Don’t Just Do Something, Stand There

My newly admitted patient was at the end of a very long struggle with a devastating genetic disorder. He had been treated by some of the finest experts in America for his rare disease, and had come to my rehab unit for aggressive physical and occupational therapy. He was exhausted, but mustered the energy to tell me (probably the 100th physician to treat him) his complicated story.

Listening to this man, and examining his frail body, I realized that he had already explored every treatment option and avenue available. He had extensive conversations about his genetic variant, and which drugs could possibly modify his course. He had tried pretty much everything once, with little improvement. He told me that the team of experts at my hospital were rallying to repeat some of the costly treatments that had failed previously, to see if maybe this time they could make a difference. Read more…


Is It Time for the Super-Generalist?

Over the last few decades, medicine has become more and more targeted. We now have not only the “ologists” like cardiologists, endocrinologists, and rheumatologists, but also subspecialists. Forget orthopedic surgeons, you now have specialists in hips, fingers, and feet.

This tendency has been due to a number of driving factors, most notably perhaps a desire for evidence-based medicine, and perhaps a sprinkling of prestige. Friends who have recently been through medical school and residency have told me the neurology residents don’t think much of the family practice residents, as an example. Read more…


When Listening Is the Best Care

Dear attending, I’m a third-year medical student fresh out of the classroom. I’ve studied from books for years, and now I finally get to see what it is like to be a doctor. It’s exciting but also a daunting experience. I look to you as a guide: what you wear, how you speak, what tools you use, and how you treat others. This is the year I will be socialized into the medical profession. How you treat your patients not only affects them, but it will affect how I treat my future patients. Your attitude sets the tone of my educational experience. Read more…


Looking Back on 20 Years of HIV Prevention

In the early 1990s, I embarked on what would become a career focused on caring for patients living with HIV. At that time, AIDS had been destroying lives and communities for ten years. As clinicians, we worked hard to help patients who were HIV-negative to remain that way. With suffering and death from AIDS so prevalent, the lifestyle prevention measures we taught were literally lifesaving and non-negotiable.

In the mid-90s, treatments were improving so much that our dream of HIV becoming a chronic manageable condition was starting to come true. Yet now we faced a new challenge: Because the virus could easily develop resistance if the medication we now had wasn’t taken absolutely as prescribed, we needed to get our patients on a treatment regimen that they could and would take every day. Our focus was on compliance. Read more…

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The Power of Population Health Interventions

Scientific guidelines produced by the American Heart Association tend to spill lots of ink on recommending complex and/or expensive tests, drugs, and procedures for patients who already have heart problems. Even when the topic is ostensibly cardiovascular prevention, as in the current AHA-endorsed cholesterol management guideline, the end result may be prescribing statins to many millions of additional adults. So it was a pleasant surprise to me earlier this summer when the AHA released the insightful consensus statement “Social Determinants of Risk and Outcomes for Cardiovascular Disease.” Read more…


How Involving Family Members Can Improve Diagnoses

I learned a valuable lesson recently about how difficult it can be to make the correct diagnosis when you see a patient for a very short period of time. In the acute rehab setting, I regularly admit patients who are recovering from severe, life-altering brain events such as strokes, head injuries, and complex medical illnesses. It is challenging to know what these patients’ mental function was prior to their injuries, and so I rely on my knowledge of neuroanatomy, infectious disease, and pharmacology to guide my workup.

However, I have found that asking the patient’s family members about what they were like (in their healthier state) is extremely important as well. Personality quirks, likes and dislikes, and psychiatric history all offer clues to ongoing behavioral challenges and mental status changes. Read more…


Three Things Doctors Can Do to Help Runners Stay Healthy

“Why am I experiencing knee pain?” Perhaps you’ve heard this question from your patients when seeing them after a running-related injury. This time of year, “fun runs” seem to occur practically every weekend, and training for year-end marathons is just as common. What many newcomers don’t realize, however, is that running is just like any other sport in that the body must be in shape to do it safely and effectively.

When running, the force that crosses the knee joint is approximately three to four times our body weight. Knee pain is a common occurrence as a result of the load and repetitive motion, along with the activation of several muscle groups. So what can we, in the course of a typical checkup or routine medical consultation, say to help steer patients toward healthy running habits? Here, I’ve listed three things that physicians can do to help runners stay healthy. Read more…

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Promoting Healthy Eating in Hospitals

I remember the day like it was yesterday. I was a medical student, rounding with my team, and we had just talked to a diabetic patient who was recovering from a myocardial infarction. The Attending looked over at the side and saw some chocolate donuts and cakes lying on the tray table, which had been brought in by the patient’s relatives. He shook his head disapprovingly and said, “I don’t think those are going to do you any good!”

He had an excellent point. If there’s one place in the world where we should be promoting healthy eating and addressing the real source of so many of the chronic diseases that are afflicting our society, it’s in our nation’s hospitals. Yet we aren’t. Read more…


Kim Kardashian, the FDA, and the Future of Online Medical Content

Last week, the Washington Post reported that the FDA has issued a warning letter to a pharmaceutical company concerning statements Kim Kardashian made about a new prescription drug. On both Instagram and Twitter, Kardashian touted the effectiveness of Diclegis, a drug indicated for pregnancy-associated morning sickness. Ms. Kardashian has a substantial following on social media – including nearly 35 million on Twitter and nearly 45 million on Instagram. She is also a paid spokesperson for the drugmaker Duchesnay USA. Read more…

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Changing Patient Feedback Forms Could Transform Healthcare

We’ve all seen them: those once paper but increasingly digital forms that enthusiastically request our feedback.Tell us how we’re doing, they cheerfully announce, or Help us improve!

Some of us even send them out as part of our practices or health systems or educational programs.

We also fill them out, both as regular citizens and as clinicians. Or we mean to. I certainly try to, with some exceptions. Recently, I deleted a survey from a hotel I stayed at for one night in a country I am unlikely to return to in this lifetime. I just didn’t care enough to bother. Read more…