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Latest Posts

When Instinct Trumps Expertise

A hard thing about being an ER doctor is that I know a little, sometimes very little, about a lot of things. When I am faced with a particular condition, I often need to call the specialist for that organ, who knows way way more about it than I ever will, and they all think I’m an idiot because I don’t know as much about their organ as they do. There’s a huge asymmetry of knowledge, and it can create some tension and conflict.

I’m OK with it, because I can ignore their condescension and I am secure with what I do know, and its limits. But sometimes I get perplexing instructions from the specialists. The emergency medicine dogma can be overbroad and a little hidebound and what the specialists will do in the real world often radically diverges from what the Emergency Medicine textbooks say to do. It’s often an interesting learning opportunity for me, especially when it’s a condition I don’t encounter that much.  But I also have to work to maintain a flexible and open-minded attitude when I call a consultant and my side of the conversation consists of “Really? I didn’t know you did that for this…” You need to know and trust your colleagues in other specialties, and know when to call BS on them and push to do something else, which is really hard to do when you are talking to someone who is so much more of an expert than you are.

So I saw this guy recently, an urban hipster who was perhaps a bit too old to be riding his longboard on the hilly streets of our fair town. He didn’t seem to be too good at it, judging by the collection of crusted abrasions and aging ecchymoses he was sporting. He had been falling a lot recently — we only get about a month of sun here, so I guess he was making the most of the summer weather practicing his new hobby.  He had a variety of complaints from Read more »

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

Why We Need Both Primary Care Physicians And Sub-Specialists

An article in the March 24 NEJM called Specialization, Subspecialization, and Subsubspecialization in Internal Medicine might have some heads shaking: Isn’t there a shortage of primary care physicians? The sounding-board piece considers the recent decision of the American Board of Internal Medicine to issue certificates in two new fields: (1) hospice and palliative care and (2) advanced heart failure and plans in-the-works for official credentialing in other, relatively narrow fields like addiction and obesity.

The essay caught my attention because I do think it’s true that we need more well-trained specialists, as much as we need capable general physicians. Ultimately both are essential for delivery of high-quality care, and both are essential for reducing health care errors and costs.

Primary care physicians are invaluable. It’s these doctors who most-often establish rapport with patients over long periods of time, who earn their trust and, in case they should become very ill, hold their confidence on important decisions — like when and where to see a specialist and whether or not to seek more, or less, aggressive care. A well-educated, thoughtful family doctor or internist typically handles most common conditions: prophylactic care including vaccinations, weight management, high blood pressure, diabetes, straightforward infections – like bacterial pneumonia or UTIs, gout and other routine sorts of problems. Read more »

*This blog post was originally published at Medical Lessons*

How To Choose A Great Doctor

As a practicing family doctor, it’s easy for me to figure out how to choose a great doctor. Let me tell you the secrets in finding the best one for you and what I tell my family and friends. Look for the following:

– Board certification
– Report card on quality
– Licensing/public reporting

As a doctor, I know many doctors who have great bedside manner but aren’t particularly reliable in giving the right medical care you deserve, and these traits separate the so-so doctors from the truly excellent ones. Read more »

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

Democracy, Tyranny, And The Online Revolution

Image by pomarc via Flickr

When status quos collapse, for whatever reasons, are their replacements necessarily better? Does the demise of traditional media powers mean that new media powers will lead to more Democracy? Will cultivated professions which require years of training and mistakes and experience – such as Medicine – give way to amateurs who can succeed in creating appearances of Authenticity?

Last century, not everybody could publish their thoughts without expending some form of considerable energy. Now, with Twitter, anyone can tell the world what s/he thinks at virtually zero expense (save the time value of their tweets). This is no doubt a radical shift in communications and publishing and connecting.

It’s easy to call this democratizing. But is it? Read more »

*This blog post was originally published at phil baumann online*

Online Health Information: Does It Make You An Expert?

The advent of the internet, combined with social media, has made everyone experts and has increased the disdain for authority.

No where is that more apparent than the firestorm that surrounds vaccines and its detractors.

The Los Angeles Times’ James Rainey writes a column on the phenomenon, observing the backlash against a well-written, nuanced piece debunking the link between vaccines and autism.

But as we know, those who already believe there is a connection are unlikely to be swayed. And on the web, it’s easy to find data and studies that fits an already established mindset. Read more »

*This blog post was originally published at*

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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