“I don’t need no doctor, ‘cause I know what’s ailing me. He gave me a medicated lotion But it didn't soothe my emotion” -John MayerIf someone asked you to draw your image of medicine, what would you sketch? Would it be a person wearing a long white coat with a stethescope? Would your picture be set in a hospital room, the ER or the office setting? Would there be any patients ...
October 2011
All Stories
MKSAP: 68-year-old man with a sensation of dryness in his eyes
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.A 68-year-old man is evaluated for a 6-month history of a sensation of dryness in his eyes. He notes that it feels as though there is sand in his eyes.On physical examination, the eyes are red, and trichiasis (ingrown eyelashes) and symblepharon (adhesions of the ...
The safety of approved drugs needs to be closely watched
Over the past decade or so, there have been at least 20 prescription drugs removed from the market, including several cases of high-profile blockbuster drugs that were found to be harmful only after millions of patients had taken them. Vioxx, the pain reliever sold by Merck is one example; taken by an estimated 20 million Americans, it increased the risk of heart attack and stroke in some patients. The company ...
Dear future practicing physician, choose primary care
Dear future practicing physician,Choose primary care. I know all around you there are pressures to choose to become a specialist. I remember those pressures well. In medical school, one of my favorite mentors was predicting that after I got a taste of primary care, I would “come crawling back” to him. I still chuckle about that conversation to this day. In residency, I remember several seminars for us built ...
The problem with round the clock hospitalist coverage
Two recent articles, one from the New York Times, the other from The Hospitalist, initiated some 24/7 staffing issue rumination on my behalf. It stems originally from a recent op-ed by Lucian Leape: "Given the accrediting council’s reluctance to act, the federal government needs to get tougher. If we are serious about curbing the tide of injuries stemming from medical errors, Medicare should make its funding of graduate ...
Makes you want to pull your hair out: Treating trichotillomania
One of the saddest, but more treatable, causes of hair loss in patients is trichotillomania, the impulse control disorder in which a person repeatedly pulls out hair from their body for non-cosmetic reasons. While some people have never even heard of trichotillomania, according to the Trichotillomania Learning Center, as many as ten million Americans (or 4% of the U.S. population) suffer from the disorder.According to the Diagnositic and Statistical Manual ...
How can pharma earn the trust of patients?
Never in recorded history have Americans been more distrustful of how the U.S. government spends its money. According to Gallup poll, Americans on average say that the federal government wastes 51 cents of every tax dollar, the highest level ever recorded since the poll was first taken in 1979. DTC marketers should understand that this mistrust is also leading to mistrust of marketing and advertising as well as big ...
Physicians should embrace patient engagement
The doctor/patient relationship is certainly changing and evolving. A term I hear a lot today is: “patient engagement/activation.” Why is this concept so important and what does it mean? What can physician executives do to make it easier for our patients to become engaged and activated?Judith Hibbard has pioneered the study of patient engagement, and she noted that one needs knowledge, skills, and emotional support to actively engage in one’s ...
Why doctors should be careful on Twitter
Doctor, do you Tweet?No, not really. I registered on Twitter some years ago and began but did not keep it up, although I do have a number of Twitter followers. When I first checked Twitter out, the dominant drivel of narcissists pretty much turned me off.Were you also slow to start using the Internet?No, I quickly recognized a huge upside to a well-utilized Internet, so we were very early ...
Why haven’t surgeons been on the front line of public health?
Public health has often focused on prevention tools that impact an entire community or population. Before Henry Bigelow MD described the use of Ether in 1846 to mitigate pain during surgery or Joseph Lister MD discovered the value of sterile technique, surgical candidates were few. Even if one were convinced tolerate the pain of surgery, more than half would die from the risk of infection. For most of surgical ...
The difference between male and female patients
It's never so obvious to me that there's a big essential difference between men and women as when we take a family trip to Target.First, when you're holding a small baby or even an older baby or even a preschooler, you get a lot of attention. People love to look at small babies. And by "people," I mean "women" only. When I walk around with the baby, women are constantly ...
Why radiology is the cornerstone of any hospital
Radiology is the cornerstone of any hospital. An efficient, high-quality, well-run radiology department increases patient satisfaction as a result of its ability to improve patient care. Over time, a well-run radiology department adds significant patient volumes to the hospital, which, of course, favorably enhances the hospital's bottom line. Regardless of whether the hospital is not-for-profit or for-profit, a smooth-sailing radiology department vastly increases the profitability of the hospital. The ...
Use social media to spread the family medicine revolution
It’s not easy trying to describe the importance of family medicine in 140 characters. Just a few months after I logged on to Twitter for the first time, I joined the "family medicine revolution," known as #FMrevolution on the social networking site. My friends immediately noticed a marked change in my tweets. "FM revolution?" they’d say. "Is pop radio making a comeback?" If you’ve turned on a stereo lately, you ...
Why nursing homes need more doctors on site
The recent New England Journal of Medicine article, highlighting burdensome healthcare transitions in a subset of nursing home patients, is certainly of documentary value. However, for many of us with real-world experience in the nursing home medical care venue, the article certainly falls short of newsworthy. Not even mildly surprising really.Too many of our nation’s nursing home staffs suffer from a lack of onsite MDs for evaluating acute ...
It’s time for a VBAC court
We understand the problem: the VBAC (vaginal birth after cesarean) rate is too low. It's time for a bold solution. We need a "VBAC Court."VBAC is a safe option for most women, and almost 3/4 of women who opt a VBAC will deliver vaginally and avoid another C-section. But we also know that approximately 0.8% of women attempting VBAC will end up with a ruptured uterus, a catastrophic complication ...
Sexual harassment in the medical workplace
Sexual harassment in the workplace is an important topic to discuss, one that is all too often swept under the rug. I recently had an uncomfortable encounter with a clinician in the doctor’s lounge – I work at many hospitals so think I can say this pretty anonymously. He introduced himself, and asked me immediately if I was married. The way he did it – body language and demeanor, mostly ...
The limitation of blogging about patients
Running a medical blog has become much more challenging over the years. It has always been understood by medical and health care bloggers that you should never post information that violates a patient’s privacy. In other words, do not post patient’s names, photographs of patients, or any other information that can specifically be used to identify them.However, changing patient demographics and limiting the information discussed such that the patient ...
The art of practicing template medicine
The art of practicing medicine is dying, soon to be replaced by the art of template medicine.Modern medicine is based on laudable terms: "quality," "outcomes," "cost effective," and "evidence based medicine," which all sound good when sold in infomercials to the medical world and public. When examined closely, all are vague and open to abuse.Each of these terms is intent on taking the human factor out of medicine. Each ...
A covenant between doctor and patient
I mean it is kind of lonely being your doctor. I picture it as sort of a covenant. Between you and I.On one side you. And your family. And friends. Your house and your dogs. Your communities and lives.On the other side me. Alone. Of course there is always the hospital, but were really not friends. My partners and specialists. They all make an appearance. But when the going gets ...
Tort reform and integrated systems in health reform
Here are my next two principles of affordable healthcare reform.First, healthcare reform cannot occur without tort reform. Anything less is akin to a drunk leaning up against a lamppost for support but insisting it is for illumination.It is well known that fear of malpractice suits accounts for defensive medicine; e.g., performing tests and procedures and making unnecessary referrals to assure staying out of the court room. We are all ...
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....
