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Doctor's voice: A failing report card for women’s health
January 7th, 2011
01:52 PM ET

Doctor's voice: A failing report card for women’s health

As report cards go, this one was pretty depressing. The Women’s Health Care Report Card for 2010 from the National Women's Law Center showed a nation failing the majority of its population. Not a single state in our fine union received a “Satisfactory” grade. Not one!

On just about every count, women’s health is doing worse—from access to care to preventive tests, to measures of disease.

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November 17th, 2010
12:08 PM ET

Doctor's voice: The engine of cancer screening rolls on

Recently, I heard the expression “cancer screening engine.”  It was used in the context of cancer screening being very powerfully focused, with a momentum that—for better or for worse—is hard to alter. The public fracas over the U.S. Preventive Service Task Force's guidelines for mammograms a year ago this month is an example of the depth of resistance.

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A prescription for writing in medicine
October 29th, 2010
06:21 PM ET

A prescription for writing in medicine

Writing has always been a prominent part of medicine. Doctors write “histories” of their patients all the time—brief for ordinary office visits, extensive for admissions to the hospital. Some medical schools use creative writing to help students gain empathy and insight.

There are doctors who write more publicly—from Anton Chekhov and William Carlos Willams to Oliver Sacks and Jerome Groopman—bringing medicine beyond the clinic walls.

Patients, too, have been writers. William Styron’s "Darkness Visible" could be seen as one of the most important “textbooks” on depression that exists.

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October 8th, 2010
12:17 PM ET

Mammograms: One doctor, her patients, herself

Monday:  Our journal club at the hospital reviewed the recent Norwegian trial showing limited benefits of mammograms.

Tuesday: I had my appointment for my own mammogram.

Wednesday: Veneta Masson’s article titled “Why I Don’t Get Mammograms” appeared in Health Affairs magazine.

There’s been a lot to think about in the realm of mammograms lately. As a primary care internist, I have to counsel patients on a daily basis about this screening test. As a faculty member of a medical school, I have to analyze the scientific data with my students. As a patient, I have to decide about my own medical care.

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September 24th, 2010
11:39 AM ET

Opinion: Emergency care as the new primary care

George Bush once famously (or infamously) commented that health care is indeed available for all:  You just go to the emergency room.

Unfortunately, this is a reality for a significant swath of the American people, and the problem continues to worsen.  A report in the September issue of Health Affairs points out that less than half of the 345 million annual visits for acute-care problems take place with a patient’s personal physician.

Nearly a third of these visits takes place in the emergency room.  The ER is of course the right place for bleeding wounds, crushing chest pain, and motor-vehicle accidents, but an enormous chunk of these visits are not actually emergencies. FULL POST


September 16th, 2010
09:34 AM ET

What makes a good doctor? Can we measure it?

Everybody wants quality health care. Who can argue with that? But it’s not so easy to measure “quality’ in medicine in an accurate and meaningful way.

Physician report cards are a big part of the quality movement, and they have generated a lot of controversy. As a primary care doctor, I receive a regular report card on my patients with diabetes. The problem is, these reports usually measure only what is easy to measure—small details taken in isolation that don’t capture the totality of complex medical care. Yet this is what we are graded on.

When I wrote a recent essay in the New England Journal of Medicine about how dispiriting these report cards are, I was besieged with negative blogosphere commentary about how doctors are afraid to be rated like everyone else. Many of these commentators, interestingly, were doctors who were not practicing clinicians. FULL POST


What is the social mission for medical schools?
September 15th, 2010
10:43 AM ET

What is the social mission for medical schools?

What exactly is the mission of a medical school? Is it to train the best and smartest doctors? Is to tend to our nation’s health? Is it to further medical knowledge?

Go to the website of just about any medical school and you will see roughly the same “three-pillars” message from the dean, or the chairman, or the residency program director. Every medical school stresses their commitment to the triumvirate of education, research, and patient-care.

An interesting analysis of the “social mission” of medical schools comes in the Annals of Internal Medicine. The researchers created their own three-pronged metric that measures three areas that are currently lagging in medicine: physicians working in primary care, physicians working in medically underserved regions, and physicians from minority groups. FULL POST

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Filed under: Cancer

September 6th, 2010
10:49 AM ET

Could 'runner's high' chemical help curb overeating?

As a primary care internist, my practice spans the common adult ailments—diabetes, hypertension, high cholesterol, coronary artery disease, arthritis. It is hard not to avoid the difficult truth that obesity, while perhaps not causing all of these illness, certainly exacerbates them greatly.

With my patients, I stay away from issues of blame—it’s a pointless endeavor and causes unwarranted guilt and shame—but obesity is a critical medical issue that cannot be ignored just because it is difficult to treat.

I've always been a bit leery of medications and surgery to “treat” obesity, partly because of their limited efficacy but also because rethinking the way we eat—in the long term—is a cornerstone of good health.

Nevertheless, despite my ongoing discussions about five servings of fruits and vegetables, avoiding soda and fast food, etc, I’ve come to accept that other “treatments” have a role in treatment for at least some patients.

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August 23rd, 2010
12:43 PM ET

What does your doctor hear when you talk?

Whenever a patient asks me about the side effects of a particular medication, I point to the very long roster of symptoms listed for the drug. “It’s anything any patient has ever experienced,” I say, then try to help prioritize the symptoms into the more common ones versus the rarer ones.

This list has always represented for me the presence of the patient’s voice in medicine. It turns out, though, that this is not the case. Not long ago I was reading article in the New England Journal of Medicine, and I learned that these side effects listed on the package insert are not the ones the patient actually complains of. No, they are the symptoms the patients’ doctors choose to report, the doctors’ impressions of what the patients are describing.

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Get a behind-the-scenes look at the latest stories from CNN Chief Medical Correspondent, Dr. Sanjay Gupta, Senior Medical Correspondent Elizabeth Cohen and the CNN Medical Unit producers. They'll share news and views on health and medical trends - info that will help you take better care of yourself and the people you love.

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