Confronting Scandalous Physician Behavior: The Annals Of Internal Medicine Takes The First Step

Val Jones, MD

This post first appeared on Better Health.

If you have not read the latest essay and editorial about scandalous physician behavior published in the Annals of Internal Medicine (AIM), you must do so now. They describe horrific racist and sexist remarks made about patients by senior male physicians in front of their young peers. The physicians-in-training are scarred by the experience, partially because the behavior itself was so disgusting, but also because they felt powerless to stop it.

It is important for the medical community to come together over the sad reality that there are still some physicians and surgeons out there who are wildly inappropriate in their patient care. In my lifetime I have seen a noticeable decrease in misogyny and behaviors of the sort described in the Annals essay. I have written about racism in the Ob/Gyn arena on my blog previously (note that the perpetrators of those scandalous acts were women – so both genders are guilty). But there is one story that I always believed was too vile to tell. Not on this blog, and probably not anywhere. I will speak out now because the editors at AIM have opened the conversation. (more…)

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Over-Reliance on Tests: Why Physicians Must Learn to Trust Themselves & Their Patients

Val Jones, MD

The post below ran yesterday on Better Health.

I met my newly admitted patient in the quiet of his private room. He was frail, elderly, and coughing up gobs of green phlegm. His nasal cannula had stepped its way across his cheek during his paroxsysms and was pointed at his right eye. Although the room was uncomfortably warm, he was shivering and asking for more blankets. I could hear his chest rattling across the room.

The young hospitalist dutifully ordered a chest X-Ray (which showed nothing of particular interest) and reported to me that the patient was fine as he was afebrile and his radiology studies were unremarkable. He would stop by and check in on him in the morning.

I shook my head in wonderment. One look at this man and you could tell he was teetering on the verge of sepsis, with a dangerous and rather nasty pneumonia on physical exam, complicated by dehydration. I started antibiotics at once, oxygen via face mask, IV fluids and drew labs to follow his white count and renal function. He perked up nicely as we averted catastrophe overnight. By the time the hospitalist arrived the next day, the patient was looking significantly better. The hospitalist left a note in the EMR about a chest cold and zipped off to see his other new consults. (more…)

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Newly Minted Doctors Begin Their First Jobs In July: Should You Be Afraid?

Val Jones, MD

Today’s post first ran on Better Health on July 4.

The short answer, in my opinion, is yes.

The long answer is slightly more nuanced.  As it turns out, studies suggest that one’s relative risk of death is increased in teaching hospitals by about 4-12% in July. That likely represents a small, but significant uptick in avoidable errors. It has been very difficult to quantify and document error rates related to inexperience. Intuitively we all know that professionals get better at what they do with time and practice… but how bad are doctors when they start out? Probably not equally so… and just as time is the best teacher, it is also the best weeder. Young doctors with book smarts but no clinical acumen may drop out of clinical medicine after a short course of doctoring. But before they do, they may take care of you or your loved ones.

It has been argued that young trainees “don’t practice in a vacuum” but are monitored by senior physicians, pharmacists, and nurses and therefore errors are unlikely. While I agree that this oversight is necessary and worthwhile, it is ultimately insufficient. Let me provide an illustrative example. (more…)

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TBT: Turf versus Access to Care

Diana Mason

This week’s TBT post was written during last year;s National Nurses Week. Although the situation has improved there still is a ways to go. The post is a good reminder of what nurses do and how an expanded role for them would improve the health care system.

This is Nurses Week, often a time when health care organizations patronize nurses with free food and tchotchkes. We’d rather have the right to be able to contribute our talents and expertise to improving the health of people by being able to practice to the full extent of our education and training. Last week, the New York Times published a commentary on The Opinion Pages by cardiologist Sandeep Jauhar that continued to prop up the old and inaccurate message by organized medicine that nurse practitioners must be supervised by physicians. It perpetuates turf battles instead of focusing on improving access to safe, quality, affordable care. At a time when the Affordable Care Act has provided millions of people with coverage for care, building our primary care capacity is essential. (more…)

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Mind-Body (in my case Mind-Butt) Connection

Archelle Georgiou, MD

Colonoscopy…no way, no how, don’t want it, don’t need it. I’d rather have colon cancer. I don’t have any risk factors anyway. Can’t I have a root canal instead?

