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Showing posts from June, 2012

You Have Cancer! How to Deliver Bad News to Patients.

When I see patients in the office, I try to guess their occupations from their demeanor and mannerisms. Salesmen are the easiest to ID. In general, they are gregarious males with manly handshakes. They laugh loudly and like to tell jokes. Teachers are more reserved and often give their narrative in a logical and chronological order, as would be expected. Another clue that the patient is an educator is that their appointments are usually in late afternoons. I have a solid record picking out the engineers and scientists. (For physician readers, I estimate that with regard to engineers, my sensitivity and specificity are 60% and 90% respectively.) Engineers can be tough patients for gastroenterologists to treat. They operate in a computational universe, where numbers add up and problems have concrete solutions. Doctors, particularly gastroenterologists, function in an entirely different milieu. Our world is nebulous. Engineers see mathematical truths, while GI physicians see fog. When

Bloomberg Soda Ban Ignites Controversy. What's Next?

I’m a gastroenterologist and I should be against obesity. I should counsel patients who have reached a designated rung on the body mass index (BMI) ladder on the risks of carrying excessive poundage and the benefits of achieving a more streamlined silhouette. I should encourage them to pursue a regular pattern of exercise and to choose food and beverage items wisely. I should advocate that the optimal tactic to achieve and maintain weight loss is to adopt a sustainable lifestyle change, rather than engage in a short distance sprint. Any controversy so far? I doubt it. While I want my patients, and indeed everyone, to make wise choices in life, I won’t make them do it. Doctors advise and patients decide. Intelligent folks who know the risks of their choices are entitled to make them freely. Mayor Michael Bloomberg, a RINO (Republican in name only), has recently issued a citywide sugary drink ban that has made news across the country and beyond. While there are loopholes that will

Choose Wisely Takes Aim at Unneccessary Medical Tests. Shooting Blanks?

Low Hanging Fruit As I write this, it is months away from the election. The election season has been fascinating. I watched many of the Republican ‘debates’ which ranged from informative to entertaining to absurd. Candidates came and candidates went. Many enjoyed short lived surges, only to flame out afterwards. I was drawn early on to Jon Huntsman, but it seems that decent folks who tell the truth without pandering can’t succeed. So, now we are left with Romney vs Obama, a contest that at present seems too close to call.  The continued anemic job creation statistics, which may not be the president's fault, will hurt him.  If the economy appears to creep forward in the months ahead, and there are no unforeseen events to sandbag the president, then I think he will prevail. It is the unforeseen that worries the Democrats. If several economies in Europe implode and drag us to the edge of the cliff, it will have a political impact here in November. Neither candidate is ideal.

Improving Patient Satisfaction: What’s Holding Doctors Back?

Some time ago, I endured a medical staff meeting, where attendance is taken and 50% attendance of all meetings is required. I learned that they are serious about this rule when, a few years ago, I was demoted from active staff when I failed to attend enough meetings. This demotion did not demoralize me, as I was only losing my right to vote, which I did not regard as a cherished right with respect to voting on hospital affairs. I learned later, however, that the hospital’s insurance panels all required active staff status of its physician members. I decided that the right to make a living superseded the right to vote. My attendance lapses were remedied and my honor was restored. Today, a hired consultant was advising us on the importance of improving our patient satisfaction scores. Which of the following reasons to improve were offered to the staff, all of whom regard ourselves as paragons of the medical profession? As in all standardized test questions, choose the best answer (1