A recent study suggests that doctors may put off holding end of life care discussions that involve subjects like advance directives, hospice or site of death.
Recommendations suggest that physicians hold these conversations when patients have about a year to live, but the data show those guidelines aren’t being followed.
Why? Read more »
*This blog post was originally published at KevinMD.com*
This week’s obvious news consists of findings that you might have hoped weren’t true, but really you already knew they were.
First, sending your spouse off to war will make you unhappy, according to the New England Journal. “Among wives of soldiers deployed for up to 11 months, researchers found almost 3,500 more diagnoses of depression, anxiety, sleep disorders and other mental health issues than among wives who husbands stayed home,” reported HealthDay. Guess these women actually liked their husbands!
Then, it turns out that diabetics should not pig out, especially on salt, according to the Archives of Ophthalmology via HealthDay. A study of black patients with diabetes found that those who ate more calories and more sodium were more likely to develop diabetic retinopathy. “These results suggest that low caloric and sodium intakes in African-American individuals with type 1 diabetes mellitus…might be part of dietary recommendations for this population,” the authors concluded. Shoot, now we will have throw out those “hot dog a day keeps the doctor away” guidelines.
*This blog post was originally published at ACP Hospitalist*
One of my favorite patients died last week.
My reaction to this was not quite what you would think: I smiled. No, I didn’t smile because of his death; I smiled because of his life. I smiled because I got to be a part of that life. His death wasn’t his tragic end, it was the exclamation point to his life.
I am around a lot of death – it’s one of the things that makes being a doctor different from other jobs. My goal with all of my patients is to keep them healthy, to relieve their pain, and to do my best to keep them alive. Ultimately, though, it’s a losing battle; 100% of them will eventually die. That’s why I don’t like statistics about how many people who die due to inadequate doctoring. Our job is to resist an irresistible force. We are standing up to the hurricane, the avalanche, the flood. Read more »
*This blog post was originally published at Musings of a Distractible Mind*
Have you ever stopped bothering to care about a patient? A doctor sent me his own personal account of the smoking Mr Jones:
Dear Happy. I read your article on bounce backs with great interest, and was astonished by some of the vitriol it elicited. I remember having one COPDer bounce back to me three times within a month at the VA when I was a medicine resident. He would leave, smoke and drink, and then come back and be readmitted to my service with exactly the same course each time. It was like Groundhog Day.
Finally I had a little talk with him and said: “Mr. Jones, each time you come in, you’re on death’s door. So I come down to the ER, stay up with you all night and save your life. But you know, I’m really getting tired of having you come in after drinking and smoking and then working like a dog to save your life. So let me tell you, if you don’t quit smoking, the next time you do this there’s a good chance that I’m not going to bother. Why should I? It doesn’t seem to be doing either of us any good.”
To my complete astonishment, he actually quit smoking and stayed quit for about a year. Then he fell off the wagon, deteriorated too far before getting to the hospital and died. I was frankly proud of him for the effort, but somehow suspect that I’d be shot in a drive-by if I ever told that story in public. Read more »
*This blog post was originally published at The Happy Hospitalist Blog*
President Obama’s Healthcare Reform Bill will not work. It is based on decreases in physician reimbursement while forcing physicians to increase overhead with unaffordable electronic medical records. More and more physician groups and practices are starting to realize that they cannot make a living from the reimbursement from Medicare. They are quitting taking new Medicare patients and trying to get rid of the old ones by not taking assignment.
President Obama’s idea is to force physicians to be more efficient producers. It is very difficult to force anyone to do anything they cannot afford. Read more »
*This blog post was originally published at Repairing the Healthcare System*
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…
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…
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…
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…
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…
