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Latest Posts

Many Physicians Don’t Identify Red Flags In Teen Athletes’ Health

Before reaching for tests like EKGs to screen teen athletes, we should first ask ourselves if we’ve taken a careful history:

The new study consisted of Madsen and his fellow researchers sending out surveys to every pediatrician and family practice doctor in Washington State. They received a good response–surveys were returned by 72 percent of pediatricians and 56 percent of family practitioners.

The results were disheartening:

  • 28 percent of doctors surveyed failed to always ask if a teen experienced chest pain during exercise.
  • 22 percent of doctors surveyed failed to Read more »

*This blog post was originally published at Dr. Wes*

Book Review: Just Like Someone Without Mental Illness Only More So

I’ll cut to the chase: I loved this book. Five stars. Two thumbs up.

When I read books, especially psychiatry books that I write about on Shrink Rap, I often read more carefully and sometimes more critically. I was so immersed in reading “Just Like Someone Without Mental Illness Only More So” that I didn’t stop to think, I just went on the journey.

Mark Vonnegut is a pediatrician and the son of my favorite author when I was in junior high school. His memoir is a poignant and candid account of his struggles with, well, life in general, and life with a psychotic illness in particular. Schizophrenia, bipolar disorder — who knows? (I’ll vote for bipolar disorder.) Some illness where he had three episodes in his twenties, then another episode 14 years later.

Thorazine and lithium and megavitamins and psych wards. Xanax and alcohol and how humiliating it is to be psychotic on a stretcher in the ER hallway of the hospital where he works. Divorce and remarriage. First and second families. Childhood as the son of a financially struggling, not-yet-famous eccentric writer, and adulthood as the son of an icon. Vonnegut is a hippy, a mainstream doctor, a middle-aged softball player, then finally a guy who accidentally poisons himself with wild mushrooms. Read more »

*This blog post was originally published at Shrink Rap*

If This Were Your Child, What Would You Do?

Child's doctor visitMany times when faced with a clinical dilemma, a parent will turn to me and ask: “What would you do if this were your child?”

When faced with this question, I never quite know what to say. And each time I feel a little on-the-spot. But why is that? Aren’t I comfortable recommending for someone else exactly what I would do for my own child? After all, what have I got to hide?

Here’s the problem: The decisions we make as parents involve our values, tolerance of risk, level of concern and frustration, prior health experience, and religious belief — to name but a few. There’s no way to fully tease those things from the parent sitting across the room. Read more »

*This blog post was originally published at 33 Charts*

Defining Family Practice

Family DoctorI like Dr. Rob, the one with the “distractible mind.” And although I thoroughly agree with the stance he takes in his recent post against cholesterol screening in kids, I must take issue with his opening statement:

I have a unique vantage point when it comes to the issue universal cholesterol screening in children, when compared to most pediatricians. My unique view stems from the fact that I am also an internist who deals with those children after they grow up on KFC Double Downs.


“Unique: existing as the only one or as the sole example; single; solitary in type or characteristics.”

Your med-peds training allows you to follow patients from birth to death (but no obstetrics or gynecology). You can care for all organ systems and all stages of disease (but without as much training in psychiatry). Congratulations! You’ve just (re)invented family practice (except for the above shortcomings). Oh, wait — that’s already a recognized specialty with its own residency programs, boards and everything like that, forty years now.

This misuse of the word “unique” is one of my pet peeves. “Unique?” I don’t think that word means what you think it means. After twenty years in practice, I agree that there probably isn’t much difference between what Dr. Rob does and what I do. After twenty years, I’m not even sure how much relevance remains from our “training.” Still, there remains a great deal of confusion about the very real differences between family practice and med-peds residencies. Read more »

*This blog post was originally published at Musings of a Dinosaur*

Public Service: Does Having An Opinion Disqualify You?

Many conservatives are up-in-arms about President Obama’s decision to appoint Don Berwick, a pediatrician and renowned expert in quality improvement and patient safety, to lead the Center for Medicare and Medicaid Services (CMS). They object to Dr. Berwick’s views on a range of issues, and to Obama’s decision to use his office’s authority to appoint Dr. Berwick while the Senate was out on a short Independence Day holiday recess. As a “recess appointment,” Dr. Berwick was able to take office without Senate hearings and confirmation, but he can only serve through the end of the 111th Congress — that is, until the end of 2011 — unless ratified by the Senate.

Berwick, though, also has many supporters. Maggie Mahar articulates the “pro” viewpoint on Dr. Berwick’s appointment in a recent Health Beat post. She observes that two former CMS administrators who served in Republican administrations have commented positively about Dr. Berwick’s qualifications. Read more »

*This blog post was originally published at The ACP Advocate Blog by Bob Doherty*

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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