MedWorm: Family Physicians

Are new technologies really the reason for rising health costs?

Kevin, M.D. - Medical Weblog — Tue, 07 Feb 2012 16:00:17 +0100

Over the last four weeks I have written about new technologies and their coming impact on medical care. We generally think of new technologies (and new, branded drugs) as pushing up the cost of healthcare. There is truth to this contention, of course, but often the real problem from a cost perspective is inappropriate use. And this happens all to often in medical practice today because the physician does not have (or perceives he or she does not have ) the required time for a more complete history and some thought time to figure out a patient’s problem.Read the rest of Are new technologies really the reason for rising health costs? on KevinMD.com.Category: Physician | Tags: Health reform | No comment (Source: Kevin, M.D. - Medical Weblog)

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The Dark Side Of Love

In My Humble Opinion — Tue, 07 Feb 2012 15:56:00 +0100

It was an innocent question. I was running through the social history when the young woman sitting in front of me started to cry. I asked about her husband not knowing that he had died a few months earlier.They were bitter tears. She smiled awkwardly though the tissue as she apologized. She never expected to find herself a single mother at such a young age. I paused and allowed my patient time to collect herself.As we sat in silence, I searched for solace. How many times had I comforted mourning spouses? Days, months, years after their partner died, the sadness remained. I would like to assure her that it would get better, but in some ways it wont. The wound will not heal. It changes, scars, and is often momentarily forgotten. But it never goes away.*Where is Harry? Did he wander off? I lo...

How I approach ovarian cancer screening with patients

Kevin, M.D. - Medical Weblog — Tue, 07 Feb 2012 13:31:13 +0100

Ovarian cancer screening clearly touches a nerve.No one doubts that ovarian cancer is a devastating diagnosis, often found when the disease is at an advanced stage. Tests to look for the disease, such as the transvaginal ultrasound or the CA-125 blood test, are not specific enough. That leads to false positive tests that necessitate more studies that may not be beneficial to patients.A recent anecdote on this blog talked about how the CA-125 blood test turned into a $50,000 ordeal.Read the rest of How I approach ovarian cancer screening with patients on KevinMD.com.Category: Pho | Tags: Cancer, OB/GYN, Primary care | 3 comments (Source: Kevin, M.D. - Medical Weblog)

Treating heart failure on a budget

Kevin, M.D. - Medical Weblog — Tue, 07 Feb 2012 12:00:10 +0100

As a third year medical student, I spent one afternoon each week at a health clinic at a community hospital affiliated with my medical school. This health clinic was focused on primary care for patients with HIV, and many of our patients were poor, homeless, immigrants, or uninsured. Many were also living with their diagnosis in secrecy and had to hide their medications and medical bills from family members.Read the rest of Treating heart failure on a budget on KevinMD.com.Category: Conditions | Tags: Heart, Medical school | No comment (Source: Kevin, M.D. - Medical Weblog)

House — Episode 11 (Season 8): “Nobody’s Fault”

Polite Dissent — Tue, 07 Feb 2012 05:00:00 +0100

An interesting set-up on this week’s episode of House, but, alas, it led to a poorly execute denouement. And the medicine could have been better, too. The episode begins with House and his team being questioned individually by Dr. Cofield, a doctor from another hospital, as part of a disciplinary hearing. It all started with a patient named Bill, who is a thirty-two year-old high school chemistry professor who collapsed while jogging and is now in a coma and “paralyzed in all four extremities.” There was no history of trauma, and CT scans of the brain show no evidence of stroke or structural lesions. Reviewing the case, House initially suggests transverse myelitis, but admits it doesn’t really fit the situation. He then presents the patient to his team, who suggest the diagnos...

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The pitfalls of email communication with patients

Kevin, M.D. - Medical Weblog — Tue, 07 Feb 2012 00:00:22 +0100

A recent article in the Wall Street Journal reviewed the emerging role of email in healthcare, arguing that doctors should more aggressively offer their patients the option to communicate with each other through email. Unlike other professionals in the United States, doctors have generally resisted the adoption of email into their practices. But according to the WSJ article, email can result in many benefits to both the doctor and patient. With email capability, patients have more immediate access to the office staff and can potentially get their problems and concerns addressed more quickly. They can also maximize their cost savings by minimizing office visits and reducing lost time from work. The author further elaborates that although doctors are not permitted to submit a charge to Medic...

The fear of malpractice will always be in the back of my mind

Kevin, M.D. - Medical Weblog — Mon, 06 Feb 2012 20:00:21 +0100

“I wouldn’t hesitate to sue you.”I’m sorry, what?That is what I heard from the mother of one of my patients. I was evaluating a high school athlete who had recurrent stingers (nerve injury that affects an upper limb, usually resolves with time) and a possible episode of transient quadriparesis (affecting all limbs this time). I wasn’t on the sidelines for these injuries, so I had to go on the reports given to me by the athlete and the school’s athletic trainer.Read the rest of The fear of malpractice will always be in the back of my mind on KevinMD.com.Category: Physician | Tags: Malpractice | 14 comments (Source: Kevin, M.D. - Medical Weblog)

Why physicians may not buy into ACOs

Kevin, M.D. - Medical Weblog — Mon, 06 Feb 2012 16:00:17 +0100

I’m sure Ezekiel Emanuel hates being referred to as Rahm Emanuel’s brother, so I won’t describe him as such. After working as one of Obama’s main health care advisors, he’s now at U-Penn in a job spanning medicine, economics, and ethics. He’s also been writing engaging essays in JAMA about health care reform and economic change, that give us an augur into where health care reform might lead us.Read the rest of Why physicians may not buy into ACOs on KevinMD.com.Category: Policy | Tags: Health reform, Specialist | 8 comments (Source: Kevin, M.D. - Medical Weblog)

Preparing for your visit with someone in hospice care

Kevin, M.D. - Medical Weblog — Mon, 06 Feb 2012 12:00:48 +0100

Visiting someone who is dying or critically ill is an experience many of us will have in the course of our lives. Whether your visit is to be in the person’s home, a hospice or a hospital, there are a few rules of thumb to guide your time together so that it can be mutually satisfying.Read the rest of Preparing for your visit with someone in hospice care on KevinMD.com.Category: Patient | Tags: Palliative care, Patients | No comment (Source: Kevin, M.D. - Medical Weblog)

Superhero

In My Humble Opinion — Mon, 06 Feb 2012 01:19:00 +0100

Suzie remembers what it felt like to be fifteen. She can still hear the creek of the steps leading to the third floor and the quaint finished bedroom that housed her grandmother that fateful summer. Originally, grandma was set to move into the small room next to Suzie's parents. But after his first night in the attic, Billy refused to set foot up there again. So dad lovingly wrapped grandma in his muscular arms and carried her to her final resting place. It's not like it really mattered. Grandma was bed bound and didn't know the difference.It was a lonely summer. Unable to afford camp, Suzie's parents asked that she stick around the house and take care of her grandmother. Although she originally protested, Suzie learned to enjoy the quiet moments in the sun drenched room that became her se...

MKSAP: 60-year-old woman with pruritic hives

Kevin, M.D. - Medical Weblog — Mon, 06 Feb 2012 00:00:48 +0100

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.A 60-year-old woman is evaluated for pruritic hives that have persisted for 12 weeks. The lesions appear, resolve within hours, and leave no residual mark but reappear at a later time. She does not associate the hives with any particular foods or exposures. Her medical history is significant for a 40-year history of asthma. She was diagnosed four months ago with peripheral vascular disease and was started on aspirin and a supervised exercise program. In addition to aspirin, her current medications are beclomethasone, salmeterol, albuterol (as needed), lisinopril, and simvastatin.Physical examination discloses wheals on the trunk and extremities with no angioedema.Which of the foll...

Father And Son

In My Humble Opinion — Sat, 04 Feb 2012 23:29:00 +0100

My son is busy. He holds a binder in his hands that was given to him at school. On the back he has affixed a photograph of himself. The author page.He explains this as if I should already know. Next he works on the title before beginning the body of the story. He has plans to scan the result into his mother's computer and then print several copies. Tomorrow, he imagines he will go to the Barnes and Noble and put them on display.Later, he collects all the books in his room. He arranges his furniture to create an entrance to his new "library". He cuts out ten long strands of paper and writes "librari Kard 50 sents" carefully on each one of them.When he's finished, he runs down the stairs to the mud room and puts on his boots and jacket. He calcualtes that if he sells all ten, he will have pl...

Patient preferences may not be rational, but they are not irrelevant

Kevin, M.D. - Medical Weblog — Sat, 04 Feb 2012 16:00:27 +0100

Everyone in our industry — policymakers, clinicians, healthcare facility administrators, public and private payers, technicians, pharmacists — shares concerns about the state of healthcare in the U.S., each of us from a slightly different viewpoint.The thread that joins us all is that one day each of us will be a patient.As its title suggests, patients are central to almost every provision of the Patient Protection and Affordable Care Act (Act), and we stand to benefit from more patient-centered, high quality, safe healthcare from our providers.Read the rest of Patient preferences may not be rational, but they are not irrelevant on KevinMD.com.Category: Policy | Tags: Health reform, Patients | No comment (Source: Kevin, M.D. - Medical Weblog)

A doctor reflects on his TED talk

Kevin, M.D. - Medical Weblog — Sat, 04 Feb 2012 12:00:06 +0100

I had performed this procedure dozens of times before. It was routine. I stand under the bright lights, I take a deep breath, I wait for my hands to stop shaking, and then, I begin.This time was different, though. The lights were blinding, there were lots of people watching, and there were TV cameras. Oh, and the guy performing before me was a Grammy winner. This was one of many talks I’ve given, but this was different because it was my first TEDx talk.Read the rest of A doctor reflects on his TED talk on KevinMD.com.Category: Physician | Tags: Specialist | 1 comment (Source: Kevin, M.D. - Medical Weblog)

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Fringe — Episode 11 (Season 4): “Making Angels”

Polite Dissent — Sat, 04 Feb 2012 05:00:00 +0100

A very good B-plot, a mind-numbing A-plot. Neil should have visited me before I saw this episode to put me out of my misery. The Plot: A man recently diagnosed with melanoma, but given a good chance of survival, is found dead, with mysterious bleeding from his eyes. The Fringe Team is called in to investigate. During the autopsy, Walter discovers that the victim was killed with a strange mixture of chemicals that shouldn’t act as a poison, yet they do. He concludes, with logic bizarre even for Walter, that it was impossible for someone to discover this toxin on their own — that they must have learned it from someone else, someone with godlike powers. A second victim is found. Then a third victim manages to escape the killer. The Fringe Team talks to him at the hospital, but learns...

Why we need to go from e-patient to i-patient

Kevin, M.D. - Medical Weblog — Sat, 04 Feb 2012 00:00:21 +0100

I found a recent Associated Press article on an aspect of the new health care law that many of us may have overlooked. It requires consumer-friendly summaries of what insurance plans cover, a provision that now seems to be at risk. The insurance industry is up in arms about implementation costs and added regulatory burdens. (There’s a good story at NPR, which includes a link to an example of what the language would look like.)Read the rest of Why we need to go from e-patient to i-patient on KevinMD.com.Category: Patient | Tags: Cancer, Health IT, Health reform, Patients | 1 comment (Source: Kevin, M.D. - Medical Weblog)

Identical twins with different ideas about healthcare

Kevin, M.D. - Medical Weblog — Fri, 03 Feb 2012 20:00:21 +0100

Jack and John are identical twins, but have varying interests in life. One day Jack, 43-years old, decides he has had enough of these headaches and calls his family doctor and asks what he should do. He is told that his doctor can see him in 4 days and to take some over the counter ibuprofren. And to definitely go to the ER if the headaches worsen.Read the rest of Identical twins with different ideas about healthcare on KevinMD.com.Category: Policy | Tags: Health reform, Neurology, Primary care | 1 comment (Source: Kevin, M.D. - Medical Weblog)

Experiencing an uninvited gift

Kevin, M.D. - Medical Weblog — Fri, 03 Feb 2012 16:00:45 +0100

It’s been five years since she was told she was cancer free. Today she was told it was back, and the future was quite grim.My job was to make sure she understood how to properly take the medication that would reduce the swelling around the tumor so radiation could start as soon as possible.That was my job. Clinically speaking it wasn’t the most challenging or difficult issue of the day as I scanned her file. Then I went to speak with her.Read the rest of Experiencing an uninvited gift on KevinMD.com.Category: Physician | Tags: Cancer | 3 comments (Source: Kevin, M.D. - Medical Weblog)

A Gentle Landing Place

In My Humble Opinion — Fri, 03 Feb 2012 14:38:00 +0100

65 years. We've been married 65 years.I take a seat in the chair next to the bed and wait quietly. The nursing home is strangely inactive so early in the morning. The sun has begun to rise and light washes over the grassy prairie outside the window. An elderly man is sitting in the recliner beside me. He leans over to hold his wife's frail hand. She lays unconsciously next to us. As I imbibe the scene, it becomes rapidly apparent that I have little to offer as a physician. My stethoscope is impotent, my medical knowledge is transparently thin.I stand and begin my physical examination. Not out of medical necessity, but more for the husband's comfort. There is something about the familiarity of the laying of hands that brings calm and control to an ungraspable situation. The woman in the bed...

