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New Pap Smear Guidelines: The Right Care Or Rationed Care?

The American College of Obstetricians and Gynecologists (ACOG) recently reiterated their position that Pap smears should be performed on healthy women starting at age 21. This is different from the past which recommended screening for cervical cancer at either three years after the time a woman became sexually active or age 21, whichever occurred first.

How will the public respond to this change?

Over the past year there have been plenty of announcements from the medical profession regarding to the appropriateness of PSA screening for prostate cancer and the timing of mammogram screening for breast cancer. Understandably, some people may view these changes in recommendations as the rationing of American healthcare. Read more »

*This blog post was originally published at Saving Money and Surviving the Healthcare Crisis*

Failure For A Doctor

I went to a patient’s funeral this past weekend. I generally don’t do that for people whose relationship I’ve built in the exam room. It’s a complex set of emotions, but invariably some family member will start telling others what a nice doctor I am and how much the person had liked me as a doctor. It’s awkward getting a eulogy (literally good words) spoken about me at someone else’s funeral. This patient I had known prior to them becoming my patient, and his wife had been very nice to us when we first moved here from up north.

But that’s not why I am writing this. As I was sitting in the service, the thought occurred to me that a patient’s funeral would be considered by many to be a failure for a doctor. Certainly there are times when that is the case — when the doctor could have intervened and didn’t, or intervened incorrectly, causing the person to die earlier than they could have. Every doctor has some moments where regrets over missed or incorrect diagnosis take their toll. We are imperfect humans, we have bad days, and we don’t always give our patients our best. We have limits. Read more »

*This blog post was originally published at Musings of a Distractible Mind*

Transitioning Primary Care To “Patient-Centered” Team Care

While the “patient-centered medical home” may be a good idea, it needs a better name. It sounds like a hospice, reports surgeon and columnist Pauline Chen, M.D. She outlines the initial experiences of practices making the transition to the new practice model.

One problem uncovered by pilot projects is that doctors in transition to the practice model have to spend inordinate amounts of time of things other than patients. And while the patients want and welcome the changes, they face a learning curve too, as they move from seeing just the doctor to working with a team of providers for their care. 

Physicians suggested using resources from the Patient-Centered Primary Care Collaborative, a collaborative group set up to help offices make the transition. (New York Times)

*This blog post was originally published at ACP Internist*

When Medical Professionals Turn Their Backs

Good SamaritanA few weeks before Christmas, Eutisha Rennix, a pregnant restaurant worker, collapsed while working. She started having a seizure and her co-workers were screaming for help.

There were two EMT workers in line at Au Bon Pain shop in Brooklyn and they refused to help. They told onlookers to call 911 and they walked out of the store after picking up their bagels, presumably because they were on a coffee break. An ambulance was called and the 25-year-old woman and her baby girl died shortly afterward. She is survived by a 3-year-old son. Read more »

*This blog post was originally published at EverythingHealth*

Career Counselor? Thoughts On Becoming A Doctor

As a physician, I’ve had several people ask my “honest” opinion of their plans to become a doctor. I know what my response is to this question, but I wonder what others in my profession would answer. Would your response depend, in large part, on who’s doing the asking — could you answer your own child as you would someone you just met? Be careful, your answer to this question, if honestly given, might shine an unsettling light on your own feelings about your current career choice.

Last week I spoke with a college junior working to fulfill her lifelong plans to become a physician. She told me about a recent conversation with her own doctor where she shared her plans to go to medical school and he’d tried to dissuade her. She couldn’t recall a single cogent reason given for avoiding the medical profession, yet it appeared to me that his odium had negatively imprinted her image of the medical profession, which is a shame. At this time more than ever, we –- doctors and patients alike — need to encourage the most talented of our youth to join the medical profession. Read more »

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

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How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

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Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

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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…

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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…

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