| KevinMD.com

Choose your primary care physician with particular care

Physician

December 6, 2010

I told a friend what I did recently to get in to see a dermatologist and she was shocked.

“You wrote a letter asking her to take you as patient?” “Wow!” “Yes,” I admitted. “I’d called her office for an appointment; she wasn’t taking new patients; I needed to resort to an over-the-top approach.”

You see, I’d researched her (ok, I Googled her) and after reading her background, schooling, and patient reviews, …

Medicare rates will be influenced by comparative effectiveness

Bob Doherty

Health Policy

December 5, 2010

From its inception, Medicare has been agnostic about the effectiveness of different treatments when it sets payment rates. Once a treatment is found to be “reasonable and necessary,” Medicare establishes a payment rate that takes into account complexity and other “inputs” that go into delivering the service. But it is prohibited by law from varying payments based on how well an intervention works.

This would change under a “dynamic pricing” approach …

Redundant tests waste health care dollars

Doctor Grumpy, MD

Conditions and Diseases

December 5, 2010

B12.

Sounds simple, huh?

1 letter, 2 numbers. One of the B vitamins. It’s important in a number of body functions, particularly the nervous system and blood cell production. It’s in pretty much all meats and vegetables, and multivitamins you can buy.

To me, it’s also a good example of what’s wrong in health care.

Let’s take Mrs. Olde.

She goes to her internist, and is complaining of feeling weak and tired. So he checks …

Priapism is indicative of spinal cord injury in trauma

StorytellERdoc, MD

Conditions and Diseases

December 4, 2010

It had been a high-speed motor-vehicle accident. One car. A twenty-something male driver without passengers. No seat belt. And now, this same driver had no movement from his waist down and no sensations below his mid-abdomen.

According to bystanders, he had been driving his sedan dangerously fast, some estimates of nearly 100 m.p.h., before losing control. The car veered off the roadway to the right, flipping mid-air before smacking head-on into …

Sleep-breathing, your immune system, and colds

Steven Y. Park, MD

Conditions and Diseases

December 4, 2010

Have you ever wondered by some people never get colds? Why do other people get colds at the drop of a sneeze?

An opinion piece recently published in the New York Times explains away a common myth—that you have to strengthen your immune system to fight a cold. His argument is that your symptoms of a cold are actually your immune system over-reacting to harmless viruses. This is …

Why the Pre-Existing Condition Insurance Plan (PCIP) fails

Kevin

Health Policy

December 4, 2010

by Ray Carlson

As we all know, this past March Congress passed and the President signed The Affordable Care Act. One component of the new legislation was the creation of a program called the Pre-Existing Condition Insurance Plan (PCIP). This is a federally funded high risk pool for state residents who – having been denied individual insurance coverage within the past 12 months for a pre-existing condition – would now, theoretically, …

Waste at hospitals in developing countries

Yann Meunier, MD

Physician

December 3, 2010

Year: 1993

Setting: Mendi Hospital, Southern Highlands province, Papua New Guinea
Position: Chief medical officer for Chevron

Chevron is contributing to the budget of Mendi Hospital in the capital city of the Southern Highlands province. Each year, the hospital director sends a financial request to the company’s medical department, and this is my first time to review and approve it. Curious about how the money will be used, I phone the director to …

Appendicitis in children and radiation exposure from CT scans

Skeptical Scalpel, MD

Conditions and Diseases

December 3, 2010

Recently, medical writer and pediatrician Perri Klass wrote in the New York Times about evolving issues regarding the diagnosis of appendicitis in children, which are also applicable to adults. There is well-documented concern regarding the excessive radiation exposure associated with CT scans.

For example, a recent paper reported that a single abdominal CT scan with contrast delivers a radiation dose equal to undergoing more than 200 regular …

How the pharmaceutical industry changed psychiatry

Jan Henderson, PhD

Medications

December 3, 2010

What’s happened to psychiatry over the last 15 to 20 years? That’s a big subject, discussed in many recent and excellent books. One of those books is by Daniel Carlat, author of Unhinged: The Trouble with Psychiatry – A Doctor’s Revelations about a Profession in Crisis.

One of the problems Carlat readily acknowledges is that psychiatry is excessively focused on psychopharmaceuticals at the …

Educate the patient about their disease and discharge plan

Lyle Fettig, MD

Physician

December 3, 2010

Have you ever discharged a patient from the hospital and had a gnawing feeling that maybe you could have done more to educate the patient about their disease, medications, and plan of care?

Probably so. A recent survey published in the Archives of Internal Medicine tells us that this feeling is based in reality (I’m guessing that you already knew this) and that you are not alone.