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How the CA-125 became a $50,000 blood test

Kevin, M.D. - Medical Weblog — Fri, 03 Feb 2012 12:00:27 +0100

What could be so simple as a blood test?A quick prick with a needle, a wait of a day or two for results and a discussion with the doctor about those results. In the words of our vaunted politicians, it would be an “up or down vote” on whether there was anything to deal with.That was the thinking of my wife’s physician when she ordered a test called the “CA-125.” At the time, it was popular as a screening test for ovarian cancer, a disease that had painfully and prematurely ended my wife’s mother’s life. My wife felt fine, so an abnormally high level could indicate the presence of a small (read curable) cancer. A normal level would signal relief from fear.Read the rest of How the CA-125 became a $50,000 blood test on KevinMD.com.Category: Conditions | Tags: Cancer | ...

Why EMR is a dirty word to many doctors

Kevin, M.D. - Medical Weblog — Fri, 03 Feb 2012 00:00:14 +0100

Don’t get me wrong, EMRs (electronic medical records) are inevitable. Over the long-run they are almost certainly good for physicians, patients and the healthcare industry.However, their origin and the ulterior motives currently driving their adoption is sowing the seeds of their failure. First, what is actually happening out there? The most recent CDC data would seem to be encouraging for EMR adoption, with EMR use (finally) passing 50%.Too bad there is more to the story.Read the rest of Why EMR is a dirty word to many doctors on KevinMD.com.Category: Tech | Tags: Health IT, Health reform | 23 comments (Source: Kevin, M.D. - Medical Weblog)

Why patients with implantable defibrillators deserve their data

Kevin, M.D. - Medical Weblog — Thu, 02 Feb 2012 20:00:56 +0100

The objective of Measure 12/15 of Meaningful Use regulations of the HITECH act which refer to electronic health records, states that eligible professionals “provide patients with an electronic copy of their health information (including diagnostic test results, problem lists, medication lists, medication allergies) upon request.” A patient’s implantable defibrillator consists of a diagnostic test of the patient’s rhythm as well as of the implanted device itself. I do not see a distinction between data derived from these devices and other diagnostic tests.Read the rest of Why patients with implantable defibrillators deserve their data on KevinMD.com.Category: Tech | Tags: Health IT, Heart, Specialist | No comment (Source: Kevin, M.D. - Medical Weblog)

Understanding the pain of fibromyalgia

Kevin, M.D. - Medical Weblog — Thu, 02 Feb 2012 16:00:05 +0100

Many healthcare professionals find fibromyalgia difficult to believe as “a real disease” and most of all difficult to handle, and to be honest it is not so difficult to see why. Doctors and other healthcare professionals have learned how to search for diseases based on the specific symptoms the patients present, but fibromyalgia – and several other chronic pain syndromes – do not fit into that model.The patients are presenting a broad spectrum of subjective symptoms and feelings that can not be objectified. A patient presenting a pain problem must in general be examined for the reason for the pain based on the localisation of the pain, but in conditions like fibromyalgia the pain is so widespread, that it is difficult to detect where it started and thereby to look for evidence for ...

Vacation?

In My Humble Opinion — Thu, 02 Feb 2012 14:41:00 +0100

I knew Leslie my whole life. A friend of my parents, she remembered the day I was born. So I felt a slight sense of trepidation when she asked me to be her doctor. But how could I refuse?I have always been cognizant of the pitfalls of taking care of family and friends. I constantly worry that personal feelings will blur the lens of objectivity. On the other hand, I could see where my loved ones would enjoy knowing that their doctor has extra "skin in the game".Little did I know that a few years later Leslie would be gone, and I would find out in the worst way.*I couldn't help but sigh as I sat down to the large stack of papers that had collected on the desk in my absence. I stared up at the clock. One hour before my first patient would arrive. I hugged my shoulders tightly and shuttered. A...

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How a doctor uses Google to market and recruit patients

Kevin, M.D. - Medical Weblog — Thu, 02 Feb 2012 12:00:54 +0100

When I relocated my radiation oncology practice from Jacksonville to Tampa, Florida, I had to figure out how to compete against urologists in a market that was radically different from the one I had left. Unlike their peers in Jacksonville, Tampa urologists owned their own radiation centers, guaranteeing I wouldn’t receive referrals from them.Read the rest of How a doctor uses Google to market and recruit patients on KevinMD.com.Category: Tech | Tags: Cancer, Radiology | 8 comments (Source: Kevin, M.D. - Medical Weblog)

Lo, There Shall Come a Groundhog

Polite Dissent — Thu, 02 Feb 2012 05:00:00 +0100

Time for a classic post: Happy Groundhog Day! Tags: groundhog comics (Source: Polite Dissent)

3 best practices for both physicians and patients to treat diabetes

Kevin, M.D. - Medical Weblog — Wed, 01 Feb 2012 12:00:01 +0100

As diabetic patients and their physicians continue to work together to combat this metabolic disorder, researchers and medical organizations are uncovering new ways to fight this illness. With 26 million Americans currently battling the disease and 79 million already diagnosed with pre-diabetes, this disease poses a serious threat to our society and our overall healthcare system.With these startling statistics in mind, the Northern States Ambulatory Research Network (NORTHSTAR), a practice-based research network composed of primary care providers in North Dakota and led by Charles Christianson, MD, joined together with The Physicians Foundation, a nonprofit national organization dedicated to improving the quality of healthcare for all Americans and advancing the work of practicing physicia...

Tuesday PSA: You Can Help Superman When You Help the Special Olympics!

Polite Dissent — Wed, 01 Feb 2012 05:00:00 +0100

Click on the image for the full PSA I’ve got nothing negative or snarky to say today, I think the Special Olympics are a great organization and I’ve had a great time every time I’ve helped them (and apparently I helped Superman as well). More PSAs Tags: comics psa superman special olympics (Source: Polite Dissent)

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How adopting an EHR is like treating cancer

Kevin, M.D. - Medical Weblog — Wed, 01 Feb 2012 00:00:46 +0100

EHRs are not ready for prime time. EHR benefits are questionable and there are documented instances where patients’ deaths were directly attributed to an EHR. EHRs are cumbersome and slow. They are unnecessarily complex and built on very old technology. The people who build EHRs have no concern for the end user and therefore EHR usability is pretty abysmal. And EHRs are expensive to buy and expensive to maintain, not to mention that they can completely derail your practice through loss of productivity. The fact that some users seem to do well with their EHRs, and even derive some joy from using them, is not a valid counter argument since most users are not so fortunate and through no fault of their own. There really is no excuse for such failure in this day and age. Just look at the iPad...

Are physicians addressing the root causes of health problems?

Kevin, M.D. - Medical Weblog — Tue, 31 Jan 2012 20:00:01 +0100

While in residency, I took care of a toddler who was hospitalized following an anaphylactic reaction. During a diaper change at home the child suddenly developed lip swelling and severe difficulty breathing for no apparent reason. The child was urgently brought to the hospital by ambulance and initially treated in the emergency room. By the time I met her on the inpatient floor her breathing and swelling had significantly improved. The first thing I noticed, however, was the child’s bumpy and irritated red skin which was covered with a thick layer of ointment. While I examined her she would claw and scratch at her skin with little relief. She looked miserable. Her mother had been suspecting food allergies and described a frustrating process of selective food avoidance and various skin ...

Analyzing what the President said about health care

Kevin, M.D. - Medical Weblog — Tue, 31 Jan 2012 16:00:17 +0100

President Barrack Obama delivered a 6,944 word State of the Union address to the American people. Of the speech, less than .01% was devoted to healthcare, which is remarkable considering the major changes in healthcare that are on the horizon if Obamacare survives a challenge in an upcoming U.S. Supreme Court case. During the speech, there were only three sentences that mentioned healthcare.The first was this: “I will not go back to the days when health insurance companies had unchecked power to cancel your policy, deny you coverage, or charge women differently from men.”Read the rest of Analyzing what the President said about health care on KevinMD.com.Category: Policy | Tags: Health reform | No comment (Source: Kevin, M.D. - Medical Weblog)

The D Word

In My Humble Opinion — Tue, 31 Jan 2012 13:15:00 +0100

My daughter has begun to use the D word.When I die, people will walk on me?Even at the age of four, she knows that the dead are buried in the ground. More questions follow rapidly. She thinks that if a grandparent doesn't show up to pick up her classmate from school one day, he must have died. The same if someone goes on vacation for a week. Her statements are crude but yet shockingly honest. Unfettered by the complexities of the adult mind, she is free to explore unencumbered. There is no guilt or embarrassment in her voice. Our conversations lack the fear and angst that so often cloud this kind of discussion amongst grown ups.She is curious.Was I dead before you had me?*In some ways, my daughters fascination with death will not likely evolve as she grows older. She will lose the innocenc...

Be aware of your food choices, especially when pregnant

Kevin, M.D. - Medical Weblog — Tue, 31 Jan 2012 12:00:21 +0100

I come back into the exam room, keeping my best poker face, sit down and turn to face her. She’s on the edge of her seat, nervous and barely able to contain herself, maybe not even sure which answer she wants.“Congratulations,” I say. She lets out her breath and smiles, huge.“Thanks!”Read the rest of Be aware of your food choices, especially when pregnant on KevinMD.com.Category: Physician | Tags: OB/GYN, Obesity, Patients, Primary care | 1 comment (Source: Kevin, M.D. - Medical Weblog)

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House — Episode 10 (Season 8): “Runaways”

Polite Dissent — Tue, 31 Jan 2012 05:00:00 +0100

House shows some heart in tonight’s episode, unfortunately, he seems to have left his brain at home. A teenager presents to the Princeton-Plainsboro Hospital clinic complaining of some difficulty breathing. All she wants is an inhaler for her “asthma” but House correctly recognizes that she is homeless and the man with her isn’t really her father. What really piques his interest is when she starts bleeding from her ear. He mentions that this is a sign of a skull fracture, but can find no fracture — or any other cause of the bleeding — so he admits her to his service. The team’s initial diagnoses focus on her homelessness and consist of drug use, malnutrition, or HIV. Chase goes further and suggests she may have a squamous cell cancer of the middle ear with parane...

House Challenge — Week 10

Polite Dissent — Tue, 31 Jan 2012 05:00:00 +0100

This week, Roxana wins with 9 points. Harvey, Little apple, rileyjo, Rouge Rogue, Silvina and TheJester were second with 8 points. Overall, James H retains the lead with 46 points. Dr. R moves back up to second with 44 points. Nextsundayad and Roxana are tied for third with 42 points. wkmaier is fifth with 40 points. If you have 35 or more points, then you are in the top 10%. Click here to see the full scoreboard. (Source: Polite Dissent)

How changing patient workflow can make using an EMR fun

Kevin, M.D. - Medical Weblog — Tue, 31 Jan 2012 00:00:35 +0100

One day, about 5 years into using the electronic medical record in my practice, I came to the realization that I wasn’t having fun anymore. I was sitting throughout most of every office encounter facing a computer screen, my back to the patient on the exam table across the room. The joy of face to face interaction with people, the real reason I went into medicine in the first place, had been replaced with the more pressing urgency of data entry.Read the rest of How changing patient workflow can make using an EMR fun on KevinMD.com.Category: Tech | Tags: Health IT | 3 comments (Source: Kevin, M.D. - Medical Weblog)

Natural language processing in EMRs can improve disease tracking

Kevin, M.D. - Medical Weblog — Mon, 30 Jan 2012 20:00:54 +0100

Years ago, if you were elderly, had diabetes, high blood pressure, low back pain, needed a yearly flu shot and came to see this electronic health record-enabled physician (now with the nom de plume “Disease Management Care Blog”), you would have had your diabetes, high blood pressure and low back pain reassessed, you would have been given a flu shot and, for good measure, the DMCB would have tossed in a discussion about the unpleasantness of getting screened for cancer. After the indignity of your physical exam, the DMCB would have typed its clinic notes into the EHR. Then the DMCB would have [click!] opened a new window,[click!] and “processed” your clinic encounter by selecting a [click!] “principal diagnosis” and some [click!] “secondary diagn...

