Interim FDA Commissioner Announced
Dr. Robert Califf’s tenure as commissioner of the United States Food and Drug Administration (FDA) is slated to come to an end ahead of the January 20th inauguration of Donald Trump as president. Deputy commissioner Dr. Stephen Ostroff is expected to take over on an interim basis after the inauguration. Ostroff has previously been acting commissioner – from April 2015 to February 2016 he served as acting commissioner. Once Califf was sworn in, Ostroff became the FDA’s deputy commissioner for foods and veterinary medicine.
Califf Permanent Replacement
Scott Gottlieb
The leading candidate to replace Califf is said t...
Source: Policy and Medicine - January 18, 2017 Category: American Health Authors: Thomas Sullivan - Policy & Medicine Writing Staff Source Type: blogs
Patient-centered communication: what are the basic skills?
Communication skills needed for patient-centered care include:- eliciting the patient's agenda with open-ended questions, especially early on- not interrupting the patient- engaging in focused active listeningPractice this at least in the first 60-seconds, the so-called "golden minute".Understand patient's perspectiveUnderstanding the patient's perspective of the illness and expressing empathy are key features of patient-centered communication.Understanding the patient's perspective entails exploring the patient's:- feelings- ideas- concerns- experience regarding the impact of the illness- expectations from the physicianPa...
Source: Clinical Cases and Images - Blog - January 17, 2017 Category: Universities & Medical Training Authors: noreply at blogger.com (Ves Dimov) Tags: Communication Patients Source Type: blogs
A 3-question patient satisfaction tool for hospitalists
About three years ago, our hospital was abuzz about patient satisfaction. Our HCAHPS scores were lower than expected, and there was a push by the administration to improve them. As a hospitalist, I wondered to myself, what could I possibly do to improve them? I already believed I was doing a very good job communicating effectively with patients.
Many years ago, I developed the habit at the end of each encounter of always asking patients, “What questions do you have for me?” Their responses were rarely focused on their health or why they were in the hospital. Instead, they frequently seemed to revolve around things su...
Source: Kevin, M.D. - Medical Weblog - January 16, 2017 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/rajil-m-karnani" rel="tag" > Rajil M. Karnani, MD < /a > Tags: Physician Hospital Hospitalist Source Type: blogs
The double meaning of despair in the hospital
How can a doctor resist an essay entitled, “The Sickness Unto Death?” Kierkegaard, the darkest of the bleak existentialists, begins by asking, “Is despair an excellence or a defect?” Can despair be an excellence?
It is December in Oregon, the rain comes down in sheets, with only a few hours daily of half-light. Kierkegaard’s winters in 1840 Denmark must have felt a lot like this, so I press on.
“In despairing over something, he really despaired over himself, and now he wants to be rid of himself.”
In my hospital medicine practice, I see a lot of death and dying. Most weeks I attend to 2 to 3 patients ...
Source: Kevin, M.D. - Medical Weblog - January 10, 2017 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/kjell-benson" rel="tag" > Kjell Benson, MD < /a > Tags: Physician Hospital Hospitalist Source Type: blogs
Why is this physician here? Because of connection.
Why am I here? It’s already a half hour past the end of my 12-hour hospitalist shift, and I’m hustling to finish admitting a new patient from the ER. Once I finish, I still need to see patients at another facility before I finally wrap-up for the night and head home. Staying late is a professional courtesy for tonight’s nocturnist nurse practitioner. Nocturnist mid-level practitioners are a unique breed of medical rock star, not only because they choose to work at night, but also because they recognize when they need to call the on-call doctor and when they don’t. So even though I’m on call tonight, I know that I...
Source: Kevin, M.D. - Medical Weblog - December 30, 2016 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/beverly-a-zavaleta" rel="tag" > Beverly A. Zavaleta, MD < /a > Tags: Physician Hospital Hospitalist Source Type: blogs
Additional thoughts on diuretics – a followup to the furosemide rant
Yesterday’s screed about loop diuretics initiated more twitter activity than any blog post this year. Who knew?
Several comments bear documenting.
Important information on comparative absorption and duration of diuretics – A wonderful long range colleague (you should follow @kidney_boy on twitter) posted this infographic concerning this question on his blog. This is a most important link.
@Ajauseon tweeted this: “aspired to teach ‘evidence-based’ diuresis on CCU this month only to find there isn’t any” This tweet reminds me that EBM does not work for all questions. This qu...
Source: DB's Medical Rants - December 27, 2016 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs
Can we say that women doctors are just better for everyone?
Recently, my friend had a patient. The guy, patient with a history of autoimmune disease came in with pain, anxiety, and tachycardia. She walked in and felt the psychosomatic overlay. What was her intervention? Meds? Psych? Nope.
She closed the door, held his hand, pulled out her mom self and let him tell her for 15 long minutes about his hard life. The nurse watched the monitor as his heart rate dropped in a linear fashion. Better than beta blocker or benzos. Took freaking forever. But no labs, no consults, discharged 45 minutes later completely happy with his care.
Not sure know many of our male colleagues could,...
Source: Kevin, M.D. - Medical Weblog - December 21, 2016 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/dara-kass" rel="tag" > Dara Kass, MD < /a > Tags: Physician Emergency Source Type: blogs
To the caregivers over the holidays: Thank you
In my former life as a hospital-based, shift-working physician with young children at home, this time of the year inevitably brought the same question from at least a handful of individuals: “Isn’t it hard on your kids not to have you home on Christmas?” Thankfully, I was always able to answer truthfully, “no.” With consistent effort and a no-nonsense attitude, my kiddos either didn’t know the difference because they were so young, or, by the time they got older, it was old hat to celebrate a holiday on a different day.
