I recently admitted a patient with a pulmonary embolism. Before heparin drip was started, my attending ordered a hoard of eccentric, non-indicated hypercoagulable workup in the hope of avoiding the effect of heparin on these test results, including phosphatidylserine antibody and methylenetetrahydrofolate reductase DNA. I watched in horror as the nurse drew out approximately 13 tubes of blood, since each test needs its own tube.On rounds, the attending of course ...
angienadia, MD
What the death penalty has to do with medical errors
A fascinating, beautifully-written article on a death penalty granted to a most likely innocent man, with interesting details on fire dynamics and the history of the judicial system pertaining to the death penalty.Reading about the system in place that should prevent an innocent man from being wrongfully executed reminds me of the supposed system that prevents medical errors from occurring - both are imperfect, with innocent victims falling through ...
From the brink of hospice to awaiting a reading machine
It was a beautiful Monday morning in May. Yawning uncontrollably, I hopped into a Ford Hybrid with my attending and drove off to visit a patient who lived two hours away from our hospital. I woke up especially early that morning since we knew the commute would take many hours.We drove past open fields and a few cows before pulling into a driveway of a lovely house with a cute ...
Emergency medicine, we can do better
When someone gets sick, what are their options?They can try to make an urgent appointment that day, but how many of your doctors actually offer that? Most people will have to wait for weeks, if not months, for a regular appointment. Even if you go to a walk-in clinic, the wait will likely be hours, and you're not sure if clinics can take care of everything, so you head to ...
New ACGME work hour regulations for interns: friend or foe?
On the night of October 4, 1984, a young girl named Libby Zion was admitted to New York Hospital in Manhattan for fever, agitation and strange jerking movements. No one knew that her death the next morning would, 27 years later, drastically change the quality of physician training, for better or worse.When Libby was evaluated in the emergency room that night, neither the ER physician nor her family physician Dr. ...
Welcome our new (doctor) computer overlords
In February, IBM supercomputer Watson won Jeopardy! against its two human opponents, Ken Jennings and Brad Rutter.Watson’s victory rests on its power in speech recognition and the ability to understand colloquial human language used in game shows like Jeopardy!. The most interesting development of this story is that after Watson’s celebrated win on national television, IBM will partner with Nuance Communications to explore how Watson could help with medical diagnosis ...
Medical care and airlines – should there be a difference?
A recent article by Pauline Chen features a group of primary care physicians at Tufts Medical Center in Boston, who have created a concierge practice that funnels income into the traditional general medical practice that sees less-advantaged patients.Surveys (performed by the medical center itself) found that patients rated the quality of interactions with their doctors similarly regardless of their affiliation. The only significant differences in responses had to ...
Patient safety suffers when doctors are forced to learn multiple EMRs
As a new intern at a well-endowed medical institution, I was disappointed despite the flurry of excitement that comes with orientation. I was disappointed despite the brand new privilege to save lives and relieve human sufferings. And the disappointment was made clear to me over the past two days.What has happened in the past two days? As I will be working at two separate hospitals, for the past two days ...
What motivates health care workers is needed to explain health care costs
As part of the new health care legislation, the government has instituted Medicare's Physician Quality Reporting Initiative (PQRI) in an attempt to motivate health professionals to do the right thing.According to the legislation, PQRI asks physicians to report how the care they furnish aligns with evidence-based clinical guidelines for a variety of medical conditions, such as diabetes or heart disease. In 2010, physicians who successfully report these measures will receive ...
Why primary care is like air traffic control
Recently I had an interesting conversation with a few young doctors regarding the new health care reform that had been passed in the United States. One future specialist asked me why primary care doctors should receive more money than they have in the past.And this is an important question that I think sheds light on the suboptimal state of our current health care system. It is important to specialists because ...