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How algorithm driven medicine can affect patient care

Kevin, M.D. - Medical Weblog — Mon, 30 Jan 2012 16:00:58 +0100

Whenever someone is scheduled for an operation, the assigned nurse is required to fill out a “pre-op checklist” to ensure that all safety and quality metrics are being adhered to. Before the patient is allowed to be wheeled into the OR we make sure the surgical site is marked, the consents are signed, all necessary equipment is available, etc. One of the most important metrics involves the peri-operative administration of IV antibiotics. SCIP guidelines mandate that the prophylactic antibiotic is given within an hour of incision time to optimize outcomes. This has been drilled into the heads of physicians, health care providers, and ancillary staff to such an extent that it occasionally causes total brain shutdown.Read the rest of How algorithm driven medicine can affect patien...

The Sway

In My Humble Opinion — Mon, 30 Jan 2012 00:50:00 +0100

My son's hands are moving back and forth quickly over the finger board of the violin. The bow bounces back and forth rhythmically. Like most every day, he is painstakingly practicing. He moves from one piece to the next, pausing to make adjustments. When he's done, he turns the pages back and starts again.Eight months ago he stared at the gleaming instrument. For the first few weeks he practiced his plucking. Then, in no time, he was bowing. Now he plays a plethora of songs and learns something new each lesson.The sounds coming from his violin are becoming less squeaky. The melodies are more constant and the clarity of each note is beginning to shine.But more remarkable than his technical acumen, is the joy that is growing in his heart. He has started to smile as he plays. His lips curl up...

A Pittance

In My Humble Opinion — Sun, 29 Jan 2012 02:43:00 +0100

I glanced quickly at the papers on my desk. I had a few minutes between patients, and the biller had placed the statement neatly on top of a pile of labs. The word denial stood out amongst the jumble of letters on the page. I read further.Claim denied due to duplication of care. Services payed already to emergency physician.I shook my head in disbelief.*The notification that John was in the emergency room came blinking across my screen. Of course, he hadn't called me to say anything was wrong. I looked down at my watch. I could be out of the office and in the emergency room in five minutes.I ran down the steps and pushed my way between pedestrians as I crossed the hall entering the emergency room. The morning rush had yet to materialize. John was one of the only patients. I scanned through...

Repetition is the curse of the doctor-patient engagement

Kevin, M.D. - Medical Weblog — Sat, 28 Jan 2012 20:00:02 +0100

How many times as a doctor do you ask the same questions over and over again as part of the routine process of taking a history from your patient? And how often as a patient do you have to answer those same questions each time you see a new doctor? How long does this take, given that doctors and patients both complain that there is too little time for the modern consultation to cover all the bases to the satisfaction of both parties?Read the rest of Repetition is the curse of the doctor-patient engagement on KevinMD.com.Category: Tech | Tags: Health IT | No comment (Source: Kevin, M.D. - Medical Weblog)

Patients will understand an honest mistake if the doctor tells the truth

Kevin, M.D. - Medical Weblog — Sat, 28 Jan 2012 16:00:09 +0100

It was 1976 and I was a junior resident in urology at Baylor College of Medicine in Houston, Texas. I was assigned to a rotation in pathology where my job was to process specimens taken at surgery, dictate a gross description of the specimen and then place the specimens into the cassettes that would be used to make the permanent sections. I was transferring a prostate biopsy, approximately 0.5mm x 10mm, and it slipped from the forceps and was washed down the drain of the sink. I searched for the tiny sliver of tissue and even took the drain trap apart but could not locate it. I felt terrible and told the director of the pathology lab who recommended that I call the urologic surgeon, Dr. Seybold, and report what had happened with the biopsy.Read the rest of Patients will understand ...

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MKSAP: 58-year-old woman with acute left-sided flank pain

Kevin, M.D. - Medical Weblog — Sat, 28 Jan 2012 12:00:38 +0100

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.A 58-year-old woman is hospitalized for acute left-sided flank pain. She has had fever and night sweats for 1 month and a 9.1-kg (20-lb) weight loss over 6 months.On physical examination, temperature is 37.7 °C (99.8 °F), blood pressure is 135/88 mm Hg, pulse is 88/min, and respiration rate is 18/min. Heart sounds are normal. There is an early diastolic low-pitched sound after the S2 with a diastolic murmur at the apex. There is tenderness of the left costophrenic angle. The abdomen is soft with normal bowel sounds and no tenderness. She does not have rash or petechiae, splinter hemorrhages, or Janeway lesions. Funduscopic examination is normal.Laboratory studies:Leukocyte count...

Fringe — Episode 10 (Season 4): “Forced Perspective”

Polite Dissent — Sat, 28 Jan 2012 05:00:00 +0100

An average episode of Fringe that had too much bad science (and math) for me to truly enjoy. I guess we need some mediocre weeks to let us enjoy the good ones. The Plot: Emily is a teenager who occasionally catches glimpses of someone’s pending death. She quickly sketches the scene she sees in her sketchbook, rips out the page, and then hands it to the victim. She’s essentially Cassandra, and her warnings of imminent death do no good to the victim. They do bring her to the attention of the Fringe Team, especially Olivia, who is still coming to terms with the Observer who told her that she had to die. Emily gives the Fringe Team a sketch she made showing numerous victims amid piles of rubble. The image is centered on one particular man. The team is able to figure out who he is via his ...

Diagnosing an illness is an art

Kevin, M.D. - Medical Weblog — Sat, 28 Jan 2012 00:00:56 +0100

Diagnosis is the foundation on which all care and treatments rest. If the diagnosis is wrong, most probably so is the treatment. Diagnosing an illness is an art. A diagnostician needs to be one part scholar, one part detective, and four parts artist. He has to be a good listener, open minded, and capable of assimilating a large amount of sometimes confusing data into an accurate picture of a disease process. A diagnostician must also be humble, capable of seeking help and counsel from multiple sources.Read the rest of Diagnosing an illness is an art on KevinMD.com.Category: Physician | Tags: Primary care | 3 comments (Source: Kevin, M.D. - Medical Weblog)

The magic of learning medicine

Kevin, M.D. - Medical Weblog — Fri, 27 Jan 2012 20:00:05 +0100

Discussion veers from myocytes to cardiac output and stroke volume.The world, through the student’s eyes, is inflamed with passion and opportunity. The reality of doctoring is a distant dream. Hope peals back layers of fear and loss of confidence. Reward is imagined as a handshake, a return to health, and gentle guidance and counseling.And there is no better place to be.Read the rest of The magic of learning medicine on KevinMD.com.Category: Education | Tags: Medical school, Residency | 3 comments (Source: Kevin, M.D. - Medical Weblog)

Patient engagement is the holy grail of health care

Kevin, M.D. - Medical Weblog — Fri, 27 Jan 2012 16:00:16 +0100

For health care professionals, patient engagement is the holy grail of health care. It is the key to patient adherence – a prerequisite to achieving better outcomes, fewer ER visits and hospitalizations and more satisfied patients. It is easy to recognize an engaged patient – they do what their health care providers recommends …what their health care team knows what is right for them.Read the rest of Patient engagement is the holy grail of health care on KevinMD.com.Category: Patient | Tags: Patients | 7 comments (Source: Kevin, M.D. - Medical Weblog)

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In Memory Of A Wonderful Friend

In My Humble Opinion — Fri, 27 Jan 2012 14:44:00 +0100

He was my guy. You know, my financial guy. The kind of guy that everybody loves when the market is up. When the market is down....well you know what I'm talking about.He took me out of pity. The meager sums I saved were nothing near his average client. I was well below his minimum. But we had a common friend. And he liked me and my wife. We were his kind of people. Bargain shoppers. We bought low and sold high. Over the years we talked every few months. He would take my wife and I out to dinner in the early days. Later, he would come to the house and entertain my children before we could chase them off to bed and talk financials.It was a working relationship. But certainly he was the type of guy I would be friends with anyway. He invited us to his house many times to meet his wife and kids...

Physicians have a natural role as advocates

Kevin, M.D. - Medical Weblog — Fri, 27 Jan 2012 12:00:29 +0100

As physicians, we are often called upon to be advocates for our patients. Sometimes they have no other person to turn to. At those times, in particular, we evaluate their health in the context of relationship, family, and workplace. Having practiced family medicine for so many years, and now in counseling medicine, I have had the responsibility of advocating for my patients with their health insurance companies, within their families, and with their employers. I take this responsibility very seriously.Read the rest of Physicians have a natural role as advocates on KevinMD.com.Category: Physician | Tags: Patients, Primary care | 3 comments (Source: Kevin, M.D. - Medical Weblog)

The Internet is where patients go for pre-visit consultations

Kevin, M.D. - Medical Weblog — Fri, 27 Jan 2012 00:00:58 +0100

As a physician, technology cannot replace you, but it can make you more efficient and effective.This was the message from Richard Satava, MD, who spoke on the future of surgical technology at the recent Seattle Surgical Society Annual Meeting. Dr. Satava’s speech was fascinating as he laid out the future for robotics, remote surgery, internal locomotion actuators, molecular imaging biosurgery, etc. I looked over my shoulder a couple of times to make sure that I had not mistakenly joined a Star Trek convention.Read the rest of The Internet is where patients go for pre-visit consultations on KevinMD.com.Category: Social media | Tags: Health IT, Patients | 2 comments (Source: Kevin, M.D. - Medical Weblog)

Our society expends huge sums on futile care

Kevin, M.D. - Medical Weblog — Thu, 26 Jan 2012 20:00:21 +0100

Mike was a runner, outdoors-man, and fitness nut. This was not so much as for health reasons as for “feeling good”, but he did hope that it would help him avoid illness. It was worrisome when he started with some belly cramping and noticed some blood streaks in his stools. It took about a month until he could be scheduled for a colonoscopy. The news was shocking. “There’s a cancer in the bowel, and you need an abdominal CT scan ASAP.” The scan brought even more serious news, “Mike, your cancer has spread to the lymph nodes, the liver, and to the lungs. It’s an advanced cancer – State IV.”Read the rest of Our society expends huge sums on futile care on KevinMD.com.Category: Physician | Tags: Cancer, Palliative care | 3 comments (Source: ...

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Superman Versus the Measles

Polite Dissent — Thu, 26 Jan 2012 05:00:00 +0100

The Mayor of Metropolis summons Superman because he needs his help. It must be some major problem, right? Like a failing dam, a fire at a hospital, or an orphanage perched atop an EPA super-fund site, right? Nope. The mayor has the measles, yet still wants to attend the City Council meeting. Truly a problem requiring all the abilities of the Man of Steel (sorry, orphans, try to enjoy the searing pain from the toxic waste). This is Superman, so he must have a brillaint plan to “beat those measly measles,” right? Wrong again. No shrinking down and battling the evil virus and its zombified cells. No jumping forward a few years in time, grabbing a measles vaccine, then jumping back in time to before the mayor was infected. None of that. Instead, Superman visits a glass factory an...

Will Anybody Care?

In My Humble Opinion — Thu, 26 Jan 2012 02:01:00 +0100

There are certain habits I'm not proud of. Certain things that are better left unsaid. But there's no embarrassment in the radio station that I have chosen to grace my ears each morning as I drive to work. That's right, I have ditched the top forty dance music, escaped the salacious morning DJ's, and landed on something more sublime. My dial is set to 91.5, national public radio. There's something about the reporting style, the ebb and flow, that draws me in. The content is superb; the stories informative. My car becomes a haven of calm and warmth in the midst of the frigid Chicago winter. So when I heard the name of my hospital role gently off the lips of the voice on the other side of the speaker, my ears perked up. It appears a celebrity was admitted overnight. Someone who garners a lot...

