Honesty between doctors and patients goes both ways

Physician
September 28, 2011

Yesterday, someone asked me, “Can I be perfectly honest with you?”  I wanted to reply, “No, just be dishonest, I like it better that way!”  “Can I be” implies that, in past conversations, my patient has been dishonest.  Dishonesty is a relationship breaker.  Dishonesty leads to distrust and if I cannot trust what a patient is telling me, I cannot be effective; the doctor-patient relationship is terminated.

Am I being too …

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Honesty between doctors and patients goes both ways

Why medicine is not health

Meds
September 26, 2011

Being a physician certainly biases how I view the world around me. I can’t help but think in terms of problem-solving and healing. But have you noticed how medicalized our society has become? The other night watching television, we watched at least four drug commercials and one health insurance commercial — during a half-hour show! I believe we are in the middle of the medicalization of America, and I don’t …

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Why medicine is not health

Why do doctors cling to continuous fetal heart monitoring?

Physician
September 25, 2011

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 …

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Why do doctors cling to continuous fetal heart monitoring?

Do doctors have a moral obligation to serve?

Physician
September 23, 2011

Since it strikes at the very core of what this blog is all about, I couldn’t pass up the opportunity to comment on Dr. Karen Sibert’s recent op-ed piece in the New York Times.

She argues that, especially given the current shortage of primary care doctors in this country, being part of the medical profession confers one with the moral obligation to serve and, as such, conflicting …

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Do doctors have a moral obligation to serve?

ADHD and the lack of quality sleep

Conditions
September 19, 2011

As the new school year begins, it’s only natural that there’s more awareness about learning and behavior issues. One of the most controversial topics that came up frequently is ADHD, or Attention Deficit Hyperactivity Disorder. It’s thought that 2-4% of children have this condition, and a shocking 50% of children with this condition are on some form of prescription medication. Not only is it seen in children, but adults …

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ADHD and the lack of quality sleep

When professional courtesy could get physicians in trouble

Physician
September 18, 2011

More likely than not, a physician or a dentist has at one point provided discounted or free healthcare services to some patients by waiving all or part of a fee or the copayment and/or coinsurance obligations as a “professional courtesy.” According to the Office of Inspector General’s (OIG) Compliance Program For Individual and Small Group Physician Practices guidelines, however, this practice may expose a physician to an investigation.

To be sure, not all professional courtesy discounts or free …

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When professional courtesy could get physicians in trouble

False assumptions and clinical errors in modern medical practice

Physician
September 18, 2011

Here are 22 false assumptions, practice failures, and everyday clinical errors that we believe are common in modern medical practice:

1. Lack of appreciation of the phenomenon of physician persuasion and its hidden power. The placebo effect is scientific, potent, and worthy of use.

2. Lack of understanding of the power of prevalence or pretest probability in the diagnostic process, leading to frequent false positives and “overdiagnosis” of nonexistent diseases.

3. Lack …

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False assumptions and clinical errors in modern medical practice

How your physician is like a chef

Physician
September 17, 2011

I wear lots of hats.  Over the years, I have developed analogies for most of the things I do and for the things I want my patients to do.  Analogies help people conceptualize the complexities of medicine in a way that makes sense.

Today, I had my chef’s hat on.  I was actually treating a young chef and found myself talking about food and medicine.  There is a direct correlation.  My …

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How your physician is like a chef

When not to use a physician recruiter

Physician
September 11, 2011

As a physician recruiter of prominence, a number of times during any given week I get a fair number of calls from physicians in training who, honestly, should not be calling me whatsoever and I am very frank in telling them this.  The call normally starts something like this:

“Hi Bo, my name is Dr. Doe.  I am finishing up my dermatology residency and I want to be there in …

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When not to use a physician recruiter

Human capital makes doctors special

Physician
September 9, 2011

If you’ve ever been sick, especially with anything serious, you quickly realize that doctors, nurses and their ilk are an unusual and precious resource.

First you have to find smart people with personalities willing and able to put up with a lot of guff in the service of their fellow man.  Then they have to be willing to (usually borrow, and) spend tens or hundreds of thousands of dollars for …

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Human capital makes doctors special

The specialty that makes doctors rich and happy

Physician
September 8, 2011

A long time ago, I was very close to becoming a cardiologist.  Really.