Pediatric intensive care nurse Alysia Huber recalls a similar situation with her littl...
Source: Kevin, M.D. - Medical Weblog - December 21, 2016 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/juliet-b-ugarte-hopkins" rel="tag" > Juliet B. Ugarte Hopkins, MD < /a > Tags: Physician Hospital Pediatrics Source Type: blogs
Do Women Make Better Doctors Than Men?
By ASHISH JHA, MD
About a year ago, Yusuke Tsugawa – then a doctoral student in the Harvard health policy PhD program – and I were discussing the evidence around the quality of care delivered by female and male doctors. The data suggested that women practice medicine a little differently than men do. It appeared that practice patterns of female physicians were a little more evidence-based, sticking more closely to clinical guidelines. There was also some evidence that patients reported better experience when their physician was a woman. This is certainly important, but the evidence here was limited to a few specifi...
Source: The Health Care Blog - December 21, 2016 Category: Consumer Health News Authors: John Irvine Tags: Uncategorized Source Type: blogs
How an oncologist used Pac-Man to teach his patient
The most exciting and difficult part of my job is keeping up with all the rapid changes occurring in the field of cancer treatments. It is amazing how each day there seems to be a breakthrough treatment coming along, shifting old cancer paradigms. Although this is a good problem to have, finding time to stay current is easier said than done. Even more difficult is making sure we can explain these new changes to our patients, so they are educated and informed. I believe effective patient education is essential for any doctor irrespective of the field of medicine or practice setting. Trying to explain immunothera...
Source: Kevin, M.D. - Medical Weblog - December 20, 2016 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/prateek-mendiratta" rel="tag" > Prateek Mendiratta, MD < /a > Tags: Conditions Cancer Source Type: blogs
Quality improvement shouldn ’t be dirty words
With the recent election, there has been a new recognition of the various “bubbles” we all seem to be living in. It reminds me of the parable I like to often mention, popularized by the late great writer David Foster Wallace:
Two fish were swimming along when an older fish swam by, nodded his head at them and said, “Mornin’ boys, how’s the water?” The two young fish nod back and swim for a bit, then one turns to the other and says, “What the hell is water?”
Recently, I read a paper that helped me realize I had been swimming in a different lake from most of the “real world” in medicine. I trained and the...
Source: Kevin, M.D. - Medical Weblog - December 16, 2016 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/christopher-moriates" rel="tag" > Christopher Moriates, MD < /a > Tags: Physician Hospital Source Type: blogs
Keeping the human connection in medicine
Last month, the New England Journal of Medicine published a thoughtful essay by David Rosenthal and Abraham Verghese on the many changes in how doctors are trained and how they practice medicine. Efforts to improve efficiency and accuracy — including the introduction of electronic medical records — offer benefits, and pose some complicated problems.
Doctors need to learn and do more, more than ever
The health care system strives to deliver better care while keeping costs down. Advances in medical science and technology mean there is ever more information for a doctor to know, and policies to curb waste have limited the...
Source: Harvard Health Blog - December 12, 2016 Category: Consumer Health News Authors: John Sanford Limouze, MD Tags: Health Health care Managing your health care Source Type: blogs
Don ’t like the election outcome? Here’s what you can do from now on.
Like many of you, I have experienced a turmoil of emotions since Tuesday night’s presidential election. Sadness, anger, fear, disgust, and uncertainty have permeated my thoughts since I learned of our new reality. What does the future hold? What will the consequences be for my gay, minority, and Muslim friends, family, and patients? How will this affect the vulnerable children that I care for every day?
As I began to process this information, my first reaction was that I wanted out. Sign me up for Canada! I hate cold weather, but I love Vancouver and maybe I could get on one of those HGTV shows that films the...
Source: Kevin, M.D. - Medical Weblog - November 15, 2016 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/morgan-leafe" rel="tag" > Morgan Leafe, MD < /a > Tags: Policy Health reform Source Type: blogs
Sepsis bundles – why sensitivity and specificity matter
Graham Walker(@grahamwalker) tweeted this in response to yesterday’s blog post:
Agree w @medrants on Abx usage. Sepsis guidelines mandating Abx for anything that COULD be sepsis is the problem
I responded that his example is brilliant. Let’s dissect the problem.
Sepsis is a severe problem that responds better to early aggressive treatment.
Those invested in diagnosing sepsis desire bundles that have a high sensitivity. In case you forgot the definition of sensitivity, it is the true positive rate. Sensitivity here represents the percentage of sepsis patients that you treat promptly. Sounds good –...
Source: DB's Medical Rants - November 3, 2016 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs
Use generous orthodoxy to drive health care change
“You must respect the body you are trying to heal.”
I heard this said twice into my headphones, the second time more slowly and firmly than the first, while I sat on the runway about to take off. It continued to echo in my head over the course of the flight. As a physician, the reference to healing a body has obvious resonance. However, as I embarked on yet another gathering of health care leaders discussing how to make our health care system better, this assertion took on a broader significance.
Clinicians often hear about — and experience daily — our “broken health care system.” There is little doubt ...
Source: Kevin, M.D. - Medical Weblog - November 1, 2016 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/christopher-moriates" rel="tag" > Christopher Moriates, MD < /a > Tags: Physician Hospital Source Type: blogs
