The Yale Journal for Humanities in Medicine

XXY

Robert S. Rosson - rerosson@comcast.net — Sun, 12 Jul 2009 09:56:21 -0400

I turn now to the case of recently deceased popular music star, Michael Jackson. I mean no disrespect to him or his memory. I am, however, unashamedly giving him the diagnosis of Klinefelter’s Syndrome. In this disorder males have an extra X chromosome, giving them a profile of XXY rather than the normal XY. This has a feminizing effect and is characterized by a scarcity of facial and body hair, small testes, low testosterone levels and absence of sperm.

Mount Sinai

Caleb Gardner - gardner.caleb@gmail.com — Sun, 12 Jul 2009 09:36:07 -0400

First - more of a formality than anything else - I get a few vials of dark blood drawn from my arm. Work won’t begin until the results come back, so I leave the hospital, and by the time I get home it’s already early evening.

Montefiore

Caleb Gardner - gardner.caleb@gmail.com — Sun, 12 Jul 2009 08:59:39 -0400

Somewhere around 160th street more people start getting off than on and the train empties gradually from stop to stop as we near the end of the line. In the waiting room, a middle-aged man from somewhere else in the world sits down one empty seat away from me, ...

Where the Blue Line Leads

Brian T. Maurer - btmaurer1@comcast.net — Sun, 05 Jul 2009 10:05:10 -0400

Now that I’ve been working in primary care pediatrics for three decades, I seldom perform such procedures anymore. If a patient needs blood drawn, I send him to the lab. If she is sick enough to require intravenous fluids or medications, I send her to the hospital. In this era of modern medical practice, where time is at a premium, I no longer have the luxury of doing these procedures for my patients.

Medicare is not mediocre

evolpintesta@snet.net (Ed Volpintesta) — Fri, 26 Jun 2009 13:55:00 -0400

June 26, 2009
New York Times

Re “The Only Public Health Plan We Need” (OP-ED, June 25): To suggest that “Medicare is a “mediocre-quality insurer” is wrong. If the goal is to mislead the public with prejudices and misconceptions as do all opponents of public health insurance, why no just call it socialized medicine, a scare-tactic that has halted progress of public health insurance for over fifty years.

Millions of Americans would have undergone bankruptcy if they were not protected by Medicare. I have not seen or heard of any Medicare patients having their cancer treatments denied or their insurance cancelled because of pre-existing conditions something that happens not infrequently with private insurers.

Clearly, Medicare is not mediocre, mercenary, or merciless, common complaints often hurled, as they should be, at private insurers.

Ed Volpintesta MD

Younger physicians' idealism drives public health insurance

evolpintesta@snet.net (Ed Volpintesta) — Fri, 26 Jun 2009 13:56:00 -0400

June 26, 2000
The New York Times

Regarding “ The Prescription From Obama’s Own Doctor” (OP-ED, June 25): It is encouraging to read that the American Medical Student Association strongly supports public health insurance. Often younger physicians’ idealism affords them the ability to envision the future of medicine more clearly than their older colleagues whose vision is often clouded by a timid conformity that impedes progress and perpetuates the errors of the past.

Ed Volpintesta MD

Public health insurance, a necessary alternative to private insurance

evolpintesta@snet.net (Ed Volpintesta) — Fri, 26 Jun 2009 13:59:00 -0400

June 24, 2009

Danbury News Times
Letters Editor

In the June 24 article “President battles insurers over his health plan”, insurers complain that a government health plan would disadvantage them because they would not have a level playing field to operate on.

But insurers should not expect sympathy from patients or doctors. They have accumulated almost monopolistic powers over the past few decades precisely because they “owned” the playing field and made sure that it wasn’t level for anyone besides themselves. It has allowed them to bully doctors and underpay them with a like- it or leave- it approach. And it has allowed them to exploit patients by raising their premiums, while they reduce what they will pay for drugs, testing, and doctors’ visits. This accounts for their tremendous profits and the exorbitant salaries they pay their CEOs.

A government plan would finally inject some real competition into the health care insurance market.

No wonder private insurers are worried!

Ed Volpintesta MD

Bring Back the Blackboards

Ed Volpintesta - evolpintesta@snet.net — Thu, 18 Jun 2009 10:01:17 -0400

Technology is not yet available to make “electronic blackboard” teaching appropriate for large audiences. But any physician who presents at grand rounds (or gives any kind of talks, really) and who wants to see what’s missing in the audiovisual format should try adopting some of the techniques that make blackboard teaching more attuned to the human factor.

"Nursing" Primary Care Back to Health

Ed Volpintesta - evolpintesta@snet.net — Wed, 17 Jun 2009 21:42:17 -0400

Clearly, a new paradigm of primary care is evolving. One that requires ever greater amounts of interpersonal, coordinating, and communication skills. The old one that required intense exposure to basic science has been ineffective. The advanced practice nurses’ training may not be identical to physicians in primary care but that is not a reason to assume that doctors of nursing could not practice competently if they tailored their practices appropriately.

Aubrey Vincent Beardsley

Raymond Cavanaugh, Jr. - handofgatsby@yahoo.com — Wed, 17 Jun 2009 09:37:50 -0400

Killed by tuberculosis at age twenty-five, Beardsley’s artistic career had spanned all of six years. Until shortly after his time, tuberculosis had been attributed with certain strange side-effects. Many believed that, in the final stage of struggle, a sufferer would experience a period of mortal ecstasy.

Role of defensive medicine as driver of health costs understated

evolpintesta@snet.net (Ed Volpintesta) — Tue, 09 Jun 2009 07:48:00 -0400

The fear of malpractice suits is one of the factors that contribute to the high cost of care in Texas as much as it does anywhere and until a more humane method of treating malpractice cases is established—one that does not destroy doctors’ reputations, or cause them unnecessary distress as they wait on tenterhooks waiting for the outcome of a case—doctors will continue to practice defensively. The solution to the cost conundrum includes reforming the malpractice laws.

Insurers only partly responsible for primary care shortage

evolpintesta@snet.net (Ed Volpintesta) — Sun, 07 Jun 2009 18:23:00 -0400

Leaders of organized medicine have known about the unfair disparity between primary care and the specialties for decades. However most of the twenty-four medical specialties have largely ignored the plight of primary care. The majority of the specialties and their leaders have pursued a policy of protecting their own turfs, so to speak, and have left primary care on its own.

Death by Meeting: Is It an Epidemic?

Ed Volpintesta - evolpintesta@snet.net — Mon, 01 Jun 2009 12:55:53 -0400

Like some other physicians who attend medical meetings where professional politics is supposed to be the main focus, I often come away disheartened and disappointed. Although, like others, I bring enthusiasm and a sense that I might make a difference in our politics, I am routinely disappointed. Most of them do not foster debate and for what little debate does occur, the time allotted is minimal and not nearly enough for most issues to get properly discussed.

All

Linda Kittell - rongoble@tds.net — Mon, 01 Jun 2009 12:54:55 -0400

I had to do was answer their questions one by one to the best of my ability: Are you worried that your father is in pain? I am worried that my father is in pain.

Homeless at Our Medical Home

Ed Volpintesta - evolpintesta@snet.net — Sun, 31 May 2009 12:06:57 -0400

The medical home has political and theoretical appeal but it adds excessive burden on the shoulders of primary care doctors, many of whom are fighting off burnout. Working harder will diminish their time and ability to connect with patients who will be deprived of the understanding and attention that they expect and need from their personal physicians.

Starving the Priceless Being

Ohad Oren - ohadoren@gmail.com — Sun, 31 May 2009 11:36:42 -0400

Hans Holbein's brilliant painting "The Body of the Dead Christ in the Tomb" immediately comes to mind. Arms extended, muscles in a stubborn rigor, it is indeed this martyrdom image that has ignited the Anorexic Babes exhibition at a Jaffa art centre. As the English-Jewish artist behind the show, David Breuer-Weil, sentimentally clarifies, what he aimed to create was a "moral exhibition."

Ma'salama

Brian T. Maurer - btmaurer1@comcast.net — Sun, 31 May 2009 11:09:11 -0400

When I saw Halim last week with his infant daughter, he told me that he and his family, along with his two brothers and their families, would be returning to Syria. The current economic climate had decimated their house painting business. After five years struggling to make a go of it, they had decided to liquidate the business, sell their multi-family house and return to the land of their birth. For these three brothers it was the end of a dream.

At Eye & Ear

Barbara Lydecker Crane - cranequilts@yahoo.com — Thu, 14 May 2009 12:26:01 -0400

The technician has me prone, my head in a mold like a vase in a vise. Across my face he clamps an open helmet. I’m rolled into the looming tube, where, at least, there’s light; there's air.

A Day in the Life of Education

Melissa A. Davis - davisme@musc.edu — Thu, 14 May 2009 12:24:07 -0400

I’ve had one full blown panic attack and dozens of near attacks since beginning medical school. I don’t want to resort to beta-blockers, so I use a visualization technique that I picked up my first year from a therapist who looked like she popped beta-blockers like tic-tacs. I go to my "happy place," the dock overlooking the lake in my parents’ back yard.

Alice Dies in the Asylum

John Grey - jgrey10233@aol.com — Sun, 10 May 2009 10:59:31 -0400

It was darkness to darkness, no stopping for the merest glimpse of light. She slipped from people she didn’t know to people she would never know and recognition could go hang.

How Physicians’ Lack of Persistence Led to Their Failure to Achieve Malpractice Reform in Connecticut

Ed Volpintesta - evolpintesta@snet.net — Sun, 10 May 2009 10:52:54 -0400

More than anything else, it was the lack of persistence that caused physicians in Connecticut to fail in their attempts to win lawmakers’ sympathies during the malpractice crisis. Most of us feel still, as we did then, that the loopholes in the statutes make the malpractice system more akin to legalized extortion than justice, particularly in the way that the malpractice laws allow frivolous malpractice suits against innocent doctors.

