Reader Takes is a regular feature where selected op-ed style pieces from the audience at Kevin, M.D. will be published on the blog.

Posts are between 500 and 600 words in length, and can argue any opinion related to medicine and health care.

Original articles that are provocative, well-written, free of grammatical or spelling errors, and generally follow these guidelines are preferred.

Once a reader take is published, it will remain at the top of the blog above the fold for one day. A link to the author's book, blog, or website will be included.

Kevin, M.D. receives in excess of 10,000 visits daily, and is regularly read by major media outlets.

The piece will remain exclusive to Kevin, M.D. and may not be republished elsewhere.

If you are interested in submitting a take for consideration, please contact me.

Primary care doctors, here's a procedure we should make our own.

Maternal leaves are more harshly felt in surgical residencies and sub-specialty training, simply because these programs are smaller. The team feels an extended leave more acutely, as compared to a larger internal medicine program.

It is interesting to read that this continues even after a surgeon becomes an attending:

Interestingly, several of my female friends who have entered small private practices after training also experience similar pressures as childbearing would impact their partners' lives significantly.

Even as female students comprise more than 50 percent of medical students and doctors in training, surgery remains male-dominated.

It is no surprise that it is amongst the slowest fields to appropriately deal with maternity leave.

Continuing the theme of economic incentives, the WSJ's Ben Brewer writes about how physicians who properly treat chronic diseases are placed in a tremendous financial disadvantage:

My office has invested heavily in an electronic medical record to track and monitor chronic conditions with little financial return . . .

. . . Managing chronic diseases between visits is uncompensated work for doctors, yet the need for such care is huge.

The current financial disincentives to providing proper care for chronic disease are daunting, and the waste created by ignoring the problem is growing as the population ages.

The proposed "medical home" model attempts to correct this, by paying doctors to spend time with patients and track disease.

However, we're a long ways off from this being widely implemented.

Poorly managed chronic diseases blossom into expensive hospital stays. The longer we hold off on reforming the physician payment system, the more we'll pay for it in the future.

Not much is known on her views, but it's safe to assume she will endorse market-based reforms.

For a glimpse of what's to come, David Catron writes about a bill she introduced in Alaska, repealing the state's Certificate of Need statue. This pleases free market advocates, as this will encourage competition within the healthcare marketplace.

Michael Tanner feels the same way.

The family's expectation of prognosis is sometimes incongruent with reality. Especially with older patients in the nursing home:

It still amazes me how some families are so in tune with reality and some have no clue about reality. 87 year olds with multiple chronic medical conditions do not start dialysis and get better, and go home. They do not live out their lives in painless bliss. They suffer. Their years of smoking, immobility, obesity, alcohol abuse and noncompliance catch up. And now they live with the consequences. Some families refuse to accept reality. Some have never been explained the current reality. Some bounce from doctor to doctor with ignorance, believing there is an end of the tunnel.

Educating families and reining in expectations can help in decreasing the amount of expensive, futile care.

Dr. Rob nails it. He has taken the fee-for-service system given to him and makes the most of it.

We in primary care have an access issue. People wait months for an appointment. The demand is clearly there.

Doctors who don't find innovative ways of increasing their access are, i) causing patients to be further unsatisfied with their care, and ii) leaving proverbial chips on the table.

Medicine is indeed a business. Primary care physicians who don't treat it as such won't survive in the current environment.

Just like any other professional.

Richard Reece points to the dermatology, which is rapidly progressing into a two-tier field.

There are the third-party payer patients, who have long wait times and are often seen by physician extenders; and the cash-only cosmetic patients, who are seen instantly in luxurious settings.

So, if you want the medical profession to adopt electronic records, practice evidence-based medicine or raise the primary care numbers, provide the economic incentives to do so.

Dr. A hosts flight nurse Emily McGee tonight.

Here's how to listen.

Will this dissuade the anti-vaccine fanatics? Probably not, as their minds are made up.

But for those who are on the fence, this is more evidence that vaccines are safe.

