It didn’t seem like my college-age patient Quincy had any idea what was in store when I entered the exam room. “Hi Dr. Rifkin,” he said with a warm smile as I sat next to him. Quincy (not his real name) had been my pediatric patient for years. I didn’t delay. “Hi Quincy. I’m afraid I have some terrible news. Your lab work came back -- you’re HIV-positive.” His head went back slightly. ...

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Four months ago, a 44-year-old woman was referred to me by her audiologist and ENT for acute deafness of the right ear. She is a healthy woman without any past medical history and was not on any medication. Her otolaryngologist (ENT) could not find any physical reason for the patient’s acute unilateral deafness, including a negative CT scan. She was being referred to me to determine if there was an ...

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The policy known as meaningful use was designed to ensure that clinicians and hospitals actually used the computers they bought with the help of government subsidies. In the last few months, though, it has become clear that the policy is failing. Moreover, the federal office that administers it is losing leaders faster than American Idol is losing viewers. Because I believe that meaningful use is now doing more harm than good, I ...

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Since the first day of medical school, I was in breathless anticipation of my third year. I came to Harvard with a background in creative writing and the big draw of medicine for me lay in its compendium of human stories. In college, I volunteered at local hospitals where my primary responsibility was to go knock on patients’ doors and keep them company for a little while. This was awesome. Few ...

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Close to midnight and Tonya is somnolent, lying on an emergency department (ED) stretcher and not in her own bed at home. The change in location alters the fairy tale quality of the word somnolent from sleepy or drowsy to one that's more sinister and worrisome. Especially when Tonya is dying of brain cancer, a single mother of thirty-four, a hospice patient now situated in the ED; a space powered by a ...

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What will future of medicine look like? Start here.What will future of medicine look like? Start here. Excerpts from The Guide to the Future of Medicine. Enormous technological changes are heading our way. If they hit us unprepared, which we are now, they will wash away the medical system we know and leave it a purely technology–based service without personal interaction. Such a complicated system should not ...

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“To help other people overcome their injuries.” This mantra was accompanied by flushed faces, hidden trembling hands, and nervous chuckles as the majority of my peers told the class why they decided to pursue physical therapy as a career. Soon thereafter, this adage was lost as we dived into our studies, learning every bone, muscle, and organ. Focusing on the human body is a must for all healthcare professionals, and PTs ...

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To me, Medicaid is Obamacare’s sleeping giant -- the enabler of federal power and control over the health system. It is a far more powerful enabler than health exchanges, which have gotten most of the publicity. It surpasses the number of uninsured and underinsured that the exchanges have enrolled. In the next year, four million more Americans will joing Medicaid’s rolls. It already covers one third of America’s uninsured. Under Obamacare, ...

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You -- a medical student, resident physician or newly-minted medical attending -- are late in the game.  Sure, you appropriately hopped onto Facebook during your first few years of college, only to rightly disengage around the advent of newsfeeds and cover photos.  You passively signed up to LinkedIn last winter only to remain passively aware that your profile exists unfettered and un-updated in the inter-web ether. Despite this predictable navigation into online ...

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When I started my internal medicine residency, I was pretty sure I was going to rock this primary care thing. I knew the drugs for hypertension, the guidelines for diabetes management, and depression management seemed like nothing more than an algorithm. I felt buoyed by familiarity as I looked at the problem list for my first primary care patient: basically diabetes, hypertension, and depression. As I opened the exam room door that early July day, I ...

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Here is the attitude of ER physicians: "Here are a few pills to hold you out for one or two days. Follow up with your PCP -- he or she should be managing your chronic pain -- not me. Now get out of my ER!" Here is the attitude of PCPs: "I simply don't have the time or expertise to manage chronic pain patients. Let's refer you to pain management. Need ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 40-year-old woman is evaluated for a rash on her hands that has been present for 6 weeks. This rash comes and goes throughout the year and has been present for many years, but never as severe as it is now. She also experiences itchy skin on her body. She had eczema ...

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Dear Dr. Oz, I know the #OzsInBox question on Twitter didn’t exactly go the way you or your social media team expected.You told Sen. McCaskill when she asked you about the so-called miracles and medically baseless products that you promote on your show that you view yourself as a cheerleader, but consider #OzsInBox a wake-up call that doctors (or at least the ones who don’t want to appear on your ...

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The term "Golden Age" seemed to permeate multiple domains in the 1950s, almost to the point of triteness. The field of cardiac surgery, however, deservedly earned the term as pioneer after pioneer introduced innovation after innovation that advanced the specialty. Walter Lillehei in Minnesotta, Wilfred Gordon Bigelow in Toronto, William Chardack in Buffalo, and Ake Senning in Stockholm were just some of the trailblazers of that era. The four surgeons also shared ...

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I have to thank my colleague @SusannahFox for alerting me to this on my Twitter stream. It was a link to a Washington Post article about about a campaign to get people in Belgium to stop Googling their symptoms.

 
Wake up health care: Patients Google it
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Last year, Dean Dupuy, 46, an engineer at Apple, suddenly died of a heart attack while playing hockey. He experienced no warning symptoms and, with a healthy, active lifestyle, did not fit the profile of someone at risk. Too late to save him, Dupuy’s wife Victoria discovered that early coronary disease can be identified by simple CT scans. She recently launched a nonprofit organization, No More Broken Hearts, in San ...

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We like to say good things; we try to make normative to our profession to do the things that should be done. Many of us are saying that physicians should be advocates for their patients and communities outside of the clinic. Sounds good right? Unfortunately, what sounds good is not always a reality on the ground. I think most physicians agree that some from of advocacy for patients outside the clinic ...

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With the growing usage of EHRs, more and more doctors are bringing their computers and tablets with them into the exam room. But just because you’re using a computer in the exam room, it doesn’t mean that you’re using it properly. Computers can be one of the most beneficial tools you use in an exam room, or they can lead to deteriorating patient engagement. Make sure you don’t make any ...

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Top stories in health and medicine, November 21, 2014From MedPage Today:

  1. Clinical Focus in MS: Novel Approaches to Progressive Disease. Although the drug development pipeline still contains numerous products intended for patients with relapsing-remitting multiple sclerosis (RRMS), the consensus among clinicians is that relapses can be effectively squelched in nearly all RRMS patients with the dozen or so currently approved therapies.

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I’ve previously written about my experience with poorly designed electronic health records and how it negatively impacts provider happiness and patient safety.  Apparently, I’m not alone in my experiences and my sentiments about this subject. First, we have a study that validates the concern that EHRs waste time for doctors.  Imagine the impact for primary care physicians who are already crammed for time, seeing patients in short time intervals just to keep ...

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