There is a lot of focus on what elders with dementia can’t do. But what about more discussion of what they can do?
When you see a patient with dementia, how do you help family members maintain meaningful interactions with their loved ones? I am sad to admit that I don’t do this nearly as well as I should. After all, this is not the type of thing we are taught …
Activities for family members with dementia
by Michael Smith
When cesarean section rates are lower than expected, adverse maternal or neonatal outcomes are higher, researchers said.
But the converse isn’t true — higher-than-expected C-section rates aren’t associated with a protective effect, according to Sindhu Srinivas, MD, of the University of Pennsylvania, and colleagues.
The finding comes from an attempt to see if the risk-adjusted C-section rate can be used as a marker for the quality of obstetric care, Srinivas …
C-section rates as a marker for obstetric care quality
I have spent most of the past 2 weeks on the road – first at ACP and this week at SGIM. I have talked with many internists, but several conversations have contributed to writing this post. Each of several leaders contributed to these ideas, but I will keep them anonymous so the innocent are protected.
Here are the main assumptions:
1. Internists by training excel in the care of complexity
2. Pursuing the …
Outpatient internal medicine needs a consultant track
Beau Biden, son of Vice President Joe Biden, suffered a stroke today.
He is 41-years old, and is expected to make a full recovery according to the medical director of the Center for Heart and Vascular Surgery at Christiana Care Health System:
Biden has what the doctors “believe to be a mild stroke,” according to Gardner. “[He is] “fully alert, …
Much like many other news items, I came upon the one about the proposed name change for Physician Assistants quite by accident: it came to me as an e-mail notification of a new topic being discussed on one of the physician only discussion boards that I am a part of. Apparently, after 40+ years of the profession’s existence, there is a grassroots effort afoot to upgrade the name, and presumably …
Physician assistant name change rubs doctors the wrong way
An audiobook except from Intern: A Doctor’s Initiation, now available for download on iTunes.
Intern: A Doctor’s Initiation — Click to play audioclip
by Sandeep Jauhar, MD
Chapter one
I had been an intern less than an hour, and already I was running late. The sloping footpath leading up to the hospital was paved with gray cobblestones. My feet ached as my oversize leather …
Intern: A Doctor’s Initiation, an audiobook excerpt
by Joyce Frieden
In one of those “important but little noticed” announcements that government officials are prone to put out, the Department of Health and Human Services recently let the world know – via the Federal Register — that it has created an Office of Consumer Information and Insurance Oversight to assist with implementation of the newly passed health insurance reform law.
This new office has four divisions. Here are a …
Health insurance will be reformed by a little known department
The heresy of one age becomes the orthodoxy of the next.
-Helen Keller
The patient returned to my clinic several years after her original thyroid cancer surgery. “The cancer blood test never went completely back to zero,” she told me. “We knew there was cancer in there somewhere. Finally, the new ultrasound machine found it! I guess it is time for more surgery!”
I guess. In my patient’s situation, the latest high resolution diagnostic …
Treating cancer needs to be an individual patient decision
A guest column by the American Board of Internal Medicine, exclusive to KevinMD.com.
Imagine a sub-par doctor at a vibrant health system with care delivered and coordinated by skilled teams, using robust EHRs and other vital supports for physicians and patients. Now imagine an extremely talented, knowledgeable doctor at an underfunded community clinic. This clinic has no real computer system, …
ABIM: Quality medical care needs more than strong systems
My friend, the Buckeye Surgeon, has resisted reforms in medical residency training programs, that have eased some of the inhumane exhaustion on young interns and residents.
I have a different view on the subject. This issue generates spirited debate in the blogosphere and in teaching hospitals across the country.
Not all medical education reforms, however, provoke controversy. I learned recently from an Ohio medical student that they are now being taught …
Transparent medical pricing lowers health costs
A patient apologized to me for asking so many questions. There is no need to apologize, I said to the patient; it’s wonderful that you have so many questions concerning your health care. I mentioned to her that she is an “empowered and engaged patient,” and that is a good thing.
