Month: March 2012

Why full code should not be the default status for patients

Physician
March 30, 2012

Full code is the universal default status for patients who haven’t chosen otherwise, but I suspect most physicians believe this policy is wrong. We know in our hearts we’re doing harm when we perform CPR on poor souls at the natural end of their lives, whose bodies can do nothing more than suffer.

Appropriately timed end-of-life discussions are the supposed answer, but for doctors, they are emotionally draining, interpersonally complex, and …

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Honesty is the basis of communicating with patients

Physician
March 27, 2012

I recently came across two articles in the press concerning doctor-patient relationships and communication. I began to reflect on what makes communication between doctor and patient most successful and many questions surfaced.

In the New York Times, a new study published in Annals of Internal Medicine was referenced. In this study, the way in which doctors communicate non-verbally was examined. Non-verbal communication was often discordant to the message being relayed, particularly …

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MKSAP: 32-year-old man is disoriented, combative, and agitated

Conditions
March 25, 2012

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 32-year-old man is brought to the emergency department after becoming disoriented, combative, and agitated earlier that day. He is accompanied by a friend, who states that the patient has a history of alcohol and drug abuse, including inhalants.

On physical examination, the patient is uncooperative and …

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Mexico needs more pediatricians

Physician
March 21, 2012

Being a child in 21st century Mexico utterly differs from any other era. The last decade has been a constant whirlpool for Mexico. Political, cultural and economical changes have shaken the country to its core. Primary care physicians, particularly pediatricians, have a burdensome challenge at hand.

Problems like obesity have quickly emerged in all age groups. Obese children, childhood type 2 diabetes and sedentary lifestyles have invaded Mexican homes. Nutrition related customs …

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10 strategic questions to ask yourself about the future of health care

Policy
March 19, 2012

Today and for the next few years the weather of this industry will be dominated by pervasive, discontinuous change. Structures, revenue streams, relationships of every level: All are shifting in fundamental ways. Specifically, the weather will be driven by:

i) invention and propagation of new business models;
ii) shifting risk onto both the provider and the patient, accompanied by building of new risk-based relationships, contracts and alliances;
iii) smart primary care coming to …

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Why this pediatrician quit medicine

Policy
March 17, 2012

There are an awful lot of reasons that led up to my eventual resignation from a career in primary care medicine.  I don’t know that any one of them is more important than the other (it really just depends on which day you ask me).  One that stands out for me though as a universal problem shared by millions is Managed Health Care, and the imposition it has posed on …

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Heed the 4th year medical student spoils

Education
March 16, 2012

Looking back on the first three years of medical school, it’s hard to imagine living through the endless days of studying again. Weekends were spent cooped up in the library and there were countless holidays that I wasn’t able to spend with my family. Instead, they were spent memorizing indecent aspects of the human anatomy and performing DREs on strangers. There are better ways to get to know a person …

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Will Peyton Manning ever fully recover from his spinal nerve injury?

Conditions
March 15, 2012

Does muscle weakness improve after disc surgery?

For an NFL fan arguably the best thing that could happen to your team is to sign Peyton Manning and have him perform at or near his pre-injury level.  The corollary is that one of the worst things to happen to your team would be to take a huge salary cap hit to get a Peyton Manning with such weak throwing arm that even …

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How to prep for a successful colonoscopy

Conditions
March 9, 2012

If you really want to know what’s going on inside your colon, don’t show-up for a colonoscopy without a clean colon.

Many say that preparing for the colonoscopy is the worst part of the entire exam. But, it just so happens that it’s also the most important part.

If the prep is done right, it’s easier for your doctor to see not only big polyps but also flat polyps, which can be …

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Does leaving against medical advice stick patients with a bill?

Physician
March 8, 2012

(All names and identifying features of characters in this story have been changed.)

Nora, a third year medical student, came to me in moral distress.

Ms. DiFazio, one of the hospitalized patients on her internal medicine rotation, was frightened to undergo an invasive (and expensive) medical procedure: cardiac catheterization.

The first year doctor with whom Nora was paired, Dr. White, vented to her:

“These patients come to us seeking our help and then refuse …

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How working as a scribe prepared me for medical school

Education
March 7, 2012

After undergrad, and before starting medical school, I worked for two years as scribe in the emergency department. I followed emergency physicians and completed their charts as they saw patients. I would also remind the physicians of various tasks to complete, alert them of abnormal lab values and pull up x-rays to be interpreted.

One of the reasons I wanted the job was to gain experience in medicine, first as a …

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Denying payment for unnecessary emergency room visits

Policy
March 5, 2012

Just when American healthcare system seems so dysfunctional that it seems impossible to imagine how it could be screwed up further, a decision is made that restores one’s faith in the creativity of Man.  But before you run out of guesses as to which particular decision we’re talking about today, we’ll just blurt it out.  We are referring to a recent decision by Washington State Medicaid to deny payment for …

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Is it necessary for a doctor to examine you on each visit?

Physician
March 5, 2012

A tug-of-war is going on in medicine right now between the past and the future. The present is confused and very unsure of itself.

Though I could be writing about health care in the U.S and the looming Supreme Court battle over the new health care law, I’m actually raising a much more intimate issue: Whether your doctor touches (examines) you or not.

Many pundits have weighed in on whether the …

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Are anesthesiologists the last true generalists?

Physician
March 3, 2012

There’s been a great divide between the medical and surgical specialties ever since I can remember.   Surgeons believe internists perseverate too much when decisions need to be made.  Internists consider themselves the true intellectuals of medicine.  I suppose anesthesiologists like me fall somewhere in the middle–we work in surgery, but have to take care of all the medical problems the patient brings to the OR table.  Does that make us …

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Residency interview tips from a Chief Resident

Education
March 2, 2012

I never realized before how much work goes on behind the scenes to prepare and conduct these interview days, but I sure do now. As a Chief Resident, I schedule residents to attend the applicant dinners, lunches, and tours, and to spend time with the applicants our lounge. This makes the actual interview days go by much smoother, because two of us are present at all times to speak to applicants and answer any …

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A sick care system instead of a health care system

Policy
March 1, 2012

An excerpt from The Future of Health Care Delivery.

We Americans like to pride ourselves on having the best health care system in the world, but unfortunately that is not the case. We have a medical (that is, sick) care system—a system that waits until we become ill before it kicks into action—instead of a health care system focused on helping us stay healthy. We give lip service to prevention and, …

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