As Charlie Baker recovers from his foot injury, he talks about the difficulties of following medical orders to the letter.

Pay for performance will become widespread in the near future. How to deal with patients who are unwilling, or unable, to listen to physician orders will be a more relevant issue.

For instance, there is a subset of diabetic patients who are unwilling to take lipid-lowering therapy to treat their elevated cholesterol numbers. Should the doctor be penalized?

I can see physicians simply firing patients who do not comply with treatment recommendations, which will be one of the unintended consequences of the pay for performance movement.

A combination of Botox and fillers would help, says a group of plastic surgeons and dermatologists.

Some speculate that he's already received cosmetic laser therapy.

Information officers are paying physicians $120 per hour to participate in the implementation of electronic medical records.

That's admirable, first for including essential physician input on the planning committee, and second, for recognizing the value of a doctor's time.

(via The Medical Quack)

The truth was out there recently, when David Duchovny entered rehab for sex addiction.

What exactly is that, and how is it treated?

Rural Doctor writes about ideal traits that can apply to every physician.

I concur with "unruffleability". Performing well under pressure or unexpected circumstances is essential. This is why physicians who are booksmart do not necessarily make the best doctors.

This is especially true during training. A person's true color only comes out under the harsh circumstances that residency provides.

The bottleneck appears to be lack of faculty to teach new nurses. Predictably, the reason comes down to money:

Why would a master's-educated nurse accept a job as a professor at a local college or regional university for $60,000 yearly when (s)he can potentially earn $80,000 to $100,000+ per year as a…[clinical practice nurse in] a large healthcare network?

Many thanks to Shane Pike, who helped with the new template for my blog.

He's offering an Extreme Blog Makeover for September's top 5 contributers over at Healthcare Today, which includes blog migration, a new template, one-year of free hosting, and consultation with Shane.

For those familiar with blog tweaking, an offer like this can easily run into the thousands of dollars. It's a great opportunity for those who want to bring their blog to the next level.

I haven't tried it yet, but will soon. I've read that its Java and ASP processing is unsurpassed, in anticipation of Google re-inventing the operating system that will work solely through its browser.

How does this apply to electronic medical records? If Google Chrome takes off, Canadian EMR suggests that the next generation of EMRs will be ASP-based and will make Windows-based systems obsolete.

This makes some sense, especially with the emergence of internet-based PHRs like Google Health and Microsoft HealthVault.

If an EMR is internet-based, it needs to work 100% of the time. I don't think we're quite there yet, since even basic applications like Google Mail and Yahoo Mail crash and become unavailable from time to time.

Is strong.

Must-read piece from Maggie Mahar, explaining the implications and causes of the primary care shortage. Many points are familiar to readers of this blog, but here are a few that I'd like to underline.

i) Some physicians (invariably naive academics) feel that the lack of medical student exposure to practicing primary care doctors discourages them from entering the field.

That is absurd.

An upcoming study suggests exactly the opposite - the more students are exposed to primary care, the less likely they are to become generalists.

No wonder. What do you think happens when primary care physicians, frustrated with the system, project their anger on impressionable students.

ii) It is pointed out that primary care physicians in Denmark are compensated on par with or higher than specialists.

It that happened here, the primary care shortage will be solved almost instantly. However, the chances of this happening is zero.

For the record, I believe that the extra training specialists receive warrants a higher salary than generalist doctors.

It's the unreasonable disparity that needs to be fixed.

iii) I encourage you to follow Maggie's link to The Doctor Can't See You Now, which explains the situation nicely.

The medical home has been hailed as the savior for primary care. Specialists have yet to hop on board, likely because of the threat the increased payments have on their salaries.

Emergency physicians aren't that enthused either. They seem pretty bitter with EMTALA, and want primary care to take on all comers as well:

According to the ACEP, primary care sites should promise to continue to offer medical home services even if a patient loses their insurance (which would help keep the uninsured away from emergency rooms by making the primary care physicians provide a service for free?).

