OB/GYN

A physician not knowing her business: A cautionary tale

Physician
May 10, 2014

The future of our health care system, lies with you, dear medical students and residents. While medical school and residency training does a pretty good job giving you didactic and clinical training, they might do a better job teaching you how to avoid the potential mess you will encounter once you complete your training. Perhaps the most shocking thing I encountered after completing residency training was how non-clinical administrators placed …

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Empowering patients to become proactive with their medical bills

Patient
May 5, 2014

As health care providers are tasked with more administrative duties such as documentation, coding, and billing, the goal to minimize health care costs will continue to be extremely challenging.

In my role, I work with physicians on these challenges daily to ensure not only do the physicians get paid accurately but patients understand their benefits when they see our physicians.  Currently, I am the revenue cycle manager for the department of …

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Dr. Mom: No instructions included

Physician
April 26, 2014

The day I graduated from medical school and walked across that stage with my diploma in hand, I was sure that I had achieved the highest honor in the land.  I could not help envisioning myself in a long, crisp white coat, walking down the long hallways of the hospital, with my name badge perfectly displayed that read: “doctor.”

I was certain in my mind that I had finally made it.  …

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Arizona lawmakers have stepped into the doctor’s office

Physician
April 18, 2014

Imagine you want health care. You go to your doctor who recommends a medication. Your doctor tells you that the medication used to be prescribed one way 14 years ago, but very rigorous, more recent studies indicate a lower dose is just as effective. And has fewer side effects. And is less expensive.

You are pleased because a) your doctor is up on the latest medical therapies, and b) the least …

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Increasing the use of long-acting reversible contraception

Conditions
April 13, 2014

Of the 6.7 million pregnancies in the US each year 48% are unplanned. Disturbingly, about half occur in women who were using contraception at the time of conception.  That statistic haunts me. As health care providers we must take that to heart and change the way we think about birth control counseling. Is there more that we can do to help prevent unplanned pregnancy in those who are actively using …

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Water births should be treated as a medical intervention

Conditions
April 9, 2014

The joint statement on laboring in water and delivering in water (the latter also known as immersion births) from the American Academy Pediatrics (AAP) and the American Congress of Obstetricians and Gynecologists (ACOG) is making the rounds. I’ve linked to the full statement above, but in essence it says that some women find laboring in water helpful for pain relief (in the first stage of labor it reduces the need for epidurals) …

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Sharing secrets with my grandmother

Physician
April 4, 2014

“I feel bad …” Amy whispered, then paused.

I’m a family medicine resident, and I was doing my gynecology rotation, which involved spending a few days at a Planned Parenthood facility. This was my first day. I’d been assigned a patient to shadow: a young woman named Amy, who was here to have a first-trimester abortion.

I’m a fan of Planned Parenthood’s work providing high quality, affordable contraceptive and gynecological care. In …

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When childbirth becomes a financial stress

Patient
April 2, 2014

On December 31, 2011 right before midnight, I took the test of excitement and new beginnings and found out that I was pregnant. While this news was joyous in nature, it was soon marred by uncertainty and harsh reality.

After my test, I followed up with a doctor’s visit a month later, as was expected, and soon learned that the cost for this bundle of joy would be around $12,000 to …

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One example where the EMR can really make a difference in outcomes

Conditions
March 31, 2014

Given all the complaining I and my colleagues do about the problems with the EMR, I figured I’d take the opportunity to tell you about something good that came from having my practice online.

A patient came to see me last week for a check up and requested a prescription for birth control pills.  She’d used them in the past without problems. I wrote the script and sent her on her …

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It’s OK to laugh after a procedure

Conditions
March 31, 2014

She asked me, “Is it OK to laugh?”

