Short White Coat

On hospital charges and doctors' decisions

Fri, 10 May 2013 12:00:00 GMT

How much to treat this pneumonia? On Wednesday, the Centers for Medicare and Medicaid took a step towards answering such questions by publicly releasing how much each of 3000+ U.S. hospitals charged Medicare for 100 common medical issues in 2011...

On cabdrivers and patient empowerment

Thu, 02 May 2013 12:00:00 GMT

The cabdriver pulled up to take me to the community hospital where I work several weeks each year. Settling into the back seat, I made my request before he reached the intersection: "Could you please take 93 South?" He was...

A week after the Boston bombings, a chance to reflect

Mon, 22 Apr 2013 19:50:00 GMT

I was sitting in the resident workroom at Massachusetts General Hospital (MGH) when my co-resident showed me the text from her sister: two explosions had shaken the finish line of the Boston marathon. Though news sites had not yet published...

Chronic care at Walgreens? Why (not)?

Wed, 10 Apr 2013 16:00:00 GMT

Walgreens, the countrys largest drugstore chain, announced on Thursday that its 330+ Take Care Clinics will be the first retail store clinics to both diagnose and manage chronic conditions like asthma, diabetes, high blood pressure, and high cholesterol. The Nurse...

Revisiting non-urgent emergency department visits

Fri, 29 Mar 2013 17:15:00 GMT

Yesterday, I cared for one patient with chest pain, another with burning pain on urination, and a third with sharp belly pain. Two of the three came to see me in my primary care clinic, the third in the intensive...

Tethered to a pole: the challenge of end of life decisions

Fri, 22 Mar 2013 16:59:00 GMT

When I attended the Association of Health Care Journalists (AHCJ) conference in Boston last weekend, discussion swirled on the topics of unsustainable costs of care, doctors incentives under traditional payment models to order more tests and treatments, and the struggles...

US patients can choose better

Mon, 11 Mar 2013 14:30:00 GMT

You get a terrible headache. What do you do next? Take ibuprofen and try to sleep it off? Call your primary care physician (PCP) for an appointment? Dial 911 for an ambulance to take you to the Emergency Department...

The bitter pill, chewable for doctors

Thu, 28 Feb 2013 16:15:00 GMT

When I read Steven Brills epic takedown of health care costs in Time, my first reactions were sticker shock and outrage at the capricious ChargeMaster that has pushed so many Americans into bankruptcy. This was followed by unease: Did I...

Over-testing on the medical boards

Tue, 19 Feb 2013 12:00:00 GMT

I just took step three of the national board exams - the final in a series that all U.S. physicians must pass to practice medicine unsupervised. The two day exam, composed of multiple choice questions and simulated patient cases requiring free-text...

A doctors condolences

Thu, 07 Feb 2013 12:00:00 GMT

When a patient dies in the hospital, we go through a checklist that has become eerily mundane: Examine the patient to confirm the death. Notify the family, the senior doctor, the local organ bank, the admitting office, and (in some...

Quit (smoking) while you're ahead

Fri, 25 Jan 2013 05:07:00 GMT

I knew he was sick when he told me he'd thrown out his cigarettes on account of how badly he felt. Mr. P had gotten used to the breathlessness when he climbed stairs and the hacking, dry cough that followed him...

Did your doctor get a flu shot?

Tue, 15 Jan 2013 16:00:00 GMT

Confession: I forget sometimes to re-apply sunscreen. I go to the gym only when it is extremely convenient. And I eat maybe two servings of fruits and vegetables a day, unless you count Welchs Fruit Snacks. Patients expect their doctors to...

Christmas in the hospital

Thu, 27 Dec 2012 12:00:00 GMT

The hospital can be a strange place over the holidays. This year, it was work as usual, save the nurses' station festooned with tree lights, the occasional jolt of festivity from teen-aged Christmas carolers fulfilling their volunteer requirements, the frenzy...

Zen and the art of harm reduction

Mon, 17 Dec 2012 12:00:00 GMT

Between 7:30 and 10 a.m. on a glacial late November morning, a tall white van lingers at a street corner in Boston's South End. I consult my iPhone one more time to confirm that I'm in the right place and...

The power of a nap

Thu, 06 Dec 2012 12:00:00 GMT

Protected naptime is a luxury usually reserved for the under-five-year-old set. Might it also be a tool to combat our country's astoundingly high rates of medical errors? Trainee fatigue has been a major focus of patient safety efforts since the mid...

Residency and the hidden curriculum

Mon, 26 Nov 2012 12:00:00 GMT

Its that time of year: Amtrak is hiking up its travel fares. "All I Want for Christmas" is reclaiming its rightful place on mall playlists. And fourth year medical students are starting the interview process to match into a residency...

Younger doctor, bigger spender?

Wed, 14 Nov 2012 12:00:00 GMT

We know that physicians (and their pens/keyboards) are some of the main drivers in health care spending. But which ones are the biggest offenders? A recent study from the nonprofit RAND Corporation asked this question and found that newer doctors tend...

Stuck in the Emergency Room

Thu, 01 Nov 2012 12:00:00 GMT

The crowded emergency department (ED): It has become a symbol for our fragmented, inefficient health care system and for one presidential candidate, an acceptable alternative to expanding health insurance under Obamacare.In the wake of Hurricane Sandy, the visual has become...

Stuck on loop: why do patients have to repeat their stories?

Fri, 19 Oct 2012 12:00:00 GMT

The other night, a patient gave me a piece of his mind. Mr. Q was a middle-aged man debilitated by days of nausea, vomiting and intractable belly pain. That morning, his wife finally convinced him to get medical attention and...

Patients and doctors benefit from shared notes

Tue, 09 Oct 2012 05:07:00 GMT

When I joined the Ambulatory Practice of the Future (APF) as a first-year resident, I learned that the primary care clinic had an open notes policy: whatever we wrote about our patients could be seen by our patients through a...

Wheat from chaff: Making sense of the electronic health record

Mon, 10 Sep 2012 12:00:00 GMT

At 5am, Mr. A rolls onto the medicine floor: the fifth and final new patient to be admitted that night. The 70-year-old is well-known to our institution from his near-monthly hospitalizations and his primary care doctor, cardiologist, podiatrist, ophthalmologist, and...

Electronic health records in the classroom?

Mon, 20 Aug 2012 12:35:00 GMT

Outside a patients room in the cardiac intensive care unit (CICU), a senior doctor, a nurse, and several residents in various stages of wakefulness cluster for morning rounds. Each resident mans a computer-on-wheels (once called a C.O.W., the acronym was...

Who are the costliest patients?

Thu, 02 Aug 2012 12:00:00 GMT

Weve known for decades that a small fraction of Americans incurs the bulk of health care costs. A report released last month by the National Institute for Health Care Management (NIHCM) analyzes 2009 data to shed light on the patients...

Disagreeing with your doctor: Its harder than it seems

Tue, 17 Jul 2012 12:00:00 GMT

While our dad was in the hospital last winter, my brother shared with me his strategy for talking to the doctors we encountered - an approach honed over ten years of marriage to an internist and dozens of pediatrician visits...

The Affordable Care Act and me

Mon, 02 Jul 2012 12:00:00 GMT

When I learned about the Supreme Courts decision on Thursday to uphold (most of) the Affordable Care Act (ACA) I was lying in bed with a trash can at arms length, feeling horribly sick to my stomach. So I received...