Emotional Fugue in a Supermodel World: An Autoethnography in Very Free Verse

Michele Battle-Fisher - Battle.6@osu.edu — Sun, 10 May 2009 10:40:00 -0400

Infidelity and deceit. Sucralose and high fructose. Waistlines and bulge. BMI and IOU’s. I despise the agony Though I resign myself. I want to be healthy. Emotional entropy. Psychological centrifuge.

Second Stage of Labor

Thomas Gibbs - obdoctom@aol.com — Sun, 10 May 2009 10:30:34 -0400

Standing between stirruped legs, hands open, ready waiting, always wondering.

A Vision Triolet

Carol Smallwood - smallwood@tm.net — Sun, 10 May 2009 10:24:46 -0400

A digital fundus photo is quick, recommended for anyone just in case-- each eye must stare till photographic; a digital fundus photo is quick,

Greek Chorus or Swan Song

Carol Smallwood - smallwood@tm.net — Sun, 10 May 2009 10:23:50 -0400

Fear of abandonment is strong: panic attacks echo what’s wrong like a Greek chorus--or swan song.

Humane care, not rational care

evolpintesta@snet.net (Ed Volpintesta) — Sun, 10 May 2009 08:50:00 -0400

Rational health care can be misconstrued to mean what is economically sensible treatment as opposed to what is humane treatment. Although rational care may be good, it isn't necessarily humane. The objectives of medicine, business, and law are not always aligned harmoniously.

Critical Mass

Marilyn Hillman - marilyn.hillman@att.net — Sat, 09 May 2009 11:25:53 -0400

My left breast is a clock. It morphs from body part to timepiece in an instant, while compressed between two sheets of plastic during a mammography exam. Before I can say "Whoa, this hurts," the technician is reporting to a colleague, "she has a mass at 11:30," as if I’m a disinterested party, or worse yet, not even present.

Medical

Conrad Geller - cgeller@post.harvard.edu — Sat, 09 May 2009 11:17:43 -0400

How can I be late? I have been waiting Right here, always on time, for my appointment, Not even reading a magazine, watching The door where a pretty receptionist might appear.

Remedies: New Media

Monica Ong - monica.ong@yale.edu — Tue, 05 May 2009 21:54:00 -0400

E-literature, medical marketing, and folklore collide in Remedies, a work-in-progress by new media artist Monica Ong, who creates narrative spaces that examine cultural anomalies in public health.

Machiavelli and righteousness

evolpintesta@snet.net (Ed Volpintesta) — Tue, 05 May 2009 17:48:00 -0400

The Renaissance humanist Niccolo Machiavelli back in the fifteenth century approached realistically the problem of righteousness in politics. In his famous books The Prince and The Discourses he gives examples of leaders having to do what outsiders might consider ruthless or opportunistic in order to maintain power and provide for the common good.

No time for good history-taking

evolpintesta@snet.net (Ed Volpintesta) — Mon, 04 May 2009 20:02:00 -0400

It could be said that the single greatest wound inflicted by insurance companies on the medical profession is forcing doctors to see more patients than they ought to. For doctors who want to take a good history and perform the single greatest act that separates medicine from other professions, the only way to get more time is to see fewer patients and practice at a pace that allows good history taking.

Mindreadings: Literature and Psychiatry edited by Femi Oyebode

Howard Spiro - howard.spiro@yale.edu — Tue, 05 May 2009 11:22:18 -0400

Mindreadings, a paperback of about 142 pages, is intended to contribute its mite to the programs of medical humanities and journals -- like this one -- spun from them. The editor, Dr. Femi Oyebode, a professor of psychiatry at Birmingham University, UK, hopes that this volume will contribute to the "re-engagement of the practitioner with the subjective world of the patient." Of course, he is right and his slender volume takes a step in the right direction

Morning Lamentations

Brian T. Maurer - btmaurer1@comcast.net — Tue, 05 May 2009 11:06:19 -0400

From where I stand in my office, looking out at the morning snowfall, I can hear the child wailing. His screams grow louder as his mother drags him around the corner to the nurses’ station. "Let's see if we can get him to stand on the scale," our medical assistant says. "I need to weigh and measure him."

The Magic Mirror

Stephen Maurer - espiritunaranjo@yahoo.com — Tue, 05 May 2009 11:01:28 -0400

Behind my couch, I'm out of sight in psychoanalysis, when a young man suddenly becomes much younger, a conspirator in a boyish voice:

Memory Lessons: A Doctor's Story by Jerald Winakur

Howard Spiro - howard.spiro@yale.edu — Tue, 28 Apr 2009 11:59:17 -0400

Dr. Jerald Winakur is a good son and a loyal physician who practices in Dallas, Texas. An accomplished writer, he finds his catharsis in this new account of his elderly father's dissolution by dementia. I am 85, and preternaturally avid for accounts of aging and dementia. I find this one entertaining as well as edifying. The author digresses often enough so that the story is not a continuous downhill accounts. He intertwines a lot of experience in dealing with the elderly. He has a lot of wisdom to impart, and he writes pleasantly.

Side Effects

Erin Murphy - ErinMurphy@psu.edu — Tue, 28 Apr 2009 11:36:49 -0400

I slip out of bed and into the kitchen where I slice through the crusty loaf of rye with a serrated knife, toast the bread, pile it high with corned beef, cole slaw, Swiss, and a slather of Thousand Island, and then I am driving into the night

After Yu Guangzhong

Erin Murphy - ErinMurphy@psu.edu — Tue, 28 Apr 2009 11:36:21 -0400

This poem is not a salve. Do not rub it on your wounds.

Tic

Erin Murphy - ErinMurphy@psu.edu — Tue, 28 Apr 2009 11:36:06 -0400

His Tourette’s tic was I love you. I love you, he told the clerk in the grocery store. I love you, he told the mechanic who changed his oil.

Elective Mute

Erin Murphy - ErinMurphy@psu.edu — Tue, 28 Apr 2009 11:35:34 -0400

The boy refuses to speak. His mother swears he’s a river of words at home.

Paying primary care doctors more will not solve the shortage

evolpintesta@snet.net (Ed Volpintesta) — Tue, 28 Apr 2009 17:17:00 -0400

One of the issues that politicians face is the shortage of primary care doctors. If universal care is enacted the shortage will intensify greatly. Paying primay care doctors more more is magnanimous but shortsighted and shows how confused educators are as to why there is a shortage in the first place.

Academic and non-academic physicians must integrate their forces in medical stewardship

evolpintesta@snet.net (Ed Volpintesta) — Mon, 27 Apr 2009 20:34:00 -0400

Academic and non-academic physicians need to combine their forces in protecting medicine's ideals. But too often they act as if they are in different universes. This is bad for the common good of the profession.

Media's reportage on electronic medical records incomplete, misleading

evolpintesta@snet.net (Ed Volpintesta) — Mon, 27 Apr 2009 16:38:00 -0400

The media's information to the public on electonic medical records rarely mentions all the unintended consequences.

Primary care shortage woefully lacking in innovative solutions

evolpintesta@snet.net (Ed Volpintesta) — Mon, 27 Apr 2009 13:02:00 -0400

New ideas are needed to correct the primary care shortage but increasing med school admissions and increasing reimbursements will not increase the number of primary care doctors substantially.

Reportage of health reform incomplete

evolpintesta@snet.net (Ed Volpintesta) — Mon, 27 Apr 2009 07:24:00 -0400

The media's coverage of health reform often leaves out important issues.

Newspaper's article on retained objects in surgical patients is counterproductive

evolpintesta@snet.net (Ed Volpintesta) — Sun, 26 Apr 2009 10:12:00 -0400

Obviously, retained objects regardless of rare the occurrence or how slight the consequences are for the patient are reasons to make the system safer. Your newspaper article, however borders on the sensational and does a disservice to surgeons. Worse it unnecessarily undermines patients’ confidence in any surgery they may need in the future. This is one of the unintended and unnecessary ways that the public is frightened by public reporting of quality standards.

Will medical schools really redefine their mission?

evolpintesta@snet.net (Ed Volpintesta) — Sat, 25 Apr 2009 14:48:00 -0400

Those who believe that medical schools should loosen their stringent focus on students’ scientific prowess as the cardinal quality for acceptance and accept students with more diverse backgrounds will be gratified to read an article which appeared in the March 18, 2009 JAMA titled “Report:Growth of Medical Schools Brings Opportunity to Redefine Their Mission”.

Will there be "healers" in the future?

evolpintesta@snet.net (Ed Volpintesta) — Fri, 24 Apr 2009 17:59:00 -0400

Many doctors are healers but not all of them. In my training whenever I saw them, I recognized them by their relationship to their patients and the stories they told me about their social histories and how they may have played a role in their illnesses. Sometimes the patients of these doctor-healers praised them effusively for their caring attitude. These doctors weren’t necessarily academically brilliant, but they were competent. Also they had a good relationship with the nurses and the house staff.

News from the Thorax

Sarah White - sarah.m.white@verizon.net — Wed, 22 Apr 2009 10:35:40 -0400

The sternum is a handsome vertical bone that anchors the filigree of ribs and the wide thoracic arch. In certain surgeries, this bone is sacrificed -- split the way an earthquake might split the spire of a village church to expose the heart, whose beating must be stopped in order to proceed.

For physicians, regaining society's trust is only a matter of "time"

evolpintesta@snet.net (Ed Volpintesta) — Wed, 22 Apr 2009 15:18:00 -0400

The best way to regain trust is for doctors to spend more time with their patients. That means that physicians will have to see fewer patients per day. There is no substitute. Using nurses and physician assistants as surrogates is not the answer. Although they are well-trained and very good at what they do, until they become fully licensed to practice independently, these professionals should not be burdened with what are ultimately physicians’ responsibilities.

More than money is needed to increase the primary care workforce

evolpintesta@snet.net (Ed Volpintesta) — Tue, 21 Apr 2009 06:55:00 -0400

The move to get more students into primary care has to start in the medical schools and their admissions process. For decades the trend of medical education has been towards specialization. Some of the advantages of this approach include improved ways of treating diabetes and serious infections, life-saving cardiac bypass surgery, hip and knee replacements that lessen disability, eye surgery that prevents blindness and many new surgical techniques that improve patients’ lives.

