules based approach to the diagnosis and treatment of many diseases. This transformation is inevitable because of demographics, economics, and ...
Converting a practice to a no insurance accepted model
Not long ago, I was working for a pain management firm with 19 clinics scattered throughout three states. I was fast approaching my three year mark as the travel PA and more recently, the compliance officer. Little did I know that my career path was about to go off-road, into a new world of clinic ownership coupled with the unchartered territory of no-insurance accepted.What a difference a few months can ...
Top 10 musts for your hospital visit
Whether you are going to the hospital for an outpatient procedure or whether you will be admitted to the hospital for medical illness or surgical procedure, there are certain things you must know and certain things you must do in order to ensure that your reasonable expectations will be met.
- You must become informed about the terms and limits of your health insurance policy. See if the fees you are being ...
Implementing the Affordable Care Act will increase physician tension
It's really quite an ancient debate: 400 to 500 years before the birth of Christ, on the island of Kos (home of Hippocrates) originates the myth of Aesculapius, god of healing, son of Apollo and the nymph Coronis.As is not unusual in Greek mythology, Coronis meets a violent death, but the infant Aesculapius is saved. He is raised by a wise centaur, becomes skilled in healing arts, and succeeds in ...
Why technology should never takeover the patient encounter
Today, healthcare is criticized by the public as too high on technology and too low in touch. Computers take patients histories, provide differential diagnoses, and even supply educational materials to patients. A new specialty, tele-medicine, offers healthcare services to rural areas that were previously underserved or couldn't afford the latest diagnostic technology.A humorous story about technology occurred when a patient’s secretary called to say that her boss was too ...
Patient advocacy groups should help support research
I was a medical researcher for several decades, investigating an unusual, but not rare, condition called infective endocarditis. I found the disease fascinating, primarily because of how understanding it could unlock many secrets of the endothelial cell, the cells lining all our blood vessels. I chose my research subject because it interested me and I thought I could do some good studying it. This is the case for ...
Medicare patients should bring a companion to office visits
When a patient shows up for a doctor’s appointment with a companion, I often find myself studying (and later, interacting with) them as much as I do the patient. Most times, a quick review of body language is all I need to make an assessment – is this person looking out for the interests of the patient? Are they here begrudgingly, or out of concern? Are they indifferent, or ...
Should pediatricians be punished for asking about guns in the home?
Far be it for me, a Bay Area pediatrician, to tell Floridians about how to keep their kids safe. But having spent half of my life in the south (and I don't mean LA), perhaps I am only partially carpetbagging.Florida's Governor Scott has signed a law that penalizes doctors for asking about guns in the home. It shockingly included a $5 million fine and a five year prison sentence if ...
An ER specifically built for older patients
Seniors spend a lot of time at hospital ER's. Now, a small but growing number of hospitals in the US have built ER's especially for the aging patient - with wider hallways, motion detectors, hearing and visual aids. To me, this is long overdue.Older patients are avid consumers of emergency medical services. Older people make up a significant percentage of the total population of ER patients. A 2008
Navigating the path of contradictory medical opinions
With the advancement in healthcare and technology we are able to greatly extend the life expectancy of the population. For the healthcare provider that means that more elderly patients and patients with multiple chronic medical conditions are being admitted to the hospital. Some “complex” patients require a multidisciplinary approach with the involvement of multiple consultants.As a primary attending physician for the patient you often have to deal with contradictory ...
How medical residents should spend their time off
Here’s the scenario. It’s Friday evening. You’ll be back at work on Sunday. You’re sleep deprived because you are a resident. You haven’t spent any quality time with your significant other, friends or family because you haven’t had any real time off. Next week has plenty of call and it would really help if you planned out good food for the week and cooked something. And, by the way, ...
Adapting the medical home for cancer care
It was 1967. I was an intern in the UCLA-Wadsworth VA Rotating Internship Program when I reported for my physical as part of the Berry Plan deferment. For the younger set, physicians and dentists could elect to delay military service until completion of their first year of residency training, and we could elect our branch of service we preferred to serve in. I chose the Air Force. On the History ...
Sleep apnea is often dismissed as a non-serious condition
An article recently published in the Journal of the American Medical Association reported on a study that showed elderly women (mean age 82) who had sleep apnea were more likely to develop cognitive deficits than a similar group of women who did not have sleep apnea. The study followed these women over a period of several years. Although this study received a lot of press, the finding – one of ...
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....
