April 23, 2016

Top 100

A Country Doctor Writes is one of the top 100 healthcare blogs on eVisit’s 2016 list. They write:

This blog is a great read from a small-town doctor who’s been practicing on the same families for generations. The posts feature “progress notes,” highlighting interesting and unusual cases, along with touching stories of being the doctor for such a close-knit community.

Top 100 Healthcare Blogs: 2016 Edition

January 31, 2016

Expert Advice, But Not in Spelling

Here’s a headline from this week’s Medical Economics. The article points out that our office notes are scrutinized for lazy documentation cliches that don’t reflect the amount or complexity of work to justify our charges.

What’s that expression about throwing rocks from a glass house?

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January 23, 2016

Single Dose Propranolol and Reexposure to Phobia or PTSD Triggers Brings Cure

After one round of treatment, the arachnophobes held the spiders in their bare hands.

http://www.nytimes.com/2016/01/24/opinion/sunday/a-drug-to-cure-fear.html?smprod=nytcore-ipad&smid=nytcore-ipad-share

December 20, 2015

When Hospital Paperwork Crowds Out Hospital Care

A FRIEND was recently hospitalized after a bicycle accident. At one point a nursing student, together with a more senior nurse, rolled a computer on wheels into the room and asked my friend to rate her pain on a scale of 1 to 10.
She mumbled, “4 to 5.” The student put 5 into the computer — and then they left, without further inquiring about, or relieving, my friend’s pain.

http://www.nytimes.com/2015/12/20/opinion/sunday/when-hospital-paperwork-crowds-out-hospital-care.html?smprod=nytcore-ipad&smid=nytcore-ipad-share

September 18, 2015

Fish Oil May Have More Benefits for the Inuit than for Westerners

I have heard many people advocate eating local foods, and avoiding things from far away. Human metabolism, some say, isn’t the same everywhere. Now there is new evidence that whale blubber may be better for the Inuit than for westerners.

In the 1970s, Danish researchers studying Inuit metabolism proposed that omega-3 fatty acids found in fish were protective. Those conclusions eventually led to the recommendation that Westerners eat more fish to help prevent heart disease and sent tens of millions scrambling for fish oil pills.

Today, at least 10 percent of Americans regularly take fish oil supplements. But recent trials have failed to confirm that the pills prevent heart attacks or stroke. And now the story has an intriguing new twist.

A study published on Thursday in the journal Science reported that the ancestors of the Inuit evolved unique genetic adaptations for metabolizing omega-3s and other fatty acids. Those gene variants had drastic effects on Inuit’s bodies, reducing their heights and weights.

Rasmus Nielsen, a geneticist at the University of California, Berkeley, and an author of the new study, said that the discovery raised questions about whether omega-3 fats really were protective for everyone, despite decades of health advice. “The same diet may have different effects on different people,” he said.

http://www.nytimes.com/2015/09/22/science/inuit-study-adds-twist-to-omega-3-fatty-acids-health-story.html?smprod=nytcore-ipad&smid=nytcore-ipad-share

September 18, 2015

Value Based Care: Whose Values?

The Journal of the American Medical Association is taking a stand for elderly and disabled patients in today’s online issue:

“As Medicare moves to implement value-based payment initiatives tied only to current quality measures, the values of large populations of disabled and frail persons, whose care is the most costly and most concentrated in Medicare, are at high risk for being seriously neglected. These people will receive the medications and treatments that would be mostly correct if they were healthier, but their actual priorities will be neither noticed nor met. If the United States intends to pay on the basis of value, it is essential to ask patients what they value, and then deliver on those priorities.”

http://jama.jamanetwork.com/article.aspx?articleID=2443231&utm_source=Silverchair%20Information%20Systems&utm_medium=email&utm_campaign=JAMA%3AOnlineFirst09%2F17%2F2015

April 12, 2015

The Call Within the Call

“We all go into professions for many reasons: money, status, security. But some people have experiences that turn a career into a calling. These experiences quiet the self. All that matters is living up to the standard of excellence inherent in their craft.”

These words by The New York Times columnist David Brooks, in a piece called “The Moral Bucket List”, got me thinking more deeply about what kind of person I am, not just what kind of doctor.

He goes on to say:

“It occurred to me that there were two sets of virtues, the résumé virtues and the eulogy virtues. The résumé virtues are the skills you bring to the marketplace. The eulogy virtues are the ones that are talked about at your funeral — whether you were kind, brave, honest or faithful. Were you capable of deep love?

We all know that the eulogy virtues are more important than the résumé ones. But our culture and our educational systems spend more time teaching the skills and strategies you need for career success than the qualities you need to radiate that sort of inner light.

