Scientist J. Robert Oppenheimer once said, "There are children playing in the streets who could solve some of my top problems in physics, because they have modes of sensory perception that I lost long ago." Like physics, medicine has its share of problems, namely cost control. Like children, we must open our perception to the problem of cost control to consider other possibilities that better account for the issue than the theories ...

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There is much talk about cynicism in medicine, and I remember being confronted by it almost from the beginning. In fact, I still remember how shocked I was the first time I heard a provider describe a patient in a disparaging matter. We were responding to a 911 call regarding a woman in her 30s who was feeling short of breath. I remember being worried; she seemed too young to be ...

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I have a patient who is a full blown sufferer of health anxiety. He firmly believes he has full-blown AIDS after a single extramarital sexual contact (non-genital) one month prior with a woman not known to have HIV. (Reality check: The other person didn’t have HIV, the specific contact as described was ridiculously unlikely to have transmitted the virus had it been present, and AIDS takes months to years to develop ...

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Patient appreciation: Why I still love being a doctor Judging from recent articlessurveys, and blog posts, the medical profession is remarkably demoralized. Typical complaints range from “feeling like a beaten dog” to “living in humiliating servitude,” to being forced to practice “treadmill medicine.” Interestingly, the public response to these complaints is largely indifferent. The prevailing attitude (if the comments sections of online articles and blog posts are representative) seems ...

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She was nearing the end of a long and interesting life. Her birth was announced on the party line in her rural community’s first telephone system. Her death, which would come soon, would be shared on Facebook and via cell phone. She had graduated with a degree in home economics from the University of Minnesota in 1938 and had worked for a meat packing company during and after World War ...

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Top stories in health and medicine, September 22, 2014From MedPage Today:

  1. UN: Ebola 'Threat to Security'. The West Africa Ebola epidemic is a threat to international peace and security, the United Nations Security Council decided.
  2. Surgical Training Can Be Fun and Games. Make simulation training like a game and surgical residents will want to play, researchers reported in a letter ...

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Mrs. D was my last patient. I retired several months ago, and for some time prior I informed my patients so as to give them time to decide where they would like their follow-up care. Mrs. D was an elderly lady who I first met in the ER several years prior after a fall resulting in a displaced ankle fracture. She was pleasant and alert, understanding everything I was explaining after ...

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88.2% of all statistics are made up on the spot. - Victor Reeves There’s a growing movement in medicine in general and imaging in particular which wishes to attach a number to everything. It no longer suffices to say, “You’re at moderate risk for pulmonary embolism (PE).” We must quantify our qualification. Either by an interval: “Your chances of PE are between 15 and 45%.” Or, preferably, a point estimate: “You have a 15% chance ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 69-year-old woman is evaluated for a lump under her arm found on self-examination. She is otherwise healthy and has no other symptoms. Medical and family histories are unremarkable, and she takes no medications. On physical examination, temperature is 37.4 °C (99.3 °F), blood pressure is 110/70 mm Hg, pulse rate is 72/min, ...

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Once again government regulators have put in place well-meaning rules without anticipating the consequences. We all hate sitting around in the emergency department waiting to be seen and to be treated. On October 15, 2014 as part of the new Affordable Health Care Act and the patient satisfaction portion, hospital ERs will have about 180 minutes from the time you arrive and sign in to evaluate you , treat you ...

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Who are the best judges of physician quality? In a new Forbes article, David Shaywitz ponders whether patients are the best judges of physician quality. This is a very interesting question, not because the answer is elusive, but because the question itself is rather unusual, and may prove to be the harbinger of a new way of thinking about health care. The question raised by Dr. Shaywitz is not whether patients ...

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Just the other day I received a somewhat anxious-sounding phone message from a patient of mine, approximately 72 hours after her office visit with me, and about 24 hours after I had already gone over all of her lab results from the visit with her. She sounded quite distressed, and said she'd received a message from someone, but could not really understand what they were saying. She said she was finally ...

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We were intimate. As intimate as a doctor and patient can become.  He had long outlived his wife and there were no children, no family, just friends.  When he first came to me he was lively and active, but the years took their toll.  Our visits became more regular.  Every six months.  Then every three. His memory started to slip.  Occasionally he would look at me suspiciously when something went wrong.  His ...

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Dr. Daniela Drake writes an provocative and bold piece on the plight of doctors in America and the impact it has on patient care: "Why Your Doctor Feels Like a ‘Beaten Dog’." Though health care is very bureaucratic with administrative paperwork, huddles, and hassles, her linkage of how patients were neglected as a consequence of the system doctors work in is weak. She talks about Victoria, a teenager, who ...

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Is your doctor a hammer and you're a nail? Here's some insider advice coaxing patients to be more wary and skeptical of medical advice. Should you trust your doctor? Absolutely. But you need to serve as a spirited advocate for your own health or bring one with you. Ask your physician for the evidence. Sometimes, his medical advice may result more from judgement and experience as there may not be ...

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Ebola virus is rampant in West Africa. So far, the death toll is around 2,296, which makes it one of the largest outbreaks ever. Ebola is what’s known as a hemorrhagic fever virus, and belongs to a large family of nasty viruses that are widespread around the world. There’s even one in the American Southwest known as hantavirus, that lives in a species of mice. Yellow fever, which killed so ...

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We speak of everyday decisions in terms of cost-benefit analyses. Many of our patients can’t afford a healthy meal, let alone a hefty hospital bill, thus making cost awareness increasingly relevant. But on the day that I met Mr. R., it wasn’t the financial aspects of his care that concerned me. I was thinking about the patient, his family, and two roads diverged in a hospital ward. I was thinking ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 72-year-old woman is evaluated in the emergency department for loss of consciousness. Her son, who brought her in, says she seemed confused and agitated when he spoke to her on the telephone less than 2 hours ago. The patient has an 8-year history of type 2 diabetes mellitus. She had strict ...

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Urgent care wont replace primary care. Heres why. About seven years ago, the California Healthcare Roundtable and Health Affairs sat down to prepare a white paper on the emerging phenomenon of urgent care centers, and what it might mean for primary care. At the time the group couldn’t agree that urgent care (UC) was a disruptive innovation, but it seemed clear to all participants that it represented a threat to primary care: ...

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This is the story.  Ebola emerged in 1976 and the last major outbreak occurred in 2007 in Uganda and D.R. Congo. Now we are experiencing the largest outbreak of Ebola ever seen with a death toll of 1,848 and number of infected of 3,707, but these are only the “confirmed” cases. Ebola is affecting 4 countries in West Africa: Guinea, Liberia, Nigeria and Serra Lione, and while we have only seen ...

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