Your electronic health record may lack vital information Your electronic health record may lack vital information A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com. When you walk into any physician’s office or hospital, computers are everywhere.  By 2013, nearly 70 percent of hospitals had moved away from paper charts and toward electronic health records, or EHRs, and more are making the change ...

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There is abundant evidence for malaise in the physician workforce, but little agreement about etiology, treatment options, or prognosis.  As a senior physician who still has a lot of involvement with physicians of all ages, I want to propose an etiologic framework. Perhaps if we agree on etiology, we can look at treatment options. There are three ways to look at what doctors do: the artisanal, the economic, and the scientific. The ...

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I was recently injecting anesthetic into a boil for incision and drainage. The abscess swelled and returned an arcing spray of lidocaine laden with blood and pus, soaking the thigh of my cotton scrub pants. A cheap plastic gown would have protected me -- I usually wear one. But I couldn’t find one and had other tasks waiting. My mind went to Ebola and exposed nurse necks. What if this were ...

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We always want to get it right the first time when treating patients, but the truth is this is difficult. When there is uncertainty of disease course and prognosis, multiple treatment options, and variable responses to therapy this becomes even more challenging.  Our typical strategy to making it “just right” isn’t too different from Goldilocks. We have mild treatments (too cold), and aggressive treatments (too hot), and even in the ...

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A medical student diagnosed with cancer Ironically, we had just finished our endocrine unit when I noticed a lump in my neck. Perhaps school had made me more vigilant, or perhaps I merely fell into the realm of hypochondriac medical student, but I couldn’t ignore this lump. I set up an appointment with my doctor fully expecting a diagnosis of medical student neuroticism. Instead she agreed that it was ...

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Cheryl loved to dance.  There wasn't a time in our house when the the kids weren't jumping up and down on the furniture, the radio blasting, and her body swaying in rhythm.  Ironically, we were dancing when it happened.  It was her fortieth birthday.  The kids laughed and clapped as I dipped her dramatically and she sprung back into my arms.  And then she crumpled.  Tony, my youngest, giggled hysterically ...

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The 75 Plan: Thoughts on Ezekiel Emanuels palliative care article When teaching about life near dying, it is hard to achieve open conversation.  No matter what one says in a lecture hall or what brilliant writers publish on the terrible state of end-of-life care, change is painfully slow.  While we blame evasion by doctors of challenging conversations, failure by patients to plan or denial by families which blocks open communication, the ...

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We’ve come a long way, baby. Eighty five years ago (October 18, 1929) women were declared "persons" in Canada. On that day women in Canada became eligible to be appointed to the Canadian Senate, which up to that time, had been the sole dominion of men because women were not deemed "persons" under the law.  Five Alberta women, Emily Murphy, Irene Parlby, Louise McKinney, Henrietta Muir Edwards and Nellie Mcclung declared a ...

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Medicare punishes hospitals for taking care of poor people Such a no-brainer: If patients who receive care at hospital A are more likely to get readmitted to the hospital 10, 20 or 30 days after discharge than patients in hospital B, then hospital A must be doing something wrong. Perhaps clinicians at that hospital are less adept at diagnosing and managing patients’ problems. Perhaps the follow-up care at hospital A ...

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Recently, Dr. Peter Kramer published an intriguing, well-written, but poorly reasoned and potentially dangerous “thought piece” in the New York Times. His article, “Why Doctors Need Stories,” contains several logical flaws and erroneous arguments, but the overarching concept is a classic straw man argument. He creates a false and highly misleading notion of what evidence-based medicine ...

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In September, Doximity, a closed online community of over 300,000 physicians, released its ratings of residency programs in nearly every specialty. Many, including me, took issue with the methodology. Emergency medicine societies met with Doximity's co-founder over the issue and echoed some of the comments I had made about the lack of objectivity and emphasis on reputation. I wonder if it is even possible to develop a set of valid ...

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No CT scans for old smokers? "Traditionally, doctors used to be called in when needed. But this is now changing. Increasingly it is the doctor who calls the person in by issuing an invitation. Healthy people are asked to visit the surgery for a 'check-up,' or 'screening,' when their computerized records show they are 'due.' Non-attendance is known as 'non-compliance,' indicating an element of recklessness and irresponsibility." - Petr ...

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MRI: Myth or reality? A radiologist answers your questions. From seeing elegant pictures of our brain and spine, to definitely characterizing masses in the liver and guiding management of orthopedic issues, MRI has an established role in the delivery of optimal care. MRI is an amazing tool that allows us to see inside our bodies and helps us get answers about a wide variety of medical conditions.  As a radiologist ...

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From a physician: A plea to big medical corporations I thought more highly of business folks until I started working for them.  I thought CEOs and boards of directors of companies had a vision, whether to maximize shareholder profit, or to produce a stellar product or provide a singular service, etc.  Once the vision was elucidated, everyone worked together like a team to make it happen. Then I became employed by ...

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We all want to practice evidence-based medicine.  Yet that phrase is so overused that one must always question the true meaning underlying the use of the phrase. The first assumption that many make is that evidence is a solid structure without nuance.  Yet we can have different experts look at the same evidence and develop different conclusions!  Why else would we have competing guidelines. Consider this quote from Nietzsche: "There are no facts, ...

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One of the hardest parts about medical school for me has been the constant pursuit of approval. Having a pass/fail system during pre-clinical years helped ease things some, but there remains a personal desire to prove myself. In front of attendings, all I can focus on is performing my physical exam just right, presenting in the perfect manner, and nailing the assessment and plan. Unfortunately, my strong desire to look ...

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A while back I was sitting in a Toronto coffee bar and, as I often do in another country, I began chatting with people about their health care system. One employee taking people's orders was about to go off duty and sat down to visit. "I'm tired of hearing you Americans talk about rationing in Canada," he said. "Let me tell you how many MRIs I had when I was ...

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Burnout in medicine: Look beyond your comfort zone For those of you who have been riding along with me on my journey for the past few years , you know that it has been one heck of a ride. What started out as a little blog to encourage other doctors who were struggling with burnout has exploded. In a good way. My blog came about because I was looking for a ...

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We’re ready to work on cost savings, just not for patients. There is a tremendous amount of culture change needed to move from fee-for-service to value-based health care.  One of the paradigm shifts is for hospitals to embrace the strategy of cost reduction as opposed to the traditional focus on top-line revenue.  In a system that focuses on value rather than volume, increasing the amount of hospital resources a patient consumes ...

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“If I get a call about smallpox from the ER I’m not coming in,” an infectious disease doctor said to a colleague in the hospital where I was working.  It was the early days of 9/11 and anything seemed possible. “Are you all OK with providing care for Ebola patients?” our section chief asked.  Our ICU is the designated unit to care for all adult patients suspected of having Ebola in our system.  We ...

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