The Yale Journal for Humanities in Medicine

The Links that Bind Us

Scott A. Weinstein - herptoxmed@msn.com — Sun, 07 Mar 2010 05:54:18 -0500

Ellen was a modestly attired, middle-aged woman wearing fatigue with every facial expression. Her countenance reflected thoughts afar from the immediate surroundings of the Critical Care Unit (CCU). As I had answered numerous pages and participated in several codes on this seemingly endless night, this call to the CCU nursing station was received with tempered impatience. One of the nurses approached and indicated that the lady lost in thought was the daughter of a patient resuscitated earlier in the evening.

Competing Medical Schools

howard.spiro@yale.edu (Howard Spiro) — Sun, 07 Mar 2010 17:15:00 -0500

What could be wrong with a medical school that proudly affirms its mission to train first-class clinicians, leaving to others the training of “lab docs.” There are many questions for their faculty to answer, among them-for example- whether nurse practitioners function as well in primary care as graduate physicians. Important clinical questions of “evidence-based “ medicine can be explored with the same sense of righteousness as studying the twists and turns of the genome.

I am aware of the wide-spread conviction that “Physicians are scientists.” Whether they need to be trained as scientists is a different question. I used to light a cigar, though I could not make a match. Clinicians could forego the foreign language of organic chemistry and structural biology to become as acquainted with the character of their patients as with the structure of their molecules.

The Concept of Compassionate Engagement in Islam

Nazila Isgandarova - azerwomensc@yahoo.ca — Tue, 02 Mar 2010 08:16:31 -0500

Muslim spiritual and religious caregivers are the main providers of Islamic spiritual care. When visiting the sick in hospitals, prisons, etc., Muslim spiritual and religious care givers do not have sacraments to administer and there are no formal rites to perform. However, all devout Muslims consider their prayers important.

Flashback

Brian T. Maurer - btmaurer1@comcast.net — Tue, 02 Mar 2010 07:54:17 -0500

She brings her 12-year-old son to the office for his sixth grade physical examination. I have not seen the boy in three years. She blames it on the health insurance—"they only cover a physical every other year now"—even though I suspect otherwise. No matter: here he sits before me, quietly waiting.

Antidote for Primary Care Shortage

evolpintesta@snet.net (Ed Volpintesta) — Sun, 21 Feb 2010 11:30:00 -0500

Many students who would make good general practitioners are stymied by the basic sciences and don’t go on to medical school. The acute shortage of primary care doctors, in part, is caused by this inappropriate screening process.

Early-entry that combines college and med school into six years is a good idea. It may be the antidote to the primary care shortage.

Surge of new medical schools may not be the best way to turn out more primary care doctors

evolpintesta@snet.net (Ed Volpintesta) — Tue, 23 Feb 2010 14:32:00 -0500

By tailoring primary care doctors’ studies to what they actually use in practice, their training period could be shortened by at least two years. Not only would this allow more students into primary care programs and produce more primary care doctors quicker, but it would also reduce their student loan debt.

Ruminating on GERD

Brian T. Maurer - btmaurer1@comcast.net — Sun, 28 Feb 2010 09:10:33 -0500

I was chagrined to learn recently that 5% of infants are prescribed medication for GERD—gastroesophageal reflux disease, the latest diagnosis du jour in primary care pediatrics.

Anatomy

Tamar Rubin - tamar.rubin@utoronto.ca — Sat, 20 Feb 2010 14:27:11 -0500

The first man to cut into flesh, before anatomy texts delineated paths of tiny vessels – did it for science (or whatever he called curiosity). Unwrapping the mystery of his first cadaver, layer by layer, his fingers trembled, the first fingers to open and discover what was inside.

Lazarus on Legal Hold

Susan Palwick - susanpal@aol.com — Sat, 20 Feb 2010 14:25:41 -0500

You lie, unmoving, on an ER gurney in a chaotic hallway, wheelchairs and x-ray machines jockeying for narrow passage, blaring announcements overhead. Bandages swathe your wrists and thighs, white gauze stained pink from the rusty blades, your head covered as if you are already dead.

I hate disease, I hate all illnesses...

Paul Bussan - paul@psbpublishing.com — Sat, 20 Feb 2010 14:24:03 -0500

I hate disease, I hate all illnesses, I hate all maladies that can afflict The human body; I hate all sicknesses That have on human beings an ill effect

The Silence of Depression

Manna Valiathan - manna.valiathan@gmail.com — Sat, 20 Feb 2010 14:22:29 -0500

Words woven in silence Never spoken Silence woven in words Never broken. I am the silence The silence is me There is no meaning In making distinctions

Eliminating insurers' antitrust exemptions

evolpintesta@snet.net (Ed Volpintesta) — Sun, 07 Feb 2010 11:20:00 -0500

If insurers didn’t share information they would be compelled to gather and act on their own mortality and care data. That would make them more competitive, not less so. Broad statistical data bases can be misleading; and can dehumanize medical practice by minimizing the uniqueness of individuals’ diseases. Patients may have the same disease as far as its name goes, but the disease itself and its progression are influenced by social and economic factors, and even the geographical areas in which the patients live. Such non-statistical information is important and can seriously skew the date that insurers deal with.

"Doctors for America" a good idea

evolpintesta@snet.net (Ed Volpintesta) — Wed, 10 Feb 2010 12:41:00 -0500

It is widely known that most medical students are turned off by primary care. But merely paying these physicians more for their services is not the whole answer. Their training should be more in touch with what the “real world” requires of them. In my pre-med years I knew several students who would have made excellent general practitioners but who because of average grades in organic chemistry or biochemistry lost out on their dreams of becoming physicians. They went on to become biology teachers, chiropractors, optometrists, and business executives. Others attended foreign medical schools.