True reform impossible without liabililty reform and eliminating insurers' excessive profits

evolpintesta@snet.net (Ed Volpintesta) — Mon, 20 Apr 2009 21:26:00 -0400

The threat of malpractice suits forces doctors to order lots of unneeded tests and consultations in order to have a good defense in case a suit is file. Obviously, it is hard to estimate just how much this wasteful “defensive” medicine costs but, according to some estimates it’s over $100 billion a year. More important, the threat of malpractice has made doctors and patients view each other as potential litigants, poisoning the doctor-patient relationship.

History-taking suffers when doctors are forced to see too many patients

evolpintesta@snet.net (Ed Volpintesta) — Mon, 20 Apr 2009 20:30:00 -0400

Of the three obstacles to history-taking, the time factor is the most critical and the most difficult to resolve. For patients and doctors to engage in real dialogue—not the sorry surrogate forms that patients answer in waiting rooms by checking off what illnesses or surgeries they might have had or what their marital status is or whether they smoke — a certain “critical mass” of time is needed.

Health insurers a major obstacle to humane health care

evolpintesta@snet.net (Ed Volpintesta) — Fri, 17 Apr 2009 12:13:00 -0400

Private health insurance is expensive because insurance companies are large corporations that are under pressure to generate profits for their shareholders, not to mention the multimillion dollar salaries for some of their CEOs. Putting profits ahead of patients’ interests makes for an irresponsible health system. Insurance companies are not interested in treating patient with dignity or humanely. To them patients are statistical numbers on profit and loss charts, and little else. That is why they raise their premiums every year. It also explains why some have had to be sued by the American Medical Association for using underhanded methods to cheat doctors out of fair payment for their services. One wonders how it ever got this bad. Who was sleeping at the wheel?

Malpractice suits not always based on strong evidence of negligence

evolpintesta@snet.net (Ed Volpintesta) — Sat, 11 Apr 2009 10:15:00 -0400

I disagree with Attorney Robert V. Marrow (Letters, April 9) where he states that attorneys would not spend the time and money required to pursue malpractice suits unless there were strong evidence that medical negligence had occurred.

The dark side of electronic medical records

evolpintesta@snet.net (Ed Volpintesta) — Sat, 11 Apr 2009 10:10:00 -0400

There is a dark side to electronic medical records that was not mentioned in "Medical Records for the 21st Century" (Letters, April 11). Health insurers will have instant access to almost every patient’s diagnosis and treatment. This information will identify doctors who don’t follow their rules giving them greater control over the way doctors practice and the health care patients receive.

Counsellors

Christian Ward - christian_ward2000@hotmail.com — Sat, 11 Apr 2009 12:02:35 -0400

Jane, the first, was sweet and handled my childhood trauma with ease, navigating each event skillfully as a matador. I can’t remember much about the second, only that he blamed my parents for everything.

Opposites

Christian Ward - christian_ward2000@hotmail.com — Sat, 11 Apr 2009 12:01:48 -0400

Sometimes when I used to see Mr R, one of the schizophrenics my charity assigned me to visit every week, we, quite literally, swapped lives. He got the slur and stammer, I the cardboard childhood and fetish for pearl necklaces. At the cafe, the waiter asked him if I was his grandfather.

The Stammerer and the Mountain

Christian Ward - christian_ward2000@hotmail.com — Sat, 11 Apr 2009 12:00:52 -0400

This mountain slope is my language. A skin of stone slipping under my grip, feet pedalling the one moving spot.

We're Pregnant, But She Might Be Having a Miscarriage

Kenneth W. Kirkwood - kkirkwo2@uwo.ca — Sat, 11 Apr 2009 12:50:02 -0400

Blazing tubes of light point the way A scurrying, pensive nurse does too To my wife, who called me today Saying our little man might have died

The Leaf Blower as Metaphor

Ed Volpintesta - evolpintesta@snet.net — Tue, 31 Mar 2009 12:22:52 -0400

Whenever I see and hear landscapers or neighbors with leaf-blowing machines blasting away at a few scattered leaves or remnants of winter sand and debris on sidewalks and parking lots and driveways, I cannot help drawing a comparison of how absurdly over-dependent we have become on technology and how it is misused in many mundane activities of everyday life and of medical practice.

Bananas

Brian T. Maurer - btmaurer1@comcast.net — Tue, 31 Mar 2009 12:14:18 -0400

By my reckoning, this is the third time I've seen this toddler with his mother in the past three weeks. First it was teething discomfort; last week, a minor head cold and cough. Today it's constipation. I stand in the middle of the small exam room, scribbling a few notes in the chart as this mother chatters on.

Connecting with patients: The importance of being earnest

evolpintesta@snet.net (Ed Volpintesta) — Sat, 28 Mar 2009 14:47:00 -0400

It is quicker to order a battery of tests, a CAT scan, or a referral to a specialist than it is to spend time talking to patients and getting to know them. And let there be no doubt, talking takes time and energy. Scurrying about their offices seeing too many patients leaves doctors with little peace of mind or inclination for empathizing.

An Ode to a Patient

Jeffrey Allen Cohen - jeffrey.a.cohen@dartmouth.edu — Sun, 22 Mar 2009 21:02:56 -0400

So tonight it is the even day or odd day I don't remember ... I just know I am supposed to give myself the injection ... so is this how it all ends up giving yourself some sort of medication ...

Nursing home physician specialists and the decline of primary care

evolpintesta@snet.net (Ed Volpintesta) — Fri, 20 Mar 2009 08:44:00 -0400

Primary care’s imminent dissolution in part is attributable to our medical schools. Their preoccupation with research and specialism excluded primary care and contributed to its decline. Physician assistants and nurse practitioners are waiting to fill the vacuum as independent practitioners and even though doctors are against the idea, it will happen. There are not enough primary care doctors around to do the job.

Polypharmacy

James S. Wilk - JKandJWilk@aol.com — Thu, 19 Mar 2009 21:56:13 -0400

Daddy, please, listen to the doctor, Tanisha pleaded as only a youngest daughter can. Every day I take four pills and I’m not goin’ to take any more.

Knights in White Coats

evolpintesta@snet.net (Ed Volpintesta) — Wed, 18 Mar 2009 15:59:00 -0400

I have always thought that if real change is going to come it must come from the younger generation. It is they who have listened to previous generations' complaints and it is they who see and are repulsed by the soul-sickness that has descended on physicians almost everywhere. What's more, the resilience and fortitude and stamina that are necessary to do the job can only sprout from their youth and idealism. Many of us who have been in practice for 25-30 years have not had the uniformity of political commitment necessary to make real change happen.

Maurice Rollinat

Raymond Cavanaugh, Jr. - handofgatsby@yahoo.com — Tue, 17 Mar 2009 22:15:38 -0400

In Creativity and Madness, Dr. Albert Rothenberg states that “although creative people may be psychotic at various periods of their lives, they cannot be psychotic at the time they are engaged in a creative process, or it will not be successful.” Though many diagnosed schizophrenics often compose verse (interestingly, according to Dr. Rothenberg, “schizophrenic patients won’t revise”), it has been shown that, while psychotic, otherwise gifted creators are rendered incapable of producing work of any enduring merit. In an especially severe case, such as that of Rollinat, the patient is unable to write altogether.

Morning, V.A. Hospital: June 25, 2008

James S. Wilk - JKandJWilk@aol.com — Tue, 17 Mar 2009 21:53:06 -0400

Startled by the thump thump thump of rap music, I turned to see it pounding the reflection of the sun up and down in the tinted windows of a red Mustang, which eased between a spavined Town Car and a faded Eldorado into a parking space for disabled veterans. My head throbbed in anger to the beat.

Senescence, soul-searching, and standing on one's head

evolpintesta@snet.net (Ed Volpintesta) — Tue, 17 Mar 2009 16:54:00 -0400

It is rare to see younger (and not so young) physicians embody the qualities of understanding and empathy that seem to be second nature to many senior doctors. It is only the most self-absorbed of physicians who having reached the age of seventy years or so, have not learned something of human nature that has worth to their younger colleagues. Learning to live with uncertain diagnoses, adopting a wait and see approach, and striving to establish a human connection with patients are all important. Who but a senior doctor has the motivation and willingness to share the importance of these qualities?

Introduction to "The Coming of Age - Identity and Change"

Howard Spiro - howard.spiro@yale.edu — Tue, 10 Mar 2009 21:44:00 -0400

A few years ago, some of us at Yale’s Bioethics Center thought to put together a collection of essays about aging. Margaret Drickamer, M.D. (Associate Professor of Internal Medicine/Geriatrics), wise guide to so many of us elderly, headed up the group who went about foraging for people's experiences. We had a good collection of essays, so Carol Pollard, Associate Director of the Bioethics Center, and we thought it would be a pity not to make them more widely available here in The Yale Journal for Humanities in Medicine.

Aging, Memory, and Health Care Culture

Suk C. Chang - changsc@comcast.net — Wed, 11 Mar 2009 21:21:30 -0400

In childhood memory is involved with immediacy; in middle age with past and future, and in old age it focuses more on the past because a basic need for elders is to review and reflect upon the past, especially one's own relational past. There is a need to repair damaged relations, and to correct immature, deviant commitments, thus healing scars in the psyche, and reopening many rooms in the attic and basement of one's psyche. All this helps to restore the wholeness of one's mind. The past cannot be changed, but the way one looks at it can. This is an essential self-healing process for human elders. But largely ignorant of its importance, our culture conspires against it.

Must I Retire? Aging and Meaningful Work

Howard Spiro - howard.spiro@yale.edu — Thu, 12 Mar 2009 21:13:13 -0400

Yet once again when I reached 80, it was hard to avoid the notion that others might have the right to think that I was growing too old for clinical responsibilities. And so, I wrestled once more with the idea of retirement. Then the void opened, vast. What would I do with my time? Writing had always been a comfort for me, and an outlet. Voice-recognition technology now let me dictate to my computer and gave me little excuse for not commenting on my years in medicine. Overly presumptuous it may be, but we elderly can look backwards far better and further than we can peer ahead.

