Better Health: Smart Health Commentary Better Health (TM): smart health commentary

Latest Posts

Are Doctors More Likely To Refuse Certain Medical Care?

No CPRA must-read piece from Ken Murray:

Years ago, Charlie, a highly respected orthopedist and a mentor of mine, found a lump in his stomach. He had a surgeon explore the area, and the diagnosis was pancreatic cancer. This surgeon was one of the best in the country. He had even invented a new procedure for this exact cancer that could triple a patient’s five-year-survival odds—from 5 percent to 15 percent—albeit with a poor quality of life. Charlie was uninterested. He went home the next day, closed his practice, and never set foot in a hospital again. He focused on spending time with family and feeling as good as possible. Several months later, he died at home. He got no chemotherapy, radiation, or surgical treatment. Medicare didn’t spend much on him.

Worth the full read.

And so true. I’ve joked about getting the above tattoo when my times comes. (I would quibble that the modern CPR success rate is better than infinitesimal, especially with hypothermia, but it still ain’t great.)

It may have to do with Read more »

*This blog post was originally published at Movin' Meat*

Dealing With Cyclic Vomiting Syndrome Given How Little Is Known About The Condition

I have been working as an ER doctor for over a decade, and in that time I have come to recognize that there are certain complaints, and certain patients who bear these complaints, that are very challenging to take care of. I’m trying to be diplomatic here. What I really mean is that there are certain presentations that just make you cringe, drain the life force out of you, and make you wish you’d listened to mother and gone into investment banking instead. Among these, perhaps most prominently, is that of the patient with cyclic vomiting syndrome.

The diagnosis of cyclic vomiting syndrome, or CVS, is something which is only in recent years applied to adult patients.  Previously, it was only described in the pediatric population. It has generally been defined as a disease in which patients will have intermittent severe and prolonged episodes of intractable vomiting separated by asymptomatic intervals, over a period of years, for which no other adequate medical explanation can be found, and for which other causes have been ruled out.

That is not much in the way of good literature about this disease entity, which is surprising, because it is something that I see in the emergency department fairly regularly, and something with which nearly all emergency providers are quite familiar. These patients are familiar to us in part because we see them again and again, in part because they are memorable because they are so challenging to take care of.

Some things about the cyclic vomiting patient that pose particular challenges: Read more »

*This blog post was originally published at Movin' Meat*

Health Care Is Stuck In The Past

We respond to certain “Code Blue” situations in our hospital. In the ED, of course, and in the outpatient areas and radiology, and if needed as back-up in the inpatient units. The hospital issues one of those overhead calls when there is a code blue — a cardiac arrest or other collapse, person down, injury, etc., but we also carry a pager in the ER in case we don’t hear the overhead call. The pager also signifies which doc is designated to respond to such a call, since we often have 8 docs working at once. It’s a little ritual we have at change of shift, passing off the pager and the spectralink phone, like the passing of the torch to the oncoming doc.

So of course I took the pager home the other day and had to make an extra trip to the hospital to return it. Ugh.

As I was driving back in, I took a moment to really look at the thing, and it struck me that this pager is the exact same model I used in medical school and residency, way back in the mid nineties. The exact same one: Read more »

*This blog post was originally published at Movin' Meat*

The Changing Priorities Of A New Generation Of Physicians

Doctors are, famously, workaholics. That’s just the way it’s been forever, at least as far back as my memory goes. You work crazy hours in residency, you graduate and work like a dog to establish your practice or to become a partner in your practice, and then you live out your career working long hours because there just aren’t enough hours in the day to do everything that needs to be done. I remember, growing up in the ’80s, that my friends whose parents were doctors were latchkey kids whose dad (usually the dad, then) was never at home when we were hanging out in the rec room playing Atari.

Yeah, Atari. Look it up, kids.

Not much had changed by the time I went to medical school. There was recognition of the fact that burnout was an issue — that divorces, alcohol abuse and suicides were more common among physicians than in other professions. The unspoken implication was that being a doctor was difficult and stressful, which increased the risk of these consequences of an over-burdened professional life. These stresses were accepted as part of the turf, as a necessary part of “being a doctor.” It wasn’t optional, and indeed, most physician teachers that addressed the matter chose to sublimate it into a mark of nobility. Being a physician was a calling and a duty, and a physician must gladly subordinate his or her own happiness and well-being to the service of their flock.

But things have changed, or at least a slow shift is in progress. Read more »

*This blog post was originally published at Movin' Meat*

ER Physician Amazed By The Technological Advancements In Medicine

My father in law, now deceased, was a nephrologist. I met him while I was in medical school. He was a reserved guy, not prone to butt into what he saw as others’ business. So I still remember that while I was considering what sort of residency to pursue, he took a surprisingly strong stance that I should go into interventional radiology. His reasoning was simple: they have a great lifestyle, they make bags and bags and bags of money, and they get to play with all the coolest gadgets.

It was tempting, I admit. As anyone who knows me can attest, I am ALL about the gadgets. I’m not averse to bags of money either. But I never gave it much consideration, mostly because I am just not real good at radiology, though for an ER doc I do OK. (A low bar, it is true.)

I sometimes regret that decision. For example, I wrote the other day about a gentleman who presented with a ruptured abdominal aortic aneurysm. We had some heroic fun in the ER resuscitating him and getting him to the OR. After the fact, I had to wonder whether it was all in vain — Read more »

*This blog post was originally published at Movin' Meat*

Latest Interviews

Caring For Winter Olympians In Sochi: An Interview With Team USA’s Chief Medical Officer Dr. Gloria Beim

I am a huge fan of the winter Olympics partly because I grew up in Canada where most kids can ski and skate before they can run and partly because I used to participate in Downhill ski racing. Now that I m a rehab physician with a reconstructed knee I…

Read more »

How Do Hospital Executives Feel About Locum Tenens Agencies And Traveling Physicians?

I recently wrote about my experiences as a traveling physician and how to navigate locum tenens work. Today I want to talk about the client in this case hospital side of the equation. I ve had the chance to speak with several executives some were physicians themselves about the overall…

Read more »

See all interviews »

Latest Cartoon

See all cartoons »

Latest Book Reviews

The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

Read more »

Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

Read more »

Unaccountable: A Book About The Underbelly Of Hospital Care

I met Dr. Marty Makary over lunch at Founding Farmers restaurant in DC about three years ago. We had an animated conversation about hospital safety the potential contribution of checklists to reducing medical errors and his upcoming book about the need for more transparency in the healthcare system. Marty was…

Read more »

See all book reviews »

Commented - Most Popular Articles