My patient Linda, who was only 12 weeks pregnant, had just had a chorionic villus sampling, or CVS. During this procedure, a small piece of placenta (chorionic villi) is removed via a long, thin needle inserted into the woman’s uterus, and then the sample is sent to a laboratory for genetic analysis. My patient fell into the category of advanced maternal age, and …

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Statistical significance doesn’t always warrant a miracle headline

Conditions
March 28, 2014

Interpreting studies is a dicey thing. Often I find what might be statistically significant translated into headlines that might not really get at the nuance of the study or the results.

Take these three for example:

  1. “Pine bark extract improves severe perimenopausal symptoms”
  2. “Two weeks of antibiotic therapy relieves IBS (irritable bowel syndrome)”
  3. “Study: ‘Female viagra flibanserin’ works”

The first line of the last article: “Need a boost to your sex life. The magic could be in …

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Is acetaminophen taken during pregnancy associated with ADHD?

Meds
March 28, 2014

Readers have contacted me about a recent study that links acetaminophen use in pregnancy to the later development of ADHD in children. Is Tylenol yet another thing pregnant women need to avoid?

The study, titled “Acetaminophen use during pregnancy, behavioral problems, and hyperkinetic disorders” was published this month in JAMA Pediatrics. Dutch researchers looked at about 60,000 children born from 1996-2002. Their parents have been filling out questionnaires and …

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8 myths about painful breastfeeding

Conditions
March 2, 2014

In this post, I will do my best to try and address what is commonly said by doctors, dentists and lactation consultants who don’t understand the correlation between tongue-tie and lip-tie and poor breastfeeding. I think that we must first disprove what they think they know. I think these myths are born out of a complete lack of education, and with time, hopefully we won’t hear them as frequently.

I’ve compiled a list …

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Where is the safest place to have a baby?

Conditions
February 18, 2014

Two big studies have been published in the last few weeks, both of which have confirmed previous data: home birth is not as safe as hospital birth. These studies show that having a baby at home increases the risk of your baby dying by about 4 times. That really is a big increased risk — especially considering that most home births are supposedly low-risk pregnancies. Those babies …

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Deciding what to do with my son’s body

Physician
January 31, 2014

My eldest son, the first-born of a set of extremely premature triplets, died a few minutes after he was born. Defying the odds I remained pregnant with my other two boys for 24 days.

After holding him for some time in the delivery room, the same room where I myself had delivered hundred of babies and passed them on to families beaming with tears of joy, I was asked about his …

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Who is keeping Marlise Munoz on life support against her wishes?

Physician
January 21, 2014

Brain death is death. This is one of the definitions of death. Even in Texas.

Because brain death is death, a do not resuscitate (DNR) order or invalidating a DNR are both meaningless, because you don’t do procedures on dead bodies. This is why taking someone off a ventilator who is brain dead is not homicide, assisted suicide, or even following a DNR, it is simply the cessation of forcing air into a …

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The wishes of the patient and family versus fetal rights

Physician
January 19, 2014

Numerous strategies by antiabortion groups to curb women’s constitutional right to abortion are frequently reported in the news, and come as no surprise. However, a recent development illustrates novel circumstances in which people are using legal maneuvers to conspire to restrict medical decisions by patients and their families even when the right to abortion is not at issue.

On January 8, 2014, a front-page story in the New York Times Read more…

The greatest miracle a physician is privileged to be part of

Physician
January 17, 2014

“Welcome back. How was your trip? Or exile … you were away for a long time.”

“Almost a year,” my nine o’clock patient answered. A woman just over forty, she looked tan and physically strong. Her short hair was peppered with gray, different from the last time I saw her. She had gone abroad on assignment for a magazine and a film production company, and before she left, she had joked …

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What truly counts in medicine isn’t easy to measure

Physician
January 15, 2014

Obamacare has promised to provide all of us with quality medical care that is affordable and accessible. The very name of the law is the Affordable Care Act, which I have maintained will be short on both affordability and quality care.

Most of the country agrees with me. The postponement for a year of the corporate mandate to provide insurance in businesses with at least 50 full time employees was a …

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