Few things smell worse to me than the stank of a cigarette while trying to trying to load up on cholesterol via awesome blossom. Perhaps one such thing is the beguiling tale of what perverse fate has befallen the gobs of cash money rewarded to state governments from Big Tobacco.This seemingly righteous pursuit was fought by brave attorneys general of 46 various states to regain money we dished out to pay ...
October 2011
All Stories
A nurse offers a medical student sage advice
Last year I was assigned to complete a history and physical on a patient in the hospital. Stifling my excitement to be doing this on a weekend night, I walked to the operator's desk and paged the on-call intern, who -- I'd been assured -- knew I was coming. "You're who now for what?" she stared blankly back at me after I'd explained my task.My patient (we'll call her Betty) ...
A medical student becomes a diabetic and finds public disapproval
Recently, our whole class was asked to "become" a diabetic to try and really understand what it is we’re diagnosing people with. Fantastic idea. Fantastic opportunity.Not so fantastic to carry out. I opted for the insulin-dependent, type I option, which meant I had to keep a diary of what I ate (including counting carbohydrates), regularly check my glucose level, and inject myself before meals. (We didn’t actually inject insulin or saline, ...
Why CMS should settle with primary care plaintiffs
By mid-November, the Department of Health and Human Services (HHS) and the Centers for Medicare and Medicaid Services (CMS) must respond to the legal complaint filed in a Maryland federal court by six Augusta, Georgia family physicians.These doctors are not asking for money, but for relief from the negative effects brought about by CMS’ twenty year reliance on the American Medical Association’s Relative Value Scale Update Committee (RUC) ...
I will pray that I am a humble physician
As I sit down to drink coffee tomorrow morning and type away at the computer, I will do something quite uncomfortable for a non-religious person.I will pray.I will pray that my children make it safely to schoolThat the weather is good and the sidewalks are not slick.That their feet will be steady and their minds alert to the dangers that lurk in any suburban neighborhood.That my wife will have an excellent day.That ...
Doctor, I’m better: What does that really mean?
"Better" is another one of the difficult words I have to deal with on a daily basis."Doc, I’m better" can mean a lot of things and can lead to both misdiagnosis and poor treatment. Does "I’m better" mean you are well? If not, are you really better or is it just wishful thinking? How much better are you?On a busy, stressful day, even the most skilled physician can fall for, ...
When patient advocacy leads to patient enabling
Physicians, nurse practitioners, nurses, psychologists, physical therapists, and a whole host of other health care professionals entered their respective professions to help people. One part of being an effective health care provider is to advocate for your patient when they need it. For example, if your patient (who is a mechanic) broke his arm and needs a note for the employer for a few weeks off, you provide it. If ...
How alternative medicine may have killed Steve Jobs
When they first discovered the tumor in his pancreas in October 2003, his doctors told him an immediate operation was necessary, and could lead to a cure.As first reported by Peter Elkind in 2008, Jobs decided to think different, declined surgery, and explored alternative medicine treatments for his disease.Nine months later, in July 2004, the tumor had grown. Only then would he allow his doctors to operate.Would Steve Jobs be alive today had he consented to surgery when ...
Is wellness simply a hospital marketing term?
There’s a new term that has entered the medical lexicon. The word is wellness. Hospitals and medical offices are incorporating this term into their mission statements, corporate names, business cards, medical conferences and other marketing materials. The Cleveland Clinic Foundation has appointed a Chief Wellness Officer, an intriguing fluffy title that does not clearly denote this individual’s role and function. This is deliberate, as the word wellness is designed ...
A Canadian medical student training in Ireland
Today I went to Middle of Nowhere, Ireland for a rural lumps and bumps clinic. I really enjoy the outings to the country, hanging around the little hospitals, and seeing the old farmers who drive in on their tractors (true story).I had the chance to see a nice variety of patients: from swallowing difficulties to sebaceous cysts, urinary retention to infected toe nails. For me the real fun is with ...
How physicians develop their careers is undergoing a fundamental shift
In 2000, nearly 60% of physicians were practicing independently. Compare that to two years from now, when it’s predicted that just 33% will continue to practice solely outside of a larger health system. According to a report from Accenture, the global consulting company that released those figures, between now and 2013, the rate at which independent doctors are being employed by larger systems will increase by 5% ...
MKSAP: 25-year-old man is evaluated for infertility
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.A 25-year-old man is evaluated for a 2-year history of infertility. He and his wife have been unable to conceive since marrying 2 years ago. Analysis of a semen sample provided 3 weeks ago during an infertility evaluation showed azoospermia. The patient has a strong ...
Does your doctor really know what you should be eating?
For years, it has been widely known throughout the medical profession that basic education in nutrition for training physicians has simply been ineffective. And whether this failure was due to a lack of time or simply a failure of emphasis, the point remains that the medical profession in general is woefully inadequate when it comes to a sound knowledge base related to nutrition and its effects on optimal health. ...
Non-judgmental regard can show the best of humanity
On July 24, 1998, a psychotic schizophrenic gunman entered a side entrance at the U.S. Capitol. As he approached Rep. John DeLay's office, he exchanged fire with two Capitol Police officers who later died of their wounds. The gunman was badly wounded as well.Senator Bill Frist, a cardiologist, was leaving the Capitol when Congressional aides informed him that some men needed urgent medical assistance.A New York Times article tells ...
The fiscal realities of health care are demoralizing
In New York, I worked for an organization called Project for Psychiatric Outreach to the Homeless (PPOH). It has a humble history: Over 20 years ago, a group of psychiatrists were sitting around and discussing the need for psychiatric services for the homeless. They decided to volunteer their time and skills to this population.The organization grew and, for both administrative and financial reasons, eventually became part of another social ...
