I read with interest my fellow Brain Blogger’s article on pharmacists and their essential value to the medical team. While pharmacists do not have prescribing power and often get a bad rap as being “pill counters,” it is clear to me that their position in the medical team food chain is equivalent to having prescribing power.

At the very least, a good medical team or ICU team will have a pharmacist as part of the team to help with medications. This includes making sure the patient has no allergies, that there is no resistance or cross reactivity between medications, and checking to make sure the prescribed medication is clinically indicated. In this situation the pharmacist is sort of like the medical case manager. He or she “owns” the prescriptions of that team. Read more →

I frequently find myself having to explain the field of physical medicine and rehabilitation (PM&R) to the public, and sadly to a lot of healthcare professionals as well. If a cardiologist is a “heart doctor,” a pulmonologist is a “lung doctor,” and an orthopedic surgeon is a “bone doctor,” then what do you call a physiatrist? I would call us “function doctors.” While that title is not as flashy as the other ones, it is equally important. The old adage is that nobody knows what a physiatrist does until they need one. Read more →

In medicine a lot of physicians categorize their patients as “good” patients or “bad” patients. Good patients are patients whose care is relatively easy for the physician to handle. The patient is compliant with recommendations, is motivated to get better, and is thankful for the doctor’s care. Bad patients are generally those patients who do not follow physician recommendations, who behave in a way detrimental to their own health, who are extremely high demand, and who threaten litigation. Good patients are more likely to do better with treatment. Bad patients are very likely to have a complication. Read more →

A physician frequently gets stopped in the hall of the hospital or gets paged by another doctor for an unofficial consult. In medicine, this is called a “curbside consult.” Essentially, one physician would like some input on a case without getting the consulting physician officially involved in the patient’s care. Typically, this is done because the primary physician either knows the answer already but wants to run it by someone else. Or because he thinks the problem is not major enough to warrant an official consult. If an official consult is requested it will require the consulting physician to see the patient, write a consultation note, as well as dictate a consultation note. Read more →

In response to my last post about informed consent in my Medicine and Law series, several commenters made the point that informed consent is more than just getting a form signed. That ideally it should involve a dialogue between patient and doctor. That the burden of trust is on the doctor to inform the patient so that the patient actually understands what the risks and benefits are. That the doctor should empower the patient to make the choice. Read more →

As research has moved away from the realm of universities and into the private sector, more physicians are being paid by drug companies to enroll and monitor patients during clinical trials. Private corporations have been the largest sponsors of pharmaceutical research in both Canada and the United Sates in the last twenty years.

Research Ethics Boards (REB’s) exist to protect the safety of research subjects. However, they provide guidelines only, and often guidelines are ambiguous. REB’s may be private entities, and thus may be vulnerable to pressure. Read more →