Posted by denitzablagev on July 17, 2018 · Leave a Comment
Mr. Smith was a sixty-eight year old man who came to the Veterans Affairs hospital where I was a medical student complaining of chest pain. “With chest pain, it’s all about the story,” my resident, the physician in charge of our team, said. We talked to him to find out what he was doing when … Continue reading →
Posted by denitzablagev on July 19, 2014 · 2 Comments
When things go wrong in medicine, as they invariably do, we try to figure out what went wrong, and why. We try to learn if there’s anything we could have done better and what we should do next time. It used to be, in the days of the Giants, that the physician responsible for the patient … Continue reading →
Filed under doctor · Tagged with health, healthcare, M&M, medical error, medical errors, medical student, medicine, morbidity & mortality, Pavlov, quality improvement, swiss cheese model of error
Posted by denitzablagev on March 21, 2014 · Leave a Comment
I first met Carol* (name and identifying details have been changed) when she came to my clinic after a severe asthma attack had sent her to the Intensive Care Unit. After a few days, she had been extubated and had acquired a new diagnosis, asthma. When she saw me in clinic, she felt better than … Continue reading →
Filed under doctor, evidence in medicine, medical costs, medical decisions, quality improvement · Tagged with acid reflux, airway muscles, American Thoracic Society, asthma, asthma exacerbation, bronchi, bronchial thermoplasty, doctor, Emergency Department visit, European Respiratory Society, evidence, evidence-based medicine, GERD, Guidelines, inhalers, lack of evidence, medical decision making, medicine, new therapy, patient, prednisone, procedure, pulmonologist, Recommendations, risk of harm, severe asthma, uncertainty in medicine, unproven benefit
Posted by denitzablagev on March 5, 2014 · Leave a Comment
I. Capitation is coming Although Brent was careful to stress that despite this being gospel among those who “have drunk the kool-aid” it is not universally accepted. Still, the alternative narrative is just more of the same – more efficient fee for service – or aspirations for competing as one of a handful of fee-for-service … Continue reading →
Filed under doctor, evidence in medicine, medical costs, medical decisions, quality improvement · Tagged with ATP course, Brent James, capitation, cost of medical care, fee-for-performance, fee-for-service, healthcare delivery, medicine, NICU, quality improvement, value-based purchasing
Posted by denitzablagev on October 28, 2013 · Leave a Comment
Doctors are burned out and they don’t enjoy their job as much as they used to. But looking broadly, physicians are still spared the economic difficulties and loss of autonomy that are present in most other sectors where people are still lucky enough to be employed. There are issues that doctors rarely face: unemployment, inability … Continue reading →
Filed under doctor · Tagged with burnout, competitive medical specialties, Darwinian struggles, debt, dermatopathologist, doctor burn out, Doctors, football coach, GDP, healthcare, healthcare cost, medical bills, medical student debt, medicine, payment, physician burnout, physician compensation, Porsche, primary care, procedures, professional struggles, reimbursements
Posted by denitzablagev on October 21, 2013 · Leave a Comment
“I got run over by a golf cart at the State Fair,” my five-year-old cheerfully says to the Emergency Department technician who is checking us in. A utility cart knocked him down – he is a five-year-old running along the grass by the path, and some asshole wasn’t looking as he turned into my kid … Continue reading →
Filed under access to care, Denial, doctor, medical costs, medical decisions, quality improvement, women in medicine · Tagged with accident, apology, band aid, child, compartment syndrome, compression, doctor as patient, ED visit, elevation, emergency department, emergency room, first aid, football, fracture, hand injury, hand X-ray, ibuprophen, ice, injury, medicine, pain, pain assessment, pain score, patient satisfaction, presyncope, radiation, rest, RICE, sorry, state fair, syncope, tylenol, vaso-vagal syncope, X-ray
Posted by denitzablagev on August 28, 2013 · 4 Comments
I know why the hoopla around Emily Oster‘s new book, Expecting Better, bothers me, it’s because she hasn’t let you in on obstetrics’ big bad secret… and here it is…. from a pulmonologist. What Ms. Oster points out, and where she is absolutely correct, is that the data to support most pregnancy advice, indeed, most … Continue reading →
Filed under evidence in medicine · Tagged with alcohol, Ariake Restaurant, children, drinking while pregnant, Emily Oster, evidence, evidence-based medicine, Expecting Better, maternal fetal medicine, medicine, obstetricians, obstetrics, Oster, pregnancy, pregnancy advice, pregnancy recommendations, risks, sushi, wine during pregnancy, women
Posted by denitzablagev on August 27, 2013 · Leave a Comment
My latest post on mentoring women in medicine and science can be found at the Broad Side. It’s called “The Women’s Table” and you can read it here. http://www.the-broad-side.com/the-womens-table ————————————————————————— The Women’s Table at Yale (picture) Women’s Table The Women’s Table by renowned artist and architect Maya Lin (B.A. 1981, M. Arch 1986) lists the … Continue reading →
Filed under Published Elsewhere, The Broadside, women in medicine · Tagged with corporate ladder, glass ceiling, loser, medicine, mentor, mentoring, mentorship, physician, research, sexism, women, women's table
Posted by denitzablagev on August 17, 2013 · Leave a Comment
“Mom, who made the first people?” he asks me sweetly. It is already nine o’clock and well past his bedtime. Blah, blah, blah, I stumble a bit then build up to “people came from monkeys.” “Nah,” he says and gives me a sly smile as if I’m trying to trick him. My “really, they do!” … Continue reading →
Filed under evidence in medicine · Tagged with data, dinosaurs, drug company, Eli Lilly, fact, god, information, journal, judgement, medicine, monkeys, New England Journal of Medicine, people, Santa, science, scientific study, surviving sepsis, trial, trust, velociraptor
Posted by denitzablagev on May 29, 2013 · 5 Comments
“My friend said to tell you everything when I come,” she says as she opens a little zippered bag full of flakes. “My teeth are falling out and I can’t afford a dentist, so I use Gorilla Glue to glue back the pieces,” she says. She was referred to me for severe asthma, but she … Continue reading →
Filed under access to care, doctor, medical costs · Tagged with advair, asthma, bankruptcy, barrier to care, cost, expensive medicine, gorilla glue, health, healthcare cost, ICU, medical care cost, medicine, spiriva