I learned the value of listening to the patient

Kevin, M.D. - Medical Weblog — Wed, 25 Jan 2012 16:00:55 +0100

William Osler famously said (among other things): “Listen to the patient. He is telling you the diagnosis.”I was doing my obstetrical rotation as a first year family practice resident. I had done nearly 100 deliveries and was feeling more confident in my skills and knowledge than was justified. Although this rotation did not involve actual care for the recently delivered newborns, I loved pediatrics and frequently stopped by the nursery to see the babies whose deliveries I had attended or assisted and always chatted with the parents about their new children.Read the rest of I learned the value of listening to the patient on KevinMD.com.Category: Physician | Tags: OB/GYN, Pediatrics | No comment (Source: Kevin, M.D. - Medical Weblog)

Myths and misses about Alzheimer’s Disease

Kevin, M.D. - Medical Weblog — Wed, 25 Jan 2012 12:00:36 +0100

Mark Twain, the American author and humorist once said, “It ain’t what you don’t know that gets you into trouble. It’s what you know for sure that just ain’t so.” In my experience as a geriatrician, I’ve encountered many misunderstandings about this degenerative neurologic disease that devastates both patients and their families. Countering these can help patients, families, professionals, and all those who have someone in their lives with Alzheimer’s disease.Read the rest of Myths and misses about Alzheimer’s Disease on KevinMD.com.Category: Conditions | Tags: Geriatrics, Neurology | No comment (Source: Kevin, M.D. - Medical Weblog)

The New Knockout Gas

Polite Dissent — Wed, 25 Jan 2012 05:00:00 +0100

The doctor is working hard to “pull them thru” by…doing what, exactly? Putting a warm washcloth over their eyes? Tucking them in? Now, I’m no expect on knockout gases, but I think I could do better than that. Scene from The Three Eccentrics from Batman #21, (February-March 1944). I like the way there’s a list of rules on the back wall. I can only imagine what they say: “No roughhousing,” “No running with scissors,” “Wash your hands before returning to work” Tags: comics medicine batman robin doctor hospital knockout gas (Source: Polite Dissent)

Repeated experiences of shaming are not good for a young child

Kevin, M.D. - Medical Weblog — Wed, 25 Jan 2012 00:00:18 +0100

The little boy, who looked to be about two, darted away in a fit of giggles. His young mother, who seemed thoroughly worn out and exasperated, ran after him, grabbed him by the arm and said in a harsh whisper, “You must stand here!”We were on line waiting to board a Southwest Airlines flight. For those of you not familiar with the Southwest system, there are no assigned seats. Rather, when a passenger obtains a boarding pass, a number indicates a place in line. Then before boarding, passengers line up according to the number they have been given. It is a very well organized system, but doesn’t necessarily work for a two-year-old.Read the rest of Repeated experiences of shaming are not good for a young child on KevinMD.com.Category: Physician | Tags: Pediatrics | 2 comment...

Why more primary care doctors are referring patients to specialists

Kevin, M.D. - Medical Weblog — Tue, 24 Jan 2012 22:00:36 +0100

According to a recent study from the Archives of Internal Medicine, primary care physicians are referring more patients to specialists than ever before. In fact, the rate almost doubled in the 10-year period between 1999 and 2009.This drives up the cost of care, as specialist consults tend to be more expensive than primary care visits. Furthermore, specialists tend to order more advanced diagnostic tests.Read the rest of Why more primary care doctors are referring patients to specialists on KevinMD.com.Category: Pho | Tags: Primary care, Specialist | 5 comments (Source: Kevin, M.D. - Medical Weblog)

The Evolution Of A Love Affair

In My Humble Opinion — Tue, 24 Jan 2012 20:05:00 +0100

My husband was a wonderful man!Geraldine fidgeted on the exam table with her purse in her lap. Her porcelain skin and quaffed hair were betrayed by hands that carried the wear and tear of eight decades. Her eyes bounced back and forth between my face and the handbag. Eventually she produced a series of aged photographs and handed them over one by one.The man staring back at me in the first photo was wearing a soldier's uniform. He was handsome and tall with broad shoulders. The edges of the paper were worn and had frayed over years of handling. The second picture showed a young couple and was marked "tenth anniversary".As I fingered through the pile, the faces became wrinkled and the postures stooped forward. In just a few moments, I witnessed the evolution of a love affair. Young feverish...

Insider tips to surviving your hospital stay

Kevin, M.D. - Medical Weblog — Tue, 24 Jan 2012 20:00:33 +0100

Hospital stays can be traumatic for patients and their family members. I give you the top 10 ways to survive a hospital stay while maintaining your sanity.10. Bring your own pillow. Trust me.9. Bring a laptop computer or request one from the hospital. Hospitals all have free wireless these days and many will actually provide you with a laptop if you just ask.8. Bring an accurate and updated medication list with you. Nothing leaves you more vulnerable to hospital errors than to have your doctor give you medication you haven’t taken in months or for you to miss medications that haven’t been updated by your five outpatient doctors since they bought their worthless EMR three years ago.Read the rest of Insider tips to surviving your hospital stay on KevinMD.com.Category: Physician...

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KevinMD media mentions, January 2012

Kevin, M.D. - Medical Weblog — Tue, 24 Jan 2012 18:32:44 +0100

I’d like to thank various media outlets for recently citing KevinMD.com.1. Grand rounds: True stories. USA Today. Who makes your medical decisions? Two different patients (with the same condition) had very different opinions about who should make their medical decisions.2. How doctors can reduce medical errors, lawsuits. USA Today. Ask doctors what concerns them most, and chances are they’ll say, “medical malpractice.” A recent New England Journal of Medicine study found that 75% of doctors who practice psychiatry, pediatrics or family medicine will be sued during their career. Neurosurgeons, orthopedic surgeons and obstetricians have it worse, as virtually all of them will be sued before they finish practicing medicine.Read the rest of KevinMD media mentions, January ...

Being treated like a celebrity when giving birth

Kevin, M.D. - Medical Weblog — Tue, 24 Jan 2012 16:00:08 +0100

Celebrity is an interesting phenomenon.On a hot summer night in 1990, my chief resident and I were on call at Harlem Hospital. We were informed that a “guest” was coming to interview us. Hot, sweaty and looking haggard rather than glamorous, we wanted to choke our director when Spike Lee walked through the door with film crew in tow. Lee was there to film the infamous movie, Mo’ Better Blues. We introduced him to our staff, he hung out with us all night and a patient allowed him to witness her delivery. Lee, dressed in paper scrubs, stared in awe as most people do when witness the miracle of birth. He graciously sent the patient a dozen roses the next day. I’m sure it’s not a coincidence that one of the main character’s in the movie was named Clarke, which just happened to ...

Should Google censor anti-vaccine claims?

Kevin, M.D. - Medical Weblog — Tue, 24 Jan 2012 13:15:51 +0100

One of the reasons there is such a movement against vaccines is the democratization of information, perpetuated by search engines like Google.Do a search for “autism” and “vaccines,” for instance, and you’ll be greeted with a wealth of information linking the two, despite the fact that any connection has been scientifically disproven.A fascinating piece in Slate asks whether search engines themselves have a responsibility to screen for scientifically credible information.Read the rest of Should Google censor anti-vaccine claims? on KevinMD.com.Category: Pho | Tags: Health IT | 14 comments (Source: Kevin, M.D. - Medical Weblog)

Why the family meeting is important

Kevin, M.D. - Medical Weblog — Tue, 24 Jan 2012 12:00:14 +0100

“Are you saying, doctor, that mom’s not getting better?” Eleanor asked.“I’m afraid so.” I replied.“Someone should have mentioned this to me before.” she said, before returning her gaze to my shoes.Read the rest of Why the family meeting is important on KevinMD.com.Category: Physician | Tags: Hospital, Palliative care | 3 comments (Source: Kevin, M.D. - Medical Weblog)

House — Episode 9 (Season 8): “Better Half”

Polite Dissent — Tue, 24 Jan 2012 05:00:00 +0100

An unfortunately average episode of House where the most interesting question is left unanswered. Andres is a man with early onset Alzheimer’s disease. He is being evaluated for possible inclusion in a drug study when he develops bloody vomiting. He is admitted to Princeton-Plainsboro Hospital and assigned to House’s service. The team’s initial thought is that the patient has a gastrointestinal bleed which is causing the bloody emesis. An EGD (upper endoscopy) is performed and it shows a Mallory-Weiss tear (a rip in the esophagus of those who vomit frequently or forcefully), but that is a consequence of vomiting, not a cause. Andres is also noted to have elevated liver enzymes, and the diagnoses of gallbladder disease and steatohepatitis (fatty liver) are mentioned. House favors the...

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House Challenge — Week 9

Polite Dissent — Tue, 24 Jan 2012 05:00:00 +0100

This week, Hogan and jwsellers took first with 13 points. Nextsundayad, vivalavida, and wkmaier were close behind with 12 points. Overall, James H and Nextsundayad share the lead with 39 points. wkmaier moves into second with 38 points while Dr. R drops to fourth with his 37 points. Yerkietand mbrigdan are tied for fifth with 35 points. If you have 31 or more points, then you are in the top 10%. Click here to see the full scoreboard. (Source: Polite Dissent)

Empathy's Limits

In My Humble Opinion — Mon, 23 Jan 2012 13:24:00 +0100

Has your mother died?When I heard the words, a strange memory popped into my head. My wife and I had just been married and were sitting on an airplane. As we prepared for the flight, a family of five bungled by and occupied the seats directly behind us. I gave my wife a knowing look. There were three children and the eldest appeared to be about seven.I sunk down in my seat, and placed the headphones over my ears to no avail. The next few hours were filled with screaming, crying, and pushing on the back of my chair. I was livid. I couldn't understand how adults could have so little control over their children. That is, until I became a parent myself and had to negotiate the perils of travel.There are just some things you have to experience to understand.*Mrs Jones was dying. After years of ...

5 ways doctors can benefit from professional connections

Kevin, M.D. - Medical Weblog — Sun, 22 Jan 2012 16:00:04 +0100

Looking ahead to the next several months, I’ve found myself frequently wondering how many physicians will make this their year to take the plunge and join an online social network. There are significant advantages that can be gained for doctors who embrace social media. Here are five ways you and your practice can benefit from such professional connections.Read the rest of 5 ways doctors can benefit from professional connections on KevinMD.com.Category: Social media | Tags: | No comment (Source: Kevin, M.D. - Medical Weblog)

There is scope for harm when ordering tests

Kevin, M.D. - Medical Weblog — Sun, 22 Jan 2012 12:00:28 +0100

As the world speeds up we tend to assume that newer must be better. In some instances it is but when it comes to health, less so than one might expect. The other tendency is to overlook simple solutions and go to complicated, and often expensive ones.In medical practice there is one step even before considering what to do with a given problem and that is whether there is a need to “do” anything. The great-untold story of health and medicine is that much of what ails us will actually resolve by itself and much will resolve by actions of the individual rather than what the doctor does.Read the rest of There is scope for harm when ordering tests on KevinMD.com.Category: Physician | Tags: Primary care | 2 comments (Source: Kevin, M.D. - Medical Weblog)

A lack of incentive for medical schools to train primary care doctors

Kevin, M.D. - Medical Weblog — Sun, 22 Jan 2012 00:00:14 +0100

A social media movement is happening before our eyes with action starting to take shape. The #occupyhealthcare movement has begun within to the blogosphere and through various areas of social media by storm.What does the #occupyhealthcare movement mean to me? My main focus in advocacy for family medicine is the production of an adequate primary care workforce distributed adequately to best serve our country. Those close to me also know that the current climate of health care access, quality and cost in the civilian world is one of my main reasons for pursuing a medical career in the military. What does that have anything to do with occupying healthcare?Read the rest of A lack of incentive for medical schools to train primary care doctors on KevinMD.com.Category: Policy | Tags: Health...