The …

A better system is needed to migrate to electronic health records

Steven Reznick, MD

Health Technology

December 2, 2010

Five years ago my associate and I invested sixty thousand dollars to purchase and set up an electronic health record system and eliminate extensive paper use.

We researched all available systems and decided upon MediNotes because it was a large company with an excellent record of service and their system met all the national requirements for certification. We worked through our local computer vendor’s family …

Learning from the Massachusetts experiment in universal coverage

Joseph Paduda

Health Policy

December 2, 2010

We’re learning a lot from Massachusetts’ experiment in universal coverage – and some of the lessons are rather enlightening.

According to Bestwire, Lora Pellegrini, president of the Massachusetts Association of Health Plans, said something along the lines of “That’s the problem with the new U.S. health care reform law … it offers millions of uninsured Americans access to health insurance but doesn’t address underlying medical costs, which are contributing to costly …

Integration and virtual accountable care organizations in health reform

Joe Flower

Health Policy

December 2, 2010

They are coming in fast under the radar, out of peripheral vision, in the magician’s other hand—and they will change everything. New ideas, surprising networks, stealth business models that may change health care profoundly, are bubbling up in pilot programs, experiments and full-on corporate transformations. There is something here that does not yet have a name, that no one is yet calling a movement, that no one is yet seeing …

Lifestyle matters for specialties that want to survive

Kevin Pho, MD

KevinMD

December 2, 2010

Medical students today consider lifestyle an essential criteria when choosing a specialty.

It’s become a cliche that most are looking towards the ROAD (radiology, ophthalmology, anesthesiology and dermatology) to happiness.

There’s been some recent media attention at how women are lured to specialties that offer a greater balance between their family lifestyle and professional demands.

Claudia Golden, a Harvard economics professor, recently noted that,

high-paying careers that offer more help in balancing work …

Read more…

Lifestyle matters for specialties that want to survive

Creativity and ADHD may share some common genetic vulnerabilities

Kevin

Conditions and Diseases

December 2, 2010

by Shelley Carson, PhD

Both highly creative individuals and ADHD-diagnosed individuals often report feeling out of place, like a square peg in a round hole.

(In fact, in my creativity research questionnaires I actually ask the question “Do you often feel like a square peg in a round hole?” Participants who score high on the Creative …

MKSAP: 70-year-old woman with hypothyroidism and a fractured hip

mksap

Conditions and Diseases

December 2, 2010

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 70-year-old woman with hypothyroidism fell and fractured her hip. During preoperative evaluation for hip fracture repair, she mentions recent mild fatigue, which has not significantly limited performance of her daily activities, and ongoing right upper-quadrant abdominal pain after eating. She takes levothyroxine, 0.075 …

A neurosurgical resident’s typical day

Colin Son, MD

Medical Education

December 1, 2010

I’ve made some fairly outrageous claims about the workload of a neurosurgical resident recently. Seems like a reasonable time to lay out exactly what a day on call can be like for me and my fellow residents.

To be fair an average experience may be hard to articulate. Different rotations and different days yield different … adventures. Right now I’m on a service that could hardly be called grueling, but I …

Read more…

A neurosurgical resident’s typical day

Conspiracies against vaccines: Blame the media

Jennifer Gunter, MD

Conditions and Diseases

December 1, 2010

How did the idea that vaccines are dangerous, toxin-filled CDC experiments metastasize so quickly from the fringe to the mainstream?

Keep in mind that not only have vaccines been scientifically proven to be safe, but that some of the arguments against vaccines are so scientifically incredulous they are the equivalent of saying there is a UFO sitting in Central Park right now.

So let’s begin at the beginning. In 1998 Andrew Wakefield …

A community of healthy seniors inspires this physician

Melanie Lane, MD

Patient

December 1, 2010

I have been genuinely blessed by my career in medicine.

When I started medical school, I was living through a very rocky time, dealing with severe, at times suicidal depression. I was working through an outpatient alcohol and drug rehabilitation program, and I was about 40 pounds overweight. I had grown up with a very negative and fatalistic attitude toward life which resulted in chronic misery and a number of personal …

Energy drinks are unregulated and can be dangerous

Linda Pourmassina, MD

Medications

December 1, 2010

With the darker days upon us, it may be tempting to try to fight fatigue with energy drinks.

Ever wonder what’s really in them and what they might be doing to you? I just came across an article in the November issue of the Mayo Clinic Proceedings that broke it down nicely.

Here’s the summary.

Caffeine. No brainer. Interestingly, it is on the list of substances banned by the International Olympic Committee (which is …