These are the thoughts that swirled through my head starting at age 49 as I anticipated turning 50 and hitting the magic moment for this right of passage.

But, several months ago, the resistance disappeared. I made the appointment in March and didn’t think about it again until I had to start the prep at 4 pm on the day before my procedure. Drinking 64 oz of Crystal Light with Miralax and 10 ounces of magnesium citrate made me feel like a bloatedwhale. I was stuck in a bathroom, chilled from the cold liquid, and could only tolerate wearing grey flannel sweats. (more…)

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The Quiet Revolution: The Power of Storytelling in Health Care

Beth Toner

In 1981, my 61-year-old father died of lung and liver cancer. I was just 14 years old. This, during the “Cancer Dark Ages” – a time when there was no ondansetron to offset the devastating nausea and vomiting that so often accompanied chemotherapy, and dying at home was as alien a thought as, well, an alien. Watching his nine-month decline was, without a doubt, the most difficult experience of my childhood, and perhaps my life.

It would be years before I could set foot in a hospital without being overwhelmed by crippling sadness. Despite the fact that I’m enthusiastically extroverted with a penchant for sharing too much information, for many years I spoke rarely of that time – and then, only in generalities. (more…)

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Making Policy Personal

Shortly after I moved to Washington, D.C. to begin a fellowship with HHS, my aunt was diagnosed with stage four ovarian cancer. I took a trip back to Michigan three months later to celebrate Thanksgiving at my parents’ home where she lived. The chemotherapy she had received during that intervening time had rendered her nearly unrecognizable.  I was at home when she asked me to take her to the emergency room; she died later that day in the ICU.

I have kept the program from her memorial service pinned to the bulletin board in my office ever since. If you read the dates underneath her name, you will notice that she died the day before her 50th birthday. And even if you read the attached pages of scribbled notes that were my feeble attempt at eulogizing her life, you may not really understand why I keep this type of reminder by my desk rather than a memento of a happier time. (more…)

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Man of the Month Revisited: Dr. William Cohn

Photo Courtesy of Houstonian Magazine

Last week, we honored medical heart technologist, surgeon, and  innovator Dr. William Cohn as our man of the month. This week, he sat down with us to chat a bit  more about what he has been up to and new advances in the field of medical innovation.

How did you become interested in the intersection of technology and health care?

I’ve always been attracted to the vibe of heart surgery. It seems like the ultimate gig: it combines my passion for innovation and working in health. Growing up in Houston, I had an older brother who was very brilliant and into science. In our garage, we had a lab set up, where we made explosives, lasers, (more…)

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A Disruptive Conversation with the Co-founders of Personal Medicine Plus


We love stories about women that are truly changing the face of health care, particularly through innovation. Today is no exception. We recently sat down with Co-founders Natalie Hodge, MD and Brandi Harless, MPH of Personal Medicine Plus, an app that allows individuals to self-manage health through behavior tracking and health data metrics. Both Hodge and Harless shared their experience in developing their tool, being a woman innovation leader, and a few words of wisdom and inspiration to other women interested in following their goals. Check it out below.

What drew you to health innovation technology?

NH: My first passion was in medicine. I always had a deep interest in people and solving problems, so naturally that fits well with a career in medicine.  The interesting thing is that the problems of my early career have largely been solved by vaccines.  And in the 15 years we spent diagnosing disease, the obesity epidemic floated to the top. That’s when the opportunity for me to marry medicine and innovation arose.

BH: After studying global health at Boston University and working on health issues in Kenya, Haiti and Sierra Leone, I accidentally moved back to my hometown in rural Kentucky.  Not knowing if I would stay around, I started working with HIV patients and getting involved in the health of the local community.  After leading a local health clinic for a while, I realized the extreme need to help rural patients turn back their lifestyle illnesses.  When Natalie approached me to work on this startup that would do exactly that, I WAS IN!  (more…)

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Pam Cipriano: Woman to Watch 2014

Pam Cipriano

Pam Cipriano

“I am always inspired by seeing the resilience of the human spirit. Being a nursing and health care professional affords me the great honor to appreciate stories of real people surviving challenging experiences every day.” – Pam Cipriano