Many of us are clearer on how to build an external career than on how to build inner character.

But if you live for external achievement, years pass and the deepest parts of you go unexplored and unstructured. You lack a moral vocabulary. It is easy to slip into a self-satisfied moral mediocrity. You grade yourself on a forgiving curve. You figure as long as you are not obviously hurting anybody and people seem to like you, you must be O.K. But you live with an unconscious boredom, separated from the deepest meaning of life and the highest moral joys. Gradually, a humiliating gap opens between your actual self and your desired self, between you and those incandescent souls you sometimes meet.”

http://www.nytimes.com/2015/04/12/opinion/sunday/david-brooks-the-moral-bucket-list.html?smprod=nytcore-ipad&smid=nytcore-ipad-share

April 10, 2015

A Crazy Old-School Physician

A post by Suneel Dhand on KevinMD asks the question who is crazy – the elderly physician who knows his patient’s history by heart, or today’s young doctors, who know the computer better than their patients:

Then there’s the reality that his generation represents exactly what a personal physician should be. A solid physician with great clinical skills and highly respected by both the patient and their family. Unlike what medicine has become today, this was a doctor who would look you in the eye and think carefully and thoroughly through the diagnosis and treatment plan. It was obvious when he spoke to me that his clinical reasoning skills were top-notch. He wasn’t a doctor who was glued to his computer screen, having to spend the majority of his day clicking and typing away — about as far away as possible from the “type and click bot” doctor that is proliferating at today’s medical front lines.

http://www.kevinmd.com/blog/2015/04/the-old-school-physician-is-who-we-should-aspire-to-be.html

March 18, 2015

What Can Doctors Learn from Teachers?

An article in The New York Times about Doug Lemov’s book “Teach Like a Champion“ made me think more deeply about what to do with outcomes measures in health care.

Lemov has analyzed how successful teachers teach, measuring how long they wait for students to answer questions to how much eye contact they have to when they move around in the classroom and when they don’t. And he claims that these seemingly intuitive and almost invisible skills need to be learned and practiced.

“[The] Los Angeles school system tabulated the performance of roughly 6,000 teachers, using measures of student achievement. The best performing teacher in the whole system was a woman named Zenaida Tan. Up until that report, she was completely unheralded. The skills she possessed were invisible. Meanwhile, less important traits were measured on her evaluations (three times she was late to pick up students from recess).

[T]hese subtle skills are often not recognized or even discussed by those who talk about education policy, or even by those who evaluate teachers.

[This is like] the skill of herding cats. The master of cat herding senses when attention is about to wander, knows how fast to move a diverse group, senses the rhythm between lecturing and class participation, varies the emotional tone. This is a performance skill that surely is relevant beyond education.

This raises an important point. As the economy changes, the skills required to thrive in it change, too, and it takes a while before these new skills are defined and acknowledged.”

Thinking of where we are in health care, measuring “outcomes” is only the beginning. It needs to be followed by intelligent analysis of which methods and approaches produce those outcomes. And any implementation of what works in one community or one clinic needs to be tried and evaluated before we can be sure it also works for our own patients.

The New York Times’ article’s sobering conclusion is that the skills required for the future will not be fully defined or acknowledged in the present. Just like the highest achieving teacher received no recognition for several years, doctors that practice excellent and up to date medicine are sometimes penalized for disregarding lingering yet already outdated guidelines or prioritizing important outcomes nobody thought of measuring yet over pseudo measures that are easier to quantify.

http://www.nytimes.com/2015/03/17/opinion/skills-in-flux.html?smprod=nytcore-ipad&smid=nytcore-ipad-share

February 8, 2015

The Difference Between Care and Cure

My wife ordered a book a few weeks ago by Henri Nouwen, called “Bread for the Journey”. It was published posthumously and contains daily reflections. Nouwen is perhaps best known for his writings about the “wounded healer”. This morning over coffee, Emma asked me to look at today’s reflection, titled “Care, the Source of All Cure”:

“Care is something other than cure. Cure means “change.” A doctor, a lawyer, a minister, a social worker-they all want to use their professional skills to bring about changes in people’s lives. They get paid for whatever kind of cure they can bring about. But cure, desirable as it may be, can easily become violent, manipulative, and even destructive if it does not grow out of care. Care is being with, crying out with, suffering with, feeling with. Care is compassion. It is claiming the truth that the other person is my brother or sister, human, mortal, vulnerable, like I am.

When care is our first concern, cure can be received as a gift. Often we are not able to cure, but we are always able to care. To care is to be human.”

http://wp.henrinouwen.org/daily_meditation_blog/?p=3530

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