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Doctors need to understand what it means to be a patient

by | in Education | 16 responses
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Shortness of breath. I felt it for the first time while running on June 21st, 2011. I had just been rejected from my first choice medical school a few days prior – post-interview, the worst. I took it as a personal affront. They didn’t like me, my personality. I wondered how I had come off – fake, phony, artificially enthusiastic maybe. Maybe they didn’t think I was up to their ...

Electronic records don’t tell us stories that make cognitive sense

by | in Tech | 29 responses
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One morning recently, I found another physician standing morosely at one of the mobile computer terminals we refer to as “cows”—computers on wheels—that are everywhere now in our hospital. I asked what was the matter.  “Oh nothing, really,” she said.  “It’s just that I don’t feel I know the patients as well as I used to.”I knew exactly what she meant.  Things are different now that we have the EMR---the ...

Teams are key to solving the American health care crisis

by | in Physician | 8 responses
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Solving the American health care system crisis is among the most complex and important challenges facing this generation. Is it possible to provide high quality care with better access at a more affordable cost? Is this problem solvable or simply to complicated?  Though that answer is not yet clear, what is increasingly apparent is that a new type leadership is needed if there is any hope in achieving this goal.Professor ...

Tough talk is sometimes needed for your referral source

by | in Physician | 7 responses
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All of us would like, whenever possible, to have a bilateral referral arrangement with our colleagues. Have you ever experienced a situation in which you are sending patients to another physician and receiving no reverse referrals? Of course, you can change your referral source, hoping that the other physician will notice that there is a decrease in referrals and will call you to ask what happened, but do not hold ...

Top stories in health and medicine this morning, May 10, 2012

by | in News | no responses
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This series is brought to you by MedPage Today.1. Cath Labs May No Longer Need Surgical Backup. Many of the restrictions put on cardiac catheterization laboratories that don't have on-site surgical backup are ready to be lifted.2. IUDs Effective as Emergency Contraception. Intrauterine devices (IUDs) seem to be an effective method of emergency contraception, with a failure rate of less than one ...

Engaging patients provides another layer of safety protection

by | in Physician | one response
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A recent New York Times article predicted that accountable care organizations (ACOs) and similar care consortiums will completely upend health care delivery in the United States by 2020. While that’s provocative speculation, physicians and other care providers practicing in population management entities do need to ramp up their ability to explain new health care delivery models to their patients. In doing so, they will want to pay particular attention to increased expectation ...

The Hollywood treatment of oncologists

by | in Physician | 6 responses
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The Hollywood treatment of oncologistsRecently, I passed my friend and colleague, Dr. Ekaterini Tsiapali, in the stairwell. We rarely get to catch up these days, so it was really quite a nice surprise to see her."What did you do this weekend?" I asked."I watched Wit, you know, the movie where Emma Thompson plays Dr. Vivian Bearing, a 50-year-old woman with terminal ovarian cancer? She's such ...

Being a physician is like trying to parent two thousand teenagers

by | in Physician | 35 responses
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I walked down the hospital corridor listlessly. My feet dragged as they fought each attempt to lift off the ground. My body was tired and achy. The phone calls the night before had been relentless. Each stolen moment of sleep was interrupted before a deep, restful state was reached. It was Monday morning.I sat at the nursing station flipping through charts. A colleague across the table was staring intently at ...

Sudden death makes a mockery of preventive medicine

by | in Physician | 9 responses
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Here today, gone tomorrow.  The older I get, the more often I get the call: “This is the ER at Any Hospital, can you hold for Dr. X?”  Dr. X then comes on the line and tells me my patient had a catastrophic event, that the paramedics and ER crew did everything possible but that the patient expired.My patient had no reason to die.  He was relatively young and healthy. ...

Top stories in health and medicine this morning, May 9, 2012

by | in News | no responses
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This series is brought to you by MedPage Today.1. Study Links Late Depression, Risk of Dementia. Depression that strikes for the first time in later life may be an early sign of Alzheimer's disease.2. Outcomes Worse for Inhospital Stent Thrombosis. Among patients who underwent primary percutaneous coronary intervention (PCI) for an ST-segment elevation MI (STEMI), outcomes were worse if stent thrombosis occurred ...

Repairing the tear in health care’s safety net with social media

by | in Policy | one response
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The nation’s “safety net” hospitals are designed to ensure that uninsured, lower income and indigent populations receive adequate medical care – a noble and necessary function within the U.S. healthcare system.  No one dedicated to the field of care giving can deny the importance of providing appropriate medical care for this population.  The safety net is literally a lifeline for many in need.But for all of the vital and positive ...

Death with dignity in the emergency department

by | in Physician | 18 responses
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The ambulance crew rolled him into my ER breathless in his pajamas, O2 mask on his face, gasping for air, his short cropped hair a mess, standing straight up. Eugene was what the staff called a "frequent flyer." As the nurse injected some IV Lasix I reviewed his chart to find a classic downward spiral.It was a busy evening. The bays were full of the usual cuts, broken bones and ...

Corruption of the medical literature is impossible to prevent

by | in Physician | 3 responses
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Medicine improves regularly. Our tests, our surgeries, our medicines are better now than they were 10 years ago. The main driver of this improvement is the scientific method. Using this, the worse is discarded and the better retained. Doctors have to work hard to keep up with the progress. They rely on impartial and accurate information transmitted by articles, reviews, and CME material in order to advise and treat their ...

A shock and recall plan for ICD patients

by | in Conditions | no responses
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Much has been written about the positive benefits of communication between patient and physician. Today, in the increasingly time-pressured medical work environment, physicians are pushed to see more patients in less time. Patients are moved thru clinics as if on an assembly line. There are fewer opportunities for conversation and many patients and providers never really get to know each other on a “human” and interpersonal level. Care often suffers ...

Top stories in health and medicine this morning, May 8, 2012

by | in News | no responses
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This series is brought to you by MedPage Today.1. Breast Cancer Deadlier for Men. Relatively few men develop breast cancer, but survival lags for those who do compared with women.2. Mandates Boost Vaccine Coverage in 'Tweens. Mandatory vaccination for entry to middle school appears to increase vaccine coverage among students.3. Sudden Death in Athletes: Debate Continues. Relying on media reports ...

Look to technology to reduce health costs

by | in Policy | 3 responses
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Technology to lower costs rather than accelerate them. Smart phones to increase physician and other providers’ productivity. Fewer primary care physicians but more involvement by nurse practioneers and others. And increasing appreciation of the value of integrative medicine. These are but a few of the disruptive changes in care delivery that are coming.I have posted concepts on how the health care delivery system will change in coming years – quite ...

Embracing the longing without the outcome

by | in Patient | 7 responses
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I’m not sure when I stopped missing my husband. I suppose familiarity crept in after 7 years together and I rarely felt the pining, agitated pain of separation that I relished in the early days of our passionate love.Running our restaurant from waking to sleep, 6 days a week meant that we were rarely apart. So JP had become as familiar to me as my 4 limbs, an essential part ...

Minimize reactance in your health organization

by | in Patient | one response
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Can you say “reactance”?  Don’t feel bad, I wasn’t familiar with the term either until recently.  But as you will see, anyone that has ever been a patient will catch on pretty quickly as to what reactance is and how it works.Reactance is how we respond to something that threatens to limit or eliminate our behavioral freedom.  I recently experienced reactance in the course of “prepping” for a colonoscopy.   The ...

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