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ACP: Challenges for a competency-based framework for residency training

Medical Education

April 19, 2010

A guest column by the American College of Physicians, exclusive to KevinMD.com.

by Steven Weinberger, MD, FACP

Since the Accreditation Council for Graduate Medical Education (ACGME) instituted its Outcome Project approximately 10 years ago, residency training programs have progressively focused on how well their residents have acquired knowledge, skills and attitudes in six broad domains. These “general competencies” include medical knowledge, patient …

President Obama should have had colonoscopy without sedation

Michael Kirsch, MD

Conditions and Diseases

April 19, 2010

by Michael Kirsch, MD

Does anyone out there know why President Obama underwent a virtual ‘colonscopy’ (VC) instead of a conventional colonoscopy earlier this year?

In my gastroenterology practice, we do not offer colon cancer screening to 48-year-old individuals, unless special risk factors are present. Of course, maintaining the president’s health is in the national interest, so I understand why professional screening guidelines might not apply to him. For …

Primary care needs better physical exam skills

Kevin

Physician

April 19, 2010

by Joseph Biundo, MD

Not long ago, primary care physician Rob Lamberts did a blog post about the economics of seeing Medicare and Medicaid patients, stating that doing so was bad business. While I agree with most of his points, I have a quarrel with his statement that primary care physicians keep down the cost of care by keeping people healthy, away from specialists, and out of the hospital.

That may be …

Health reform winners and losers, and how it affects doctors

Richard Reece, MD

Health Policy

April 19, 2010

I congratulate President Obama and the Democrats on their historic health reform achievement.

Will this bill be able to win approval as it runs the parliamentary gauntlet? Is it an act of political suicide that will become manifest in November? Will it bankrupt the country because of lack of cost controls?

Regardless of where one stands, the bill is a political act of vast ambition and colossal risk.

Now may be a good …

Dabigatran is superior to warfarin, but at what cost?

John Mandrola, MD

Medications

April 18, 2010

Dysrhythmias like atrial fibrillation (AF), more often than not, require medical therapy.

The dreaded blood thinner, warfarin (Coumadin) comes to the fore often. In aggregate, I have likely spent months of my life discussing the risks and benefits of this much maligned drug. Common rat poison is made from the same ingredients as warfarin — only rats keep eating it and die days later of bleeding, while humans have the blood …

Patient appointment scheduling needs flexibility

Rosemarie Nelson

Physician

April 18, 2010

The daily appointment schedule is often a sore spot in everyone’s day:

* Patients aren’t completely satisfied because they can’t get an appointment when they want one.
* Physicians feel they’ve lost control of their day when the flow is not running smoothly and they fall behind and patients complain.
* Nurses and medical assistants are frustrated at the hodgepodge of types of appointments that get scheduled seemingly without any consideration for timing …

Prison affects how children relate to their parents

Jeffrey Knuppel, MD

Conditions and Diseases

April 18, 2010

It’s an unfortunate scenario I’ve seen time and time again:

* Parent goes to prison.
* Child, who already felt neglected by parent, becomes more upset when parent ends up behind bars. Child either blames the parent for misbehavior that results in parent being taken away from child and/or blames him or herself (as children often do).
* Parent tries to have contact with child via phone calls, letters, or visits.
* Child decides …

Medical conditions as seen in the movies

Vineet Arora, MD

Potpourri

April 17, 2010

I recently went to see Alice in Wonderland in 3D.

This epic creation by part genius–part disturbed director Tim Burton features the wickedly talented method actor Johnny Depp as the ‘Mad Hatter.’ As I was watching Johnny Depp’s orange hair and freakish eyes, it occurred to me that some of the most popular fiction movies over the last several years have featured some notable legends and their medical …

Diet pills can be dangerous and should be used with caution

Kristina Fiore

Medications

April 17, 2010

by Kristina Fiore

Diet pills that are adulterated with undeclared pharmaceutical ingredients can be addictive, researchers say.

In a case report, a 29-year-old female patient became addicted to Brazilian diet pills that contained unlabeled ingredients, and suffered subsequent psychiatric comorbidities, Benjamin R. Smith, BS, and Pieter A. Cohen, MD, of Harvard Medical School reported in The American Journal on Addictions.

“Given the rising prevalence of adulterated diet pills, increasing awareness among clinicians of …

Health costs are high, and here’s why

Toni Brayer, MD

Physician

April 16, 2010

Health costs are high because the body is complicated and doctors and patients hate ambiguity. The cost is high because a missed diagnosis can lead to death and a large lawsuit. The cost is high because we have many specialists that view the body in tiny pieces and want to feel 100% correct about their piece.

Let me give you a real life example.

