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What We Really Need: Teamwork In Medicine

Atul Gawande says that we’re used to doctors working like “cowboys” – rugged individualists who are responsible for making sure your care gets done right.  We don’t need cowboys, he says.  We need “pit crews” – teams of doctors working together toward a common goal, with each playing their own role.

It’s an appealing idea.  Pit crew-like teams work, and work well, in trauma units across the country.

But there’s a problem: if you haven’t just been airlifted to a hospital after a horrible accident, you’re not going to be treated by a pit crew.  You’re going to be on your own, shuffled from one 15-minute specialist visit to the next, likely with no one person in charge of your care.

Dr. Gawande knows this, and he picks a heck of an example of the problem: Read more »

*This blog post was originally published at BestDoctors.com: See First Blog*

TIME Magazine Promotes Evidence-Based Medicine In Its Special Nutrition Issue

Here on SBM we have frequently had cause to criticize the media for poor science reporting and for spreading misinformation. Among many other individual offenders, we have criticized Dr. Oz for promoting alternative medicine on his TV show and gullibly promoting guests who pretend to talk to the dead and pretend to heal people with carnival sideshow tricks. We tend to be negative and critical because somebody has to do it, but it’s not pleasant.  For once, I have some good things to say.

The September 12 issue of TIME magazine was a Special Nutrition Issue. The cover featured pictures of food and the title “What to Eat Now: Uncovering the Myths about Food by Dr. Oz.” It devotes 7 pages to an article by him entitled “The Oz Diet: No more myths. No more fads. What you should eat — and why.” This is followed by a 5 page article by John Cloud “Nutrition in a Pill? I took 3000 supplements over five months. Here’s what happened.” Both articles have a rational, science-based perspective without any intrusions of woo-woo.

Oz on What to Eat

Oz acknowledges that the science of nutrition is not simple and that much of what we once believed has been discarded in the face of new knowledge. He debunks a number of popular misconceptions about diet. Most of what he says is consistent with scientific evidence and with mainstream diet advice. Read more »

*This blog post was originally published at Science-Based Medicine*

Numbers Dominate Our Experience With Health Care

“My doctor can titrate my chemotherapy to the milligram but can’t tell me when I am going to die,” a friend who was struggling with his treatment for cancer complained to me a couple years ago.

Had he lived, he might have been reassured by the announcement last week of a new scale that allows clinicians to estimate the time remaining to people with advanced cancer.  He was spending his final days “living by the numbers” of his white blood cell count, the amount and size of his tumors and suspicious lesions, the dosage of various drugs and radiation treatments. And he was peeved about what he saw as a critical gap in those numbers.  He believed (hoped?) that because his cancer was quantifiable and the treatment was quantifiable, that the time remaining should be similarly quantifiable.  He needed that information to plan how to use the time that remained.

Many of us would make a different choice about knowing how long we will live when we are similarly ill.  But most of us are attracted to the certainty we attach to the numbers that precisely represent aspects of our diseases.

It is not just when we are seriously ill that numbers dominate our experience with health care.  Advances in technology have made it possible to quantify – and thus monitor – a seemingly infinite number of physiological and psychological health-related states. For instance: Read more »

*This blog post was originally published at Prepared Patient Forum: What It Takes Blog*

Why Are Some Physicians So Bad At Communicating With Their Patients?

“I don’t have the time…I don’t get reimbursed for that.”  This is an all too common refrain from primary care physicians and practice managers when ever the subject of improving physician-patient communications comes up.

I get it.   Primary care physicians in particular are under tremendous pressure to produce.   Just imagine…physicians in small primary care practices spend about 3.5 hours/week just on dealing with insurance-related paperwork.  Then there’s keeping up with recommended treatment guidelines, journals, and IT issues and routine staffing issues…not to mention routine patient care, much of which they in fact do not get paid for.  Physicians do have it rough right now.

But Doctors Can Sometimes Be Their Own Worst Enemies

Currently, in just about every State, Read more »

*This blog post was originally published at Mind The Gap*

Does Your Doctor Have Time To Think About You?

At the New York Times’ City Room Blog, Joel Cohen writes:

my wife and I are convinced that all medical students should have to pass Overbooking 101 before they can become doctors.Again and again, we arrive at a doctor’s aptly named waiting room on or before the scheduled time, only to learn that three or four others sitting there have been given the same appointment.

He says doctors need to understand the impact of this on their patients.  I agree, but not just because it’s annoying.

A typical doctor sees thirty patients a day.  Some see even more.

Reflect on that math.  If your doctor sees 30 patients a day, that’s 150 a week, 600 a month, maybe 7,000 a year.

It means that if it’s been even two months since you last saw your doctor, he has probably seen more than a thousand people since your last visit.  It’s why there’s often that Read more »

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

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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