Response to Dr. Pauline Chen's "Do You Have the 'Right Stuff' to Be a Doctor"?

evolpintesta@snet.net (Ed Volpintesta) — Sat, 20 Feb 2010 12:30:00 -0500

The shortage of primary care doctors is the most obvious example of how medical schools have created a lop-sided physician workforce. By over-concentrating on students’ scientific aptitudes, they have created a medical culture that rewards medical specialization to a much greater degree than primary care.

The result is an unbalanced, over expensive, work force that under serves many of society’s basic medical needs. The lack of primary care providers is one of the central issues of the health care debate. It most likely will be solved, in part, by recruiting suitably trained nurses to provide some primary care services independently.

A Bittersweet Prelude: My Sugared Narrative

Michele Battle-Fisher - battle-fisher.1@osu.edu — Sun, 07 Feb 2010 05:27:52 -0500

Sugar is ruling the destiny of my family. Where I come from, food is synonymous with culture. But for one cousin in my life, that culture has come with a heavy price. We both love the thought of a decadent birthday celebrating our newest years of life. With each passing year, my cousin never seems to age. We live for the flakiest sweet potato pie to bring in the new harvest. I cannot remember a moment of celebration that did not include glucose of some form.

The Heart of the Matter

Brian T. Maurer - btmaurer1@comcast.net — Sun, 07 Feb 2010 05:20:52 -0500

When I was a resident pursuing an elective rotation in pediatric cardiology, I met my mentor one spring afternoon at a local hospital. He escorted me down a long hallway to a bank of elevators, where we descended to the basement and traversed the tiled floor to the heavy metal door of the morgue.

Eliminating insurers' antitrust exemptions

evolpintesta@snet.net (Ed Volpintesta) — Sun, 07 Feb 2010 11:20:00 -0500

In a Feb. 4 editorial “Making health insurance less competitive” the Washington Times mentioned that eliminating insurers’ limited antitrust exemptions will make them less competitive. The argument is that insurers need to compare mortality and care data to operate, which sounds right, but, it has flaws that speak against it. Disease is not so easily or thoroughly identified by statistics as insurers believe. The statistics they gather and compare may approximate, but can never truly reflect the different social and economic factors reported in their statistics.

The Seven Year Night: Poems of the Medical Training Experience by James Wilk, M.D.

William G. Rector - poetry@yjhm.org — Wed, 20 Jan 2010 07:49:13 -0500

Dr. Wilk's poetry nearly always has a medical theme, often graphically so, but he freely and successfully brings his own life into his work. The best poem in the book, indeed one of the better poems I've read in some time, Hands at Forty, compares his hands to those of his father, also an obstetrician.

A Moment of Grief

Ahmad Kaako - ahmadkaako@hotmail.com — Wed, 20 Jan 2010 07:27:01 -0500

It was a shock yesterday evening after I realized that I will no longer be in the company of my best friend, with whom I have kept company for the last four weeks after my foot surgery. I called it a night after I felt on edge. Although I have decided to live with that, it has been a different and difficult day for me to go out of my house and leave her behind. Now that my friends have gotten used to seeing me with her all the time, they were surprised today when I showed up without her.

Called Back: My Reply to Cancer, My Return to Life by Mary Cappello

Howard Spiro - howard.spiro@yale.edu — Tue, 05 Jan 2010 09:13:43 -0500

This volume by Mary Cappello, Professor of English at University of Rhode Island, is beguiling in the intellectual attitudes that she brings to her breast cancer, one that engenders optimism but enlarges resentment. I have learned a lot from her story in five chapters. From Diagnosis, through Surgery, Chemotherapy, Radiation, and a Coda, Called Back, her passionately detached attitude has made her story very intriguing. She wryly describes things that can go wrong, sometimes owing to the actions or words of what are now termed "health care providers."

Eye Surgery

John Grey - jgrey10233@aol.com — Tue, 05 Jan 2010 08:53:20 -0500

The doctors are in your eyes. They're replacing night with sunrise, blur with scratching cat, gray with whatever shade the couch was when you last saw it. Memory has its marching orders, work for what happened then, not how it might look now.

Triple Digits

Brian T. Maurer - btmaurer1@comcast.net — Thu, 31 Dec 2009 08:30:48 -0500

I have cared for Jonathan since he was a newborn; I can recite his medical history like my street address, bank account and social security number. Jonathan was born with a pedunculated tumor attached to the wall of his left ventricle. So far the mushroom-like growth has given him no problems. His cardiologist and I keep our fingers crossed each time we see him.

Solar Damage

Erika Dreifus - erika@practicing-writer.com — Sat, 26 Dec 2009 11:23:10 -0500

I tiptoed back beneath the sun as a teenager, basting in baby oil beside my best friend. Both of us intent on roasting faster, brighter, deeper. Solar damage there, I concede. But not from those earlier days.

Knowing Too Much?

Ohad Oren - ohadoren@gmail.com — Sat, 26 Dec 2009 11:14:51 -0500

The neurosurgeon asked me to visit his office later that day. There he guided me from the shape of the blade, through the anatomy of the visual system, to the specific deficit exhibited by our corporal. With the sword's orientation in mind, it was possible for it to cut the right optic nerve on its inferior-medial aspect. That way, an isolated single-quadrant visual deficit, rare as it is in the non-trauma world, could be brought about.

YJHM on Facebook and Twitter

info@yjhm.org (George Trone) — Fri, 25 Dec 2009 17:25:00 -0500

In its continuing exploration of online social networking tools, YJHM has established a presence on Twitter and Facebook. The editors invite your participation and feedback.

Our page on Twitter is

www.twitter.com/yjhm

If you have a Twitter account, you can sign up to follow YJHM's tweets. We encourage you to do so. For now, we will automatically post links to newly published articles, reviews, and poems. We will also experiment by posting other updates as appropriate.

YJHM also has a new Facebook Page:

http://www.facebook.com/pages/The-Yale-Journal-for-Humanities-in-Medicine/270212575246

We encourage Facebook users to become a fan of our page. Feel free to post on our wall and make other contributions there.

