Physician

Emergency physicians and the choice of overtesting or lawsuits

Physician
June 29, 2010

Emergency physicians are in a dilemma.  Risk missing a diagnosis and be sued, or be criticized for overtesting.

Regular readers of this blog, along with many other physicians’, are familiar with the difficult choices facing doctors in the emergency department.

The Associated Press, continuing its excellent series on overtesting, discusses how lawsuit fears is a leading driver of unnecessary tests.

Consider chest pain, one of the most common presenting symptoms in the …

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Local control can be used to empower patients

Physician
June 27, 2010

by James Baker, MD

In public mental health care, “local control” is the mantra that describes the desire to assure that mental health policy is dictated by local communities rather than by state or federal government.

I hope that folks who insist upon this are mindful that power-hoarding in the form of “local control” is no blessing in itself, except when it is used, in turn, to empower the people we serve.

I …

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Difficult needs to be embraced in medicine

Physician
June 25, 2010

When I was a second-year medical student I remember thinking, after meeting with an attending physician in a physical diagnosis class, how impossible it seemed that my brain would ever contain as much medical knowledge as his.

And even if somehow one day it did, how would I ever be able to call on it, manipulate it, twist it, bend it, and turn it upside down with the same apparent ease …

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Obese patients present challenges in the ICU

Physician
June 25, 2010

Obesity is a huge healthcare problem in the United States.

It has reached the proportions of an epidemic and continues to get worse. Multiple medical problems including heart disease, hypertension, diabetes, sleep apnea and cancer are closely associated with obesity. The patients with extreme obesity can reach a body weight of five, six or seven hundred pounds and even higher. Riddled with chronic medical conditions, these patients often end up in …

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Doctors should ask patients whether they text and drive

Physician
June 25, 2010

It’s time to ask patients whether they text and drive.

An important perspective piece from the New England Journal of Medicine urges doctors to include that question during preventive health exams.

The data surrounding texting and driving is grim:

Although there are many possible distractions for drivers, more than 275 million Americans own cell phones, and 81% of them talk on those phones while driving. The adverse consequences have reached epidemic proportions. …

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Healthcare providers still aren’t washing their hands enough

Physician
June 24, 2010

by Chris Emery

Nurses and other healthcare providers complied with hand hygiene guidelines less than half of the time before participating in medical procedures, results of a new study showed.

Compliance was better after procedures, with 72% following guidelines after procedures compared with 41.7% before procedures, according to a report published in the May issue of Applied Nursing Research.

Overall compliance with hand hygiene guidelines was just 34.3%.

“It is important to note that …

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Academic and private practice doctors should not be adversaries

Physician
June 23, 2010

During my entire career I have seen unwarranted and unseemly squabbling between town and gown. I often hear the gown side insult the town side.

While I went straight into academic medicine, I did moonlight in community hospitals. For the past 6 years I have taught part time in a community hospital and part time in an academic VA hospital. I find recent negative comments about academic medicine unfortunate just like …

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Choose primary care and follow your heart, not your brain

Physician
June 22, 2010

Reams have been written on how medical students ought to select their field of medicine.

There are even personality-type tests that ask questions about what kinds of situations you like, how you react to problems, and your working style that purport to predict for which specialty you are suited. (I came up as an oncologist or a nephrologist.)

Others have opined that once you crunch the lifetime salary numbers, and then compare …

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How transparency reduces malpractice and defensive medicine

Physician
June 22, 2010

Physician errors have been the subject of discussions about both health care costs and health care quality.

We are told that if we reform the malpractice system — capping damages — that physicians will practice medicine less defensively and costs will go down as a result. We are also told that the quality of care delivered by our health care providers is less than optimal — there are estimates that nearly …

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Treating friends, and when worlds collide in the hospital

Physician
June 21, 2010

All the world is a stage,
And all the men and women merely players.
They have their exits and entrances;
Each man in his time plays many parts.
-Shakespeare

“There’s a consult downstairs, Campbell. Go check it out and I’ll catch up with you later.”

“Sure, OK.” I was a third-year medical student fumbling through my first clinical rotations. The resident headed off to whatever he needed to accomplish and I trotted down the back …

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Clinical trial conflict of interest for doctors

Physician
June 21, 2010

This is a painful story to write.

