I recently talked about how we might approach the idea of our own death. I wanted to start a discussion about how individuals engage with, think about and plan for the end of their life. In offering a medical perspective on what death is like, I hoped to stimulate self-reflection about this scary and foreign topic. However, when we think about death, we don’t just think about our own ...

Read more...

Dear Mr. Will, I read your recent column on the “supposed campus epidemic of rape, a.k.a. sexual assault” and am somewhat taken aback by your claim that forcing colleges to take a tougher stand on sexual assault somehow translates into a modern version of The Crucible that replaces witchcraft with rape hysteria. I was specifically moved to write to you because the rape scenario that you describe somewhat incredulously is not unfamiliar to me. ...

Read more...

While rotating through the local Veterans Affairs (VA) hospital during my residency in radiology, I noticed a curious phenomenon. When the weather was pleasant a large number of veterans would not show up for their scheduled CT scan or MRI. When the weather was miserable or dangerous the attendance would be maximum. We named this phenomenon the "VA paradox": a paradox because this is the opposite of what usually happens. After deeper ...

Read more...

It's a cold and rainy morning, and we've traveled to the middle of Central Pennsylvania to see a presentation at a conference about a patient-centered medical home product produced by one of the largest health care systems and insurers of the region. There are clinicians and administrators from all over the eastern half of the U.S. (plus one from California), and also a large contingent visiting from the U.K., on a ...

Read more...

In my line of work, it's not uncommon for a civil debate about the evidence for a cancer screening test (such as the PSA test for prostate cancer) to rapidly degenerate into the other person questioning my motives or suggesting that the real reason I oppose disseminating or requiring insurers to pay for a test is because I secretly want patients to suffer lingering and painful deaths. ("He obviously doesn't care about ...

Read more...

I have a love-hate relationship with practice guidelines. Love because it is often helpful to refer to a set of evidence-based recommendations as part of clinical decision-making; hate because of all of the shortcomings of the guidelines themselves, as well as the evidence upon which they are based. A recent piece in JAMA and the editorial that 
Read more...

shutterstock_136156817 I got a letter the other day from a local urologist requesting clearance for a patient of mine to have surgery.  The doctor wanted to know whether there were any contraindications, from the standpoint of the patient’s cancer, such as bleeding, infection or poor wound healing, which would preclude local anesthesia, bilateral incisions, sharp separation, ligation, and electrocauterization of the vasa ...

Read more...

It was a sunny spring day as the bus turned the corner. It was a yellow school bus filled with young children jumping up and down in their seats. It was an average day in an average school year. Nothing about it stood out. Let’s take a closer look. The boy sitting in the front of the bus holding tightly to his lunch box is named William. His clothes are tattered ...

Read more...

Tom Insel, director of the National Institute of Mental Health (NIMH) in his recent blog post, "Are Children Overmedicated?" seems to suggest that perhaps more medication is in order. Comparing mental illness in children to food allergies, he dismisses the "usual" explanations given for the increase prescribing of medication.  In his view these explanations are; blaming psychiatrists who are too busy to provide therapy, parents who are too busy ...

Read more...

In an article entitled, ”Why the ER admits too many patients,” Dr. Michael Kirsch tries to explain that emergency department admissions are inflated due to emergency physicians acting in their own self-interest.  Many emergency physicians have read this and taken offense, feeling that his assertions point unfair blame on them for a significant portion of excesses in medical care and costs.  I share this visceral reaction in part, but ...

Read more...

Most Popular