Mandatory Retirement and the Meaning of Work

Karen Lebacqx - info@yjhm.org — Fri, 13 Mar 2009 21:11:06 -0400

Minimally, work gives us a way to stay busy. Some other options for what to do with one’s time will be offered in the next chapters: one can consider a new career, volunteer one's time in the community, become a care-giver or turn to creative outlets. Yet it remains true that work fills up time. But that is surely not all. Work is often central to identity. It is not only time that opens up as a void when retirement comes; retirement threatens one’s sense of self and of identity. Our sense of identity is often wrapped up with a sense of purpose. Work gives purpose and meaning to life for many people.

Just Send a Pine Box to Pick Me Up

Carol Pollard - carol.pollard@yale.edu — Sat, 14 Mar 2009 21:40:10 -0400

With my gradual acceptance of defeat, he happily ends this topic of conversation and moves on to what he feels are more interesting topics; his work and mine. Age and infirmities have slowed him down, but, as in his earlier years, he's still defying and challenging the odds on all fronts. He's 89 and has, he says, nothing to loose. "Think of the alternative," he says.

Risk Taking and Autonomy

Margaret Drickamer - margaret.drickamer@yale.edu — Sun, 15 Mar 2009 21:36:04 -0400

One personally difficult task that I must do as a physician is to allow patients to make their own medical decisions. In my heart of hearts, I know what is best for them. With any medical procedure, be it the prescription of medicine or the performing of surgery, I describe the risks and benefits and the patient can decide what benefits are worth what risks. The patient can take the medicine or not, can sign the consent form or decline surgery. That is their right, even if I disagree with their decision.

Medical journals need to increase their correspondence sections to include more opinion from individual physicians on health care reform

evolpintesta@snet.net (Ed Volpintesta) — Fri, 13 Mar 2009 14:44:00 -0400

Clearly, too much of the reporting on medical issues is being done by non-MD journalists with incomplete insight into the affairs of medicine and too little is done by doctors. If medical journals expanded their correspondence section, members of the media would get better and more truthful information on the issues doctors are most concerned about.

Pneumonia Admission, 10 Y.O. F

Susan Palwick - susanpal@aol.com — Thu, 12 Mar 2009 21:20:25 -0400

You've been here before in asthma's chokehold, struggling against the strangling creature that steals your breath, struggling too against the grown-ups’ tubes and needles, the cotton gown that means you have to stay, prisoner even after the medicinal mist, the one thing you lean into: it smells funny, but it helps.

Living Large

Thomas Gibbs - obdoctom@aol.com — Wed, 11 Mar 2009 21:15:14 -0400

She looks large wearing three coats, one faux cheetah, over red leather, and finally, a moth eaten cashmere, layered not by design.

Association for Medical Humanities Conference 2009

noreply@blogger.com (George Trone) — Wed, 11 Mar 2009 20:50:00 -0400

The sixth annual conference of the UK and Ireland Association for Medical Humanities takes place in Durham, UK, 6th to 8th July 2009, on the general theme Taking the Body Seriously. The conference’s aim is to bring humanities resources, both single-discipline and inter-disciplinary, to bear upon our understanding of how our bodies constitute both the possibilities of, and the constraints upon, leading flourishing lives.

Acknowledging the importance of the humanities in medicine

evolpintesta@snet.net (Ed Volpintesta) — Wed, 11 Mar 2009 08:20:00 -0400

Science is important to competent practice, but how much science? And why no humanities?

Clearly the boards’ lack of concern for the humanities impoverishes the medical experience not only for patients but for many doctors as well.

Why not have all boards include questions and essays on literature or philosophy that are relevant to the doctor-patient relationship? Sort of a reading comprehension test to complement the science component? Why not make professionalism include knowledge of the humanities? As someone once said--Dr Edmund Pellegrino , I think--
is medicine the most scientific of the humanities or the most humanitarian of the sciences?

Response to "Are pre-meds well-rounded"?

evolpintesta@snet.net (Ed Volpintesta) — Sun, 08 Mar 2009 21:19:00 -0400

Harold J. Morowitz who was a member of the Yale Medical School admissions committee suggested that a course in literature that looks at the doctor-patient relationship should be a part of the pre-med studies. He mentioned the point made by Aldous Huxley that science had developed a special vocabulary to express ideas with exceeding precision but it was literature that dealt with expressing the inexpressible; and that clearly empathy was closer to literature than science. I like this distinction.

The patient and electronic medical records

info@yjhm.org (George Trone) — Fri, 06 Mar 2009 09:48:00 -0500

Assuming medical records will be digitized, will the new system be designed primarily for insurers and doctors? How much influence will patients have on what data is collected and how it is accessed? Is there the flexibility for multiple input devices including computer tablets which can capture handwriting and drawings? Or are the checkboxes on the screen just meant to satisfy the payor (the government or private insurer) and doctor that proper procedures were followed?

Somehow it seems the patient is forgotten in the debate about electronic medical records.

Many reasons why dialogue between patients and doctors is poor

evolpintesta@snet.net (Ed Volpintesta) — Tue, 03 Mar 2009 12:35:00 -0500

When patients are given time to tell their stories, it is not unusual for doctors to hear something they mention in passing that is more important than the original symptom they came in for. Many general practitioners have had the experience of someone coming in because of a sore throat and commenting casually they‘ve had some blood in their stool or a funny pain in their chest. Or that the patient is undergoing emotional turmoil because of martial stress and may need to talk about it.

Ethics debate at Harvard Medical School

noreply@blogger.com (George Trone) — Tue, 03 Mar 2009 09:30:00 -0500

On March 2, 2009, the NY Times reports that a group of students and faculty at the Harvard Medical School are debating the influence of the pharmaceutical industry on medical education.

Reform of premed education may resurrect general practice

evolpintesta@snet.net (Ed Volpintesta) — Sun, 01 Mar 2009 18:41:00 -0500

In my 34 years of practice as a primary care doctor, I have found almost no use for the intense exposure I had in premed to calculus, organic chemistry, physics, invertebrate biology and physical chemistry. This is not to say that these courses were worthless but they could have been abbreviated and made simpler.

Oversight (guidelines) carry potential for harm

evolpintesta@snet.net (Ed Volpintesta) — Sat, 28 Feb 2009 17:48:00 -0500

What is clear is that disease is never treated in the abstract. It is always alloyed with a person. Each patient is unique and because of that uniqueness the treatment however closely it follows a guideline, will have some component be it physical or emotional/spiritual that to a greater or lesser degree makes it different and peculiar to that patient. Leaving out this human dimension makes it easy to produce guidelines that seem rational but cannot deliver what they presume to. Doctors have their judgment and experience and colleagues to assist them. Maybe that is enough.

Two Sides of a Coin

Bill Zeckhausen - bill@zeckhausen.com — Sat, 28 Feb 2009 17:26:46 -0500

Facilitated physician support groups are therapeutic, but are not group therapy. In group therapy, members are diagnosed patients with individualized treatment plans, and members’ only connection is in group. In physician support groups, members are colleagues in the same or in competing practices, may be married to or socialize with one another, and one participant may be the physician to another in the group. These multiple roles sometimes inhibit what can be shared, but also provide a richness of material to address.

Telephone Triage

Brian T. Maurer - btmaurer1@comcast.net — Sat, 28 Feb 2009 17:26:46 -0500

The call came in on Friday at 9:38 PM. It had been an exhausting week at the office: an unrelenting barrage of patients every day. I could barely think straight by the time I packed it in every evening and headed home. I had dinner, checked my e-mail, lay down on the sofa to read and fell asleep instead. The next thing I knew, my wife was handing me the phone.

The Humanities, Not Just for Spectators

evolpintesta@snet.net (Ed Volpintesta) — Wed, 25 Feb 2009 13:40:00 -0500

The humanities have retrogressed because excessive attention has been focused on their value to enhance appreciation of literature, music, and art. As valuable as these passive activities are, they are not the end point of an education in the humanities. There is an active side that is rarely discussed and equally important.

Response to Dr. Pauline Chen's essay on "Getting Off the Patient Treadmill"

evolpintesta@snet.net (Ed Volpintesta) — Sun, 22 Feb 2009 11:08:00 -0500

Insurance companies have no role in profiling physicians under any conditions. Profiling coerces doctors into following insurers’ policies and gives insurers a license to determine how medicine is practiced. By compartmentalizing doctors according to set standards that only reflect the cost-cutting and "scientific" side of medicine insurers make it impossible to concentrate on the non-scientific or humanistic side of medicine. And for the extraordinary doctor who does take the extra time to talk with patients and discuss their concerns and form a trusting and personal relationship, no set of pay-for-performance standards exist and many other statistically independent functions for which insurers do not acknowledge. In this context both patients and doctors become dehumanized, faceless cogs in the health care machine.

Wasting the Talents of Medical Students

Tomlin Paul and Jacqueline Goulbourne - tomlin.paul@uwimona.edu.jm — Sat, 21 Feb 2009 16:38:52 -0500

It seems a waste that they then have to do anatomy, biochemistry, physiology and other subjects in a confined environment which does not call into action multiple intelligences. This environment is dominated by a so-called lecturer who is defined as one superior in knowledge and often suppresses their voices. It kills the fun doesn’t it? This orientation process with medical students has begun to showcase their many talents. These talents can undeniably be the energy for learning medicine if we see the curriculum as a humanistic one about people with similar talents. If we see the curriculum as being about people with organs and circulatory systems, then we will follow a certain path. Most medical school curricula are driven by the path of biomedical science with lip service to the humanities and the arts. In this respect, we waste the many talents of our medical students.

