Medical errors happen every day. Few make the headlines, but when they do, almost everyone who chimes in to comment offers the same type of solution for avoiding them. Three of the most common are guidelines, decision support and checklists. From my vantage point as a primary care physician I agree that checklists, in particular, can enhance clinical accuracy, but some of the lists I have to work with in today’s ...

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Why is medical IT so bad? A 57-year-old doctor I know is retiring to teach at a local junior college.  He is respected, enjoys practicing medicine and is beloved by his patients; therefore, I was surprised. While he is frustrated by the complexity of health insurance, tired by the long hours and angered by defensive medicine, the final straw is that he can not stand the world ...

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During my first year of medical school, in the last year of my father’s life, his oncologist had a difficult discussion with him and my mother- the decision to become do-not-resuscitate (DNR). I remember my mother was taken aback, my father was relieved and I was deeply saddened.  However, when I got the call that my father may not make it out of the hospital this last time, I was ...

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7 ways to help your caregiver My illness has been as hard on my caregiver-husband as it’s been on me. I know how fortunate I am that he’s stuck around and that he never complains about the extra burdens he’s had to take on. My heart goes out to those of you who don’t have someone to care for you in this way. This piece covers several ways ...

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When an unconscious person is first brought to the emergency room, there may be little indication if the individual has diabetes or a thyroid condition. Since millions of people have common hormone health conditions like these, emergency room clinicians and other acute care providers need to watch for cases where an endocrine disorder is causing or contributing to a medical emergency. More than 29 million people in the United States have diabetes, ...

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Whats the right way to think about Ebola? Ebola has riveted our attention: It’s a deadly disease with no known cure, and as is true of most infectious diseases, it’s easy to imagine how it could become a global pandemic and threaten us directly. For what it’s worth, though, here is what the federal Centers for Disease Control and Prevention tells us about Ebola: 1. The Ebola virus is not spread through:

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 72-year-old woman is evaluated during a routine examination. She has very severe COPD with multiple exacerbations. She has dyspnea at all times with decreased exercise capacity. She does not have cough or any change in baseline sputum production. She is adherent to her medication regimen, and she completed pulmonary rehabilitation 1 ...

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Medical students are brilliantly frugal. And it’s no surprise -- according to the AAMC, the average U.S. medical student incurs $170,000 of debt from medical education. We are a resourceful, smart, and cost-conscious group -- so why is the medical school curriculum practically silent on the cost of medicine? During medical school, we are taught to be excellent diagnosticians. The third and fourth years of training provide 60 to 80 hours a week of ...

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As of October 2013, the average medical student graduated with $169,901 of debt with nearly 80 percent of all graduates owing at least $100,000. Although these numbers are daunting, medical school educational debt is part and parcel of our profession. Truth be told, at the end of our training (which can range from three to ten years post-medical school), almost all of us will make at least $150,000 and ...

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In June, a man became very ill during a flight into Lagos, Nigeria. On the plane, he developed vomiting and diarrhea, and he collapsed in the very busy airport. Contacts on the plane and on the ground had no idea that he had Ebola -- initially, he was treated for malaria -- and many health care workers and bystanders on the plane and in the airport were exposed to his ...

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Years later, I now wonder if I overstepped my boundaries. Nancy was a pleasure to have as a patient.  A physician assistant in her early twenties, we often chatted amiably during visits.  Our conversations randomly ambled between personal and professional topics.  She recently married and was looking forward to having children.  Her gynecologic history was complicated and after a period of months of unsuccessful attempts to get pregnant, she visited a ...

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Ebola virus has grabbed headlines since the epidemic started in West Africa nearly a year ago. The death toll is estimated at 4,500 people, and the epidemic continues to spread. One person infected in Liberia returned to Texas with the disease and died, infecting maybe 2 health care workers. Ebola is a nasty virus, surely, with a case fatality rate of 80 percent. Overall health and nutrition as well as living ...

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The observation status problem has continued to grow both larger and worse. My hospitalist colleagues and I are caring for patients in hospital beds in the exact same way as other patients in the hospital, but we are told that we must give them the designation called observation status.  CMS recognizes observation status as outpatient care, like seeing a patient in a walk-in clinic. We don’t decide to make a patient observation ...

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The problem with wedding planning when youre a surgeonThe other day, I got into an argument with my parents about choosing wedding décor -- and I blame it on my surgical training.  My parents had borne the brunt of the work for the previous eleven months. allowing me to focus on my elective surgery rotation, flying to fellowship interviews, publishing my first article, and putting out the types of ...

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Just yesterday I was searching for a local surgeon, and on one website he had 2 out of 5 stars.  Hardly anyone was recommending him.  Yet prominently featured on another site he had 4.7 out of 5 stars.  Both sites had a good number of reviews.  What’s going on?  Is one site cherry picking the reviews?  Is someone falsifying reviews on one of the sites?  Which reviews can I trust? ...

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The present time has one advantage over every other - it is our own. - Charles Caleb Colton The cherubic young man smiles from the black-and-white class photo. His open, relaxed appearance captures my attention. He sits on a wooden bench at the far right end of the front row, his sharp white shirt and patterned tie cinched tightly beneath his three-piece wool suit with the stylishly wide lapels. He looks directly at the camera ...

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Do EMRs improve patient safety? A debate. “I’m here to say ‘Yes, they can,’ which is different from ‘Yes, they always do,’” says James Moore, MD, president-elect of the California Society of Anesthesiologists (CSA). To the contrary, enthusiasm for electronic medical records (EHRs) is part of a “syndrome of inappropriate overconfidence in computing,” argues Christine Doyle, MD, the CSA’s Speaker of the House. The two physician anesthesiologists (and self-identified “computer ...

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Why company paid egg freezing threatens medicine and motherhood Recently, reports surfaced that two Silicon-valley giants, Apple and Facebook, are covering elective ooycte cryopreservation, a.k.a. egg freezing, for its female employees.  Silicon Valley, like medicine, has a shortage of women at the top and it is presumed that this move will attract more women to enter -- and stay -- in the field of technology. As both a recent graduate of medical ...

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Among reams of coverage on the Ebola outbreak, Politico just published a characteristic story with the headline, “In the world of Ebola, no room for error.” The only problem is that is as soon as you introduce a human element to any system, there will be error. That’s the reality that health care leaders across the United States are grappling with now in a simultaneous effort both to tighten the health ...

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A few weeks ago an emergency room doctor called our infectious disease physician group concerning a patient who had returned from Liberia and was having nausea and vomiting. Several of the patient’s family members had died of Ebola. As panic struck us, our decisive question was: When did he return from Liberia? The Centers for Disease Control and Prevention guidelines for screening and isolating patients for possible Ebola infection are clear: ...

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