If you don’t know there is a problem how can you fix it? Checking blood sugar for a diabetic is mandatory. This applies to both Type I and II diabetics. I check my blood sugar at least 8 times per day. I do this to allow me to closely monitor my blood sugar level. As a disciplined diabetic, I run the risk of low blood sugar episodes more frequently ...
August 2011
All Stories
Personal responsibility is needed to treat drug addiction
A 44-year-old man came to my office to begin Suboxone in hopes of stopping his injecting heroin. He was raised well by married parents, whose other four children have not indulged in narcotics.He lives with a friend, unable to contribute to rent while "not working" yet somehow he affords $50 per day for narcotics through (self-admitted) hustling (comprising: working as one tentacle of the drug-dealers' network, shoplifting, borrowing with no ...
Why medicine actively and legally stifles innovation
Upon finishing my second residency at Hopkins in Baltimore in September of 2007, I moved back to Williamsburg to start a new kind of practice:
- Patients would visit my website
- See my Google calendar
- Choose a time and input their symptoms
- My iphone would alert me
- I would make a house call
- They’d pay me via paypal
- We’d follow up by email, IM, videochat, or in person
How Medicare undermines primary care
When I was a family medicine intern, I met a diabetic patient in the hospital who had stopped seeing his regular doctor after he lost his job and his health insurance. His untreated diabetes made his feet go numb. He stepped on a nail and didn't realize it until he noticed a smell that cost him his foot.He spent thousands of dollars on the surgery and subsequent hospital stay—far ...
Why my family doctor is a superhero
In the interest of full disclosure, I’m not a family physician. I never aspired to be one – I wanted to be a superhero as a kid. When I got older, I realized that all the best ones (like Spider-Man and Superman) spent their non-costumed hours as newspaper reporters or photographers, so I decided to go into that line of work instead. It eventually led me to the Pennsylvania ...
How environmental exposures can contribute to autism and ADHD
Each year, biologically based disorders of brain development – autism, attention deficit/hyperactivity disorder (ADHD), mental retardation, dyslexia, and subclinical neurodevelopmental disabilities – affect between 400,000 and 600,000 of the four million babies born in the United States. This means that between 10% and 15% of American children have some kind of learning disability.Reported rates of autism spectrum disorder (ASD) are sharply increasing. The CDC reports that the rates of ASD increased ...
Taking care of yourself sometimes means being selfish
My family, my friends and my patients think being selfish is bad. I bet you do, too. I used to think so, as well. Twenty seven years in practice has taught that being selfish is good. Actually, selfishness is essential to an individual’s health.Today, I saw a selfless young woman who was ill. She had an assortment of complaints. She had not felt well in months. If she was the ...
How politics have weakened the USPSTF
Health reform was supposed to have been good news for the U.S. Preventive Services Task Force. Until 2009, this independent panel of federally-appointed experts in primary care and preventive health was not particularly well known, and its evaluations of the effectiveness of clinical preventive services had no binding authority on public or private insurance plans. Within the small circle of physicians and policymakers who were aware of the their ...
Patients need to contribute to help their doctors
"Be a fountain not a drain," an expression used by baseball announcer Rex Hudler, is one that has motivational content particularly in terms of an individual included as part of a team.I would suggest that this expression would be appropriate when considering a basic team in medical practice: the doctor-patient relationship. It is critical in most clinical situations that both the doctor and the patient assume responsibility for making ...
Physicians need to get used to immediate feedback online
One of the shocking and sobering aspects of social media is the vast amount of contemporaneous value judging now pouring forth from those small devices. Electronically empowered consumers rate everything. It's just part of the perceived fun of being connected. Sites such as Yelp have become a major source of consumer information for this generation, and the doctor's office is no longer immune.We physicians are not used to such immediate and ...
How physicians can overcome social media anxiety on Twitter
Social media holds a lot of potential for the health care professionals. Is fear of the medium inappropriately leading to professionals avoiding this "social situation"? Have we created a social media anxiety syndrome?We are aware of the social anxiety disorder or social phobia. Among its many features are (this is a convenient list for the purpose of this post and not a strict definition):
- Avoidance of interaction with others
- Fear of being in a ...
Sponsored content on health sites can mislead patients
Occasionally, my vocation of treating obesity and my avocation of health care social media intersect.This is one of those moments. This is the story of a health care social media betrayal in which obese children and e-patients are the victims. Nobody died, except medical ethics, good judgment, and trust in doctors. This is WebMD’s Health Care Social Media Disaster.Recently, WebMD published the following “advertorial” from Kellogg’s: "Mums, kids & breakfast: The ...
The art of medicine and the power of human touch
Though I had a less than comfortable childhood, I did not know what I missed in nurturing until I played football at around age 10. The coach, a big burly man, with a voice as huge as his girth, put his hand on my shoulder as he explained something to the team.I have never been able to explain the feeling that went through me that day, that moment, like a ...
The interests of doctors and patients sometimes conflict
Organized American medicine would like for physicians to "speak with one voice."If they could do so, and if that voice were in the public interest, not only in the self-interest of those physicians, it would be a very powerful voice indeed.Arnold (Bud) Relman, the esteemed former editor of the New England Journal of Medicine, once rightly told the International Committee of Medical Journal Editors that physicians speak with many ...
It’s possible to have fun during medical school
Before I start second year of medical school, I wanted to take this time to reflect on my first year in medical school and use these lessons to ground me as I begin a new school year.When people ask me how first year was, my first answer is that it was a lot of fun. That usually comes off as a surprise. Don’t get me wrong, there were definitely ...
Beware whenever you hear a story about a simple blood test
After seeing the NBC Nightly News last night, a physician urged me to write about what he saw: a story about a "simple blood test that could save women's lives."Readers - and maybe especially TV viewers - beware whenever you hear a story about "a simple blood test."And this is a good case in point.Brian Williams led into the story stating: "Two of three women who die suddenly of cardiac heart ...
Take the effort to reach across cultural and language barriers
I was working in an urgent care clinic when I walked into the exam room to see my next patient. He was a six-year old who primarily spoke Spanish, with some broken English. Jose’s mom was with him, she only spoke Spanish.I sat down and picked up the phone receiver to contact our translator service. With the Spanish interpreter on the line I was able to proceed. I then asked ...
Regrets after patients have lost their health
Regret is a harmful emotion. Regrets are best avoided. Its one thing to regret buying a stock that plummets. It’s another to regret that you ever smoked because your chest x-ray shows a large tumor.People often don’t appreciate what they have until they’ve lost it. When you’ve lost your health, you will regret its loss for the rest of your (shortened) life. Imagine that you were supposed to take your ...
How not to treat yourself when chronic illness strikes
Despite this culture’s obsession with good health, people get sick.This piece is based on a story I tell in my book.In 2001, I got sick with what the doctors initially thought was an acute viral infection. I have yet to recover. Diagnosis: Chronic Fatigue Syndrome—a little-understood illness that is as debilitating as its more justly named cousins that also compromise the immune and neurological systems. My case is particularly ...
Why concierge and direct pay medicine is not unethical
A response to Concierge Practice: Unjust for Patients and Doctors Alike.Like the shots fired at Concord and Lexington in 1776, concierge medicine and direct pay practices are the initial shots fired by concerned primary care physicians in the revolution against health care systems which limit access to physicians and destroy the doctor / patient relationship. Concierge medicine arose as a result of government, private insurance, and employer intrusion ...
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....