"Just 300 More Pages of Change You Can Believe In" by Jeff McCallum

jeff@marksman.net (Jeff McCallum) — Sun, 20 Dec 2009 16:49:00 -0500

I don't want a Health Care Bill anymore.
Oh, I did,
You may have,
But what are we getting?
Apparently this Gordian knot is too swift a moving target
For the sword of reason to succeed,
Even coupled with the shield of compassion,
Or under its guise.

Bed Swap

Ahmad Kaako - ahmadkaako@hotmail.com — Sun, 20 Dec 2009 04:40:00 -0500

Everything in this life is made and prepared for a purpose; it is hard for me to believe in random accidents. I could not have imagined that I could not have a date for my elective foot surgery better than December 2nd.

What's in a Name?

John Thomas Clark - j.t.clark@verizon.net — Sun, 20 Dec 2009 04:17:52 -0500

It happens again, and, in disbelief, you go down – once more reduced to a sprawl of floored contortion. Several curious, browcrunched onlookers do nothing because you look able-bodied.

Number of preventable deaths exaggerated

evolpintesta@snet.net (Ed Volpintesta) — Sun, 20 Dec 2009 14:55:00 -0500

The public should be reassured that medical errors are taken seriously by all doctors; needless to say even one preventable death is a tragedy; and for that reason hospitals have committees that look at errors and make every effort to prevent them from recurring.

Shadow, Meet Ghost

Jeff McCallum - jeff@marksman.net — Wed, 16 Dec 2009 09:51:58 -0500

We, he, I Could chose to live, To say good bye perhaps, But live each moment we are granted, Each second science saves for us, Remembering every heart beat; Past and present. Our and theirs.

Ross Lockridge, Jr.

Raymond Cavanaugh, Jr. - handofgatsby@yahoo.com — Mon, 14 Dec 2009 09:35:51 -0500

Ross Lockridge, Jr. was born in 1914 in Bloomington, Indiana. He attended Indiana University, where he lived up to his nickname “A-plus Lockridge” by graduating with the “highest average” in the school’s history. On the very day Raintree County reached number one on the New York Times bestseller list, Lockridge committed suicide by carbon-monoxide poisoning. The ensuing Times obit would say that Lockridge was discovered “in the front seat, slumped behind the steering wheel with the car door opened and his feet exiting.”

Heart of the Mind

Walter A. Borden - waborden1@mac.com — Wed, 09 Dec 2009 11:33:35 -0500

Clarence Tyler and Sandra McMullen haunted me. Maier Soloman haunted me. They first rose from my depths when, during my internship, a mentor suggested there could be psychological underpinnings in medical problems. George Engel was psychoanalyst, internist, researcher, master teacher, and at bottom medical humanist. He spoke of the powerful influence of loss on health and disease.

The UConn Health Center: Whither or Wither?

Robert S. Rosson - rerosson@comcast.net — Wed, 09 Dec 2009 11:29:35 -0500

On November 21, 2009 it was announced that the University of Connecticut had rejected a proposal by Hartford Hospital to merge with the UConn Health Center to form a first rate medical school-hospital complex. I would suggest, as others have, that UConn revisit the idea of the “Harvard Model.” This system is one in which the university medical school has no hospital of its own, but rather utilizes the hospitals within its geographic area for teaching students, residents and fellows, and for care of patients and research by its faculty.

Contested Medicine: Cancer Research and the Military by Gerald Kutcher

Howard Spiro - howard.spiro@yale.edu — Wed, 25 Nov 2009 07:12:02 -0500

This passionate book is ostensibly about a long-term study in the 1950-60s at the University of Cincinnati College of Medicine, where patients with advanced cancer were turned into experimental subjects "who were used to answer questions of the US military on the effects of total body irradiation..." That may be, but in his discussion Gerald Kutcher, a professor of the history of medicine at SUNY Binghamton, provides many more valuable lessons.

The Great Dialogue in Modern Medicine: A Brief Commentary

Stephen F. Gambescia - sfg23@drexel.edu — Thu, 03 Dec 2009 09:35:56 -0500

There are troubling questions that today's doctors confront, as they become more acutely aware of human disease by using the refined senses of medical technology. Members of this historically revered profession, in modern times find themselves suffering from role conflict. Are they the caring and responsive healer for what ails the patient, or are they the relentless diagnostician who must stamp out any vestiges of disease?

Black and White in the ER: Little Rock, Arkansas, 1967

Janice Krasselt Medin - jkmedin@hotmail.com — Thu, 03 Dec 2009 09:31:56 -0500

I reached out to open his fist and hold his hand. He was Black, in his twenties. He had burned his leg on a gas heater. He screamed "Oh God, Estelle" over and over, his face swathed in sweat.

Charlotte's Gift

Sally Edwards - sedwards63@aol.com — Wed, 02 Dec 2009 10:32:33 -0500

Through the Great Depression, WWII, unemployment, and rubbing nickels together for the rest of her 45-year marriage Charlotte Barnard was the care giver par excellence of all of us: my father, three kids, her parents and in-laws, our wider family, and friends. In 1979 after months of gastrointestinal pain and testing, surgery diagnosed metastatic linitis plastica. Hooked to an intravenous hyperalimentation life-care pump and an NG tube, she became one of the cared-for.

How They Met

Frederic Platt - plattf@hotmail.com — Wed, 02 Dec 2009 10:18:34 -0500

Alone after 55 years, she grieves aloud, "I don't know how I'll go on." The tears trickle down her cheeks and her voice cracks. So I ask how they'd met.

Rogue's Gallery

Frederic Platt - plattf@hotmail.com — Wed, 02 Dec 2009 10:17:29 -0500

I might have done it better. True, I let patients know four months in advance. And true, I helped my staff find new jobs and we listed the building for sale, notified insurance companies, and told our colleagues.

Philip - Part 2

Frederic Platt - plattf@hotmail.com — Wed, 02 Dec 2009 10:14:07 -0500

The trouble with the story, one that ended well, some ten years ago, was that I never told Philip just what had gone wrong, just how close he had come, just anything about how we nearly did him in, and he was happy.