Physician Profiling Rears Its Ugly Head

evolpintesta@snet.net (Ed Volpintesta) — Fri, 20 Feb 2009 07:18:00 -0500

Clearly, profiling is an insult to doctors and just another example of how bad it can get for doctors when they let insurers decide on standards for quality and cost-effectiveness. Eventually, profiling will be used to make doctors conform to the conveyor- belt policy that is suited for dealing with inanimate objects like automobiles, computers and radios.

Profiling represents one of modern medicine’s great inconsistencies. Because it is driven by strategies dedicated in part to generating profits for shareholders, it is incompatible with the qualities of caring and service that patients expect from doctors.

The Medpedia Project

noreply@blogger.com (George Trone) — Thu, 19 Feb 2009 17:46:00 -0500

On February 17, 2009, the online Medpedia platform was released in beta. A description from the site follows:

"The Medpedia Project is a long-term, worldwide project to evolve a new model for sharing and advancing knowledge about health, medicine and the body among medical professionals and the general public. This model is founded on providing a free online technology platform that is collaborative, interdisciplinary and transparent.

"Users of the platform include physicians, consumers, medical and scientific journals, medical schools, research institutes, medical associations, hospitals, for-profit and non-profit organizations, expert patients, policy makers, students, non-professionals taking care of loved ones, individual medical professionals, scientists, etc.

Humanitas or Humanism?

evolpintesta@snet.net (Ed Volpintesta) — Thu, 19 Feb 2009 12:10:00 -0500

The person with humanitas must strive for balance between a life of contemplation and action and, that right action and thinking must be proved in the battlefield and debate.

This definition of humanitas as the quality which impels one to take one’s place in the line of battle struggling for what is right and just, of being engaged in the front lines of combat is a new to me. Ordinarily I would classify these traits as virtue or courage. I had never considered them as part of humanism as the term is commonly used.

Infusing humanitas into physicians’ understanding of humanism is something to think about. Particularly in these days of hostility and resentment against the medical profession. Most doctors are in a constant struggle to maintain their integrity and freedom, not to mention their ability to survive financially.

Being engaged on the front lines of combat is important if humanism in medicine is to be preserved.

Are Doctors Infected With The Stockholm Syndrome?

evolpintesta@snet.net (Ed Volpintesta) — Tue, 17 Feb 2009 17:10:00 -0500

For the past two years Medicare has threatened to cut physician reimbursement by 10% in 2008 and by 20% in 2009. After an outcry from physicians, the cuts were eliminated and physicians were given increases of 0.5% and 1% respectively. Many physicians were relieved to see that the cuts were reduced and some groups including the AMA actually thanked the Medicare Payment Advisory Committee (MedPAC) for being so understanding. But rather than thank Medicare for the tiny increases which some consider an insult, it would have been better if medicine’s leadership had preserved physicians’ honor and dignity by integrity by rejecting them outright.

Medicare Sticks It to Virtual Colonoscopy

Robert S. Rosson - rerosson@comcast.net — Tue, 17 Feb 2009 21:08:39 -0500

A relatively new and possibly more cost effective screening tool has been developed utilizing CT technology. While this procedure, "virtual colonoscopy," requires essentially the same unpleasant preparation as colonoscopy, it requires only one technician, a radiologist and a CT scanner in a standard radiology suite. With increasing utilization, this procedure should incur lower costs to the patient and to Medicare.

Medical Home, Gatekeeper: Skunk Cabbage By Any Other Name Smells Just As Bad

evolpintesta@snet.net (Ed Volpintesta) — Sat, 14 Feb 2009 10:59:00 -0500

Although the medical home is touted as innovative it is a resurrection of the "gate keeper" concept that insurers tried to get primary care doctors to sign on to in the early nineties. It failed then because most physicians felt that it burdened them with more work than they could handle, more responsibility than they should accept, and more pressure than they could bear. Doctors who accept the idea are supposed to get paid more for their "new" coordinating functions. But the danger is that primary care doctors will be deluged with more paper work than they can handle. Already paperwork consumes 20% or more of their time and on some days much more.

Who Has Died to Whom

Jeff McCallum - jeff.mccallum@rich2bros.com — Thu, 12 Feb 2009 19:35:25 -0500

Who is the shell The hollow person The straw pawn moved across the board As you were To the home across town And we were To the dinner table debate

The Cell and the Circle of Light

Manna Valiathan - manna.valiathan@gmail.com — Thu, 12 Feb 2009 19:31:42 -0500

I spend long hours Have spent long years Shut off from the world In a circle of light Life passes me by As I study The nuances of the cell

Physicians need to unionize

evolpintesta@snet.net (Ed Volpintesta) — Wed, 11 Feb 2009 15:05:00 -0500

Sooner or later the time and energy wasted on suing health insurers like Cigna and Aetna ["Medical Groups Sue, Say Aetna, Cigna Shortchanged Doctors", Health Care, Feb. 11] will enrage and galvanize doctors into persuading the federal government to give them a dispensation from the laws that prohibit them from forming unions.

Talking to Patients

evolpintesta@snet.net (Ed Volpintesta) — Tue, 10 Feb 2009 20:46:00 -0500

Isn't it the most telling of medical paradoxes that in an era dominated and defined by CAT scans, MRIs, numerous medical specialists, sophisticated medical procedures; and frequent media accounts of extraordinary breakthroughs in medical research -- still what often matters most is a trusting relationship developed over time in which doctors get to know their patients well?

Often it is this relationship that allows doctors to foresee problems in their early stages.

Taking a Dramatic Eye to the Doctor’s Office Interaction

Michele Battle-Fisher - battle.6@osu.edu — Sun, 08 Feb 2009 20:11:40 -0500

Physicians are asked in each visit of a face-to-face interaction with a patient to optimize the success of each visit under a number of constraints. HMOs demand this. Patients expect this. Recognizing the immense opportunity each interaction may hold in the health of the patient, the importance of maximizing each communicative discourse becomes more important. Certainly this thesis cries for the existence of a medical home and a history of a continued relationship between patient and doctor. If a doctor and patient are so fortunate to have this continuity of care (or less satisfactorily a one-shot visit), using Erving Goffman’s thesis of the person as a drama player with a splash of Butler’s performativity can be applied in ensuring better success in clinical discourse.

Gone on Tour

Jeff McCallum - jeff.mccallum@rich2bros.com — Sun, 08 Feb 2009 20:09:33 -0500

No applause, No standing ovation, No curtain call Shall coax this player to the stage.

Digitrace

Kathleen Grieger - kathygrieger@sbcglobal.net — Sun, 08 Feb 2009 20:08:03 -0500

Tracing my mind to see if a seizure will show its face Let out a roar, a whisper, so we can follow you

The Antioxidants

Howard Spiro - howard.spiro@yale.edu — Fri, 06 Feb 2009 21:40:00 -0500

I want to highlight the discussion of two well-loved and familiar novels, one by Balzac, Pere Goriot, and the other by Dickens, The Old Curiosity Shop. A group of emeritus professors, meeting at Yale's Koerner Center For Emeritus Faculty, has been looking at problems/predicaments/rewards of aging. I was surprised at the initial reluctance of my colleagues to join such a discussion group, but when Annabel Patterson suggested that we sugar-coat ourselves as "The Antioxidants," the attendance doubled, or tripled. She suggested we read those two novels, and I so enjoyed the presentations by Diane Komp and Charles A. Porter that I asked permission to share them with our readers.

The Old Curiosity Shop

Diane Komp - DoktorDi@aol.com — Fri, 06 Feb 2009 21:37:45 -0500

In the Victorian world of Charles Dickens and The Old Curiosity Shop, life is full of tragedies and financial insecurity is always lurking in the shadows. A thread of familial love weaves through it all and even strangers offer blessings on those less fortunate than themselves. Denouement is offered without a happy ending. But would a modern reader eagerly wait for the next installment of the story of a grandfather with a tragic fatal flaw? Would 21st century northeastern Americans like ourselves embrace a story where a beautiful child’s interests are subservient to those of a gambling addict? Call the social worker! Find Little Nell a foster family!

Pere Goriot

Charles A. Porter - charles.porter@yale.edu — Fri, 06 Feb 2009 21:32:12 -0500

The title Balzac gives his novel, Père Goriot, is a nice pun that encapsulates the Goriot plot. "Père" before a proper name (except in the case of a priest, where French uses the term as English does: "Father Beloin," for example) is a rather demeaning term for an old man who is not, for whatever reason, worthy of much respect. "Old Goriot," one might say in English. Goriot gets the epithet as he, mysteriously at first, loses his fortune -- and with it the respect he had been shown -- and gradually is reduced to the direst poverty. But as that happens the novel gradually unfolds to us the cause of his loss: his monomaniacal love of his daughters. "Père Goriot" becomes "Goriot le père": "Old Goriot" becomes "Goriot, father."

The Consolation of Philosophy by Boethius. Translated by David R. Slavitt.

Laurie Rosenblatt and Leon N. Shapiro - Laurie_rosenblatt@dfci.harvard.edu — Fri, 06 Feb 2009 21:29:16 -0500

Palliative Care patients face questions about meaning in their lives. A meditation on death as a way of understanding life, The Consolation of Philosophy has influenced the world-view not only of Aquinas and Dante but many centuries of lesser believers and non-believers. Boethius, a man of family, fame and fortune was a politically active scholar of sixth-century Rome. Religiously orthodox but out of step with the Arian leanings of the Emperor Theodoric, he was unjustly accused of treason. In a cell facing torture followed by a horrible death, Boethius constructed a dissertation on the nature of evil and a meditation on what is valuable in life.

Threat of Malpractice Suits Primary Cause of Moral Distress

evolpintesta@snet.net (Ed Volpintesta) — Fri, 06 Feb 2009 14:39:00 -0500

Eliminating the loopholes that permit frivolous suits against doctors will minimize the financial incentives that some opportunistic attorneys exploit. It will lessen the moral distress that doctors and nurses labor under. One way of doing this is to substitute "health courts" for the traditional adversarial-based system that is currently used. Health courts run on the principle that aggrieved parties are willing to settle differences in a reasonable manner without resorting to the underhanded and unnecessary adversarial methods used now. Using this method, patients would receive their compensation in months and not in years. The animosity between doctors and patients would be minimized. Such a system already exists in some Scandinavian countries.

