NEJM

License to Serve -- U.S. Trainees and the Ebola Epidemic

At multiple U.S. academic medical centers (AMCs), well-qualified trainees and sometimes faculty members are facing obstacles to deployment overseas in ebola areas. Given that this is the largest public health crisis many of us will ever see and that the professed mission of AMCs is to advance the health of the population, what drives the apparent resistance?

NEJM

Fear, Trust, and the Tragic Death of Surgeon Michael Davidson

When a patient's irate son shot surgeon Michael Davidson to death for a perceived involvement in his mother's death, many in the professional community at Boston's Brigham and Women's Hospital spoke of their fear of potentially violent patients. But Lisa Rosenbaum looks more closely at the random, unreasoned nature of the event and what it really means to clinicians in all health systems.

NEJM

Communicating Uncertainty -- Ebola, Public Health, and the Scientific Process

Telling parallel stories of weather forecasters and public health officials dealing with potentially panic-producing subjects like apocalyptic snow storns or ebola, MD Lisa Rosenbaum explores the more effective strategies for communicating uncertainty in a way that lessens irrational fears or panic. My instinct is to tell people who fear Ebola how much more likely they are to be sickened by influenza or heart disease. If fears were guided by facts, such comparisons might help.

NEJM

Beyond Belief -- How People Feel about Taking Medications for Heart Disease

When I began studying medication nonadherence among patients who'd had a myocardial infarction, I aimed not to change minds but to understand. How patients feel about taking medications for heart disease. Are there emotional barriers? Where do they come from? Can we find better ways of increasing adherence if we understand them?

The New Yorker

What Big Data Can't Tell Us About Health Care

The calls for price transparency, as a means of bringing down health-care costs, have certainly gained momentum in the past year. In this latest chapter, the hope is that members of the public will be empowered by their access to payments data, and will use this information to identify doctors who are behaving badly, helping to end fraud and profit-driven overuse.

New England Journal of Medicine

Invisible Risks, Emotional Choices -- Mammography and Medical Decision Making

The tangled nature of emotions and values is particularly relevant to mammography screening, as evidenced in qualitative research done since the 2009 guidelines were released. One study explored the beliefs and attitudes of an ethnically diverse sample of women in their 40s. Though many were unaware of the guidelines, the researchers found that educating them about the new recommendations strengthened rather than diminished their commitment to screening. Women also expressed fears that the guidelines were an attempt by insurers to save money and keep them from getting the care they needed.

The New Yorker

Extreme Exercise and the Heart

All runners have heard about the unexpected deaths of runners in top shape. These deaths are all the more shocking because the peak physical condition of the deceased would seem to protect them from heart disease. Hundreds of studies, as well as our own intuition, associate exercise with cardiac health. But, in recent years, a small group of cardiologists have advanced a hypothesis that suggests these tragedies may not be so shocking, after all: they believe that an excess of exercise actually damages the heart.

The New England Journal Of Medicine

Communicating Uncertainty -- Ebola, Public Health, and the Scientific Process

The challenge, when officials facing uncertainty seek to prevent panic, is that the perception of inadequate understanding by experts is one of several factors known to heighten fear. Ebola's characteristics encompass essentially all such factors and because we can't change these fear factors, the one factor seemingly within our control, projecting understanding of the disease, feels imperative.

LDI Health Economist Magazine

'A Measure of Measurement Discontent: One Clinician's Journey Through a New World of Unintended Consequences

In a dispatch from the AcademyHealth 2014 National Health Policy Conference, Lisa Rosenbaum discusses the real-world implications of the unintended consequences of new quality measurement systems on physicians' daily decisions and activities.

The New England Journal of Medicine

'Misfearing' - Culture, Identity, and Our Perceptions of Health Risks

In a NEJM article, Lisa Rosembaum writes that "our efforts to provide women with the facts about heart disease are missing something critical. If the next frontier in preventing cardiovascular disease among women is less about disseminating evidence than about understanding why the evidence may be hitting a wall, the critical question is why women might feel more fearful of other diseases, particularly breast cancer, despite ample evidence suggesting that heart disease poses a far greater threat."

The New Yorker

The Problem With Knowing How Much Your Health Care Costs

After a fall that broke her clavicle, cardiologist Lisa Rosenbaum enters the New York health care delivery system from the other side of the desk -- as a patient. In her latest New Yorker piece chronicling the event, she writes that "after leaving the emergency room I was frantically trying to understand my high-deductible health-savings-account insurance plan, unwilling to commit to further care until I knew how much I would pay.

The New Yorker

When is a Medical Treatment Like Stent Placement Unnecessary?

In her latest article in The New Yorker, cardiologist Lisa Rosenbaum wades into the confusing debate over how effective stents are for chronic heart disease patients. She notes that a common populist myth given legs by celebrities like TV's Dr. Oz suggests that 50% of all stent procedures are inappropriate and unnecessary. But drilling down into the latest study of more than half a million stent placements she finds that "overall, only 3.5% of the half a million stents placed in the United States during the period studied were found to be inappropriate."

NEJM

Taking Our Medicine - Improving Adherence in the Accountability Era

In a multimedia New England Journal of Medicine report addressing the issue of medication adherence, Lisa Rosenbaum, MD, is both author of an article and subject of an accompanying 18-minute audio podcast interview with Stephen Morrissey, NEJM Managing Editor. She predicts that the ACA "will pressure physicians to help patients to adhere to chronic-disease treatments [and] be more motivated to educate patients about medication therapy and to address barriers to its use."

The New Yorker

Why Doesn't Medical Care Get Better When Doctors Rest More?

In her latest article in The New Yorker, Lisa Rosenbaum, MD, asks why medical care doesn't get better when medical residents adhere to the rules that strictly limit their work hours. She writes that five years after the controversial rules were implemented, they have "failed to make our nation's teaching hospitals any safer."

The New Yorker

When Doctors Tell Patients What They Don't Want to Hear

The elevation of obesity to official "disease" status along with the growing connections between patient satisfaction scores and hospital reimbursements could herald a bad era for American medicine. The challenge of communicating unpleasant, possibly profoundly upsetting information to patients is timeless. What has changed, however, is that physicians are now being judged, and compensated, based upon their ability to do it. And that adds up to an awful lot of future awkward moments in the doctor-patient relationship.

The New Yorker

How Should Doctors Share Impossible Decisions With Their Patients?

In her first article in The New Yorker, LDI Senior Fellow and Robert Wood Johnson Clinical Scholar Lisa Rosenbaum, MD, writes about quandaries on both sides of the physician/patient divide when it comes to "shared decision making" -- particularly in the case of ailments and injuries of serious consequence. The piece begins as the author confronts the situation of her own mother, also a physician, who has broken her arm in four places and may need surgery that carries a 20 to 50% risk of avascular necrosis.

LDI Health Economist

Digitizing the Doctor-Patient Relationship

Our computer systems increasingly demand more attention than our patients and this has left me skeptical of the promises of the EHR. Decreased waste. Cost savings. Better patient safety. These potential benefits seem feasible in an abstract theoretical universe, where our policy discourse tends to occur. But we should worry that this intense focus on digitization threatens something fundamental to the practice of medicine.

Huffington Post

Treating Patients With Antibiotics When They Don't Need Them

Upper respiratory infections, otherwise known as the common cold, are caused by viruses for which we have no proven treatment. Currently, we are left with the tincture of time and a $2 billion dollar per year over-the-counter cold remedy industry. Yet when patients see a doctor for a lingering cold, many do not appreciate being told that they simply need to wait. How do we reconcile the desire to satisfy our patients with the imperative to provide necessary and effective care?