Philip - Part 1

Frederic Platt - plattf@hotmail.com — Wed, 02 Dec 2009 10:13:03 -0500

Philip told me he'd been upchucking and yes, it was black and red and I looked and what came out the other end was also black and it tested YES for blood and so I sent him over to the hospital.

Dental Floss

Diane Bechtler - dianamo@carolina.rr.com — Sun, 29 Nov 2009 05:53:18 -0500

So what do you do when you are stuck in the land of doubt about your life's length? After weeks in the hospital, I realized everyone lives that way. I had lived with my brain illness for an unknown period of time. People don't know when they are going to die. We don't even know what's happening in our own bodies.

Coup d' Flu

Brian T. Maurer - btmaurer1@comcast.net — Sun, 29 Nov 2009 08:03:56 -0500

Anyone working in primary care medicine can tell you that the past two months have been a nightmare. Offices and clinics have been bombarded with phone calls and patients scrambling to secure a dose of the H1N1 vaccine for themselves and their children. Initially, no one wanted the vaccine because it was so new. When it became apparent that supplies were severely limited, everyone clamored for a dose.

Who's Afraid of Primary Care?

Ed Volpintesta - evolpintesta@snet.net — Sat, 28 Nov 2009 11:27:18 -0500

It's common knowledge that fewer medical students are entering primary care and that patients are having a hard time finding a primary care doctor. Part of the reason is that insurance companies place little value on much of the work that primary care doctors do. Even though physicians' complaints are seen in the medical and lay media, it is rare to see descriptions of a primary care physician's "typical day" in either. Of course, there is no such thing as a "typical" day. Each day is different. But the coordinating care and the administrative demands and the human drama have a common threat all primary care doctors are familiar with.

Medicine in the time of the EMR

btmaurer1@comcast.net (Brian T. Maurer) — Sat, 28 Nov 2009 22:12:00 -0500

The EMR, we are told, will help us cut healthcare costs. When medical records are converted into digital format, data will be instantaneously available to all providers caring for the patient. Clinicians will have carte blanche access to previous laboratory and radiological studies, thus insuring that such investigations are not performed repeatedly or needlessly. Data will be collated and scrutinized to insure that standards of care are met and that medical errors are eliminated. Electronic billing will become the norm. One day patients might even be able to schedule their own appointments online. Somehow all this will serve to lower costs and improve the efficiency and quality of healthcare delivery.

Perspectives on the Cancer Screening Debate

info@yjhm.org (George Trone) — Mon, 23 Nov 2009 11:10:00 -0500

By coincidence, last week two expert panels recommended reducing the frequency of certain cancer screenings. In the politically-charged atmosphere of the debate over reform of the American health care system, these announcements received a considerable amount of attention. The editors at YJHM would like to add our perspectives on the debate.

At the Women’s Cardiovascular Disease Symposium

James S. Wilk - JKandJWilk@aol.com — Wed, 18 Nov 2009 08:44:30 -0500

We've come to learn of women's hearts, the easiest of women's parts to comprehend.

Our Health Care System and a Faulty Power Grid

info@yjhm.org (George Trone) — Mon, 16 Nov 2009 11:13:00 -0500

In what amounts to a proposal for a public option, poet and longtime YJHM contributor Jeff McCallum uses the image of the power grid to ask some basic questions about what America, as a supposedly advanced industrial society, tolerates with the current health care system.

Illuminating Health Care for All

Jeff McCallum - jeff@marksman.net — Sun, 15 Nov 2009 03:48:49 -0500

My mother however, or someone you know, have seen or not seen on a street corner or exit ramp With or without the sign saying "Homeless, Feed me," Or, "Why Lie, I Need a Beer" Has no health care. They are off the grid so to speak.

To the Chewing of Your Gum

Ohad Oren - ohadoren@gmail.com — Sat, 14 Nov 2009 03:20:34 -0500

Bnai Brak is the Israeli city most heavily populated with Orthodox Jews. So abundant with black Kipa extremists the speed limit – practically speaking – is about 30 kilometers per hour. But, from a public health perspective, it should make you even more concerned. Russian roulette is an all-time most popular street game here in Bnai Brak.

The Case of a Refractory Recurrence: A Lawyer’s Tale of Helping Clients Navigate the Maze of Health Insurance Denials

Wendy Luftig - wendyluftig@hotmail.com — Fri, 13 Nov 2009 04:49:45 -0500

If the national discussion on health care reform this past summer accomplished anything at all, perhaps it was to unmask the degree to which our medical delivery system has become a vast and impersonal enterprise in which special interests—particularly insurance companies—vie to preserve their own hegemony, sometimes with scant regard for the patients who are the supposed beneficiaries of the system.

Spiritual Evolution: A Scientific Defense of Faith by George E. Vaillant

Howard Spiro - howard.spiro@yale.edu — Fri, 13 Nov 2009 14:56:58 -0500

In his new book Dr. George Vaillant maintains that evolution has made us spiritual creatures and that we humans are destined to become even more so. That "destined" with its scent of purpose suggests that his inspiration stems from his religious upbringing in the Episcopal Church. My statement brings explanation, not criticism of that transubstantiation, religious belief changed into Darwinism, the physician drawn to the high church of his youth. Age brings our horizon ever nearer.

By the Numbers

Brian T. Maurer - btmaurer1@comcast.net — Sat, 31 Oct 2009 09:59:40 -0400

Numbers are the words of mathematics; mathematics is the language of science; science forms the basis of modern medical practice. How could it be otherwise? Yet sometimes, like my wife with her blood pressure readings or my patients that take care to record every ounce of formula their infants ingest, we can get caught up in the numbers to the extent that they cloud our outlook of the larger picture. We count the trees, but miss the forest. We calculate the milligrams of medication, but fail to look at the patient.