Legal Messages Waste Doctors' Time

evolpintesta@snet.net (Ed Volpintesta) — Tue, 03 Feb 2009 12:50:00 -0500

The costs of health care continue to rise and many patients are losing their health insurance. If lawmakers can eliminate the loopholes that allow frivolous malpractice suits they will have taken a giant step forward in controlling costs for everyone.

Economic Hard Times May Bring Common Sense Back to Medical Practice

evolpintesta@snet.net (Ed Volpintesta) — Tue, 03 Feb 2009 12:39:00 -0500

Medicine has become unnecessarily expensive because of over-dependence on expensive laboratory testing and imaging studies like CAT scans and MRIs. As beneficial as these tests can be, they are over-utilized and are a major factor that drives the costs of health care ever higher.

Empathy Can Be Taught?

evolpintesta@snet.net (Ed Volpintesta) — Sun, 01 Feb 2009 18:08:00 -0500

I am skeptical about empathy being taught. I mean real empathy, not the superficial kind that may be mimicked just to please a professor. It is more likely that empathy is learned in childhood from one’s parents or relatives. It may even be genetically related. But, who can say for sure?

Recertification testing for physicians

noreply@blogger.com (Ed Volpintesta) — Sun, 01 Feb 2009 15:59:00 -0500

Keeping current is important of course and the vast majority of physicians do. Retesting assumes wrongly, that they don’t. They presume that after at least 11 years of training and years of experience, doctors cannot be trusted to continue studying what they need to know in their particular practices. I, like many, consider this an insult and an effrontery.

A Boutique System of Primary Care for Medicare Patients

Robert S. Rosson - rerosson@comcast.net — Sun, 01 Feb 2009 15:47:24 -0500

The plan might work as follows: Medicare would support the formation of groups to provide boutique care exclusively to Medicare patients. Groups would consist of four to ten internists complemented by nurse practitioners and physician assistants. The groups would provide ready access to care 24/7 with same day access, easy communication by telephone or e-mail, home visits, and adequate time for office visits. The optimal panel size per physician and the amount of the annual retainer per patient remain to be determined. Hospital care and prescription drug coverage are not included in this proposal.

Waxing Nostalgic

Brian T. Maurer - btmaurer1@comcast.net — Sun, 01 Feb 2009 15:39:07 -0500

My friend Milton subscribes to several health publications, one of which he had laid open on the restaurant table that morning. Knowing my profession, he likes to ask my opinion on such things. "Yes, that’s right," I acknowledged, lifting a forkful of eggs to my mouth. "I remember the first time I saw that done --years ago one of the medical residents showed me that trick one night in the emergency room. She put a few drops of Colace into a kid’s ear and plugged it with cotton. When we looked half an hour later, voilà -- the wax was gone."

Spiritual Welding 200

Kenneth A. Bryson - Ken_Bryson@cbu.ca — Thu, 29 Jan 2009 21:54:24 -0500

When times are hard, people need to hear good news. Ethical theories provide a source of good news since they allow us to feel good about ourselves when everything else around us is crumbling. The distinction between healing and curing is vital here. A person who is dying needs a value system to heal the soul, even in the absence of a cure. Professional codes of ethics guide caregivers as they strive to meet all the needs of a patient. But uncertainty arises when several ethical options exist. This paper addresses that issue.

UnitedHealth Group settlement

noreply@blogger.com (Ed Volpintesta) — Wed, 28 Jan 2009 20:22:00 -0500

This endless struggle with insurers wastes our organizations’ time and energy and keeps physicians in a permanent state of distraction and demoralization.

Health insurers will always find creative new ways to exploit and game the system with every lawsuit that physicians win against them. In this endeavor they will use every pretence possible aimed at improving health care, including clinical guidelines, cost-effective profiles and board certification to control physicians.

Further comments on Dr. Chen’s essay "Taking time for empathy" (NY Times, Sept. 25, 2008)

evolpintest@snet.net (Ed Volpintesta) — Tue, 27 Jan 2009 20:48:00 -0500

The point is, unless physicians make an effort to limit the number of patients they see in a day, they will not have the desire or the composure necessary to practice the healing skills of which empathy is the most important and most endangered. Using mid-level providers may provide some relief initially, but many physicians who employ them still complain that as their practices get bigger so do their time constraints and patient demands. Many say their professionalism has turned into a treadmill existence. Any initial saving of time by PAs and NPs evaporates quickly as more patients enter a practice.

Poor Me Lucky and Eeyore Meet

Jeff McCallum - jeff@marksman.net — Tue, 27 Jan 2009 20:37:47 -0500

The world remains, I remain in it. Wars rage, work requires this or that, the economy falters, my cancer has stopped growing.

Medical Humanism: Aphorisms from the Bedside Teachings and Writing of Howard M. Spiro, M.D. by Robert E. Kravetz, M.D.

Martin M. Berman - mmberman@aol.com — Tue, 27 Jan 2009 20:24:24 -0500

However, in every generation new heroes arise and for us it is Howard Spiro’s life in medicine. In this work Robert Kravetz, a Yale-trained gastroenterologist and a teacher of Humanism in Medicine has undertaken the initiative of extracting, collating, recording, organizing and commenting on the teachings of his mentor Howard Spiro, who, in addition to his qualifications as a clinical gastroenterologist and teacher, founded the program for Humanities in Medicine at the Yale University School of Medicine in 1983.

National Board of Medical Examiners decision to offer boards for doctors of nursing

noreply@blogger.com (Ed Volpintesta) — Mon, 26 Jan 2009 17:00:00 -0500

For years, medical educators including those in residency programs and in the boards of internal medicine and family practice have set a standard for primary care that was out of sync with the responsibilities and demands that were required of primary care doctors in the "real world." The incomplete understanding of these groups and their dominant influence on physicians’ professional lives misled many primary care doctors to believe that they could do it all. For a while I too accepted this philosophy; and like many others I experienced burn-out and disillusion trying to live up to a standard that that was absurd.

Apple's Apudoma

Robert S. Rosson - rerosson@comcast.net — Sun, 25 Jan 2009 16:56:15 -0500

The current and highly-publicized medical situation of the well-known CEO and founder of Apple Computer suggests to me the possibility of a metastatic apudoma or neuroendocrine tumor. He is said to be a four year survivor of "pancreatic cancer" who now has a "hormonal imbalance." I have no knowledge of his actual medical diagnosis, but I am reminded of some of the most memorable patients I cared for in my career. Let me illustrate with a few anecdotes from memory.

More on Dr. Chen's "Do Patients Trust Doctors Too Much?"

evolpintest@snet.net (Ed Volpintesta) — Sun, 25 Jan 2009 14:48:00 -0500

Recertification with its academic bias often tests doctors in knowledge that is not germane to their practices. Older doctors, many of whom are not up to taking exams based on knowledge they don’t use are clearly disadvantaged. Although there are many board review courses offered (at considerable cost and time away from office) not all doctors can afford to leave their practices, especially those in solo or small practice. And it makes no sense for senior doctors to engorge themselves on information that is not germane to their practices only to regurgitate it on an exam.

Dr. Pauline Chen's "Do Patients Trust Doctors Too Much?"

evolpintesta@snet.net (Ed Volpintesta) — Sun, 25 Jan 2009 14:40:00 -0500

Ideally, patients’ best source of information on a surgeon’s or any other consultant’s qualifications is their primary care physician. For they have first-hand experience with many different surgical and medical specialists in their community.

Unfortunately, a severe shortage of primary care doctors exists and, fewer medical students are entering the field. As the shortage worsens, more patients will be compelled to defer to the good but impersonal check lists that Dr. Chen mentioned. And, as helpful as these checklists may be, getting input from their primary care doctors vastly improves patients’ chances of having made the best choice. Also having the primary care doctor's input often is a great source of comfort for patients who more often than not feel lost navigating through the labyrinth of specialists and the health care system.

For this reason alone, it is critical that medical schools turn out more primary care doctors.

Comment on Dr. Chen's recent blog post

evolpintesta@snet.net (Ed Volpintesta) — Sun, 25 Jan 2009 00:31:00 -0500

Unless the malpractice laws change and eliminate the financial incentives that exist for plaintiffs and their attorneys, the price of compassion will be determined in courtrooms and less and less in the collective common sense of patients.

Don’t Get Cancer Over the Holidays: Navigating the Maze of Cancer World Without a Map

Diana J. Burgess - diana.burgess@va.gov — Sat, 24 Jan 2009 18:00:00 -0500

My experiences are not unique. As I talk with other cancer patients I hear similar stories of having their emotional and spiritual needs discounted, being thwarted in their attempts to get the doctor to answer their questions and return their calls, and feeling oppressed by a chaotic and fragmented system of healthcare, that is driven by "efficiency" (with those 10-minute appointments) and the unwritten rule that only "medical problems" are "real" and worthy of concern.

Severe Diffuse Axonal Injury Rehabilitation: A Five-Year Ordeal

Syed Tajuddin Syen Hassan & Husna Jamaludin - tajuddin@medic.upm.edu.my — Sat, 24 Jan 2009 17:56:33 -0500

"Probably he is going to be a vegetable for the rest of his life." We, his parents, shuddered and trembled as the neurosurgeon pronounced in a nonchalant manner the prognosis on my son’s condition as he laid in the intensive care unit (ICU) of Putrajaya Hospital in Malaysia. This initial shock remains etched perpetually and eternally in memory.

Response to Howard Spiro's letter to NYT on imaging in medicine

evolpintesta@snet.net (Ed Volpintesta) — Wed, 21 Jan 2009 21:12:00 -0500

As James Gleick said in his book Faster: The Acceleration of Just About Everything we are living in the “epoch of the nanosecond.” Using technology is the quickest quantifiable way to satisfy insurers’ demands for early discharge. This often leads doctors to underestimate the value of physical diagnosis.

