Physicians Perspective

Dr. Gambert is Chairman, Department of Medicine, and Physician-in-Chief, Sinai Hospital of Baltimore, and Professor of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
Although there are currently between 46 and 48 million persons in the United States without health insurance, and there is talk among the Presidential hopefuls of finding some solution to this growing crisis, an equally important crisis is the growing number of “uninsurable” Americans—even if one is willing to fund his/her own health insurance policy. The reality is that individuals w...

I have written previously about National Patient Safety initiatives and the need to ensure that all physicians do whatever possible to reduce medication errors. Whether it is writing more clearly, using only “approved” abbreviations, monitoring side effects, or other techniques, morbidity and mortality from medication use can be reduced. A couple of months ago, I watched on national television as a celebrity couple discussed a medication error that occurred when their twins were born. Apparently, the babies were given one form of heparin that contained 10,000 u

We hear a lot about the need to provide “full disclosure” to our patients—and rightfully so—but what exactly is appropriate? Just listen to the ads on television for various medications; one is struck by the litany of possible side effects that would make anyone fear taking the medication if they gave it any thought. Is this the right forum in the first place to let the public know about a medication for a specific problem? Some would argue that it is not. 
What exactly is full disclosure, and when is it okay to hold back

"Healthy aging,” “life extension,” “successful aging.” These phrases are frequently used to promote a special lifestyle, diet, medication regimen, or treatment. While the eternal search for the Fountain of Youth remains elusive, it is easy to see how normal aging and age-associated illness can bring thoughts of vulnerability and the need to do something “different.” While some are searching for a prolongation of the lifespan itself, others are merely trying to live healthier and more productive lives for as long as possible.

Ms. J is a 62-year-old woman with a long and difficult medical history. Suffering from diabetes mellitus for most of her life, she underwent renal transplantation 16 years ago, at the same time she had a pancreatic transplant. She took insulin daily as well as a number of immunomodifying medications, including steroids. In the past few years, she was diagnosed with congestive heart failure (CHF) for which she also took a myriad of medications, including an anticoagulant. One night, Ms. J awoke complaining of

In preparing for the annual rite of teaching clinical skills to medical students, I was once again reminded of the importance of obtaining an “accurate history,” performing a proper and thorough physical examination, and obtaining necessary and pertinent laboratory testing. How easy it is to go down the wrong diagnostic path if one has erroneous information and makes the wrong assumptions. One excellent example is the frequent complaint of “weakness” when in fact the person is really complaining of feeling “fatigued.” There are over 10 million visits pe...

I have found myself appreciating The Joint Commission’s National Patient Safety Goals more than ever, despite my original impression that these stated what all good doctors should already know and be following in their daily professional lives. Time and again through my frequent rounds I find patients in the hospital being discharged on the wrong medication or dosage being prescribed. Patients are not always prescribed an essential medication that they have been previously taking for a problem other than the one necessitating the hospital admission. Unnecessary urinary catheters continue ...

We received a letter from Ms. C, who describes herself as a relatively healthy 77-year-old woman. At her recent checkup, her physician recommended she have a screening colonoscopy. After expressing her “less than enthusiastic feeling toward the upcoming experience,” she was told by the physician that she should cheer up because a colonoscopy is recommended only every 10 years, and at her age, she shouldn’t have to undergo it ever again. Regarding being told so bluntly of her finite expected lifespan, Ms. C comments, “I am not exactly ready to leave in 10 years. In fact, I am descend...

It has been almost 25 years since I and a number of my colleagues published an article entitled “Role of the Physician Extender in the Long-Term Care Setting.”1 This article was based on positive experiences that we had using both physician assistants and nurse practitioners, despite their previously limited role in any aspect of geriatric care. Both of these fields were in their formative years at that time and were still trying to become a part of mainstream medical care. Geriatric medicine was just another playing field and place to establish a presence. It has been interesti

Mnemonics are frequently used to help physicians remember key facts about clinical problems or illnesses. I have never found these particularly useful, as I for one find it just as easy to remember the facts themselves as trying to figure out what each letter in the mnemonic stands for, and which mnemonic goes with what I am trying to remember. One mnemonic that I have found useful when teaching students and residents, however, relates to treatable/preventable forms of dementia, a cause of approximately 25% of cases. I find this easy to remember primarily because it does not require muc