In this day and age, with excellent rehabilitation care available for nearly every injury or illness—no matter how serious—it’s hard to believe that there are millions of people who leave the acute medical system far worse off than they entered it, and aren’t routinely offered rehab. I’m talking about cancer survivors-- a group of individuals known for their tremendous advocacy abilities. It’s no surprise that these folks are really starting ...
November 2011
All Stories
The art of Alzheimer’s disease
Physicians are not trained to interpret paintings, and most patients do not have a lifetime of artwork to analyze. However, a rare opportunity for both to occur is at the Museum of Modern Art’s exhibition de Kooning: A Retrospective.Wilem de Kooning, regarded as one of the most prolific American artists of the twentieth century, grounded himself in the Abstract Expression movement. The AbEx movement is widely associated and recognized with ...
The therapeutic value of touch in medicine
My wife has two world-class oncologists who help her manage her stage 4 lung cancer. Both are excellent clinicians. Yet their skills differ in one very important way. Her radiation oncologist physically touches her a lot (in a good way of course!). There are the touches on her arm, a hand on the shoulder, hugs, and of course a thorough hands-on physician exam. Her medical oncologist not so much.We all ...
When applications ask about your psychiatric history
Sam is young man is applying for a summer program, a real resume builder. Among other things, the application asks if he has been treated for a psychiatric disorder. In fact, he's seen a therapist and he's felt anxious at times. His internist gave him some Lexapro samples and he feels better. The symptoms of his problems have been limited to his own subjective distress. His anxiety is not something ...
Is it a crime that retainer physicians make more money?
Many readers know that I co-authored an Annals of Internal Medicine article on retainer medicine. The article has received (as expected) mixed reviews, because the concept causes angst for some physicians.I believe (and I will not speak in this rant for my co-author) that retainer medicine emerged because of the current payment system. Retainer medicine is a response to burnout. Yes, many retainer physicians are making more money. Is ...
Health IT has problems, but is worth the price
I started working with computers in medicine in 1963. I was a Captain in the United States Army Medical Corps in San Francisco when a Lieutenant Colonel told me to "automate the California Tumor Tissue Registry."I said, "Yes, Sir. How would I do that?" He told me to walk across the Presidio parking lot and go into a building that had a big machine in it that is called a ...
Why doctors need to be better negotiators
Pediatrician Rahul Parikh has a great piece in Salon, Why doctors can’t say no. You should go read it.In the piece, he cites a recent study showing that, in about 10 to 25% of cases, patients come into an office visit with an agenda, or something specific they request.It can be an antibiotic, x-ray or a scan, for ...
First world healthcare expectations in a third world country
I am a third world doctor.My patients have first world expectations.Somewhere in the middle, I end up working too hard and then going home feeling cheated. For I too have expectations. I am in a tension between the reality and my aspirations.In Jamaica, health care is free. Day after day, and night after night its freeness is confirmed, tested. But the system is inanimate. It doesn't feel its own failure, ...
5 reasons why physicians will love mobile health
1. Mobile health technology will increase patient engagement. Most patients do not take the responsibility they should for their own health. They are likely preoccupied with all the stresses of everyday life and might therefore take the ‘I feel good, so I must be’ approach. They possibly mutter these words after wiping their faces, hurriedly walking out of McDonald’s for lunch. Or is it because of mistrust of their physician ...
Problems with the Multiple-Mini Interview for medical school
Some medical schools have altered their admissions process by replacing the traditional applicant interview with the Multiple-Mini Interview (MMI). MMI resembles speed-dating: applicants rotate through numerous interview stations, where they act out scenarios and solve puzzles, sometimes alone and sometimes in groups. A July New York Times article presented a good overview of MMI, as implemented by Virginia Tech Carillon.As you might expect, schools that have adopted MMI (UCLA ...
Medical school is a fragmented, intimate experience
His face was four inches away from mine. I tried not to blink as he shined the ophthalmoscope’s light into my left eye and stared into my pupil as though it were the most interesting thing in the world. He frowned, placed his hand on my head, and used his thumb to pry my eyelid higher. He maneuvered for about 45 more seconds while I sat stone still, and then, suddenly, ...
10 ways doctors can lose their patients
As a neuropsychologist, I have the chance to talk to patients throughout the week in detail about their medical histories, supplemented by a comprehensive medical records review. Part of this involves discussing which provider the patient has seen and if the provider was changed, why. Sometimes, a provider is changed for a benign reason, such as a move or an insurance change but other times there are significant complaints. Granted, ...
Why this doctor moved to private practice
Chief of Medicine Evanston Hospital October 23, 2005To whom it may concern,I would like to take a moment to express my deep displeasure with one of the interactions I had with a physician in the Church Street location. I use the term "interaction" loosely since the doctor in question, Dr. Jordan, never actually saw me. Apparently he was too busy.Last Thursday I was shopping in downtown Evanston when I felt the sudden ...
Why the future of medicine is not looking too good
Question: What is the most important thing concerning residents finishing training and looking for a practice in 2011?a. Feeling of insufficient medical knowledge b. Health system reform c. Educational debt d. Availability of free time e. Dealing with patientsIf you said “d. Availability of free time,” you are either very perceptive and in tune with today’s young doctors or you read an article about this in American Medical News. According to survey ...
We are seeing more terminal patients being referred to hospice
At the University Hospital in Madison Wisconsin in 1938, a patient was dying from a very painful bone cancer which had produced fractures. The young interns knew that more morphine injections were needed but they feared they might be blamed for giving a lethal dose. So a tacit agreement was reached. Every hour or so,one of them would come into the patient's room and give a shot of morphine. This ...
Delta Air Lines goes anti-vaccine
I have many, many patients and their families who are very active travelers. Business flights, vacation trips … some of you really rack up the miles.It is with shock and disappointment that I must report; Delta Air Lines has made a very poor choice.An ad, produced by the National Vaccine Information Center (NVIC), is currently being shown to passengers on Delta flights through the month of November. The ad encourages ...
A disconnect between medical resources and health care delivery
Imagine what health care in the United States could look like if we devised a system that was based on sound medical practice and proven cost effectiveness. What if we put our brains, energies and passion behind designing the smartest health care system possible?That was the question that kept poking through my train of thought as I read a study that appeared in the most recent issue of Pediatrics, the ...
I will never be the physician that my father was
Let me start by saying that I love my father dearly. We have an excellent relationship, and talk regularly. So there’s no bitterness in this post, nor any desire to engage in armchair psychology.My father, now retired, was a general and thoracic surgeon, who was triple-boarded in critical care, and ran a trauma unit in inner-city Philadelphia. He was in private solo practice for most of his career. He worked ...
Grief takes no holidays
The glittering commercialism and noisy cheer of the holiday season can be stressful for any of us. But for the parent who’s lost a child during the past year, facing the first Thanksgiving and Christmas with an empty place at the table can make already unbearable grief so much worse.No one in modern America expects a child to die. Children only die in nineteenth century novels and third-world countries, or ...
Living with chronic illness during the holiday season
In the U.S., we’re getting ready to celebrate Thanksgiving. Soon, people around the world will turn their attention to the holiday season. Chronic health problems can take a toll on relationships any time of the year. Most people have to experience unrelenting pain or illness themselves before they understand how debilitating it is, physically and mentally. Loved-ones (by whom I mean family and close friends) may be in some form ...
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...