Years ago I was admitted to the hospital with severe abdominal pain that began in my epigastrium and settled in my right lower quadrant. A young surgeon examined me and said he wasn’t sure of the diagnosis and that a CAT scan was in order. Shortly thereafter, his partner, a senior surgeon came in and examined me. He said I had acute appendicitis and took me to the operating room. He was right. My peritoneal fluid suggested signs of early peritonitis. Fortunately, I had an unremarkable recovery.

If I had waited for the CAT scan my recovery I could have developed full-blown peritonitis or even sepsis.

Clearly, skill and confidence in physical diagnosis is important and residents must learn it well.

Kaplan Publishing - Call for stories from surgeons

noreply@blogger.com (George Trone) — Wed, 21 Jan 2009 15:49:00 -0500

The first time you have to deliver bad news to a patient’s family. The fiftieth time you’ve stayed late to perform a surgery. That patient you’ve never been able to forget. The mentor who made you a better doctor. Every surgeon has stories like these.

Kaplan Publishing, the #1 educational resource for medical professionals, is launching Kaplan Voices: Doctors, an exciting new series of nonfiction books that share the stories behind the relationships, experiences, and issues doctors encounter over the course of their careers—from those med student days, to everyday life as a practicing doctor.

From med student to intern to practicing specialist, The Real Life of a Surgeon features first-person narratives from the students and doctors who’ve chosen to specialize in this challenging field.

We are now accepting stories for the following anthology:

The Real Life of a Surgeon
With the risky nature of surgery, so much can be at stake, and emotions often run high. How do you tell a mother that her child didn't survive his surgery? When do you go against conventional wisdom to save a life? What’s your average workday like? This anthology features first-person narratives from the students and doctors who have devoted their careers to this path, and offers an unblinking look at daily life in the field. We want to hear your stories. Share a story about an event that explores:

* What led you to surgery as a specialty
* The challenges and rewards of the field
* Dealing with mentors early in your career
* Unusual or memorable patients you’ve encountered
* Diagnoses that were especially challenging
* Mistakes or missteps that helped you learn along the way
* Other doctors who taught you something significant
* Unique experiences during your med school or intern days
* Your everyday life as a practicing surgeon

Submission Deadline: February 13, 2009
Send stories to: surgeon.stories@gmail.com

GUIDELINES
Payment: $250 if published, along with a complimentary copy of the book.
Story length: 1,000–2,500 words
Point of view: First Person
Nonfiction: All stories must be true, previously unpublished stories from your personal experience.
Tone: Inspiring, poignant, and, when appropriate, humorous.
Format: Microsoft Word, 12-point Times New Roman, double-spaced

Contact info: Each submission should include your name, address, phone number, and email address.

Remember: Tell a story that has a beginning, middle, and end. Write from your heart about a life-changing or life-defining experience. Be sure to make your story rich by vividly painting the characters, the setting, and dialogue.

Before final acceptance, you will receive an agreement that outlines the terms and conditions of publication. All manuscripts selected for publication will be subject to editing.

To Submit Your Story:
Typed submissions are preferred, but we will accept a hand-written submission.
Each submission must include your contact information, including your full name, mailing address, phone number, and email address, if you have one.
Each submission also must include a story title and word count.
Electronic (emailed) submissions are preferred; mailed submissions are acceptable.

Submissions via email: In the subject line, cite the story title. Type the story into the body of the email or send an attachment in Microsoft Word. One (1) submission per email, please.
Submissions via regular mail: You can send more than one story per envelope. Include one self-addressed, postage-paid envelope for each submission. Send only the paper copy of the story; do not send computer disks or CDs. Mail to:

Kate Lopaze
Kaplan Publishing
1 Liberty Plaza, 24th Floor
New York, NY 10006, USA

Science of Virtues

noreply@blogger.com (George Trone) — Wed, 21 Jan 2009 15:30:00 -0500

The Arete Initiative at the University of Chicago has launched a grant competition for scholars and scientists working on the notion of virtue. As their website puts it, the primary question is: In what ways might the humanities and the sciences cooperate to develop more adequate models of virtue for modern societies? The application deadline is March 2, 2009.

Doctor nurses

noreply@blogger.com (George Trone) — Wed, 14 Jan 2009 15:30:00 -0500

An article in The Chronicle of Higher Education reports on the controversy surrounding the doctorate of nursing practice degree and the certification exam offered by the National Board of Medical Examiners.

Primary Care: Where's the Rage?

Ed Volpintesta - evolpintesta@snet.net — Fri, 09 Jan 2009 12:00:00 -0500

No one would want to lose the benefits of the new procedures and treatments that flow from our medical teaching centers. But something insidious has been going on for decades. The humanism of medicine has withered. Because it is not sufficiently honored or acknowledged, many doctors believe that by using all available technology and following so-called guidelines, they are acting competently.

Heartfelt Morning

Brian T. Maurer - btmaurer1@comcast.net — Wed, 07 Jan 2009 12:00:00 -0500

I drove on through the darkness in silence. Leaves blew across the road, dancing momentarily in my headlights. Ten minutes later I pulled into my friend's driveway, backed the car around and waited. Shortly, he appeared, overdressed in his winter parka, holding an ancient leather suitcase. He slid into the seat beside me and extended a hand in greeting.

Empathy and Imagination

Sara T. Baker - saratbaker@bellsouth.net — Wed, 07 Jan 2009 12:00:00 -0500

What I think physicians and healers can bring to their patients is a willingness to be "wounded healers." If we can be present to our own wounds, our griefs, our failings, our disappointments, if we can eschew the seductively powerful role of being "carers" and instead be whole human beings encountering other whole human beings, then we can work towards empathy.

Show and Tell

Barbara J. Bache-Wiig - barbbw@tds.net — Sun, 21 Dec 2008 12:00:00 -0500

Not long ago I found out that I'm a princess... hmm... it started for me when one day I was groaning and complaining because my right shin, ankle, and big toe had been giving me pain.

Putting Down Pooch

Susan Woldenberg Butler - csbutler@sctelco.net.au — Sun, 21 Dec 2008 12:00:00 -0500

The bell above the surgery door tinkled, its feathers of sound too insubstantial a scaffolding for the drama about to be erected. Bring on the gongs. Organ. Ding dong avine calling. In jerked a tough old bird with a miner's body: compact and low to the ground, nuggetty, so he wasn't always bumping his knees and head on rock faces. No gravity pulled Cyril forward, despite all those years spent eroding earth from inside. Only one thing rounded those shoulders: the load he bore like an offering, forearms extended and parallel, palms cupped. He wept over his mutt, silently, except for the odd uncontainable squawk.

Letter in Science Times

noreply@blogger.com (George Trone) — Wed, 17 Dec 2008 15:27:00 -0500

Howard Spiro's letter to the editor ("When Imaging Falls Short") appeared in the December 15, 2008, edition.

Growing Old, Gracefully

noreply@blogger.com (George Trone) — Thu, 11 Dec 2008 20:30:00 -0500

If there’s one thing that we cannot avoid, it’s the passage of years and death. The grim reaper comes calling on each and every one of us without fail – the only difference is that some of us go early while others are allowed to live to a ripe old age. I’m sure we’d all like to live forever, but since that’s not possible; we try for the next best thing, which is to live as long as we can. But there’s a downside to this scenario – because with age comes a lot of associated baggage that we don’t really care for, like senility, various aches and pains, wrinkles and bags, forgetfulness, and a host of other ailments and illnesses.

Growing old gracefully is something we’d all like to do, and towards that end, here’s what we can do:

• Accept that you’re growing old: Some people hate to admit that they’re showing physical signs of aging, and to make themselves look younger, rely completely on cosmetic surgery and cosmetics. But Botox has a nasty way of leaving telltale signs and layers of cosmetics do nothing to hide the ravages of time. Rather than have people snigger behind your back at your futile attempts to show that you’re young, give in gracefully and act your age.
• Remain young at heart: Just because time decides that your body should grow old, there’s no need to let your mind age too. You are as young as you think you are, so keep doing the things you used to do as far as physically possible. Listen to your body though, for signs of fatigue and exhaustion, and give in to them by taking a nap or resting for a while.
• Stay healthy and fit: Keep fit by exercising according to your physical condition. Walking is a safe exercise for people of all ages, but if you want to do anything more strenuous, consult your doctor before you begin a new routine or continue your old one. Exercise keeps you active and energetic as the years go by and also prevents your bones from falling prey to arthritis and osteoporosis.
• Eat the right food: Your digestive system slows down as you grow old, and you must respect your stomach by eating food that’s easily digested. Food that’s too rich, oily and starchy may have adverse effects on your system and give rise to embarrassing moments that you would rather avoid. Fill up on fresh fruits and vegetables to get your daily dose of vitamins and stay healthy.
• Stay independent: Even if you have a loving family to look after you, don’t stop taking care of yourself and being responsible for your own needs. You never know when you’re going to be left all alone, and when you are, you don’t want to find yourself helpless and unable to take care of even the most simple of your needs. So stay independent, and learn to do things for yourself.

This article is contributed by Sarah Scrafford, who regularly writes on the topic of Radiology Technician Training. She invites your questions, comments and freelancing job inquiries at her email address: sarah.scrafford25@gmail.com.

Reflections on Our Humanity

Jack W. Love - jwlove@cardiomend.com — Thu, 11 Dec 2008 12:00:00 -0500

Man is a fragile animal, a life form unique among all the multitude of living things on Earth, perhaps in our entire universe. From a physician's perspective, the fragility is striking, and a cause for a combination of humility, some humor, and great awe.

The Delmar International Speedway

Paul Gorrin - pgorrin@aol.com — Wed, 10 Dec 2008 12:00:00 -0500

I was in the pit of the Speedway, squinting against the floodlights, as I wandered from lighted areas to dark, peering thru the haze of dust, exhaust and engine noise that rose and fell rhythmically as the pack approached and swung away--trying to find Durbin Johnson's stock car. For three years, when I would see him for his regular office visit he would invite me to come to the races, and of course see the stock car he worked on. I was curious and wanted to go, one of these summer Saturday evenings, but hadn't. That is until I diagnosed him with lung cancer.