Why hospitals and physicians should get serious about patient-centered care
Health care professionals are a cynical lot. We joke about the "fad or buzzword of the month," usually some vague concept heralded by the powers on high. Our job is to promote the idea, knowing full well that the "next big thing" is probably right around the corner.Take "patient-centered." It sure feels like a buzz word. I suspect most hospital and physician executives, and their ad agency partners, ...
Judging a guideline just by financial interest is intellectually lazy
Tom Sullivan, blogging over at Policy and Medicine, recently noticed another flurry of activity in the long running debate about conflicts of interest. His post is titled Coordinated Ad Hominem Attacks on Physician-Industry Relationships in Guideline Development: The Next Frontier?He opens, saying, "Recently, we saw concerted attacks on clinical guidelines committees, but interestingly, not on the science coming out of them. Instead, the attacks were focused on whether the writers ...
Stop paying for tests that don’t improve health
The October 19 Health Affairs briefing entitled “Saving Medicare Dollars and Improving Care,” sponsored by the ABIM Foundation and other funders, was a watershed moment in which ideas that would require less spending on health care that would actually improve care for patients were discussed on K Street. This is a great message for patients and, it so happens, for the super committee deliberations a few miles away.Dr. Nancy Morioka-Douglas, Clinical Professor of Medicine/Family and Community Medicine ...
Quality care is dependent on the total engagement of nurses
Six months after Congress passed the health reform law last year, the Institute of Medicine of the National Academy of Sciences issued a landmark report on nursing. Although seemingly separate events at the time, it’s clear now that they are integrally linked: Never has quality care been more dependent on the total engagement of nurses as well as other health professionals.At its core, the Affordable Care Act is about ...
Compassionate care is a crucial component of care
I remember when my best friend was in the hospital thirty years ago and I brought her 3 year old daughter to visit. My friend could not speak. She could only blink one eye and was paralyzed on one side. How she was able to communicate was through the blink of her one eye. I felt her energy of wanting to spend time with those she loved. It was Christmastime ...
Kevin Pho, MD
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Why Priscilla Chan may become the country’s most influential doctor
Who has the potential to be the most influential physician of our generation? It's Priscilla Chan, who not only recently graduated from...
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Confused about prostate cancer screening? Make a shared decision
In a widely anticipated move, the USPSTF officially recommended against prostate cancer screening in healthy men. Case closed, right? Hardly. The prostate...
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When it comes to doctors and social media, hospitals fail miserably
When it comes to medicine and social media, much of the attention is negative. Doctors losing their hospital privileges because of Facebook....
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Warren Buffett’s prostate cancer choices aren’t right for every man
A version of this column was published on April 24, 2012 in USA Today. There has been a recent uptick of elderly men...
Physician
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Why test recalls should not be considered cheating
I was appalled recently by the coverage of radiology “test recalls” by CNN, amplified by Dr. Gary Becker of the American Board...
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Why physicians are susceptible to hardball tactics
I was invited to a medical staff leadership conference sponsored by our hospital. A company specializing in training physician leaders ran the...
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How we deliver bad news is critical to how families deal with grief
As a cardiac electrophysiologist, I have had to discuss bad news with patients and families more times than I would like during...
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His father’s suffering had already been too great
He looked dead. The paramedics brought him down the hall toward one of my critical care beds, and for a moment I...
Patient
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How death can be a beautiful experience
I was honored to be part of a beautiful experience in late January of 2011. It was the death of my mother-in-law...
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What meaningful encouragement can be given to someone who is dying?
Theirs is a lonely journey; to be moving towards the separation and end of all things known and loved. Being with a...
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Health care journalists have tendencies similar to those of doctors
As a patient who was asked to speak at the Association of Health Care Journalists 2012 conference, I felt a bit covert....
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Adaptation can be painful, but it can also be a gift
Nothing will force you to live life on your own terms faster than almost losing it. In 2008, I was on fire....
Policy
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What should America’s health care vision be?
America has this paradox of excellent biomedical science, innovative drug manufacturers and entrepreneurial device developers along with outstanding providers but at the...
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Hospitals around the world aim to remain relevant to patients
"It was the best of times, it was the worst of times ..." So begins a story called A Tale of Two...
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Repairing the tear in health care’s safety net with social media
The nation’s “safety net” hospitals are designed to ensure that uninsured, lower income and indigent populations receive adequate medical care – a...
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Look to technology to reduce health costs
Technology to lower costs rather than accelerate them. Smart phones to increase physician and other providers’ productivity. Fewer primary care physicians but...
Tech
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Mobile health apps don’t always follow conventional wisdom
Propaganda and non-truths abound all around the Internet saying that mobile health apps are everything from a threat to Big Pharma to...
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When patient care becomes secondary to filling out the medical record
The policeman was two cars in front of me. I meandered down the road cautiously adjusting my speed a few ticks above...
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Doctors, use Google to get more patients in less than 7 minutes
Every month, hundreds of thousands of people look for a doctor on Google. As an amazing practitioner, your site deserves to be...
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The user interface for EHRs should be uniform
The first thing I noticed when I walked into the physician’s office were the tall cabinets filled with manila folders, tabbed with...
Social Media
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We need to see the potential harm of social media
Prior to 1794, farms across the world could only pick cotton as fast as humanly possible. In the late 18th century, Eli Whitney...
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Why social media may not be worth it for doctors
Social media in healthcare is all the rage these days. You can’t visit even one physician-oriented website without someone breathlessly advising you...
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Transparency defines social media success for doctors
Want to understand social media? Physicians wanting to learn about social media must learn transparency. We must learn transparency on a personal...
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How Twitter was used in a potential mass casualty scenario
It was my first ER shift in charge of the resuscitation area. Needless to say, my adrenaline and nerves were firing like...