Trusting Doctors by Jonathan Imber and Taming the Beloved Beast by Daniel Callahan

Howard Spiro - howard.spiro@yale.edu — Sat, 31 Oct 2009 09:51:27 -0400

Both these timely monographs from the Princeton University Press arrived about the same time. The first, Trusting Doctors, details how trust in physicians in America has so weakened since the 19th century. The second, Taming the Beloved Beast, summarizes the reasons for the cost-benefit analyses that Dan Callahan has long advocated, to right what he sees as the imbalance between the old and the young.

Pavor Nocturnus

Stephen Maurer - espiritunaranjo@yahoo.com — Thu, 29 Oct 2009 10:25:30 -0400

She smiled at you today. But you never risk showing interest. You're afraid of her aren't you. So you sleep alone, again, another night no moon or stars

Gaslighting

Stephen Maurer - espiritunaranjo@yahoo.com — Thu, 29 Oct 2009 10:24:45 -0400

I'm in an auditorium mesmerized by the zeal of fellow analysts, as a visiting professor uses Freud's axioms, subordinates the ego, constructs a superordinate self with the libido.

Medical School Nightmares

Jeffrey Calhoun - we.were.meant.to.live@gmail.com — Thu, 29 Oct 2009 10:02:04 -0400

Naked at a spelling bee, I stutter on hyperplasia. Smurfs dance the circumference of a bone metastases. A genetic counselor explains myelin degeneration.

Transplant

Jeffrey Calhoun - we.were.meant.to.live@gmail.com — Thu, 29 Oct 2009 10:00:41 -0400

Sometimes this city feels like it will never die. I sit in the shell of a tenement never finished. This is Hell's Kitchen and there are rats.

Monotony in Kansas Before the Tornado

Jeffrey Calhoun - we.were.meant.to.live@gmail.com — Thu, 29 Oct 2009 09:58:56 -0400

Inside, three men play cards like Vegas machines. Sister and I sit on the patio. Her skin pulled taut over her bones.

Homeostasis

Jeffrey Calhoun - we.were.meant.to.live@gmail.com — Thu, 29 Oct 2009 09:57:18 -0400

It all boils down to chemistry. Testosterone, your boyfriend's fist the shape of a boxing glove and your mouth full of vanilla ice cream. Your liver knows what to do with the sugar. The gauze knows how to sop the blood.

Induction

Jake Wolff - jake.wolff@gmail.com — Thu, 29 Oct 2009 09:51:49 -0400

You wake up—-you should not have woken up. The endotracheal tube is pressed to your tongue; in your memory the texture is ridged like the bark of a tulip tree, but that cannot be possible.

The Red Sea

Alexandra H. Godfrey - ax3316@wayne.edu — Thu, 29 Oct 2009 09:26:05 -0400

When I examined Karen, I was shocked by my findings. Criss crossing her body, I saw not only the new scars of her recent surgeries, but hundreds of old scars -- faint white lines revealing a lifetime of angst. Karen's life had been punctuated by with trauma. As I worked to rehabilitate her shattered body, she told me the story that lay beneath the scars.

Cholecystectomy

Stacy R. Nigliazzo - srnigliazzo@gmail.com — Tue, 20 Oct 2009 09:41:33 -0400

Black blood oozing, pink flesh torn away— I knew my place— a good three feet behind the scrub tech. Latex fingers interlaced, held away from my green gown as if in prayer. The surgeon's blade glinting— So, Stacy, you're a nursing student?

Spirit in the Sky

Tim Connelly - tconnely@earthlink.net — Tue, 20 Oct 2009 09:29:10 -0400

He has dreams. Dreams of recovery. He sits up in a cot at the medical center, every few minutes, his face wrinkles and he begins to cry.

Columbus Day Reflections: The World Is Not Flat

info@yjhm.org (George Trone) — Mon, 12 Oct 2009 09:08:00 -0400

For too many Americans, historical figures are seen as cartoons whose beliefs were shaped by superstition and ignorance. Perhaps it also plays into the myth of Columbus the hero to romanticize his voyage across the ocean. Perhaps it makes him into an even bigger hero for us to think that despite having the crazy idea that the world was flat and that he might fall off the cliff of the sea, he persevered and achieved remarkable things.

YJHM Reader Survey

George A. Trone - info@yjhm.org — Thu, 01 Oct 2009 08:30:27 -0400

YJHM editors are interested in learning more about using online publishing and networking tools. We invite you to take a brief survey to help us evaluate the prospects for creating online discussion groups and other interactive features. The survey has 10 questions, and it will take less than a minute to complete. Thank you for your time and interest. Link to Survey Link to Survey: http://www.surveymonkey.com/s.aspx?sm=jcBoBbXmvqI_2byXVoGbhblQ_3d_3d

Operating on My Daughter's Heart

Mark Saba - mark.saba@yale.edu — Thu, 01 Oct 2009 08:28:22 -0400

Everything was ready: the flesh rent, heart opened, one rheumatic valve ready to be excised. The surgeons had called and given their instruction: I must be the one.

Saint Blaise

Mark Saba - mark.saba@yale.edu — Thu, 01 Oct 2009 08:24:36 -0400

My son needs to pick a saint for Confirmation Day, one that sounds cool, that no one else has. I suggest Casimir. “No, he wore a hair shirt.” Frances of Assisi? “Everyone’s doing him.” Anthony? “Hmm.” Blaise? “What did he do?”

Physical Medicine: Arms and the Man

Brian T. Maurer - btmaurer1@comcast.net — Thu, 01 Oct 2009 08:10:42 -0400

The boy is a miniature version of his father, who stands 6 feet tall and weighs close to 300 pounds. I don't see his father all that often, but today he has come in with his son. Knowing Billie as I do, I imagine that his mother sent his father along for reinforcements. Like many kids, Billie doesn't like shots. Unlike most kids, Billie is capable of inflicting major bodily harm on an adult of slender build—in this case, his primary care provider.

Relaxing, Rejuvenating, and Rejoicing in Residency!

