“Let’s ask Ben Shapiro to come speak,” the nurse practitioner said. “He’s popular.” “Or we can mention the ten plagues, since Passover is coming up,” offered a pediatrician. They were talking about countering anti-vaccine propaganda among ultra-Orthodox Jews, and they were brainstorming with a hint of desperation. Trying not to obstruct women in strollers and men on the way from morning prayer, I had made it to this conference room in ...

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I covered one of the chief residents in our hospital for two days recently, seeing more than 40 patients in total. My off-the-cuff remarks on Facebook still apply: “Twenty-two inpatients later, it is time once again to declare my awe and admiration for all who do this work daily: hospitalists, housestaff, nurses, techs, custodial staff (et al., et al.). And, of course, the patients who are -- on the other side ...

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A recent research article in the Journal of General Internal Medicine, and the gap between its findings and the real world, helps point up the usefulness and limitations of research. The article, by Susan H. McDaniel, PhD, and coauthors, set out to determine how often doctors speak about their colleagues in supportive or critical ways. Their method is one widely used in the field: simulated patients, actors, were prepared with lifelike stories ...

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I’m not going to discuss the entire subject of cholesterol in this post, but one part of it: specifically, how to discuss with your doctor how much cholesterol should matter to you. If you have read any health news recently, you know that the American College of Cardiology and the American Health Association issued new guidelines to help doctors advise patients about cholesterol medications. The new recommendations are accompanied by a ...

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As an advocate of patient-centered care, I have to recognize that some varieties of patient-centrism make me more comfortable than others. If I really want the patient to do X, and the patient doesn’t want to, I generally feel okay about that. Frustrated, sure, and often times convinced that my way is the right way and the patient’s way is some sort of detour. Most often, though, I am able to ...

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There’s one question I get asked a lot: “I research my health problems on the Internet. Am I a hypochondriac?” First, we should ban that word when talking about ourselves. No one wants to be called that, and doctors who use that word are committing malpractice. Everyone has some range of complaints and worries in life, often physical and mental together, and this is our job as doctors: to hear them ...

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At the International Conference on Communication in Healthcare, which I just returned from, there was a discussion continuously coursing beneath the surface and bubbling up every once in a while. If we, acolytes of shared decision making, whether patients or providers, want to encourage decision making that has the person involved at the center, recognizing their preferences and values, does the kind of decision in question have anything to do ...

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My institution recently switched from its home-grown electronic medical record (EMR) to EPIC, a system for which many great things have been promised. Indeed, it is a considerable improvement over the past one. A number of hopes have been pinned on the latest-generation EMRs, not the least of which is the idea that finally, with this newest generation of tools, a nexus can be created and sustained among comparative effectiveness ...

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An excerpt from Talking to Your Doctor: A Patient's Guide to Communication in the Exam Room and Beyond (Rowman & Littlefield, 2013. All rights reserved.) There are plenty of books out there to teach us how to boldly and proudly advocate for ourselves in the doctor’s office. ...

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The more I try to help people in this field of mine, the more I realize that it doesn't take a village. It takes a huge industrialized city, all its wires and arteries humming with constant activity, just to try and make one woman better. In this case, one smiling woman in her 50s, ethnicity I couldn't figure and of dubious relevance, who came to our clinic seeking advice about ...

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The blogosphere is alive with the sound of Silver -- Nate Silver, that is, the head of what should be called the FiveThirtyEight Modeling Agency. Silver constructs statistical models to calculate the probability of electoral outcomes. Though he hasn't shared his model yet, the results fit his model very well. Is that the point? Statistical models can be constructed to serve various ...

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I was chatting with someone who asked what I did for a living, and I told him I am a doctor. "The kind that helps people?" he joked. I knew what he meant. The MD is the practical fixer, the PhD the omphalocentric academic. Many believe in this dichotomy, as false as it is. And such a philosophy underlies the opposition to some elements of the PPACA, aka Obamacare. There's a board of ...

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Atul Gawande, MD, is a technophile and a believer in the checklist, and he yokes these ideologies to an attractive metaphor in his newest essay for the New Yorker. The article is worth reading in its entirety, but it can be easily paraphrased. The Cheescake Factory, like other successful restaurant chains, has "brought chain production to complicated sit-down meals." They've done it by far-reaching standardization of the best possible ...

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I took a deep breath. I had to think carefully. It's not that this was unexpected - Johns Hopkins has been anointed the country's best hospital for 21 years running by US News. But I wanted to tell the patient the truth without alienating them or failing to mention the many admirable aspects of my institution. One truth, however, cannot be denied: to call one hospital the best is not simple. Let's start with ...

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A number of respected physicians have called for a renewed emphasis on the physical exam. Perhaps most prominently, Abraham Verghese has joined with colleagues at Stanford University to publicize the Stanford 25, a list of physical-exam maneuvers that they hold should be required of internal medicine residents. These calls reflect in part the fear that checklist medicine will lead to doctors' obsession with what Jerome Groopman calls the "iPatient" (the ...

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Johns Hopkins Hospital is consistently named one of the best in the country. I can't disagree with that; after all, I just started working there as an internist in September. Coincidentally, in the midst of the raging debate around health care reform, the past few months have seen increasing discussion of a small but crucial question: why do some of the best hospitals spend more money than others? If other ...

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