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When patients see their medical record

Kevin, M.D. - Medical Weblog — Sat, 21 Jan 2012 20:00:37 +0100

Traditionally, the patient chart stayed in the doctors office and rarely did a patient get a glimpse of anything in the record. Photocopying the chart is expensive and no physician would let a chart leave her office because the record must be held safely for a minimum of 7 years. Now more and more offices are doing away with clunky paper charts and electronic medical records are becoming the norm. With electronic portals, is there any reason a patient shouldn’t have access to their own medical record?A study published in the Annals of Internal Medicine reported that up to 97% of patients queried thought the ability to have “open visit chart notes” was a good thing. Doctors weren’t quite so eager.Read the rest of When patients see their medical record on Kev...

Paperwork causes unintended distractions for physicians and nurses

Kevin, M.D. - Medical Weblog — Sat, 21 Jan 2012 16:00:49 +0100

I admittedly snorted out loud when I read a New York Times article recently regarding increased physician distraction due to electronic devices, especially with the advent of the smartphone with its emails, text messages, calls, and other alerts that ping intermittently throughout a typical work day.There is no question that electronic devices distract physicians as the article pointed out. But that’s like complaining about a leaky faucet when there’s a flooded basement and a hole in the roof.Read the rest of Paperwork causes unintended distractions for physicians and nurses on KevinMD.com.Category: Physician | Tags: Hospital, Specialist, Surgery | 5 comments (Source: Kevin, M.D. - Medical Weblog)

Notification

In My Humble Opinion — Sat, 21 Jan 2012 12:50:00 +0100

No it's alright, I'll notify the family.I hung up and took a moment to clear my head before making the phone call. It was the middle of the night and my eyes felt as if they were sown shut. I hobbled into the bathroom and stared at my cell.I was about to make a call that would forever change someones life. Right now, they were tucked away in their beds sleeping quietly. In a few moments there would be chaos. I felt uncomfortable conveying such information over the phone, but I had no choice. I couldn't just wait till morning.I listened to the ringing and thought about the nature of being a physician. It always made me sad to know that I become aware of such profoundly intimate news before the family. A few moments later a sleepy voice picked up.Hello?I try not to mince words when giving no...

Google knows more about certain diseases than physicians ever will

Kevin, M.D. - Medical Weblog — Sat, 21 Jan 2012 12:00:09 +0100

Professor Gunter Dueck, is a calm and eloquent german mathematician who’s also the CTO of IBM Germany. He studied mathematics and philosophy and eventually turned out to be a great writer and speaker. Unfortunately he only does so in German, which is why it doesn’t make much sense to post a video of him here.Read the rest of Google knows more about certain diseases than physicians ever will on KevinMD.com.Category: Tech | Tags: Cancer, Health IT | 6 comments (Source: Kevin, M.D. - Medical Weblog)

Fringe — Episode 9 (Season 4): “Enemy of My Enemy”

Polite Dissent — Sat, 21 Jan 2012 05:00:00 +0100

The second cat-and-mouse Fringe episode in a row, and the second good one in a row. Coincidence? The Plot: Fauxlivia and otherLee arrive at the warehouse they learned about at the end of last episode, and find David Robert Jones waiting for them inside. He makes a not-so-subtle threat by killing one of his own shapeshifters, and then surrenders himself to them and asks to be taken to their leader. At Fringe HQ, Peter recognizes Jones as the man he thought he killed, and watches alternaBroyles’ interrogation of him. Peter even does a little interrogation of his own, a situation that seems to unnerve Jones, even though he doesn’t recognize Peter. Jones asks for a certain hard drive hidden by the shapeshifter Brandon, and when it does not arrive in time, kills an ER full of people. He th...

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Obesity is a sign of good health in some cultures

Kevin, M.D. - Medical Weblog — Sat, 21 Jan 2012 00:00:40 +0100

On the first day of the 1st Caribbean Obesity Forum, I presented various talks on obesity – its economic implications, its assessment and the need for firmly anchoring obesity treatment in primary care.Interestingly, several family doctors in the audience raised the interesting issue that here on Barbados (as probably on other islands) many patients are actually quite happy with their weights.Read the rest of Obesity is a sign of good health in some cultures on KevinMD.com.Category: Conditions | Tags: Obesity | 1 comment (Source: Kevin, M.D. - Medical Weblog)

Stories help the public make sense of evidence

Kevin, M.D. - Medical Weblog — Fri, 20 Jan 2012 20:00:51 +0100

Recently, I presented Family Medicine Grand Rounds at Georgetown University School of Medicine on resolving conflicts between screening guidelines. During the question and answer session, Department Chair James Welsh, MD asked how evidence from carefully conducted clinical trials can possibly overcome powerful emotional stories of “saved lives.”I answered that evidence-based medicine’s supporters must fight anecdotes with anecdotes. For every person who believes his or her life was extended by a PSA test or a mammogram, statistics show that many more are temporarily or permanently injured as a result – and their stories matter too. As Kevin Pho, MD wrote about the USPSTF’s recent prostate cancer guideline, “Task Force advocates will need to put a human f...

What should be the stated aim of health care in America?

Kevin, M.D. - Medical Weblog — Fri, 20 Jan 2012 16:00:59 +0100

The triple aim of health care, as defined by the Center for Medicare and Medicaid Services (CMS) is: improving the experience of care, bettering the health of populations, and reducing the per capita costs of health care.This struck me as odd when I first read it. Why should the stated aim of any system become to decrease the costs associated with that system?Which led to the next logical questions: What should be the stated aim of health care in America? And where would we need to put our money to reach that aim?Read the rest of What should be the stated aim of health care in America? on KevinMD.com.Category: Policy | Tags: Health reform | 5 comments (Source: Kevin, M.D. - Medical Weblog)

Another Trip To The Moon

In My Humble Opinion — Fri, 20 Jan 2012 15:33:00 +0100

The young man walking in the door looked vaguely familiar. I glanced down at the computer screen sitting on my lap, and clicked through the visit history. I had never seen him in the office before. I studied the landscape of his face searching each wrinkle and furrow for the hint that would unhinge the avalanche of memory. He looked up at me quizzically and our eyes met.You don't remember, do you?By now my embarrassment was replaced by curiosity. He proceeded to explain that he had seen me as a patient ten years ago in my previous office. I marveled at the idea of time passed. A decade younger, I had just married and my kids weren't even born yet. I was a recent graduate then. Wet under the ears and fresh out of training, medicine was more like a space odyssey; a trip to the moon. I marvel...

How Moneyball applies to healthcare

Kevin, M.D. - Medical Weblog — Fri, 20 Jan 2012 12:00:35 +0100

The storyline is familiar. An organization is challenged to achieve better results without spending more money. An executive is committed to obtaining these better outcomes and recognizes that more financial resources aren’t forthcoming . Faced with the option of near-certain failure if he continues to work within the historic operating framework, he decides that a different approach is necessary. With the help of a young and visionary analyst, they decide to challenge the way “things have always been done.” Introducing data and analytics, the two men decide that they can bend the cost curve and still achieve successful outcomes. This approach is met with derision and resistance by others within the organization and the industry. Given a thoughtful array of tools and reso...

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The ambiguity of a hospital charge

Kevin, M.D. - Medical Weblog — Thu, 19 Jan 2012 16:00:16 +0100

It all started while out to dinner with a couple of my fellow Brigham/Massachusetts General Hospital OB/Gyn residents. We were discussing our favorite old TV shows and one fellow resident’s love of The Price Is Right with Bob Barker. After talking about the game show, a light bulb went off in my head and I thought, “Why can’t we play The Price is Right with hospital charges to our patients?”Read the rest of The ambiguity of a hospital charge on KevinMD.com.Category: Physician | Tags: Hospital, OB/GYN | No comment (Source: Kevin, M.D. - Medical Weblog)

Selling Primary Care Down The River

In My Humble Opinion — Thu, 19 Jan 2012 12:57:00 +0100

Dr. Lake used to be a businessman. His books were clean and orderly. His staff was efficient and kind. He steered his ship agilely through troubled waters and still managed to provide the highest quality care. His was not only physician but small business owner. He was proud.As the political climate changed, Dr. Lake became more distressed concerning his situation. His overhead was increasing and the regulatory culture was expanding. Laboring under the strain of advanced technology, the time for patient care diminished.Looking in the mirror one morning, Dr.Lake decided that this wasn't the job that he trained for. He shuttered his doors, and signed a contract with the hospital owned medical group. At least now he would be able to ply his trade and leave the regulations to someone else.Dr. ...

Why palliative care and hospice is the ultimate gift

Kevin, M.D. - Medical Weblog — Thu, 19 Jan 2012 12:00:16 +0100

Dear Doctors:I am writing no less than 45 days after my mother died from a GI bleed from ovarian cancer. Not once did my mother’s team of doctors mention palliative care. It was not until days and even hours before her death that hospice was discussed and implemented. Our family was blind sighted by this.While no one likes to talk about the topic of death, it is important to remember that this is a natural cycle of life. Doctors are always on the cutting edge of medicine and talking about the possibility of death seems like failure. In reality not talking about the services available to family is the ultimate failure.Read the rest of Why palliative care and hospice is the ultimate gift on KevinMD.com.Category: Conditions | Tags: Cancer, Hospital, Palliative care | No comment ...

Another Comic Book Truth Serum

Polite Dissent — Thu, 19 Jan 2012 05:00:00 +0100

To the best of my knowledge, Demerol has never been considered a truth serum. That is a term usually reserved for certain barbituates (sodium pentothal, amobarbital) or anticholinergic drugs (scopolamine). Demerol (generic name meperidine or pithidine), on the other hand, is a very potent narcotic pain killer. Admittedly, unlike most narcotics, Demerol does have some anticholinergic effects, but these don’t kick in except in very high doses, and the poor victim would be unconsciousness and probably dead from a Demerol overdose long before the effects became clinically useful. More Comic Book Truth Serums (Source: Polite Dissent)

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Early lessons from Haiti in global health

Kevin, M.D. - Medical Weblog — Thu, 19 Jan 2012 00:00:32 +0100

Doctors, nurses, ministers, first-responders and many individuals have interrupted their daily lives for weeks and months at time to lend a helping hand. To show solidarity communities have thrown parties, organized fundraisers and joined with relief organizations. “Text for Haiti” became a popular way to make individual contributions through mobile phone text messages as many leaders urged financial contributions over direct donations of foodstuffs, clothes and other supplies. Early indications show a real boost in this approach to philanthropy, which etymologically means “the love of humanity.”Read the rest of Early lessons from Haiti in global health on KevinMD.com.Category: Conditions | Tags: Infectious disease | No comment (Source: Kevin, M.D. - Medical Weblog)

Sleep deprivation as a medical student

Kevin, M.D. - Medical Weblog — Wed, 18 Jan 2012 20:00:00 +0100

An excerpt from Everything I Learned in Medical School: Besides All the Book Stuff.My body jolts awake to a familiar sound. After a few blind swipes, my blows hit their target, and once again, there is silence. The air in the room is cool and crisp, and every fiber of my being wants me to remain in the welcoming warmth under the covers. It is Saturday morning. On any other Saturday of my life, I would be waking only when my body is ready. But this month is different. My body no longer calls the shots.Read the rest of Sleep deprivation as a medical student on KevinMD.com.Category: Education | Tags: Medical school | 8 comments (Source: Kevin, M.D. - Medical Weblog)

Implementing strategies to encourage patient accountability

Kevin, M.D. - Medical Weblog — Wed, 18 Jan 2012 16:00:17 +0100

While payers and providers are usually in the spotlight when it comes to accountable care, the most successful models will be the ones that place a strong focus on patient accountability. More and more frequently patients are selecting doctors with the best outcomes, asking proactive questions, and taking an active role in their lifestyle and behaviors. Empowering patients with the support and tools to be responsible for and more involved in their own health is critical to improving outcomes and reducing costs as part of any accountable care environment.Read the rest of Implementing strategies to encourage patient accountability on KevinMD.com.Category: Policy | Tags: Health reform, Patients | 2 comments (Source: Kevin, M.D. - Medical Weblog)

USA Today column: How doctor-patient communication can reduce lawsuits

Kevin, M.D. - Medical Weblog — Wed, 18 Jan 2012 14:00:31 +0100

My column was published in this morning’s USA Today: How doctors can reduce medical errors, lawsuits.I discuss the contentious issue of medical malpractice, and explain how doctor-patient communication is key to improving patient safety and reducing lawsuits in the first place: “Doctors also must create and maintain open lines of communication with patients, which is critical to preventing lawsuits in the first place. Doctors have to better explain, and patients better understand, that not all adverse outcomes are due to physician errors. Although the Institute of Medicine’s 1999 seminal report, ‘To Err is Human,’ concluded that medical errors caused up to 100,000 patient deaths a year, 90% of those deaths were attributed to systemwide procedural failures at m...