Ahmad Kaako and Mukta Panda - ahmadkaako@hotmail.com — Mon, 28 Sep 2009 09:16:29 -0400

I have been traveling this way every day for two years, but today I felt more alive to the natural wonder surrounding me. Did this have anything to do with the weekly “RRRR" ("relaxing, rejuvenating and rejoicing in residency") session we are lucky to have every Thursday afternoon in our residency program?

Chasing the Dragon

Jeff McCallum - jeff@marksman.net — Mon, 28 Sep 2009 08:56:02 -0400

Chinese? I ask, His father was and now he rides the dragon. Great wings and fire rise, take him far, so far he remembers what he never thought he knew, chasing dreams and dragon’s breath beyond the cords and corridors of self until the face or form of god is seen.

Blessing and Opportunity

Jeff McCallum - jeff@marksman.net — Mon, 28 Sep 2009 08:54:51 -0400

I have been fortunate, as so many of the dying say, To live. Not well, For I have issues of misunderstanding; Neglect to water such flowers as my garden grows, To grasp, harvest, split and taste; Savor the sweet papaya that ripens on the vine.

Response to attorney's response to my September 15 post: Lawyer mistaken about defensive medicine

evolpintesta@snet.net (Ed Volpintesta) — Sat, 26 Sep 2009 07:48:00 -0400

I appreciate Attorney Patrick J. Filan’s response and am happy that he found at least one point on which we could agree, namely, that it is difficult to estimate accurately the cost of defensive medicine.

Humanities, Empathy, and Medical Education

info@yjhm.org (George Trone) — Wed, 23 Sep 2009 10:57:00 -0400

In the March/April 2009 issue of Stanford Magazine, J. Martin Evans, the William R. Kenan Professor of English at Stanford, reflects on the value of the humanities for education and society in general. His remarks hold some clues for why the humanities are important for medicine.

Inviting in the Life World: Illness Narratives and Personal and Creative Writing in Medical Education

Jessica Singer Early and Meredith DeCosta - jessica.early@asu.edu — Mon, 21 Sep 2009 08:34:25 -0400

Over the last thirty years there has been a shift in medical education in countries around the world to include the voices of patients and doctors through the medical humanities and, more specifically, through literary studies and personal and creative writing.

Thomas Chatterton

Raymond Cavanaugh, Jr. - handofgatsby@yahoo.com — Sun, 20 Sep 2009 09:15:56 -0400

On August 24, 1770, seventeen-year-old poet Thomas Chatterton returned to his bereft Central London room, tore up his manuscripts, then swallowed arsenic, abandoning poetry and poverty forever.

Malpractice reform would lessen specialists' worries over proposal to "subsidize" primary care doctors' compensation

evolpintesta@snet.net (Ed Volpintesta) — Wed, 16 Sep 2009 17:56:00 -0400

If defensive medicine, that is, the unnecessary ordering of tests just to protect against frivolous malpractice suits were controlled, all physicians would be paying less for malpractice insurance. The only way to make this happen is to reform the malpractice laws. They are ineffective and slow in getting awards to patients. Too many innocent doctors get sued and about half of the money spend on a trial goes to attorneys’ fees and court costs.

Health care reform must address why defensive medicine exists

evolpintesta@snet.net (Ed Volpintesta) — Sat, 19 Sep 2009 09:18:00 -0400

Even if doctors have not done anything wrong, they can be hit with malpractice suits and be penalized emotionally and financially. To avoid these threats doctors often order tests that are not needed just to have a good defense in case a malpractice suit is filed. Not only does this raise the cost of heath care tremendously but it also subjects patients to risky procedures. Sometimes the tests that are ordered are inconclusive and lead to further testing. The results can be confusing and futile, making patients’ care not only expensive but also wasting their time as well as doctors’.

Criticism of Obama Neglects His Ability To Stand Up To Private Insurers

evolpintesta@snet.net (Ed Volpintesta) — Sat, 19 Sep 2009 11:32:00 -0400

Whether one agrees or disagrees with Mr. Krauthammer’s assertions that the President misleads and misdirects and is distant and imperial, one thing is certain. President Obama has done more to keep health care in the public arena than any other president or any one else for that matter. Let’s give credit where credit is due.

Lawyer mistaken about defensive medicine

evolpintesta@snet.net (Ed Volpintesta) — Tue, 15 Sep 2009 19:49:00 -0400

It is impossible to calculate accurately just how severe the cost of defensive medicine is because it varies from doctor to doctor and from state to state and does not lend itself reliably to statistical analysis. One thing however is certain. As long as doctors are forced to think of zebras when they hear hoof beats and not horses, the costs of health care will remain uncontrolled.

Remembrances of Internship Past

Robert S. Rosson - rerosson@comcast.net — Wed, 02 Sep 2009 11:15:16 -0400

As I read the recent obituary of Dr. A. Stone Freedberg (NY Times, 8/24/09), memories of my internship at Boston’s Beth Israel Hospital came flooding back. Dr. Freedberg, who died at the age of 101, had a long and distinguished career in cardiology at that institution. I recall herein some of my experiences of some 50 years ago.

In Retirement, Remain a "Person"

Vincent A. DeLuca, Jr. - vindel@pol.net — Sun, 30 Aug 2009 10:09:57 -0400

At this time in my life, I find myself reflecting on what influenced my retirement from a medical career of over 50 years, and why I changed to forestry. How did the way I lived influence the way I now live in my retirement? Was it difficult for me to give up a profession which I cherished? I will tell why I decided not to pursue part time medicine, which might have eased the change.

One Man's Meat

Brian T. Maurer - btmaurer1@comcast.net — Sun, 30 Aug 2009 09:51:10 -0400

Sometimes attempting to educate a patient turns out to be an education in itself.

The triumph of language over truth

evolpintesta@snet.net (Ed Volpintesta) — Tue, 25 Aug 2009 19:27:00 -0400

I suspect that when those opposed to health reform got wind of doctors being paid for “advance directives”, they manipulated the language to their advantage. By calling advance directives “death panels” they flipped president Obama’s “public option” on its back like a helpless turtle.

