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Talk Like a Doctor: Is There Gender Bias when Physicians Speak?

I have given a number of medical talks over the years – reports on my research, reviews of surgical topics, mentoring speeches, and grand rounds, among others. I prepare for these talks extensively but tend to speak extemporaneously to engage better with my audience. I’m pleased to say that, in general, I have received good feedback. Several times, however, I have been given the “constructive criticism” that my voice is “girly” or “immature.”

I will be the first to admit that I am not an expert on oration or public speaking. I have no background in stage acting or performance. And despite the speech accolades of my youth (as a high schooler I was the Lincoln-Douglas Debate state champion in California, and while in college a friend and I won the Adams Cup for Parliamentary Debate at Yale), I know very little about what the ideal speaking voice is supposed to sound like. Read more…

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The Importance of Smaller Clinical Trials

It’s a common scenario. A new treatment is tested in a randomized study of, say, 8,000 people, and the results are overwhelmingly positive (so much so that the trial is even stopped early). Soon after, the drug is released with a lot of fanfare and promotion.

But what about smaller trials that showed positive results, yet didn’t have the financial backing of a major device or pharmaceutical company? How does the medical community respond when there is no team to educate and promote to the public or prescribers? In my field of cardiology, I see many examples of studies that, after perhaps a brief blip on the media radar, turn into buried pearls – full of value, yet largely forgotten. Read more…

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Why Comfort Care Is Essential

A hospital can be full of discomfort. My patients tell me that the food is unappetizing. The beds hurt their backs. The noise echoing through the hallways at night makes it impossible to sleep. And for those patients near the end of life, the treatments being offered may no longer be of benefit, causing more pain than good.

The answer to discomfort for those who are very ill is comfort care, the use of palliation when life-advancing measures are no longer indicated or desired. These measures include things like giving morphine to dull the pain and ease the breath, applying lip balm over cracked skin, offering ice chips to revive the mouth, adjusting blankets or fans, deciding not to press on someone’s chest, to stifle their airways with tubes, if their status declines. The decision to turn to comfort care often means that a patient can receive a private room in the hospital for family to stay close, to feel sunlight through a window. The triumph of comfort over the many indignities of being away from home. Read more…

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It’s Time to Advocate for Effective Medical Records Exchange

As healthcare professionals, we’ve all experienced the challenges of accessing patient medical information. The first time I encountered this issue was during my third year of medical school at Boston University. I’d just started rotations, and I needed to get information about a young patient who came in through the emergency room. Ultimately, it took us eight full days to gain access to her records, during which time we repeatedly hit treatment roadblocks that would have been much more solvable had we known more about our patient’s medical history.

The same problem came up repeatedly during all of my rotations; past records were unavailable or incomplete and we, the doctors, struggled to ask the correct questions in order to puzzle together a history that could inform our care. In nearly all circumstances, this resulted in prolonged or sub-optimal treatment. Read more…

A Prescription for Time Well-Spent

Last night, one of my close friends told me about an experience at her recent annual gynecology appointment. Her longtime gynecologist had retired, and she was meeting her new physician. After taking a history, the new doctor explained to her that since she always had normal Pap smears, she now only needed a one if “her husband’s penis has been inside another woman.”

The message was medically accurate, certainly. But it was delivered like a blunt scalpel; not an approach that would likely be successful in conveying important information to a person who has unhesitatingly scheduled Pap smears over the years. Being the intelligent and pragmatic person she is, my friend spoke with her feet and sought advice from a second gynecologist. Read more…

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At CE Week NYC, Health Tech Courts Mainstream Consumers

Digital health is a fast-growing category of consumer electronics, and many new mobile and wearable health devices were featured at the 2015 CE Week held in New York City.

The five I’ll focus on are good examples of technologies aimed at mainstream consumers shopping in middle market retail, an area that’s ripe to be served. The mega-trend here is that new devices are getting easier and more accessible. Read more…

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The Importance of Metaphors in Medicine

I’ve always been fascinated by how patients of all ages, backgrounds, and health statuses can report symptoms of chest pain, pressure, tightness, shortness of breath, palpitations, rapid or skipping heartbeat, and countless other varied symptoms – and immediately, intuitively attribute the cause to their hearts. More interesting still is that often, their hearts are working just fine.

Even a coronary arteriogram, (or cardiac catheterization) will not convince a surprising number of patients that the physical heart is not the root of the trouble. And no wonder: The heart is the rhythm keeper we’re born with, tirelessly beating all day, every day, sustaining us without fail upon going to sleep and continuing its work as we rise and start again each morning. Read more…

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Why Doctors Sometimes Fail to Deliver Bad News

Information exchange, education, and sharing of expertise are critical activities that add to the effective practice of medicine. Yet not all healthcare providers are able to relay information or test results in a way that is easily digested and processed by patients. Recently, for example, a disturbing report indicated that in a database of Medicare patients who were newly diagnosed with Alzheimer’s disease, only 45 percent were informed of their diagnosis by their physician. How can this be? Why would a physician not tell a patient about a potentially life-changing diagnosis?

I think that there are many reasons for this finding and that we must address these issues in order to provide ethical and timely care to our patients. Read more…

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Bringing Surgery into Global Health

The conversation about global epidemics often circles around a few notorious players: HIV/AIDS, malaria, polio, and recently, Ebola. But another equally critical public health crisis has evaded popular discourse, even though most people have seen or known someone who has experienced it firsthand. The epidemic? Traumatic injuries.

Understanding the impact that a traumatic injury can have on a person’s livelihood is sometimes difficult to get across to the public and to donors. It doesn’t have the same menacing urgency that a hemorrhagic fever might have. In the United States, the solution is often as quick as a trip to the hospital. Read more…

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Breast Cancer Is Not Biased. What Male Patients Need to Know.

We all know what the American Cancer Society, the American College of Radiology, and countless other professional societies recommend regarding screening and diagnosing breast cancer in women. But a subject that comes up far less frequently is what to do with men. While it is significantly lower than in women, a man’s risk is not nearly as low as we might think: one in a thousand will get breast cancer in his lifetime.

As with women, everything that increases estrogen in a man puts the breast tissue he was born with at an increased risk of developing malignancy. Chemicals and pollutants, obesity, radiation – all the same reasons breast cancer is an ever-growing concern among our female patients – affect our male populations as well. Read more…