An oncologist’s deal with fate

Kevin, M.D. - Medical Weblog — Wed, 18 Jan 2012 12:00:20 +0100

Recently, a very dear friend learned that her breast cancer (diagnosed in 2010) had spread to her brain. Despite my many years as an oncologist, having faced questions from my own patients about “Why me?”, “What did I do to deserve this?”—questions I am fully aware have no answer—I found myself asking the same questions, expressing the same anguish: “Why her?”… “This is so unfair”…Read the rest of An oncologist’s deal with fate on KevinMD.com.Category: Physician | Tags: Cancer, Specialist | 1 comment (Source: Kevin, M.D. - Medical Weblog)

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The Only Thing We Have to Fear is Fear Gas

Polite Dissent — Wed, 18 Jan 2012 05:00:00 +0100

I’m sure they weren’t the first villains to use fear inducing drugs, but the Scarecrow and Mr. Fear are undoubtedly the best known villains who make use of them. I thought I’d take a brief opportunity to look back and see when they first started using their concoctions. Scarecrow’s first two appearances were in the Golden Age and, frankly, were not terribly imaginative or exciting. Jonathan Crane was little more than a thug (albeit an over-educated one) who used a scarecrow motif. The only fear he caused was by threatening and shooting victims with a run of the mill pistol. It wasn’t until the Scarecrow’s first Silver Age appearance in Batman #189 that his fear gas was seen, and even then it was fairly underwhelming and only seen in one panel. The gas was just one of several te...

A Two Way Street

In My Humble Opinion — Wed, 18 Jan 2012 01:19:00 +0100

As I approached the room, the nurse stormed out with an exasperated look on her face. Half way to the computer bank, she turned back to warn me:I wouldn't get too close if I were you. She kicked the CNA in the chestI entered the room to find Myrna pinned to the bed by her middle aged son. Russian curses spewed from her mouth intermixed with deeply accented English. Her legs kicked and her arms tried to flail against human flesh. The fatigue on her son's face showed as he let her go and sprung back to stand beside me.Myrna was delirious. Her brain encumbered by plaques and tangles was unable to stave off the ill effects of fever and dehydration. Her usually calm demeanor was replaced by demonic screaming and unwieldy thrashing. Her ninety year old body was suddenly strong and agile.Myrna lo...

A medical student’s first patient encounter

Kevin, M.D. - Medical Weblog — Wed, 18 Jan 2012 00:00:34 +0100

This is an account of my first encounter with an in-patient from a little while back — I have provided only minimal details about the patient to maintain compliance with HIPAA.After a firm handshake with each of us, our preceptor embarked purposefully up two floors to our first in-patient encounter. As we walked, I peeked into the rooms with the door left ajar and wondered what brought each individual to the hospital. I absorbed the environment full of harsh fluorescent lighting and the doppler effect of whirring machinery. As long white coats hurried past, I admired how they could make that swoosh sound of purpose that mine lacked.Read the rest of A medical student’s first patient encounter on KevinMD.com.Category: Education | Tags: Medical school | No comment (Source: Kev...

Monday PSA: Salute to Our Fellow Citizens of Puerto Rico!

Polite Dissent — Tue, 17 Jan 2012 05:00:00 +0100

Puerto Rico, You lovely island Island of tropical breezes Always the pineapples growing Always the coffee blossoms blowing Click on the image for the full ad Interesting how the PSA claims the citizens of Puerto Rico have full rights and privileges of U.S. citizens, right before enumerating which rights they don’t have. Apparently people living on Hawaii lack certain rights as they are not “mainland” citizens. (For the record, this PSA was published several years after Hawaii became a state.) Back when I was a doctor in the Air Force, about a hundred of us were returning to the States after a several month deployment to Haiti. We had an overnight stay in San Juan, Puerto Rico, before flying the rest of the way back to Nevada. As we were getting off the plane, one of the a...

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Hippocrates Or Hypocrite; Let's Make A Deal

In My Humble Opinion — Tue, 17 Jan 2012 00:57:00 +0100

I never said I was perfect. Nor do I feel that even on my best days I approach such a pristine state. Of course there are appearances. My pressed gray lab coat and buttoned down shirt contrast your suit, jeans, or sweat pants. The roles and expectations are set in a frigid stone of familiarity. I will point, prognosticate, and occasionally shame you. You will listen, cower, and shake your head in agreement. Often my voice will be strong and confident. For one who has never smoked, it is easy to rail about the evils of tobacco. No longer having the time or taste for alcohol, convictions will drip convincingly from my lips.But other times, I will squirm and struggle to keep my voice steady. I will tell you that three hundred pounds is too much, yet secretly I lust for the jelly donut waiting...

In Praise Of Mothers

In My Humble Opinion — Mon, 16 Jan 2012 01:09:00 +0100

I cradled my son's miniature body in my hands. Only moments old, he looked up with large glassy eyes. He was so alert, so perfect. I carried him over to the bedside. The obstetrician worked on the afterbirth as my wife waited patiently to hold her child.At the time, it hadn't sunken in yet how much our solitary lives were changing. The nurses swept the baby away for routine testing and measuring. I settled into the chair and reclined for a few minutes before the the first signs of morning.I didn't wake up for hours. Overwhelmed and exhausted, my body stumbled into deep sleep. My dreams were vivid and startling. And they brought back memories locked away and guarded with a key.*Any student rotating through the obstetrics department can tell you the stories. Every academic center has them. A...

Fringe — Episode 8 (Season 4): “Back To Where You’ve Never Been”

Polite Dissent — Sat, 14 Jan 2012 05:00:00 +0100

A good episode of Fringe — one of the best of the season. It occurs to me that the “espionage” episodes of Fringe have been some of the best of the last two seasons, probably because — thanks to the shapeshifters — Fringe can pull of paranoia better than any other show. The Plot: Peter Bishop has decided that he needs to get home to his universe, and in order to do so, he needs to recreate The Machine. He can’t do this without Walter’s help, but Walter still wants nothing to do with him. Peter heads over to talk with Olivia in an attempt to convince her to get Broyles let Peter cross the bridge over into the other universe and talk with Walternate. Instead, Olivia tells Peter where to find Walter’s original dimension-crossing device. She and Peter and ...

Jordan Grumet Interviews Himself

In My Humble Opinion — Fri, 13 Jan 2012 21:16:00 +0100

Q: Thank you for agreeing to this interview. Before we start, I just wanted to say that your much more handsome in person than I expected.A: Ya, I get that alot!Q: Um...OK. Moving on. I notice that you write a new blog post on most days. How are you so prolific?A: I have been writing my whole life. As a child I was greatly impacted by the death of my father, and growing up with a learning disability. Living through these experiences made me think deeply about my surroundings. I learned to search for the profound in every day life.I categorized my thoughts, one by one, in the recesses of my brain. The actually placing pen to paper (hand to keyboard if you will) only occurred later as I developed the requisite vocabulary to do justice to my observations.I try not to think too much about my b...

Quick Radiology Q&A

Polite Dissent — Fri, 13 Jan 2012 05:00:00 +0100

Q: You need to x-ray Superman, but a normal x-ray won’t penetrate his Kryptonian skin. What technique should you utilize? < A: You use a Super XXX-ray, of course! (Source: Polite Dissent)

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Granting rights to a fetus at the cost of the mother

Kevin, M.D. - Medical Weblog — Thu, 12 Jan 2012 16:00:16 +0100

While I, as a physician, would not perform an abortion unless there was an extreme, medical rational, abortion is a choice. It is a woman’s determination of how best to live and manage her life. Also, while the issue of viability is an important medical topic, and while I believe that any life, from the moment of conception, is of supreme value, some women do not. If they are the ones who are pregnant, I do not have a right to impose my value system on them. I do not have the right to require them to sacrifice their values so as to bring a fetus to full term and deliver. I defend, as a basis of moral principle, a person’s right to choose. If after 1 day or 36 weeks, a woman chooses a course for her own body that ultimately leads to the abortion of a fetus, that is her right.Read the re...

For Just About Everything Else

In My Humble Opinion — Thu, 12 Jan 2012 15:40:00 +0100

The sound of squeaking shoes and huffing ventilators filled my ears as I sat to type at the desk in the ICU. I was lucky to steal the only remaining station from a nurse who had left her chair to give report.The nurses were dispersed in groups of two huddling around computers and signing out to each other. The ancient ritual of the changing of shift had modernized by technological necessity. Quiet voices recounted patient histories and recent lab tests. Occasionally my ears would perk up when a nurse placed special emphasis and her voice catapulted above the hum of the crowd.A middle aged woman stood with her back to me with tattered blue scrubs and a stance of authority. She spoke melodically with occasional stops and starts. The young woman receiving her soliloquy was petite and outfitte...

Physician, don’t heal thyself

Kevin, M.D. - Medical Weblog — Thu, 12 Jan 2012 12:00:09 +0100

A couple of months ago, I was dragging a large suitcase that got hung up on a curb, giving my arm and shoulder a good yank. Over the next few days, my shoulder began to ache a bit. Applying the very reasonable ‘tincture of time’ principle, I rested it a bit, hoping that with time the symptoms would resolve. Two months later, I was getting an MRI and anticipating surgery for a torn rotator cuff that would turn me into a disabled dependent, relying on my non-dominant hand and my wife to help me with everyday tasks, including driving and getting into and out of shirts and a bulky shoulder immobilizer for three months. The good news: the MRI showed no tears, so I did not need surgery. The bad news: I was the victim of my own mismanagement, and had a partially frozen shoulder,...

Daredevil, the Heart Rate, Lying — and Pacemakers

Polite Dissent — Thu, 12 Jan 2012 05:00:00 +0100

Daredevil/Matt Murdock believes Hogman to be innocent because there was no change in his heartbeat when he declared his innocence. According to Daredevil lore, Hogman must be telling the truth because Matt can detect lies by hearing the increase in the heart rate (discussed in depth yesterday). However, after he’s been acquitted of the charges, Hogman admits to Murdock that he did indeed kill Flapper. How did he get this lie past Daredevil? I’ll let him explain it: Oops. How could Matt have missed that? Actually, I can’t blame Matt for missing it, because it makes no medical sense. Pacemakers only affect a slow heart rate — they do not affect a rapid heart rate. In other words, pacemakers are used to speed up a heart that is beating too slowly, or one that skips t...

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A concierge or boutique label is discredits retainer medicine

Kevin, M.D. - Medical Weblog — Thu, 12 Jan 2012 00:00:18 +0100

Health care is in crisis. Reimbursements from insurance companies continue to dwindle, while the expenses of running an office continue to rise. Looming cuts in Medicare are only weeks away, and many physicians may stop taking Medicare. If these cuts go into affect, it is possible that primary care physicians could lose up to 50% of their salary. Just recently CNN reported that some doctors are going bankrupt.Read the rest of A concierge or boutique label is discredits retainer medicine on KevinMD.com.Category: Policy | Tags: Health reform, Primary care | 5 comments (Source: Kevin, M.D. - Medical Weblog)

Is it ethical to prescribe a placebo for a patient?

Kevin, M.D. - Medical Weblog — Wed, 11 Jan 2012 20:00:14 +0100

Betty was complaining at an escalating rate. She’d been in her nursing home for four years and wasn’t happy. She kept coming up with new symptoms like aching, fatigue, nervous stomach, tingling, dizziness, etc. Her daughter Nancy was getting daily calls from Betty and the staff at the nursing home. Multiple trips to the doctor for diagnostic tests had ensued: blood counts, liver functions, x-rays, thyroid function, plus many others. All were coming back normal. The neurologist and theumatologist had been unable to come up with anything. Betty was getting a bit forgetful but wanted to be in charge of everything – her finances, health decisions, and daily life.Read the rest of Is it ethical to prescribe a placebo for a patient? on KevinMD.com.Category: Meds | Tags: Medicati...

