As the clock ticks away on Primatene Mist, the only over-the-counter asthma inhaler left on the market, it is being ginned up as an argument against regulatory overreach by the Obama administration. I have been observing the Primatene controversy for decades as an asthma specialist. I have to say that there’s blame enough on many sides of this discussion, not just pro and con government regulation, but both the pharmaceutical ...
Posts tagged Specialist
MKSAP: 72-year-old woman with fatigue and decreased exercise capacity
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.A 72-year-old woman is evaluated for fatigue and decreased exercise capacity. The patient has severe chronic obstructive pulmonary disease, which was first diagnosed 10 years ago, and was hospitalized for her second exacerbation 1 month ago. She is a former smoker, having stopped smoking 5 ...
Psychiatry should not be a tool for social justice
A doctor’s primary responsibility is to heal, and all of our efforts and resources should be devoted to that goal. At times, it is impossible to restore a patient to perfect health and he or she must unfortunately deal with some degree of chronic disability. Still other times, though, the line between "perfect health" and "disability" is blurred, and nowhere is this more problematic than in psychiatry.To illustrate, consider ...
USPSTF prostate cancer screening guidelines need emotion to resonate
Prostate cancer screening has always been controversial.Now, with the USPSTF is recommending against screening for prostate cancer, gas is about to be poured on the proverbial fire.Recently, the New York Times Magazine published a lengthy piece on the issue, perhaps not coincidentally, perfectly timed with the Task Force's announcement.In 2009, advocates for breast cancer screening were ...
Healthcare professionals need to get an annual flu shot
Whether you are a physician, nurse, physician assistant, pharmacist, or someone else who cares for sick or disabled people, your job as a healthcare professional is an important one. Healthcare professionals are expected to provide services to individuals in need and to do so with quality and care.One way we can help ensure that we are doing our job the best way possible is to get our annual flu ...
The use of a signing bonus as tool for physician recruitment
As someone whose livelihood is dependent upon successfully recruiting physicians to various practice opportunities, whenever possible I use the tool of a "signing bonus" and it may not be for the reason you think.If you have found yourself in the role of recruiter for your practice, you should be open to use of this valuable tool within the physician recruiting process.Now, I must say, that whenever this is brought ...
Patients and families must be tireless in expressing any frustrations
I was reading the other day in a magazine the personal account of a woman who had a "perfect example of a mitral valve click" (a type of heart murmur) that was so textbook in sound that she was asked to be a listening post for a class of medical students. She was pleased to help, but was disappointed in how of the 15 examiners no one treated her like ...
Keith Ablow on Chaz Bono and the outrage that follows
Dr. Keith Ablow is an assistant clinical professor at Tufts University School of Medicine. So am I. Ablow has a problem with transgendered people. I do not. I first learned about Ablow's well publicized stance Wednesday via an email to the Tufts community, signed by the university's president, the dean of the medical school and the chair of the psychiatry department.The university reaffirmed its commitment to the complete inclusion ...
Universal board certification can solve the Doctor Nurse controversy
I'm going take on the Doctor Nurse controversy.This isn't a new issue, as the doctorate in nursing degree has been around for awhile. But a recent piece in the New York Times gave it new life.The topic is a ripe invitation to "doctor bash," with the predictable arguments about physicians protecting their turf, elitism, and the like.Yawn.To sample ...
Use a beginner’s mind in your medical practice
As a mom and first-time parent, I marveled at my tiny daughter's curiosity about and interest in the world. Her quest for knowledge was insatiable and her ability to sit absorbed in what she was doing and the moment enviable. Now that she's 8 (“8 and a quarter, mom!”, said with a sigh and an attitude), she seems to have morphed into a smart, verging-on-sassy pre-tween who's beginning to think ...
The decision to pursue a rare illness
Patricia Daly, FACP, of Warren Memorial Hospital in Front Royal, Va., told us about the case of a 49-year-old man who presented with marked weight loss. A year prior, the patient had weighed about 220 pounds and intentionally put himself on a diet, but after losing 45 pounds, he developed poor appetite and early satiety.He continued to lose weight to a nadir of 143 pounds. He found it increasingly difficult ...
Physicians lack harmony in this age of health reform
At every turn, we in health care are being told we must fundamentally change the way we deliver care to the patients who come to us for assistance, advice, and decisions as to how they can, if not maintain health, at least survive in an increasingly burdensome world. Whether referenced as medical home, health care home, advanced primary care, patient-centered approaches, or accountable care organizations, it all sounds the same ...
Bias in CME due to the presence of commercial support is overrated
So I missed out on the whole CME outrage that came up earlier this year in a Archives of Internal Medicine study, but I do have a theory about it that I’d like to try out.I’m not interested in getting into the “perceived potential bias” vs “actual bias” argument – which is a good one and one Tom Sullivan wrote about extensively – but would rather take a look ...
How to isolate problems in your scheduling system
Though there will always be times when an emergency disrupts your schedule, there is usually little reason for patients to wait more than 20 minutes for their visit. You will also find that continually double booking, arriving late, or having general mayhem in your office will inevitably result in everyone having to stay later than expected. Rather than experiencing all of these problems, you will be well served by isolating ...
The only anesthesiologist in this vast hospital
His blood pressure disappeared. The arterial tracing, a red line on the monitor reassuringly undulating with every beat of his heart, falling from 122/83, 99/64, 80/50, 67/42, then a flat line at 48.I had just come off the elevator, ushered in by the surgery resident who found me in the hallway searching for the right room.Epinephrine. Get the code cart. Check for a pulse. The nurse screwed the two halves ...
If you need to say you’re all about the patient, you aren’t
Sir William of Ockham has achieved a degree of mortality via the wide promulgation of an aphorism, now generally known at Occam's Razor (I'll use the more economical spelling). There are many iterations of the razor, but my favorite is this: "simpler explanations are, other things being equal, generally better than more complex ones." That trips off the tongue more easily than, say, "plurality should not be posited without necessity."In ...
See more patients with same day appointments
No one knows for certain what the future holds for American medicine. With cutbacks again on the horizon, we do know that reimbursements are going to decrease in the near future resulting in a decrease in income. An effective way to maintain our incomes is to increase the volume of patients seen but also to increase the income per patient that is seen in our offices. One of the best ...
Why do doctors cling to continuous fetal heart monitoring?
My patient needed to be delivered. She had just developed eclampsia, a potentially fatal disease that afflicts women in the second half of pregnancy. She had suffered a seizure and dangerously high blood pressure, and was at risk for far worse, including a stroke. No one knows why this condition arises, but delivery sure clears it up in a hurry.So we gave medication to start labor, and the nurses placed ...
Why a physician recruiter needs to consider the spouse of a doctor
Whether you are a physician saddled with the task of spearheading the recruitment efforts of your practice, a group practice administrator, an in-house physician recruiter, or an agency recruiter like myself, you have probably heard the following at least once (if not several times, as in my case) in your career from a prospective physician candidate you are seeking to recruit:"You know, I just wanted to say that I really ...
The day my mother became a saint
It was 1976 and I had just started my solo practice. I employed only a receptionist and a nurse. My nurse was absent because of an illness and I asked my middle-aged mother to come and serve as my chaperone for the afternoon.The first patient was a young lady and I asked her to give a urine specimen and place it in the turnstile in the restroom. My mother, wearing ...