It’s no secret that health consumers are turning to the internet for health information.
In a recent article from MediaPost News, …
Social media starts the patient dialogue with doctors and nurses
by John Gever
Up to one-third of children with febrile bacterial infections failed to receive antibiotics in a large emergency department, while 20% of youngsters without such infections received antibiotics unnecessarily, Australian researchers said.
A computer algorithm based on standard test results could do a better job of assigning feverish children to the correct treatment sooner, Jonathan C. Craig, MBChB, PhD, of the University of Sydney, and colleagues reported online in BMJ.
Although …
Children with fever may not receive antibiotics in the ER
One of the biggest emergency room problems is contacting patients after they leave.
Patients sometimes leave false contact information — which makes it difficult for the emergency room staff should problems arise after the visit.
The issue was illustrated in a piece from msnbc.com. Many times, results like blood cultures or x-ray findings take time to return. And if there’s something that needs to be acted upon, contacting the …
False patient contact information worsens emergency care
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An excerpt from How to Survive a Medical Malpractice Lawsuit: The Physician’s Roadmap for Success.
by Ilene R. Brenner, MD
The most important part of your case is upon you: the pretrial deposition. If you do a poor job, you can ruin your case and make a defensible lawsuit become indefensible.
So what is a deposition? It is the sworn testimony of a witness taken before trial, in a location …
Medical malpractice deposition survival tips for doctors
by Chris Emery
Acne patients who received online treatment from dermatologists had similar outcomes to patients who were treated in the doctor’s office, a new study found.
Patients who participated in “e-visits” with dermatologists experienced similar reductions in inflammatory lesions as those who had office visits, Alice J. Watson, MBChB, MRCP, MPH, of the Center for Connected Health in Boston, and colleagues wrote in the report, published online April 19 in the …
Online dermatology visits for acne can be effective
Hypothetical case scenario
27-year old female presents to the office with a complaint of irregular periods. Menarche was at age 15, and periods occur about 1-2 times a year. Breast development began at age 9, followed shortly by axillary & pubic hair. Growth spurt was at age 13. She’s been trying to get pregnant for the last one year now, and has never been seen before for her irregular periods.
On physical …
How PCOS can be diagnosed and treated in primary care
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 21-year-old man is evaluated for painful sores in his mouth. Episodes of these sores have occurred two to three times yearly since he was 16 years old, and he believes they are associated with stress. They usually appear on the inside of his mouth as a single, round, painful lesion, lasting for 5 …
MKSAP: A 21-year-old man is evaluated for painful mouth sores
by David Edelman, MD
Heartburn and acid reflux disease are common problems affecting women of all ages. The problem develops when acid in the stomach backs up into the esophagus. There is a muscle known as the diaphragm that separates the chest from the abdominal cavity. When you eat or drink, the food goes from the mouth down the esophagus, through the diaphragm and into the stomach. …
Hiatal hernia in women can present with heartburn
by John Gever
“Jersey Shore” wannabes beware: some people crave the indoor tanning experience so much that it qualifies as an addiction, researchers said.
Among 229 college students completing a survey, 39.3% met DSM-IV criteria for addiction, reported Catherine E. Mosher, PhD, of Memorial Sloan-Kettering Cancer Center in New York City, and Sharon Danoff-Burg, PhD, of the State University of New York at Albany, in the April issue of Archives of Dermatology.
Participants …
Indoor tanning can be an addictive behavior
He is 93 and has numerous medical problems, most of which involved aging blood vessels, as well as multiple orthopedic issues, including compression fractures and diffuse arthritis. The bony issues have resulted in a severely compromised mobility of late.
Despite ongoing treatment with both aspirin and clopidogrel, he presents after numerous hours of focal neurologic symptoms. A CT scan shows no evidence of bleeding and the diagnosis is a major stroke …
Dying of old age in the era of modern medicine
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