Encouraged to achieve limitless dreams by her parents, Pam Cipriano, PhD, RN, FAAN, represents a perfect mix of imagination, grit, and determination. She currently serves as Editor-in-Chief of American Nurse Today and works as the University of Virginia Health System’s Special Advisor to the Chief Nursing Officer, and also serves as clinical associate professor at the UVA School of Nursing. She has received numerous honors throughout her career, including being named a distinguished member of the ANA and a Sigma Theta Tau International Distinguished scholar. An accomplished nurse and mentor, Pam is the Senior Director at Galloway Consulting where she is focused on the art of clinical transformation.  (more…)

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Kenda West: Woman to Watch 2014

Kenda West

Kenda West

“Show you’re willing to get in there and start shoveling. Make smart choices, be generous, and be diplomatic – but speak your mind…If you can apply common sense to problems and solve them calmly, you’ll get noticed. I promise.” – Kenda West

Driven by the passion and success of her high school field hockey coach, Kenda West was molded at an early age to have discipline and always dig deep in the pursuit of her goals. Landing in the health care IT space just three days after her last exam in college, Kenda first entered health care in 1983. This year, Kenda joined Voalte, a company specializing in mobile smartphone applications that caregivers use, as its Chief Operating Officer. (more…)

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Rebecca Mitchell Coelius: Woman to Watch 2014

Rebecca Mitchell Coelius

Rebecca Mitchell Coelius

“Read, travel, and speak to people with a diversity of opinions as often as possible, and, most importantly, never get too invested in seeing a problem from only one angle.” – Rebecca Mitchell Coelius

Treasuring the history of health science and continuously pursuing the next opinion, idea, or discussion, Rebecca Mitchell Coelius first became a physician with the goal of becoming part of the health care industry. Rebecca’s career has taken her through that system, to entrepreneurship, to her current role at the Office of the National Coordinator where now works with entrepreneurs, investors, and innovation centers every day. (more…)

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Disruptor Profile: M. Bridget Duffy, M.D.

Dr. Bridget DuffyRecently, DW interviewed  Dr. Duffy, e Chief Medical Officer of Vocera Communications, Inc. Dr. Duffy is working to provide breakthrough mobile communication technologies and solutions that address critical communication challenges facing health care today. Prior to her appointment as CMO at Vocera, Dr. Duffy co-founded and served as CEO of ExperiaHealth, that assists organizations rapidly improve staff and patient loyalty through innovative solutions that restore the human connection to health care. Dr. Duffy was an early pioneer in the creation of hospitalist medicine and launched programs to accelerate clinical discovery in the field of Integrative and Heart-Brain medicine, helping to establish the Earl and Doris Bakken Heart Brain Institute. She previously served as Chief Experience Officer (CXO) of the Cleveland Clinic, the first senior position of its kind in the nation—leading the institution in improving patient experience as its top strategic priority. She is a frequent speaker on the subject of why patient experience matters and how it impacts clinical outcomes. Her work has earned her the Quantum Leap Award for taking the risk to spur internal change in her field and has led her to be featured in HealthLeaders magazine as one of “20 People Who Make Healthcare Better.” (more…)

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Opportunities Abound for Women in the Armed Forces Medical Field

Dr. Jacqueline ThompsonPrior to WWI, women’s roles in the Armed Forces were limited to helping on the home front. WWI marked the first time in U.S. history that regular nurses in the Army and Navy were allowed overseas, and women were permitted to enlist in the Navy and Marine Corps as civilian volunteers.

Now, women are an integral part of the Armed Forces, standing toe-to-toe on the frontlines and in hospitals with their male counterparts, treating and serving their country as equals. The opportunities available to women in the military medical field have never been more promising, and the flexibility for serving in conjunction with a civilian career — and even while raising a family — makes military medicine the perfect platform for launching a successful career. (more…)

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Develop a Coaching Culture

“I know I blow up and get angry. I am protective about my patients and the physicians in my department and I can’t help myself.”

Dr. Leonard was one of my coaching clients, a surgeon who had left a trail of destruction by his combative style everywhere – the operating room, staff meetings and medical executive meetings.

“I’m a leader in my surgical specialty. People expect me to be forceful.”

I asked, “What do you look for in a good leader?”

“I want someone who listens to me, who looks at all options without stuffing his solution down my throat. I want someone who is calm, thoughtful and . . .”

After a long pause I heard “Oh.” (more…)

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