My patient, Rick, is a brilliant attorney. He …

Read more…

Health costs are high, and here’s why

Breastfeeding rates cost the country billions

Crystal Phend

Physician

April 16, 2010

by Crystal Phend

Poor compliance with breastfeeding recommendations costs the nation at least $13 billion each year, with nearly all of the cost related to infant morbidity and mortality, according to a comprehensive economic analysis.

If 90% of new mothers followed guidelines for six months of exclusive breastfeeding for their children, an estimated 911 deaths would be prevented annually, said authors Melissa Bartick, MD, MSc, of Harvard Medical School, and Arnold Reinhold, …

ABIM: Maintenance of Certification – For the public

Chiduzie Madubata, MD

Medical Education

April 15, 2010

A guest column by the American Board of Internal Medicine, exclusive to KevinMD.com.

The debate about recertification recently in the New England Journal of Medicine and highlighted earlier this week on KevinMD.com and in an Associated Press article brings to light some of the real challenges facing the future of the Maintenance of Certification (MOC) program.

I have been through …

Physicians are leaving medicine for alternative careers

Joseph Kim, MD, MPH

Physician

April 15, 2010

When physicians choose to leave clinical medicine to pursue alternative careers, what motivates them to make such changes? Is it money? More time with family? Scheduling flexibility? Avoiding litigation? To pursue new challenges? Maybe you’re getting bored with medicine.

Depending on that key motivating factor, physicians end up choosing all types of career paths. For instance, let’s take a look at some of these motivators:

Money. Let’s face it. Some physicians love …

Checklists help reduce hospital deaths

MedPage Today

Physician

April 15, 2010

by Michael Smith

The use of treatment checklists for 13 common diagnoses was associated with a dramatic reduction in patient deaths at three London hospitals, researchers said.

The year the checklists were introduced, the three facilities in the North West London Hospitals NHS Trust registered 255 fewer deaths than the previous year, according to Brian Jarman, PhD, of Imperial College London, and colleagues.

The targeted diagnoses accounted for 174 fewer deaths than the …

Read more…

Checklists help reduce hospital deaths

Primary care doctors are saying farewell

Aldebra Schroll, MD

Physician

April 14, 2010

It has been three months since I closed the door on my primary care office for the last time. It was with a heavy heart that I said goodbye to the many patients I cared for over the last six years. I am the fourth physician to leave the practice in as many years.

As the economy faltered, I found my private office practice had simply become unsustainable. With the popularity …

Rural medicine won’t be helped by health reform

Kevin

Physician

April 14, 2010

by Rick Bendinger, MD

I am a rural health provider in Abbeville, Alabama and have been here almost 30 years. I originally went to school on a public health scholarship and took the private practice option. This was a program that existed in the 1980s that paid for tuition and a stipend with the obligation to go either to a prison, rural area, or Indian reservation.

Sadly the program no longer exists. …

Patients who visit the emergency department have insurance

MedPage Today

Health Policy

April 14, 2010

by Joyce Frieden

Most patients who visit the emergency department (ED) four or more times a year have health insurance and a primary care physician, a review of the literature found.

“The uninsured represent only 15% of frequent users and are no more likely to be frequent users than they are to be occasional ED users (<4 visits/year),” Eduardo LaCalle, MD, MPH and Elaine Rabin, MD, of the Mount Sinai School of …

Patient stories on the web may not be real

Lisa Gualtieri, PhD

Patient

April 13, 2010

“On the Internet, nobody knows you’re a dog” was the caption of the famous cartoon by Peter Steiner in the July 5, 1993 issue of The New Yorker. The same is true of patient stories on health Web sites: nobody knows who really wrote them.

In the case of Lifestyle Lift, the company agreed to pay a $300,000 settlement last year to New York State because their patient stories were employee-generated.

Patient …

Price transparency will improve patient care

Leslie Ramirez, MD

Patient

April 13, 2010

Debora T. had a blood pressure of 180/110 during her routine visit in my internal medicine clinic. She was already on every blood pressure medication I could think of, save one — amlodipine. I prescribed the medicine and asked her to follow up in a week. I feared her blood pressure was going to cause a stroke if it went up any higher.

At our next visit, her blood pressure was …

Healthcare workers in the ER hit hard by H1N1

MedPage Today

Physician

April 13, 2010

by Michael Smith

Healthcare workers in a New York City emergency department had the highest rate of infection among employees of an urban hospital system during the first wave of the H1N1 pandemic flu, researchers said.

In a single-institution study using medical and administrative records, the adult emergency department had an H1N1 infection rate of 28.8% during April, May, and June of 2009, according to Robert Bristow, MD, and colleagues at New …

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