Even though my fascination with ID and microbiology started in medical school — and believe me, not much fascinated me in medical school — the fact that all the top residents in my program were going into cardiology made me feel that somehow I should be doing this too.  Plus, the guy who was Chief …

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The specialty that makes doctors rich and happy

How a doctor reviews cases for both plaintiff and defense attorneys

Physician
September 7, 2011

Early in my career, a local defense attorney working with my hospital would occasionally ask me to review a case in which another physician client of her firm was the defendant. As Medical Director of Evergreen Hospital Emergency Department, I was comfortable with hospital records, knowing where to look in a record for information – both recorded and not recorded – that either helps or hurts a case. I found …

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How a doctor reviews cases for both plaintiff and defense attorneys

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Phil Mickelson’s psoriatic arthritis explained

Conditions
September 6, 2011

Golfer Phil Mickelson has had a rough year and a half. First, his wife and mother are diagnosed with breast cancer, and then he has a health scare of his own. Last year, after the US Open, Mickelson began to experience some troublesome symptoms.

In an interview with Extra’s AJ Calloway, Mickelson opened up about what was going on: “After the U.S. Open last year, I wasn’t able to …

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Phil Mickelson’s psoriatic arthritis explained

10 ways to make a difference in the lives of your patients

Physician
September 5, 2011

Most of us who write about health believe that knowledge can make a difference. But is the primary health issue facing us today a lack of knowledge? Or is it, instead, something I’d call the tenth-patient-of-the-day challenge?

Here’s what I mean: You pick up a chart and head to Exam Room B, reading as you speed-walk. Your patient’s blood sugar is running high again, she didn’t show at the smoking cessation …

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10 ways to make a difference in the lives of your patients

Don’t always blame anesthesia for problems in the OR

Physician
September 5, 2011

People blame anesthesia personnel for everything. You name it, they blame us for it. They call us by the umbrella name “Anesthesia” and if there’s a problem, it’s always “Anesthesia’s” fault.

Got into the room late? Blame Anesthesia. (Even though the anesthetist’s been sitting at the bedside for twenty minutes waiting for the surgeon or the nurses to be ready.)

Patient craving ice cream when she woke up? Must be Anesthesia’s fault.

No …

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Don’t always blame anesthesia for problems in the OR

Heart valve repair without open surgery

Conditions
September 2, 2011

A major innovation are the recent reports of success in replacing or repairing diseased or damaged  aortic or mitral valves via catheter-based techniques instead of open surgery.

Mitral regurgitation is when the valve becomes unable to close tightly. Once the regurgitation becomes sufficiently severe to cause heart failure, the death rate reaches about 5% per year. Most such individuals are referred for cardiac surgery to either try to repair the valve, …

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Heart valve repair without open surgery

How medical students can prepare to be hospitalists

Education
September 1, 2011

A second year medical student reader asked me to comment on what rotations to take in medical school to prepare for an internal medicine or hospitalist medicine career.

I am a second year medical student, very interested it practicing the art of Hospital Medicine, and I was wondering if you had any advice/comments on any specific electives to consider to help prepare me for an Internal Medicine residency.

Great question.  As …

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How medical students can prepare to be hospitalists

Medical students spending time in a nursing home as a patient

Education
August 31, 2011

An interview by Curaspan Health Group with Marilyn Gugliucci, PhD.

Every summer, a handful of medical students spends two weeks in a nursing home as a patient. That’s part of what’s been called “the life-altering education” established by Marilyn Gugliucci, Ph.D., the director of geriatrics education and research at the University of New England College of Osteopathic Medicine.

Gugliucci spoke with Curaspan Connections about the inspiration for her unique approach to elder-care …

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Medical students spending time in a nursing home as a patient

Treating fungal laryngitis in patients with asthma

Conditions
August 31, 2011

It is a big bummer to be an asthmatic. Not only is breathing a problem, but even the treatment for asthma can cause problems.

Take for example steroid inhalers like Advair, Symbicort, fluticasone, etc.

All asthma patients know to rinse their mouth out after inhaler use due to risk of oral thrush, but what about from the back of the mouth down to the vocal cords? This nether region can’t be …

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Treating fungal laryngitis in patients with asthma

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