Motivate physicians through technology

Kevin, M.D. - Medical Weblog — Wed, 11 Jan 2012 16:00:51 +0100

In the modern medical environment of unpaid insurance claims, malpractice lawsuits and rushed patient encounters, many doctors feel unmotivated and unhappy.Could the use of improved healthcare technology make doctors feel motivated and fulfilled again?The hierarchy of needsMotivating others is always difficult task. But according to Dan Heath, author of Made to Stick, all employers need to do to effectively motivate employees is get out of the basement – Maslow’s basement that is.Read the rest of Motivate physicians through technology on KevinMD.com.Category: Physician | Tags: Health IT, Primary care, Specialist | 5 comments (Source: Kevin, M.D. - Medical Weblog)

How can we train more geriatricians?

Kevin, M.D. - Medical Weblog — Wed, 11 Jan 2012 12:00:25 +0100

In 2003, authors Warshaw and Bragg published a paper that reported on three decades of progress in creating a workforce to care for our aging population.They noted that, as of academic year 2001-2002, 120 geriatric medicine fellowships were training 338 fellows. U.S. medical schools had 869 full-time equivalent (FTE) geriatrics faculty members teaching in IM residency programs and FP residency programs. From 1988-2002, more than ten thousand Certificates of Added Qualifications in Geriatrics were awarded. But, as Warshaw and Bragg pointed out, that growth was not producing enough geriatricians to care for the increasing elderly population.Read the rest of How can we train more geriatricians? on KevinMD.com.Category: Physician | Tags: Geriatrics, Primary care | 16 comments (Source: Kevin, M...

Daredevil, the Heart Rate, and Lying

Polite Dissent — Wed, 11 Jan 2012 05:00:00 +0100

From his very first appearance, Daredevil has had the ability to tell if someone is lying by listening to their heartbeat. It’s a skill he’s used numerous times over the years, and continues to use to this very day. Other heroes, such as Supergirl, have demonstrated a similar aptitude (I don’t know if Daredevil was the first to show this skill – you’d have to ask Waid, Busiek or Shutt about that — but he’s certainly used it the most.) But is it true? Does someone’s heartbeat speed up when they’re lying? Daredevil presents as a certainty (“I can hear his pulse rate. It’s speeding up, indicating he’s lying!”), but is it? I have my doubts. Certainly there’s a grain of truth there. When someone is stressed — and lying is generally stressful — their...

Which celebrity diet will you recommend to patients?

Kevin, M.D. - Medical Weblog — Wed, 11 Jan 2012 00:00:45 +0100

Based on a survey conducted by the largest cosmetic surgery provider in the U.K., 76% of British women feel “depressed” about their appearance in January, related to an average weight gain of 11 pounds during December. Inquiries about cosmetic procedures peak on the third Monday in January, dubbed “Fat Day” in the U.K..Most people will, of course, try various diet and exercise programs before resorting to cosmetic or bariatric surgery. And, in case you hadn’t noticed, the annual media blitz is on, complete with nonstop TV commercials and infomercials, magazine covers and celebrity spokespersons touting the diet plan that supposedly helped them lose weight and regain their glam looks.Read the rest of Which celebrity diet will you recommend to patients? on Kevin...

Educate patients when it comes to cancer screening tests

Kevin, M.D. - Medical Weblog — Tue, 10 Jan 2012 20:00:55 +0100

In this study fifty percent of men and women over the age of 75 said they had a test to detect cancer because their doctor recommended it. Clearly for many patients they may not be receiving the most up to date information with which to make an informed decision. With physicians having less and less time to spend with each patient we will need to come up with more appropriate means of educating patients regarding these tests.During the past few years healthcare has become a focal point of discussion with politicians telling us government and insurance companies should not get between a doctor and his patient. While it is true that patients in general trust their physician, the article cited above by Dr. Keith Bellizzi makes it imperative that new educational methods be employed to equi...

The League Of Custodial Healers

In My Humble Opinion — Tue, 10 Jan 2012 13:08:00 +0100

For the first six months at the hospital, Leandro try to avoid The LOCH business. It was a new job and he desperately needed the money to support his wife and baby. But when the League of Custodial Healers approached a second time, he found himself sitting in a small room in the bowels of the facility with a group of serious looking environmental service consultants (or that's what they called themselves).The leader was an elderly gentleman with a thick creole accent. He learned the Voodoo art during his first assignment at Charity hospital in New Orleans. Since then, he had taught thousands of custodial assistants the refined art of patient healing. His eyes became large and hands moved in an animated sweeping motion as he described to the group the ancient technique.For centuries, doctor...

Hawk and Dove #5: Cages and Crossroads

Polite Dissent — Tue, 10 Jan 2012 05:00:00 +0100

I’m not going to beat around the bush here: this was a disappointing issue on many levels, and an underwhelming end to Hawk & Dove’s first storyline. Using an imprisoned Deadman, Condor and Swan escape through a doorway to the “War Realms.” Desperate to find Deadman (in Dove’s case) and Condor (in Hawk’s), the pair contact Madame Xanadu who sends them to Salem (Massachusetts, I presume, though maybe Oregon or Illinois) to squeeze the information out of a demon. What they learn leads them back to a theater in Washington DC that holds an entrance to the War Realms. Once they enter the Realms, Hawk and Dove are confronted by a monstrous Condor who drones on once again about the War Circle and finding and killing all the Avatars of War. He shrugs off an attack by Hawk then g...

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Dignity Transcends

In My Humble Opinion — Mon, 09 Jan 2012 13:32:00 +0100

Leslie was the kind of person who made both men and women's heads turn as she walked down the hallway. Her back arched forward with perfect posture as she waited for me to enter the exam room. She stood, using one hand she parted the blond curls that fell in front of her face, and extended the other towards me in greeting.I sat comfortably at the desk and opened my computer in preparation to start the physical. Leslie swayed back and forth in her chair slowly, and I sensed that something was bothering her. Because she was a new patient, we chatted about her current health and past medical problems. I asked gentle probing questions to tease out the source of her discomfort. Although I had finished all the requisite social and family history, I still found myself searching I opened the cabin...

Captain Nice

Polite Dissent — Mon, 09 Jan 2012 05:00:00 +0100

One of my favorite Christmas gifts this year was a reading copy of the relative obscure comic, Captain Nice #1. The comic, and the TV series it is based on, appealed to me the minute I discovered that it 1) features a pharmaceutically-enhanced super-hero (a particular interest of mine); and 2) stars William Daniels, probably better known — depending on your tastes — as Dr. Craig in St. Elsewhere, the voice of KITT in Knight Rider, or John Adams in 1776. Never heard of Captain Nice? Well then, let me educate you. A product of the era when camp was the name of the super-hero game (at least on TV), Captain Nice lasted half-a-season in 1967. The series featured Carter Nash, a quiet, overly-polite police chemist who still lived at home with his parents. One day, Carter discovered a ...

Reports Of Our Demise

In My Humble Opinion — Sun, 08 Jan 2012 05:03:00 +0100

I shuffled some papers on the desk to avoid looking into the hospital administrator's eyes. His lips curled into a half baked smirk as he talked. I marveled at the tailored suite and the crisp tie.He was a business guy. And it didn't take long to ascertain that he saw me as an asset. I was a widget; an interchangeable part. If one physician wasn't on board, find another. I imagined that somewhere in his slick briefcase there was a list with each physician's name and two columns. Check marks were neatly penciled in to demarcate the doctor's status. Pens were never used because they were not erasable.The majority of the conversation was like a Peanuts cartoon where most of the words sounded like distorted rubbish. Occasionally my ears would perk up as a phrase caught my attention.Blah blah b...

Physicians must advocate for their patients

Kevin, M.D. - Medical Weblog — Sun, 08 Jan 2012 00:00:22 +0100

Editor’s note: Please read Dr. Yang’s entire Red Herring series for background prior to reading this post.***The patient really is fine.She returned to the gastroenterology clinic several times for treatments to widen her esophagus. (It’s a neat procedure: The GI doctors insert a small balloon into the esophagus. They gently inflate the balloon to stretch the stricture a few millimeters. With repeated stretching, the esophagus will remain open.) The patient ate more. She stopped vomiting. Her weight increased.For the sake of flow, I did not include two complications that occurred during the course of events:Medication problems. Although I had written a letter to hospital staff that included the patient’s history and list of medications, the psychiatrists in the first hosp...

Why the physician shortage is a perfect storm

Kevin, M.D. - Medical Weblog — Sat, 07 Jan 2012 20:00:52 +0100

In the past few years, the small rural community where I practice has seen five primary care physicians close their practice. This phenomenon is not an anomaly.Why do doctors close their practices? There are many reasons. Doctors can be broken down into demographics like everyone else.Baby BoomersMost of my boomer patients are not retiring right now. In fact, they are financially hurting and looking for work, or for a second job. So why are virtually all of your Boomer doctors contemplating full or partial retirement, and why are so many following through with it? For many of them, it stems from job satisfaction. Gone are the days of autonomy in their work and fair reimbursement. Professional status has taken a sting, respect from patients has diminished, and administrative...

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The impact of social media on a physician assistant

Kevin, M.D. - Medical Weblog — Sat, 07 Jan 2012 16:00:52 +0100

The impact of social media on medicine could arguably be compared to the impact of the industrial revolution on the human condition. Access to newer means of technology at the turn of the century changed most of society from primarily agricultural, to flourishing manufacturing centres. At the end of the 20th century, with relocation of manufacturing centres and the birth of the digital age, the concept of the American dream continued with the ideal that wealth was accessible to all.Read the rest of The impact of social media on a physician assistant on KevinMD.com.Category: Social media | Tags: Facebook, Twitter | 1 comment (Source: Kevin, M.D. - Medical Weblog)

Physicians do not receive adequate training in nutrition

Kevin, M.D. - Medical Weblog — Sat, 07 Jan 2012 12:00:25 +0100

As an MD, nutritious and healthy cooking and eating are very important to me.We as physicians do not receive adequate training in nutrition, healthy lifestyle choices, and disease prevention in general while in medical school or in residency. On top of that, we work long and difficult hours, often overnight shifts during which we consume processed, fatty foods, void of any nutritious value and we find ourselves suddenly with an extra butt cheek and elevated cholesterol levels and we ask, “how did that happen?”Read the rest of Physicians do not receive adequate training in nutrition on KevinMD.com.Category: Physician | Tags: Medical school, Residency | 2 comments (Source: Kevin, M.D. - Medical Weblog)

The 3 types of residents that medical students will encounter

Kevin, M.D. - Medical Weblog — Sat, 07 Jan 2012 00:00:01 +0100

Every medical student is a bit apprehensive when he/she knows they will be assigned a new resident. The same questions always come up. Will the resident be nice? Will they understand my busy schedule? Will they make me do a ton of scutwork? Will they make me write all of his/her progress notes? And maybe most importantly, will they let me leave early to study for boards or enjoy the occasional night out?After a year and a half of clinical rotations in various hospitals throughout NYC, I have learned that every resident can fit in to one of three general categories.Read the rest of The 3 types of residents that medical students will encounter on KevinMD.com.Category: Education | Tags: Medical school, Residency | 3 comments (Source: Kevin, M.D. - Medical Weblog)

Metamorphosis

In My Humble Opinion — Fri, 06 Jan 2012 21:01:00 +0100

When I heard the phrase, I couldn't quite believe what I was saying. Not only were the words cruel and unforgiving, they were intentional and calculated.I hope you sleep well tonight knowing that you tortured this poor lady in her last moments before death.I could hear the sounds of CPR in the background as the nurse paused to digest what I said. I imagined strong arms pushing against the cracked ribs of a frail, demented, elderly woman whose quality of life had been minimal for the last few years. Even though I spent months trying to convince the family, they had only agreed to the Do Not Resuscitate order a few days prior. I dutifully placed the paperwork in the hospital chart, but apparently it meant nothing till the power of attorney signed the form. Days later, as my patient was codin...

