Christopher Johnson is a pediatric intensive care physician and author of Keeping Your Kids Out of the Emergency Room: A Guide to Childhood Injuries and Illnesses, Your Critically Ill Child: Life and Death Choices Parents Must Face, How to Talk to Your Child’s Doctor: A Handbook for Parents, and How Your Child Heals: An Inside Look At Common Childhood Ailments. He blogs at his self-titled site, Christopher Johnson, MD.
I have a colleague who has lost his capacity to continue practicing pediatric critical care medicine. It didn’t happen suddenly; it came on gradually over a year or so. It also didn’t follow from a single event or bad experience. It was just a creeping uneasiness that culminated in his unwillingness, after two decades, to go on doing this. Even though I’ve been practicing pediatric critical care for thirty years, …
This little cartoon, courtesy of xkcd, highlights a problem we have had for some time, but which is getting worse–highly antibiotic-resistant bacteria. Soon after the first antibiotics appeared, especially penicillin, doctors noticed the phenomenon of developing bacterial resistance to them. The cause is evolution in action. The replication time for bacteria is extremely fast, as short as …
A recent little essay entitled “Do patients bond best with doctors who misinform them with optimism” got me thinking about balancing honesty and optimism in practicing any medical specialty in which patients not infrequently die.
Tragic things can happen in the pediatric intensive care unit. Anyone who works there — doctors, nurses, respiratory therapists, and many others — see these …
There is one aspect of our relentlessly rising healthcare costs that seems particularly out of control — administrative costs. An interesting recent editorial in the New England Journal of Medicine provides some sobering details.
Every physician confronts daily the burden of dealing with healthcare bureaucrats of various sorts. The average doctor personally spends 43 minutes each day at it, and behind every physician there is an army of coders. …
There are some important new recommendations both about strep throats in general and about tonsillectomy – taking out the tonsils — as a treatment for recurrent strep throats.
Some of us can recall a time when getting your tonsils out was one of the rites of passage of childhood. Usually a related procedure is added — an adenoidectomy, removing the adenoids as well. It’s called a T&A …
The electronic medical record (EMR) is here to stay. Its adoption was initially slow, but over the past decade those hospitals that do not already have it are making plans for implementing it. On the whole this is a good thing because the EMR has the ability greatly to improve patient care. Physicians, as well as all other caregivers, no longer have to puzzle over too often barely legible handwritten …
There is a broad consensus among healthcare policy wonks that the 800 pound gorilla in the healthcare cost debate is that a big chunk of the medical care we provide — some say as much as a third — does not help. It may even make things worse for patients. Aside from the ethical issue of doing things that don’t help, and may hurt, this useless and dangerous care is …
As all of us know, there is a long, long tradition in our culture of disciplining or punishing children using physical means. “Spare the rod and spoil the child,” as the old saying goes. That explicit wording, by the way, does not come from the Bible, as most people think. Rather, it comes from a seventeenth century satirical poem by Samuel Butler. Still, The belief that …
There are about 27 million visits by children to America’s emergency departments each year. About a quarter of those are to rural EDs or ones at some distance from a dedicated children’s facility, such as a children’s hospital. Over the last decade or so it’s become clear that, for critically ill children, early transfer to an advanced pediatric facility improves outcomes. The children do better if they can be transferred …
I’ve written about this before, but some recent encounters with medical students have me thinking about it again. I went off to medical school thirty-eight years ago. For the era, I went to what folks regarded as a very progressive place. It had a curriculum that was quite revolutionary for the time. Among other things, we started having interactions with actual patients during our first year, rather than the third …
The drama surrounding the Supreme Court decision upholding the ACA as constitutional has ended. As legions of reporters and bloggers have written, the law has far-reaching effects. In my corner of medicine it will greatly help (already has, really) a small but not insignificant number of children and families. These families are those who have a child with a severe chronic medical condition. Many of these these children spend time …
Does your doctor have something on the wall that starts with “American Board of … “?
The terms “board certified” and “board eligible” are confusing to people not in the medical profession. It doesn’t help that more than a few doctors blur the distinctions to their own benefit. This post gives you a brief rundown of the distinctions at stake.
The first thing to understand is that anybody who has graduated from …
Like many of my colleagues, I teach and supervise students, residents, nurses, and respiratory therapists. I’m also the medical director of a PICU. Overall, I’ve been teaching and doing administration for over 30 years. And, like most of my colleagues, I never received any formal instruction at all in how to do these things. To some extent I got help from my own mentors, primarily by watching what they did, …
The principle of autonomy is one of the four guiding principles of medical ethics, the others being beneficence, nonmaleficence, and justice. It means that patients have the right to decide what is done to their own bodies. For children under eighteen, the age of majority, this means their parents decide for them. What happens when parents refuse a treatment that their child’s doctors recommend? (The right of a minor child …
There is a long tradition in folklore, one shared by shamans and occultists, that knowing the true name of something gives you power over it.
Many years ago I had a very sick patient in the PICU who one morning, totally out of the blue, broke out in a bright, red rash all over his body. The boy had many critical problems already and, although the rash didn’t seem to be causing …
I’ve written before about how children from poor families have a higher chance of needing PICU care than do children from more affluent families. Eligibility for Medicaid is a good marker for this; nearly half the population of most urban PICUs is made up of children on Medicaid, even though the national average (it varies a little from state to state) for children on Medicaid is about 25%. So poor kids are …
I was a medical researcher for several decades, investigating an unusual, but not rare, condition called infective endocarditis. I found the disease fascinating, primarily because of how understanding it could unlock many secrets of the endothelial cell, the cells lining all our blood vessels. I chose my research subject because it interested me and I thought I could do some good studying it. This is the case for …
There are some important new recommendations about tonsillectomy — taking out the tonsils — as a treatment for recurrent strep throats.
Some of us can recall a time when getting your tonsils out was one of the rites of passage of childhood. Usually a related procedure is added — an adenoidectomy, removing the adenoids as well. It’s called a T&A in the medical world, and it’s one of the …
I went off to medical school thirty-seven years ago.
For the era, I went to what folks regarded as a very progressive place. It had a curriculum that was quite revolutionary for the time. Among other things, we started having interactions with actual patients during our first year, rather than the third year, as was traditional then.
These days many, probably most, medical schools …
We badly need effectiveness research — which medical treatments work and which ones don’t. After all, some reasonable estimates are that a third or so what we spend on medical treatments is for things that aren’t known to work, or worse, don’t work. Effectiveness research means comparing two competing therapies to see which works better; if both work the same, our preference …
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