One point I do agree with. Small practices are going to have trouble meeting the criteria for the medical home. Most can't even get a functional EMR running, yet alone meet the enhanced requirements the medical home demands.

The public may have little sympathy for "overpaid" physicians and some think they deserve a pay cut.

That's fine.

But how does that really solve the reality of the situation?

Medical students graduate with a mortgage-sized school debt see specialist salaries several times more than their primary care counterparts. Predictably, this leads to a specialist boom.

Motivated undergrads read about declining physician salaries in the face of a worsening practice environment, and subsequently steer clear of medicine:

The simple fact is that fewer and fewer people will apply for medical schools and enter a field where the price for education is high, the process is incredibly long and difficult, and when you get out you get the privilege of working excessive hours with many all-nighters, high stress, high liability, personal health risks, expensive insurance costs, and diminishing compensation!

The opinion or fact that American physicians are more highly compensated than their European counterparts is completely irrelevant to the situation at hand.

People can criticize "high" physician salaries all they want, but how does that help the new Medicare patient desperately trying to find a primary care physician?

A man works at a law firm by day, and takes one a night a week to volunteer as an EMT. As he puts it, "At work and at home, no situation rivals the pressure of emergency care."

Nicely put. I would propose that all the policy wonks shadow a shift in the emergency room.

Perhaps some of their ideas may change after experiencing first-hand the potential impact of their decisions.

Is it really too much to ask?

Emergiblog is upset that nurses are being restricted in starting the initial workup for chest pain and obvious fractures.

I agree that this is ridiculous, especially in the emergency setting where every second counts.

Every nurse order eventually has to be signed by a physician. With overzealous regulation by JCAHO and hospital administrations, doctors are often looking over their shoulder, fearing the repercussions of any mistake.

This leads them to be overly cautious in seemingly routine situations.

A Chronic Dose hosts the weekly best of the medical blogosphere.

Dr. Secretwave reflects on the increasing requests for work notes, and wonders if we as a society are caving in the laziness. Is it a consequence of left-leaning thinking?

The problem with conservative political theory is that it has no good answer for misfortune. Something goes wrong in a truly conservative system, and you’re dead. However, liberal political theory has an Achilles heel as well. In a truly liberal system, there is no answer for laziness. If people don’t want to work but devise a reasonable story about the misfortune in their lives, a socialist system can do nothing but cave in and give them money.

Bruce Campbell on the importance of the follow-up appointment, especially if you have a history of cancer.

A study from the BMJ suggests that pharmaceutical companies are simply wasting their time and money on drug ads.

One problem with the study was that it was done in Canada, where physician prescribing patterns are markedly different.

I'm not sure you can apply results based on Canadian patients and doctors to the United States.

HIPAA has been harder to enforce in the case of celebrities (especially at some California hospitals). The tabloids blatantly pay for information, and the urge to snoop is often too great.

No excuse though. Celebrities deserve the same right to privacy as the rest of us, and any medical personnel who gets caught should justifiably be fired.

Drunk doctors joke about a patient's death during a hospital staff meeting. What's going on down in Australia?

The Gone Wild series continues.

As if the firestorm over blogging about patients isn't hot enough, here are a couple of takes talking about those who Twitter about patients at work.

Although blogs and tweets about patients are often the most interesting, the privacy issues are the ones major media will focus on, and often stir up the most controversy. Don't assume that there is any anonymity on the web.

The surest way to stay out of trouble is to write as if your boss is reading your posts.

The whole issue of tort reform is pretty much DOA now. If it couldn't be done in the past 8 years, it's certainly not going to happen with the next administration. That being said, here's are McCain and Obama's take on the issue.

Rather than caps, physicians should be pushing for more expedient compensation to injured patients. No-fault malpractice would be an ideal solution, providing quicker payments for patients and removing the adversarial nature discouraging physicians to admit their mistakes.

Interesting case of a boy who kept on growing. Endocrinologists treated him with testosterone to force an early puberty, which can cause the growth plates on the bones to close themselves off.