A close friend of mine, in his 40’s, had a persistent light cough for many months. Finally, when he had an X-ray taken, it showed a large tumor on his lungs. He was diagnosed with stage 4 lung cancer. As a non-smoker and strapping, physically fit man, he was shocked, as you can imagine.

He went to his non-Boston-based medical practice, and he was told …

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Heart catheterization worries that every cardiologist face

Physician
June 18, 2010

Malpractice and heart catheterization have been in the news recently.

A spicy concoction for sure. An epidemiological study published in an online subsidiary of Circulation addresses the role of three major medical issues facing cardiologists today: malpractice, heart catheterization, and medical costs.

It is hard to get more controversial.

Heart catheterization, the invasive assessment of the coronary artery lumen, has always been a hot-potato topic. The “percent-normal” was the buzz word when I …

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Measles from rejecting vaccines, and the price society pays

Physician
June 17, 2010

Vaccine rejectionism is based on a profound lack of knowledge about immunology, statistics and science. Virtually every single empirical claim of vaccine rejectionism is factually false, but parents who lack even the most basic understanding of immunology are often incapable of evaluating those empirical claims.

Indeed, those parents most likely to proclaim themselves “educated” on the topic are generally the most ignorant.

A new paper on a recent measles outbreak, Measles Outbreak …

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Extra fees may save private practice primary care

Physician
June 17, 2010

I was interested in an article in USA Today about the growing number of physicians, especially primary care doctors, who are boosting their revenues by requiring patients to pay new fees for services that insurance doesn’t cover.

No longer is your insurance payment “all-inclusive”. These fees can include annual administration fees, no-show fees, medical report fees, and extra fees for email or phone consultations. If private practice medicine is going to …

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Physicians need to focus on wellness to prevent burnout

Physician
June 16, 2010

I recently received a bulletin from one of the medical societies to which I belong: the topic was on promoting physician wellness.

My first reaction, “It’s about time “. Historically physicians have struggled with multiple health impacts from the demands of their work, with higher rates of depression, anxiety and suicide than in the general population. Physicians train under circumstances of extreme stress often resulting in unhealthy coping strategies; strategies frequently …

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Why a doctor chose OB over family practice

Physician
June 16, 2010

by RH+, MD

More than anything in life I wanted to be a family practitioner (FP).

Going into medical school there was little doubt in my mind that this was my chosen path. I chose a school that had a significant focus on primary care and was president of the Family Practice Club my second year. I had shadowed several FPs and truly enjoyed the continuity of care that went into FP.

When …

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Why the medical chart may not improve patient care

Physician
June 15, 2010

Why do we physicians chart the way we do? Hopefully, you do it perfectly well and have no concerns at all. But where I practice emergency medicine, we are approaching maximum inefficiency in charting.

It all became much clearer when we started using our new EMR system. Let me make it clear, I’m not against EMR. In fact, typing and templates work better for me than dictating. My dictations were usually …

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Primary care is more than just office visits

Physician
June 13, 2010

If you’ve ever been on a diet, you know that it really helps to keep a food log. Seeing your consumption chronicled in one place is illuminating – and often explains why those love handles aren’t melting away despite two hours on the treadmill each week.

In a recent issue of the New England Journal of Medicine, internist Rich Baron Rich Baron chronicles the work of his 5-person Philadelphia office practice …

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Primary care doctors at a competitive disadvantage to midlevels

Physician
June 13, 2010

A primary care resident wrote in one of the journals recently about making the limited time she has with each patient matter the most.

How refreshing, I thought when she concluded that time ultimately is an absolute and finite resource. We often feel as if we are battling time as much as we are battling disease, and we sometimes have trouble admitting when we are losing either one of those battles. …

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Don’t let a doctor make you feel uncomfortable

Physician
June 12, 2010

by Diana E. Lee

One member of my health care team is a migraine specialist in another state. Since we don’t have many opportunities to work together in person, we generally try to pack a lot into my periodic two-day visits.

Last time I was there I had an experience that has left me feeling guilty all these months later.

My doctor, who I respect and admire greatly, asked if I was interested …

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