Training for medical residents

noreply@blogger.com (George Trone) — Wed, 03 Dec 2008 22:03:00 -0500

The Institute of Medicine has issued a report, Resident Duty Hours: Enhancing Sleep, Supervision, and Safety, with recommendations on how to change medical residency to reduce errors and increase learning.

Trusting Doctors

noreply@blogger.com (George Trone) — Mon, 01 Dec 2008 16:38:00 -0500

The New Republic has Sherwin B. Nuland's review of Trusting Doctors: The Decline of Moral Authority in American Medicine by Jonathan B. Imber.

Sally

Barbara J. Bache-Wiig - barbbw@tds.net — Sun, 30 Nov 2008 12:00:00 -0500

When I told our daughter I was going to see our friend Sally comatose in hospice care, Anne reminded me, "It's the circle of life, Mom."

Carving Out a Legacy

Brian T. Maurer - btmaurer1@comcast.net — Sun, 30 Nov 2008 12:00:00 -0500

When she first heard about the practice, the lay counselor was astounded. How could anyone, especially a young girl, take a razor knife to the skin of her own body, over and over again?

Hurry Down Sunshine by Michael Greenberg

Howard Spiro - howard.spiro@yale.edu — Tue, 18 Nov 2008 12:00:00 -0500

The book is worth reading by caretakers for yet anotherB illustration of what the families of the deranged endure. There is much in the varying responses the author recounts, finally recognizing his transference feelings towards the psychiatrist, much that should stimulate discussion among medical students. In a poignant insight, Greenberg suspects that the professionals believe that theB family is partly responsible for, contribute to, his daughter's derangements. We are not yet free of the discredited "schizophrenogenic mother" theory that so beset parents in the 1960s.

The Two Kinds of Decay by Sarah Manguso

Howard Spiro - howard.spiro@yale.edu — Mon, 17 Nov 2008 12:00:00 -0500

I picked this book up in our local library in the mistaken notion that it was a philosophical inquiry, but when I saw that it was the account of a young woman with a neurological disease related to the Guillain-Barre syndrome, I took it out more enthusiastically.

Can the Humanities Mend Medicine?

Howard Spiro - howard.spiro@yale.edu — Tue, 04 Nov 2008 12:00:00 -0500

Medical practice has been much strengthened by technology, but that is nothing new. Physicians used to lay an earB down on the patient's chest to listen to the heart until in 1816 the invention of the stethoscope did away with such intimacy -- to let the physician stand tall again. In 2008 cardiologists don't even need to listen to the heart, let alone the patient; ultrasound does that for them, recording sounds onto a screen, so that the physician need never touch the patient. Stethoscopes still adorn the neck, but like theB head-mirror in the 1940's, they have become an icon to show who is a doctor -- or latterly a nurse. But I never see anyone use a stethoscope, on TV anyway.

There Are No Ordinary Moments

Brian T. Maurer - btmaurer1@comcast.net — Mon, 03 Nov 2008 12:00:00 -0500

I arrive at the office early to find a stack of charts already waiting on the desk for my attention. I drop my briefcase, unlock the desk drawers and settle in to sort through the pile. Some are prescription refill requests, some are lab studies that have come in over the course of the night, one is an x-ray report on an 8-year-old girl's foot that a colleague had ordered two days ago.

Thoughts on Roe v. Wade

Jack W. Love - jwlove@cardiomend.com — Mon, 03 Nov 2008 12:00:00 -0500

Physicians once would only heal, Or try to ease life's pain, They labored with committed zeal, The goal was pure and plain. To cure was once that only goal, But when illness would not yield, A physician helped the suffering soul, Gave comfort, if not healed.

Gurney Ride

Jeff McCallum - jeff@marksman.net — Mon, 03 Nov 2008 12:00:00 -0500

Between the beds three deep on either side of the long long corridor piles of walkers and wheelchairs wait like sad used vehicles on a dusty dull mid-town car lot lacking only the Se Habla Espanol signs

More on medical blogging

noreply@blogger.com (George Trone) — Sun, 05 Oct 2008 21:11:00 -0400

This recent article in Psychiatric News discusses the growing phenomenon of blogging by doctors.

Pauline Chen on taking time for empathy

noreply@blogger.com (George Trone) — Fri, 03 Oct 2008 21:23:00 -0400

Pauline Chen, author of Final Exam: A Surgeon's Reflections on Mortality, reflects in a recent article on how a busy clinician may still have time to interact empathetically with patients.

Post Partum

Theresa Wyatt - tvwyatt@aol.com — Sun, 28 Sep 2008 12:00:00 -0400

You gently wipe finger prints off cream colored walls and proceed downstairs, a descent so familiar you feel as if you're floating to the basement where piles of pre-sorted lights and darks, dread and disdain, make a pathway to the marital machine.

An Elephant in the Room

Brian T. Maurer - btmaurer1@comcast.net — Sun, 28 Sep 2008 12:00:00 -0400

Congenital hip dislocation, now known as developmental dysplasia of the hip--DDH. I knew the terminology well. I also knew the names of those simple maneuvers used to diagnose it: Ortolani's and Barlow's tests. Over thirty years of pediatric practice I had performed both of them countless times. Of those thousands of babies I had examined, a handful had exhibited the telltale sign indicating the dislocation. Most of them had a good outcome. Then I remembered Layla. Layla had been born prematurely at a regional hospital. She remained in the nursery for several weeks until her neonatal problems resolved. Due to a miscommunication, one crucial piece of information was never passed along to me: the fact that she had a questionable Ortolani's sign on her discharge examination.

On Being Ill by Virginia Woolf

Lisa Kerr, Ph.D. - liskerr@springmail.com — Mon, 15 Sep 2008 12:00:00 -0400

Woolf's essay will appeal to providers and patients alike, particularly those interested in the intersection of medicine and literature. Her salient points regarding language and illness will make 21st century readers question how much has changed in the world of literature regarding illness: Has illness emerged as a more prominent theme in literature? Do the ill have a better vocabulary for communicating their experiences today? And if the ill do have an effective vocabulary, who is listening to what they have to say?

Howard Spiro's 2008 message to YJHM readers

noreply@blogger.com (George Trone) — Wed, 10 Sep 2008 20:34:00 -0400

Howard Spiro, founder and editor of YJHM, shares his thoughts about the journal in an updated message for readers.

New online medical encyclopedia

noreply@blogger.com (George Trone) — Thu, 04 Sep 2008 10:43:00 -0400

The Chronicle of Higher Education profiles Medpedia, a new online medical encyclopedia with thousands of contributors. Plans are to go live in fall 2008.

Open-Ended Questions

Brian T. Maurer - btmaurer1@comcast.net — Tue, 02 Sep 2008 12:00:00 -0400

In pediatric practice, the month of August is historically a dry stretch, with few medical challenges to test the clinician's diagnostic acumen. Instead, for me, this becomes the season of the open-ended question. After all, we clinicians have to engage patients in some sort of conversation. Despite the persistent popular myth, pediatrics is not veterinary medicine. There is an art to encouraging kids to share whatever is on their minds. Sometimes results can be surprising, sometimes devastating; but always poignant.

Killer Cliche'

Jeff McCallum - jeff@marksman.net — Tue, 02 Sep 2008 12:00:00 -0400

It's not how many breaths you have left, it's how you use them. Of course, some of us need each one to simply survive the day, brush our teeth, reach out and touch someone. Wheeling to the dining room towing tubes and oxygen becomes no mean feat.

Medical blogs: Who are they good for?

noreply@blogger.com (George Trone) — Tue, 26 Aug 2008 13:33:00 -0400

The Ethics Forum of the American Medical News has an interesting discussion between medical bloggers Maurice Bernstein, MD (bioethicsdiscussion.blogspot.com) and Robert Lamberts, MD (http://www.distractible.org/).

The Weather Map

Jeff McCallum - jeff@marksman.net — Mon, 25 Aug 2008 12:00:00 -0400

A forecast is not prophesy only an educated guess based one would hope on data experience vaults filled with scrolls and computer print-outs years of field tests modeling statistics and probability

Diagnosis

Jeff McCallum - jeff@marksman.net — Mon, 25 Aug 2008 12:00:00 -0400

Though thunder rolls through pregnant skies let forecast serve as guide, not eyes; for rain drops may or may not fall, the clouds may cease to grey at all. Emerging sun holds storms at bay as song birds sing to crown the day.

Is There an Ethical Doctor in the House? Avoiding "the Dream of [Having] an Ethical Algorithm"

Norman Swazo - ffnks@uaf.edu — Mon, 25 Aug 2008 12:00:00 -0400

The television series "House," and specifically its central protagonist Dr. Gregory House, brings that question fully to the foreground even as one takes pains to distinguish between "dramatic representations" and "actual medical practice." But, that distinction glosses over what is unsettled even for experienced medical practitioners and seasoned bioethicists. For many having a basic formation in clinical ethics, the above question is readily answered: One answers having appropriated a concept of bioethics as "a sequence of equally weighted, verbally-defined principles to be upheld through a decision to participate or withdraw" from the clinical case at hand. Thus, an ethical physician should be non-maleficent first and foremost and beneficent to the extent she is able, provided her conscience permits her continued participation in the decisions to be taken and her engagement in action issues from a principled deliberation about means and ends.

Being One With My Monkey

Tim Connelly - tconnely@earthlink.net — Mon, 25 Aug 2008 12:00:00 -0400

Nearly every day, as part of my treatment for PTSD and related behavior problems that have plagued me for decades, I work with my monkey at the Veterans Serenity Therapy Program.

Taking the time for a diagnosis

noreply@blogger.com (George Trone) — Wed, 06 Aug 2008 01:02:00 -0400

In a recent op-ed piece, a medical school professor specializing in difficult-to-diagnosis conditions discusses the systemic problems (economic, educational, political, and so forth) related to the diagnosis and treatment of certain patients.