This might have been prevented if physicians were given a larger role in the health care debate. So far, the democratic process has circumvented them. They must be more visible and more vocal. Their input is vital and yet they are invisible. Perhaps that, more than anything else is the hallmark of the discussions so far.

Malpractice reform ignores what bothers doctors most

evolpintesta@snet.net (Ed Volpintesta) — Mon, 24 Aug 2009 17:44:00 -0400

More than the increasing costs of malpractice insurance, physicians constantly worry about the effects that even one frivolous malpractice suit can have on their reputations, their careers, and their livelihoods. Even though most of the malpractice suits that end up in court are decided in favor of the doctor, they wait on tenterhooks for four or more years before the case is settled. The stress involved can be overwhelming.

How Credible is the Institute of Medicine's Report on medical errors published in 2000?

evolpintesta@snet.net (Ed Volpintesta) — Sat, 22 Aug 2009 11:43:00 -0400

The Institute of Medicine (IOM) has produced some reports of some value including the often quoted “To Err is Human: building a safer health care system”. Most of what the IOM reports is already known. But published under the aegis of the IOM, its reports take on a sovereign aspect that can have unintended effects of questionable value.

Physicians not included in health debate

evolpintesta@snet.net (Ed Volpintesta) — Fri, 21 Aug 2009 14:05:00 -0400

How can a journalist or a politician who has never had to take care of a patient with a ruptured appendix or a patient with life-threatening injuries suffered in a high-speed automobile accident even come close to knowing what is right or wrong with the health care system? Or never having had to fight with an insurer over the need for a CAT scan or having been faced with an unwarranted malpractice suit?

Preexisting Conditions

Jeff McCallum - jeff@marksman.net — Wed, 19 Aug 2009 10:39:01 -0400

Cultures where the aged and dying, The toothless and slow wander off, Trek as purposefully as their unstable gait allows Toward the wilderness, the elephant burial ground To leave us unburdened Are dead, aren’t they? Except for America.

Was a Doctor

Frederic Platt - plattf@hotmail.com — Wed, 19 Aug 2009 10:23:08 -0400

I was a doctor, I say, all that is left are the memories and the stories and the fading ring upon the water.

Nobody Dies on My Shift

Frederic Platt - plattf@hotmail.com — Wed, 19 Aug 2009 10:21:37 -0400

Nobody dies on my shift today, not tomorrow or the day after. It used to be a burden and towards the end I couldn’t stand it any more. Please, I’d hope, wait a while.

More than money is needed to restore prestige to primary care

evolpintesta@snet.net (Ed Volpintesta) — Wed, 19 Aug 2009 16:41:00 -0400

For their new roles, a “hybrid” primary care doctor is needed. This means shortening their training period by two to three years so that it reflects what they actually do in the real world and not what medical educators think they should be doing. Clearly medical schools have been out of touch with what primary care doctors do.

Your Online Ethics Quiz

Robert S. Rosson - rerosson@comcast.net — Tue, 18 Aug 2009 12:06:03 -0400

Welcome to Your Online Ethics Quiz (with questions on Rick Pitino, Sheryl Weinstein, Michael Vick, Sarah Palin, and Mark Sanford). Submit your answers to The Institute for Ethics Research. Be sure to go online next week when our quiz topic will be: “Are there any ethical challenges on Wall Street?”

To Know

Jeffrey Allen Cohen - jeffrey.a.cohen@dartmouth.edu — Thu, 13 Aug 2009 10:36:34 -0400

So I see a woman feeding the squirrels And I stare into the face hoping to know But I am not sure that time, reading, or experiences Have made me any more capable to really know

On Living with Parkinson's

Gus Achey - gachey@msec.org — Sun, 09 Aug 2009 07:33:55 -0400

Parkinson’s is a disease that is gradually progressive As time passes the tremors and loss of balance become excessive Some victims of this insidious disease eventually must use wheelchairs Their balance is gone and tremors become so severe they can’t use stairs But I am convinced that this outcome is not inevitable Through exercise, diet and attitude I will remain able To continue to do physical things that I like I will even be able to continue to ride my bike

Life Can Be Very Cruel, But Hey

Jeffrey Ahmed - jeffrey.ahmed03@imperial.ac.uk — Sun, 09 Aug 2009 07:24:16 -0400

We have a lot to learn from our patients. They may sometimes tire us, irritate us, humour us or upset us. But above all they nourish our lives in a profound way. When we let down the barriers, allow them into our lives just a little, we allow them the opportunity – in ways often unexpected and surprising – to help us as we help them. In this way, our patients are often able to heal us.

The Downside of Electronic Medical Records

Elliot M. Livstone - ElGutDoc@aol.com — Sun, 09 Aug 2009 07:07:35 -0400

Politicians on both sides of the aisle have accepted the unproven notion that the electronic health record is going to solve the financial problems of a reformed universal health care system; they accept this idea as a matter of faith with little evidence that electronic records will add more than they take away from the personalized health care Americans expect. In fact, almost every function that health care ideologues give as a reason for doctors and hospitals to utilize electronic records can be duplicated at the present time by a lower cost and lower tech solution.

Advising patients not to have tests can be a source of malpractice suits

evolpintesta@snet.net (Ed Volpintesta) — Fri, 07 Aug 2009 17:59:00 -0400

Until the malpractice laws are changed so that doctors are not penalized for using their judgment, most doctors will be very tentative about talking patients out of tests. This is the modus operandi that prevails.

Health reform without tort reform is incomplete.

What's missing in the health care debate?

evolpintesta@snet.net (Ed Volpintesta) — Fri, 07 Aug 2009 17:52:00 -0400

After a lawsuit, a physician cannot help practicing defensively. Nor can he help viewing patients as potential law suits. This unhealthy state of affairs has been going on for at least thirty years. It’s time that our lawmakers muster the courage and faced this problem head-on.

