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A Two-Biscotti Physician

[Recently] I ate at one of my favorite Italian restaurants. I had eaten there many times before, but the experience this time was different. After ordering, I received a vacuous bread basket with precisely two pieces of bread. At the end of my meal I was offered two biscotti — and no more. Only the manager could offer an explanation: As a means of containing costs, the decision had been made to capitate bread and biscotti distribution.

I was disappointed. I had been eating here for years. When Colic Solved was released, my publication party was held here. After all those anniversaries, New Year’s celebrations, and birthdays, I’m shortchanged on cookies? It’s remarkable how a great experience can be shadowed by something so small.

Then I got to thinking: Perhaps I’m a two-biscotti physician. Like this restaurant, there are times when I don’t finish well. I may do a phenomenal job with assessment and diagnosis, only to delay a callback on biopsies or X-ray results. Perhaps I get it all right, but fail to get the detail right on the home health orders. Are there small pieces missing in my encounter that represent everything a parent remembers? I know that there are, and I know there are things I have to work on.

There’s a lot we can learn from a restaurant. I don’t want to be a two-biscotti physician.

*This blog post was originally published at 33 Charts*

Swanson: Physicians Have An Ethical Duty To Participate In Social Media

Wendy Sue Swanson, MD

Most physicians still don’t see the need to blog, Tweet, or spend time on Facebook. They groan when you ask if they participate on social media platforms. “I’m too busy seeing patients,” they say, “and why would I expose myself to legal risk? Someone might think that I’m giving medical advice, or disclosing personal information about patients online.”

While these fears are pervasive, early adopters of social media like Dr. Wendy Swanson (and yours truly, by the way) have a different view. Not only should physicians become active in social media, but they have an ethical responsibility to do so.

Wendy is a pediatrician, mother, and blogger at Seattle Children’s Hospital. My friend “ePatient Dave” deBronkart recently encouraged me to watch an excellent video of Wendy speaking at the Swedish Symposium 2010 conference. I’d like to summarize Wendy’s pro-social media arguments for you here, with the hope of luring more of my peers to join the conversation online! Read more »

Teen Pregnancy Decline Is Likely As Low As It Will Go

Teen pregnancy rates have declined, but likely bottomed out, according to a report by the Centers for Disease Control and Prevention (CDC).

Teen births dropped by a third between 1990 to 2005, but rose again in 2006 and 2007. The latest figures for 2008 show a decline of 2.4 percent, to 41.5 pregnancies per 1,000 teenagers. Experts told My Health News Daily/MSNBC the dropping rates have bottomed out, and that new strategies are needed to deglamorize teen pregnancy.

Teen birth rates were consistently highest in states across the South and Southwest, and lowest in the Northeast and upper Midwest. In 2008, state-specific teenage birth rates varied widely, from less than 25.0 per 1,000 15-19 year olds (Connecticut, Massachusetts, New Hampshire, and Vermont), to more than 60.0 per 1,000 (Arkansas, Mississippi, New Mexico, Oklahoma, and Texas). Read more »

*This blog post was originally published at ACP Internist*

Does It Matter What The Hospitalist Thinks?

I read this article about a young child with heterotaxy syndrome with great interest. Not because I find heterotaxy syndrome something of great fascination, but because of the lack of communication — on both ends of the spectrum:

Even though 5 other Dr. all came in and listened to his lungs and said that he didn’t sound like he was wheezing and that his lungs sounded really good. But because this hospital is overly political, process driven, bureaucratic, and in a constant state of litigious fear they are unable to make any conclusions based on actual medicine and patient care. Common sense is blown out the window when you  have a system were a hospitalist one year out of medical school has an opinion that is as valuable as a cardiologist with 25+ years experience.

But in fairness, they all had to “really consider her opinion.”

So they went and got a pulmonologist to evaluate him, which Scott and I were very happy about because there was nothing in the world that would’ve made me more happy in that moment than to have her proven wrong. Which she was.

The whole article is a case study in stress, distrust, and legalism. Read more »

*This blog post was originally published at The Happy Hospitalist*

ADHD: Is It Genetic?

British scientists announced that attention-deficit/hyperactivity disorder (ADHD) has been linked to deleted or duplicated DNA segments (copy number variants), which leads to developmental difference in the brains of children with the condition.

Researchers scanned genomes of 366 children with ADHD and compared them with 1,047 unrelated, ethnically matched control subjects. They reported full results in The Lancet.

Rare copy number variants were almost twice as common in children with ADHD compared to the other children. Researchers commented to Reuters that there was a significant overlap between copy number variants found in ADHD and elements of the genome linked to autism and schizophrenia, specifically in a region on chromosome 16.

*This blog post was originally published at ACP Internist*

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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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