As we address the issue of quality in healthcare, there is much to be learned from other industries. I believe our current approach, though, is a dangerous one, one that won’t yield the desired results. Thus far, we’ve approached quality assurance as if healing were an industrial process, a process similar to those that yield cars, air conditioners, or even cheeseburgers. But in an age where science, technology, and health policy ...

Read more...

Recently, I treated a young patient with diabetes in the hospital. Throughout her young life she had struggled with glucose control, and on this day her struggle left her in a state of diabetic ketoacidosis (DKA). DKA is a life-threatening condition that diabetics often face when their body is  unable to uptake enough glucose, leading to utilization of fat and consequential build up of acidic ketones, which cause blood levels ...

Read more...

Today’s question is a simple one. How many patients can a physician see in one day and still be thorough? Don’t get me wrong; I’m all for efficiency. But we need to recognize when efforts at efficiency become “medical sloppiness” or, frankly, malpractice. With health care policy and insurance reimbursement what they are today, it’s not uncommon to encounter physicians seeing forty, fifty, and even sixty or more patients a day ...

Read more...

I was on call this past weekend, rounding at about 8am on the cardiology floors, and a woman I didn't recognize approached me.  She asked if I remembered who she was, and was quick to tell me that if I didn't it was ok.   She had had bariatric surgery about 6 months previously, and I had seen her in the office for a pre-surgical consultation. She went on to tell ...

Read more...

As a family doctor based in Brooklyn, New York, who has served the needs of my community since completing residency in 1982, I find myself with a unique privilege and opportunity to observe disease and wellness, the effects of lifestyle, policy and the collective efforts of myself and others, as we attempt to keep our patients well and affect the statistical bottom line. I’m typing this as I also think ...

Read more...

Diabetes is an emerging national crisis.  It is the leading cause of heart disease and stroke and the 7th leading cause of death in the United States. According to recent data from the Centers for Disease Control and Prevention (CDC), an estimated 25.8 million people are affected with diabetes with a staggering 79 million more living at high risk for the disease, a stage known as pre-diabetes. Unfortunately, about a third ...

Read more...

Children who live with diabetes, like all children with chronic diseases, learn to grow up rather quickly.  In order to survive, they must learn how to manage a disease with which most adults struggle. In particular, not only must children completely change their diet, but they also have to deal with checking blood sugars daily, time and dose insulin shots, all while trying to fit into a world where they ...

Read more...

Recently, I was bemoaning the fact that while the first conference specifically addressing diabetes and depression was a good start, there really wasn’t a significant patient presence. Lots of experienced professionals in the field, but startling few people who had actually walked-the-walk with significant depression for years, decades even. While this format will surely offer a lot of information from the professionals viewpoint, it seems that it would be a bit ...

Read more...

The state of diabetes drugs has gotten to the point where it is good news that a drug does not produce worse outcomes than a placebo. I am not kidding. The New England Journal of Medicine published two trials, each testing whether a diabetes drug increased the risk of heart attacks and death from heart disease. The trials are a result of FDA guidance for companies to assess the cardiovascular safety of new ...

Read more...

You probably already know that what you do know about your medicine could kill you. You may not know that what you don't know could do so as well. Hold that somber thought -- we'll get back to it. You, and I, and everyone else has seen those direct-to-patient drug ads that Big Pharma runs on primetime television. Invariably, they feature a person skipping through butterflies and wildflowers, demonstrating the ...

Read more...