Earmarked Evidence

Brian T. Maurer - btmaurer1@comcast.net — Sun, 02 Aug 2009 09:19:07 -0400

Three decades of practice have taught me to always listen to the mother of a pediatric patient; she’s usually right in her initial assessment.

Doctors too isolated to organize

evolpintesta@snet.net (Ed Volpintesta) — Fri, 31 Jul 2009 13:41:00 -0400

With twenty-four different medical specialty boards, each of which protects the “turf boundaries” of its members, physicians are destined from the time they finish their residencies to isolate themselves from seeing the big picture. This fragmentation of health care by specialization, for all the good it has done to advance medical science, has at the same time neglected primary care, which like a dilapidated house, is shunned by medical students. This is one reason why so many people cannot find a primary care doctor. Fewer are being trained and many of those in practice are overworked and are not taking on new patients.

Defensive medicine must be put on health care agenda

evolpintesta@snet.net (Ed Volpintesta) — Wed, 29 Jul 2009 19:44:00 -0400

Some people confuse defensive medicine with thoroughness and competence, thinking that the more tests the better. But, defensive medicine actually complicates their care and can expose them to risky procedures and treatments.

Lawmakers must address tort reform

evolpintesta@snet.net (Ed Volpintesta) — Wed, 29 Jul 2009 19:46:00 -0400

Clearly, the fear of malpractice suits is one of the factors that contribute to the high cost of care everywhere in this country. 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.

Alpha and Omega of Medicine

evolpintesta@snet.net (Ed Volpintesta) — Tue, 28 Jul 2009 20:58:00 -0400

Quality of care is a vague term when applied to the health system and offers little to defining its problems. Robert Pirsig in his book Zen and the Art of Motorcycle Maintenance: An Inquiry into Values devoted a large portion of his book to searching for a meaning. He said it is hard to define quality but everyone recognizes it when they see it. He never arrived at a clear definition but he did mention that the Greek word arête which means wholeness or oneness of life came close.

Rivalry and Mistrust Among Physicians

evolpintesta@snet.net (Ed Volpintesta) — Tue, 28 Jul 2009 20:43:00 -0400

Rivalry and mistrust has steadily worsened since Sir William Osler first reflected on them in 1875. They not only undermine solidarity among doctors but have also limited their abilities to provide a physician workforce in touch with the needs of society. This is most apparent in the area of primary care.

Allowing itself to become infatuated with specialism, the profession has failed to nurture general practice. Overshadowed and pushed aside by specialty medicine for decades, primary care is almost at the tipping point of no return.

Health reform incomplete without addressing reform of malpractice system

evolpintesta@snet.net (Ed Volpintesta) — Sun, 26 Jul 2009 11:59:00 -0400

The need for reforming the malpractice system so that doctors are not forced to practice defensive medicine was not mentioned. Yet, defensive medicine is responsible for wasting immeasurable amounts of money, medical resources, and doctors’ time. Not to mention, exposing patients to unneeded medical procedures, biopsies, and medications.

Defensive Medicine: Medical Reform's Achilles' Heel

evolpintesta@snet.net (Ed Volpintesta) — Sun, 26 Jul 2009 12:25:00 -0400

Clearly, a more balanced method of handling malpractice cases is needed: one that treats patients fairly and does not destroy doctors' careers or reputations. Without significant reforms in the rules for malpractice suits and awards, doctors will continue to practice defensively. And defensive medicine will remain the wild card that drives the cost of health care higher every year.

Beyond Trauma: The Aging Experience of Holocaust Survivors

Laura E. Finkelstein and Becca R. Levy - becca.levy@yale.edu — Fri, 24 Jul 2009 09:50:51 -0400

Aging can bring Holocaust experiences to the forefront, even for those who have not necessarily experienced any posttraumatic symptoms in the previous decades. Survivors who were previously busy adjusting to life in a new country, raising families, and maintaining careers may only begin to actively encounter their Holocaust memories several decades after the war as retirement can bring more time to think about the past.

Smoke Screen

Wendy Luftig - wendyluftig@hotmail.com — Thu, 23 Jul 2009 09:20:34 -0400

Those who are addicted to the joys of nicotine Who revel in the clouds of smoke that linger and careen, Lips pursed in expectation for those soothing little tokes Are captive to the high romance a burning stick evokes.

Karl: Down Seemingly Endless Hallways (excerpts)

Ron Goble and Linda Kittell - rongoble@tsd.net — Thu, 23 Jul 2009 09:00:04 -0400

I ask Karl to tell the stories that I've heard too many times, especially in the last four years, the stories that I once feared would be repeated in loops so tight that they would strangle, the loops that tied into themselves—subject, verb, and direct object/subject. Sometimes they wove Borgesian loops that brought one back around with surprise, but were littered with lost details. I ask my father to tell me the stories, but now he says he can't remember. How about I start?

A Treasured Empathetic Experience and a Rare Hepatic Hemangiopericytoma

Joseph T. Mingoia - mingoia@musc.edu — Sun, 19 Jul 2009 09:15:14 -0400

Early in medical school empathy is explained to us and then it shall remain for the rest of our professional lives to develop and to exercise the hidden mysteries of this art. Its place and importance amongst the hustle-bustle of our daily clinical work can be overlooked as we are attempting to hone in on our new skills and as our developing responsibilities arise. What I wondered as we began our clinical years in medical school was this: if we are not able to provide our patients with prescriptions, diagnostic expertise and certainty, what would happen if instead we simply provide each one of them with more of us during our time?

Vioxx and the Fragile Transparency

Ohad Oren - ohadoren@gmail.com — Sun, 19 Jul 2009 08:28:36 -0400

When faced with genuine consumer safety concerns, drug companies should be innately committed to complete long-term safety trials during all four phases of drug application process. If not compelled to perform a bona fide investigation to revalidate their submitted results, manufacturers might be deterred by a financial force that would regulate unmet research requirements.

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.