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Menthol: Mounting Evidence That It Makes Smoking Cessation More Difficult

I’m writing from the second conference on menthol and cigarettes, in Washington DC. This conference was organized to review the evidence on the effects of menthol in cigarettes and to discuss what further research is necessary and what actions should be taken.

To me, the presentations appeared to suggest that right now the evidence that menthol cigarettes are more harmful to health is weak. However, the evidence that menthol cigarettes are a starter product for youth and that menthol cigarettes can (under certain circumstances) be more addictive and harder to quit, is quite strong and getting stronger all the time. Read more »

This post, Menthol: Mounting Evidence That It Makes Smoking Cessation More Difficult, was originally published on Healthine.com by Jonathan Foulds, Ph.D..

When Should A Doctor Break Up With His/Her Patient?

Sedaka
They say that breaking up is hard to do
Now I know, I know that it’s true
Don’t say that this is the end
Instead of breaking up I wish that we were making up again

There are times that relationships need to end.  Usually something happens to undermine trust; it’s hard to build trust, but it’s very easy to destroy it.

I had a discussion today with the other physicians in my practice as to when patients should be “discharged” from our practice.  I have always found it somewhat ironic that we use the term “discharge” when we are basically telling patients we don’t want them to be our patients anymore.  Doctors deal with discharges of various sorts – most of which are not pleasant.  Here is a dictionary definition of discharge: the emission of pus, mucus, or other liquid from an orifice or from diseased tissue. True, there are other definitions of discharge that don’t cary that connotation (we discharge patients from the hospital), but if I see an appointment on my schedule with the word discharge as part of the reason for visit, I am not excited.  I am praying for a no-show. Read more »

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

Physician Payment: Why So Complicated?

Over 25 years ago I witnessed a crime, committed by my family doctor. I was waiting to pay for my visit when an elderly, dignified, but obviously poor woman pulled out her checkbook, clicked open her pen, and asked, “How much do I owe?”

The receptionist’s answer piqued my interest and admiration, “The doctor said no charge, we’ll just bill your insurance.” I still remember the gratitude conveyed by her body language as she said, “Thank him for me,” returned her checkbook to her purse and left.  Naïve to the complexity involved in medical billing, I was unaware that anything wrong had been done and did not resent having to pay for my office visit since our family could afford to pay; however, he eventually served time in jail for what I have always considered crimes of compassion. Perhaps I lack the details of his legal case to properly consider his actions but I’ll never forget the respect shown him by my home town in rural Tennessee after his time had been served; my family among many he continued to care for. Read more »

If I Could Fix One Thing About U.S. Healthcare…

In my post yesterday about lessons we can learn from Israel’s health care system I wrote:

So, yes, the focus on health insurance reform will lead to many changes, and more complexity.  And some day, years from now, someone will be explaining the American system to an audience, and people will wonder, how did anyone ever create a system such as this?

In response, a friend of mine challenged me:  if the system is too complicated, how should we simplify it?

I wish more policy-makers were asking this question.

For me, the answer is clear: Primary care.  Time was, your primary care doctor was able to serve as the hub of your medical activity.  He or she could spend all the time needed to figure out what was wrong and to coordinate with your specialists.  It’s not true anymore.  Patients are left on their own trying to navigate the system.  In many ways they end up acting  almost as their own primary care doctors.  Patients try to pick their specialists, find out what to do about their condition, decide on good treatment choices. Read more »

*This blog post was originally published at See First Blog*

Insights From Harvard’s Primary Care Innovators Round Table

In 2005, I was invited to participate in an innovators’ workshop by the Harvard Interfaculty Group, funded through a grant from the Robert Wood Johnson Foundation. The question at the meeting was this:

“If primary care is critical to a vibrant and cost effective healthcare system, and
If primary care is going extinct, which most now predict;
Who is out there innovating new primary care systems and what is their vision?”

During the four years since this conference, I’ve found that this question is first and foremost when it comes to changing primary care.

I felt honored and surprised to be invited to the meeting. After all, our practice and its innovations are simple and are based on the following: 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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