Physicians need to wake up to the importance of a good night’s sleep

Kevin, M.D. - Medical Weblog — Fri, 06 Jan 2012 19:08:22 +0100

Studies in the past have shown that when someone complains about not being able to sleep to a doctor, more often than not, a sleeping pill is prescribed. The reason is that young doctors are taught in training that pharmaceuticals like Zolpidem (Ambien) stimulates GABA receptors in the brain, promoting sleep. There’s essentially no mention that cognitive behavioral therapy for insomnia works just as well for insomnia in the short term, but is superior to drugs in the long term.Read the rest of Physicians need to wake up to the importance of a good night’s sleep on KevinMD.com.Category: Conditions | Tags: Specialist | 4 comments (Source: Kevin, M.D. - Medical Weblog)

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Distance medicine will transform medical practice

Kevin, M.D. - Medical Weblog — Fri, 06 Jan 2012 16:00:49 +0100

Distance medicine technologies can be disruptive in the way physicians and other care givers interact with patients and with each other and can fundamentally change how patients are able to interact with the entire health care system. This is of increasing relevance as medicine gravitates toward chronic illnesses where diagnosis and treatment are complex and require multi-specialist teams. It also has potential to alleviate some of the effects of the growing shortage of professionals.Read the rest of Distance medicine will transform medical practice on KevinMD.com.Category: Tech | Tags: Health IT, Patients | 4 comments (Source: Kevin, M.D. - Medical Weblog)

Do positive emotions increase life satisfaction?

Kevin, M.D. - Medical Weblog — Fri, 06 Jan 2012 12:00:02 +0100

The answer is yes and they do it by building resilience. University of North Carolina professor Barbara Fredrickson has spent the past two decades looking into why we have positive emotions and what we do with them. She even has her own term for her work: positivity.To quote an old commercial, “Why ask ‘why’?” when it comes to positive emotions? Shouldn’t we just enjoy them while they’re around? Sure, but maybe we can find even more about how these emotions benefit us.Read the rest of Do positive emotions increase life satisfaction? on KevinMD.com.Category: Conditions | Tags: Psychiatry | 4 comments (Source: Kevin, M.D. - Medical Weblog)

Designing a friendly patient portal for consumers

Kevin, M.D. - Medical Weblog — Fri, 06 Jan 2012 00:00:21 +0100

More and more providers see the value of providing patient portals. In an attempt to be responsive, EMR vendors are providing patient portals that have some limited capabilities (get lab results, email your doctor and possibly fill out a form requesting an appointment). However, just as the ability to design an airplane cockpit is radically different from a car dashboard, so to is designing an EMR geared towards medical professionals is very different than designing for consumers. A highly trained pilot can deal with the myriad complexities of a cockpit that would overwhelm a typical consumer.[Note: As a KevinMD.com contributor, Dr. Wendy Sue Swanson (aka @SeattleMamaDoc), points out access to portals varies by specialty. She thinks it's a huge missed opportunity that the many systems tu...

Dirty Little Pills

In My Humble Opinion — Thu, 05 Jan 2012 15:47:00 +0100

His hands shook as he unfurled the sack of bottles. He placed them on the examining table one by one. He looked at each label, and then shook his head quietly as if he was reaffirming his own good judgement. Much to his chagrin, I noticed the empty can of Jolt laying in the wastebasket. It hadn't been there a few minutes ago.We talked a few moments before I tackled the supplement issue. I could picture a cigarette dangling from his brown stained fingers. His belly protruded over his waist and struggled to conform to his undersized pants.He was working too hard, eating poorly, and spending little time with his family. He felt too nervous to quite smoking, but too lethargic to stop imbibing energy drinks. His business teetered from complete destruction to overwhelming success on any given da...

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Birds of Prey #4: A Medical Review

Polite Dissent — Thu, 05 Jan 2012 05:00:00 +0100

Birds of Prey #4 “Absolutely Mental” Duane Swierczynski, writer Jesus Saiz, penciler Reading the otherwise excellent Birds of Prey #4, I ran across a common misconception about the AMA (the American Medical Association): The American Medical Association is a no more than a professional organization of physicians — essentially a large powerful lobbying group. They are not a government agency and have no official sanction. The AMA has nothing to do with drugs, or side effects to drugs. They certainly have no power over patients taking drugs — even for unapproved purposes — so would be no concern to Black Canary. Additionally, the AMA has no authority over any doctor’s medical license — they cannot award them or suspend them (not an issue in this comic, b...

A Gift To The Dying

In My Humble Opinion — Wed, 04 Jan 2012 13:59:00 +0100

The photo was more for my benefit then hers. The ninety five year old woman staring at me through the frame was completely blind. She wouldn't be able to enjoy it. Yet she had her young companion bring a camera to the visit. We snapped the shot, and two weeks later she walked in with a beautifully framed picture. It would be our last visit before she died.I studied my own face. Had it been a full decade? My features were softer, my hair thicker. I glowed with an innocence that has long since faded. As I contemplated my growth as a physician, I struggled to remember her name. My face burned with embarrassment and then settled with a heavy sense of guilt.So much had been gained over the last couple of years, and so much lost.*I have watched hundreds of patients die. I start each journey with...

What’s The Point…

Polite Dissent — Wed, 04 Jan 2012 05:00:00 +0100

Of bandaging the head over the costume? scene from Daredevil #164 (by McKenzie, Miller, and Janson) (Source: Polite Dissent)

I wish my patients could see what I see

Kevin, M.D. - Medical Weblog — Wed, 04 Jan 2012 00:00:47 +0100

. I see through a lens sharpened over 30 years of experience. I see the present and often the future. Yes, I’m a fortune teller! Many times, the picture of the future I see is bleak.It’s my job to predict the future and then try to change it. A friend once told me that he believed life was a movie playing on a VCR tape. It was his belief that each of us had a library filled with thousands of tapes and at any time, we could hit the eject button, remove the current and put in a new tape that would play to a different ending.Read the rest of I wish my patients could see what I see on KevinMD.com.Category: Physician | Tags: Patients, Primary care | No comment (Source: Kevin, M.D. - Medical Weblog)

How patients can avoid medical errors

Kevin, M.D. - Medical Weblog — Tue, 03 Jan 2012 20:00:54 +0100

Most of you are quite familiar with the rather astounding facts regarding medical errors. There are many reasons why medical errors occur in healthcare. There are errors in omission, there are errors because of poor communication, there is the ever present risk of human error and perhaps the ever increasing stress on physicians to see more and more patients in less and less time. There are patient specific variables too.Read the rest of How patients can avoid medical errors on KevinMD.com.Category: Patient | Tags: Specialist, Surgery | 1 comment (Source: Kevin, M.D. - Medical Weblog)

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Should healthcare providers hug their patients?

Kevin, M.D. - Medical Weblog — Tue, 03 Jan 2012 16:00:47 +0100

Imagine this scenario. You are a male health care provider and you complete an evaluation of a woman close to your age. You establish good rapport as you always do, she laughs at some of the same jokes you make with all patients, and she expresses delight that you are listening to her problems (unlike those other providers she says she has seen), feels you are helping her, and is looking forward to the next appointment with you. At the end of the visit, she walks up to you and opens her arms to give you a hug. What do you do?Read the rest of Should healthcare providers hug their patients? on KevinMD.com.Category: Physician | Tags: Patients, Primary care | 13 comments (Source: Kevin, M.D. - Medical Weblog)

Place the frustration of cost uncertainty on health insurers

Kevin, M.D. - Medical Weblog — Tue, 03 Jan 2012 13:08:33 +0100

As we enter 2012, many patients will be changing to new insurance plans.And for a few, deductibles will be rising.One thing that’s emphasized in the Affordable Care Act, however, is that preventive services would remain “free.”However, consider this story of a man, who thought he wouldn’t have to pay for his screening colonoscopy, instead was charged over $1,000 for the procedure.Read the rest of Place the frustration of cost uncertainty on health insurers on KevinMD.com.Category: Pho | Tags: gi, Health reform, Patients, Primary care | 6 comments (Source: Kevin, M.D. - Medical Weblog)

Physician online professionalism in social media

Kevin, M.D. - Medical Weblog — Tue, 03 Jan 2012 12:00:18 +0100

Dr. Bryan Vartabedian (on Twitter as @Doctor_V) posted to his blog the narrative of a Grand Rounds presentation he gave in which he focused on the risks and benefits of physicians’ use of social media.The post is long, but provides an overview of Dr. V’s approach to social media. If you review his blog, you will see that this post (and the related presentation) neatly summarizes what Dr. V recommends as best practices to using social media. I think it is a good read … but I do not agree entirely with his recommendations and conclusions.Read the rest of Physician online professionalism in social media on KevinMD.com.Category: Social media | Tags: Facebook, Twitter | 1 comment (Source: Kevin, M.D. - Medical Weblog)

An Officer, A Gentleman

In My Humble Opinion — Tue, 03 Jan 2012 02:06:00 +0100

I wasn't surprised by the sirens. As I pulled over to the side of the road, my speedometer floated down from the fifty mile per hour mark. The first sign of sunlight was inching over the horizon. I was one of the only cars on the road. The officer moved at a glacial pace. I imagined him tapping away at his computer similar to how a physician does as he enters a patients room. The flashing lights reflected in my rear view, blinding me. My feet shook nervously as I waited.It was a hell of a welcome back from vacation. The night before my partner called to tell me that Mrs. Silver was in the ICU. As I listened to his report, I couldn't help but feel guilty.Mrs. Silver was a charming eighty five year old with her share of chronic medical conditions. For some reason, I doted over her like she w...

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A portfolio of watercolors remind me of why anatomy is fascinating

Kevin, M.D. - Medical Weblog — Tue, 03 Jan 2012 00:00:05 +0100

Gross anatomy is exactly as it sounds. You learn anatomy, and smell gross afterwards. You spend 6-8 hours the day before studying and preparing for a 2-hour dissection the next day. When an exam approaches, you double the 6-8 hours each day and sometimes forget who you, your friends, and family even are. Not to mention the perpetual question, “Why am I doing this?”Read the rest of A portfolio of watercolors remind me of why anatomy is fascinating on KevinMD.com.Category: Education | Tags: Medical school | No comment (Source: Kevin, M.D. - Medical Weblog)

Advice for doctors who want to change careers

Kevin, M.D. - Medical Weblog — Mon, 02 Jan 2012 20:00:15 +0100

An interview by MedCrunch with Ashley Wendel, MA, CMC, PDC, a Physician Executive Coach and Healthcare Organization Consultant dedicated to helping physicians create meaningful and sustainable change that positively impacts their professional lives.MC: Thank you so much Ashley for your time!Ashley: Thank you, I’m really happy to share anything I can.MC: You are a physician coach, what are the most common problems you encounter in your practice?Ashley: Well, for many of the physicians who find me, their biggest issue is that they are feeling somewhat lost in their professional lives. We hear a lot about the churn and uncertainty in healthcare right now (certainly in the U.S.), but this is more personal. I often talk to docs who feel unfulfilled in daily clinical work and they know that th...

I told a man that he was dying

Kevin, M.D. - Medical Weblog — Mon, 02 Jan 2012 16:00:30 +0100

Two weeks ago I told a man that he was dying. We sat together in the mid afternoon haze. Puffs of snow meandered by the hospital window and wended their way down to the ground. The sun was lost behind winter’s never ending clouds.The tempo of my voice was steady, lacking variation in tenor and pitch. I clung to my lab coat as if I was floating outside the window and being blasted by the inclement conditions.Read the rest of I told a man that he was dying on KevinMD.com.Category: Physician | Tags: Patients, Primary care | 4 comments (Source: Kevin, M.D. - Medical Weblog)

The phenomenon of concussions in professional sport

Kevin, M.D. - Medical Weblog — Mon, 02 Jan 2012 12:00:13 +0100

Recently, the Philadelphia Flyers announced that all star defensive stalwart Chris Pronger has been shut down for the rest of the NHL season with what the team has described as “post-concussive syndrome”. Pronger joins Pittsburgh Penguin superstar Sidney Crosby, teammate and NHL leading scorer Claude Giroux, and Ottawa Senator forward and NHL second leading scorer Milan Michalek out of action due to concussion. To list every star player currently on the shelf would fill several blogs. The NHL may well call these an unfortunate coincidence. I call it the tipping point beyond which the NHL will take effective action to prevent further carnage or will risk losing a multitude of fans - including this die-hard Leaf fan.Read the rest of The phenomenon of concussions in pro...

MedWorm: Family Physicians

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