2010

March 2, 2010Mar 2, 201011

Imagine that as a child you thought you had been born in the body of the wrong gender. If you were biologically male, in your mind you really thought of yourself as female. Likewise, if you were born in a…

Yes, you were probably more interested in children’s role-playing games more often associated with the opposite gender as well, but the …

Health policy

The Danny Williams surgery shouldn’t be controversial

MedPage Today

March 2, 2010Mar 2, 20109

Originally published in MedPage Today by Michael Smith OK, don't take this the wrong way, but .... Chill. Relax. Give the other guy the benefit of the doubt. Don't jump to conclusions. And most of all, think before you speak,…

Originally published in MedPage Today

by Michael Smith

OK, don’t take this the wrong way, but ….

Chill. Relax. Give the other guy the benefit of the doubt. Don’t jump to conclusions. And most of all, think before you speak, blog, natter, comment, or otherwise pontificate on issues of the day.

And when I say ‘think,’ I don’t mean trying to find the …

Health policy

Medicare slashes pay to doctors, and what that really means

Wes Fisher, MD

March 1, 2010Mar 1, 201023

What we're learning from the 21% Medicare pay cut to physicians that occurred today: * There really must be a cost-control crisis with Medicare and the only politically-acceptable way to implement those cost controls are by cutting working physicians' payments.…

What we’re learning from the 21% Medicare pay cut to physicians that occurred today:

* There really must be a cost-control crisis with Medicare and the only politically-acceptable way to implement those cost controls are by cutting working physicians’ payments.

* There’s was widespread political support for blocking the scheduled pay cuts to doctors, but central government control moves very slowly. That’s because doing so is expensive. For now, doctors have been …

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Drugs and prescribing

Bipolar disorder and how Rebecca Riley could have been saved

Claudia M. Gold, MD

March 1, 2010Mar 1, 2010

Carolyn Riley’s act of giving her daughter Rebecca an overdose of prescribed medication may have been the immediate cause of Rebecca’s death, the conclusion reached by the jury that convicted her of murder. Even if, as the prosecutor argued, Carolyn…

Even if, as the prosecutor argued, Carolyn and her husband concocted symptoms of mental illness and the psychiatrist, who diagnosed bipolar disorder, was a gullible enabler, the real guilty party in this story is, in my opinion, …

Health policy

Medicare cuts will strengthen doctors’ negotiating position

Richard Reece, MD

March 1, 2010Mar 1, 201011

Doctors will soon be wagging the reform dog. Look at it this way. Expansion of insurance coverage to the 31 million more Americans, as envisioned in the current reform bill, will require more doctors to care for them. The starting…

Doctors will soon be wagging the reform dog.

Look at it this way. Expansion of insurance coverage to the 31 million more Americans, as envisioned in the current reform bill, will require more doctors to care for them. The starting entry of 78 million baby boomers in the Medicare pool, starting in 2011, will also take more doctors.

As everybody knows, coverage does not equal access. This is most vividly illustrated in …

Drugs and prescribing

Your metformin may smell like dead fish

MedPage Today

March 1, 2010Mar 1, 20102

Originally published in MedPage Today An immediate-release form of the antidiabetic agent metformin has a dead fish odor that may cause patients to stop taking the drug, clinicians warned. Metformin is known to cause adverse gastrointestinal effects such as diarrhea,…

Originally published in MedPage Today

An immediate-release form of the antidiabetic agent metformin has a dead fish odor that may cause patients to stop taking the drug, clinicians warned.

Metformin is known to cause adverse gastrointestinal effects such as diarrhea, nausea, vomiting, flatulence, distention, and abdominal pain. Those side effects “often necessitate discontinuing the drug,” a group of physicians and pharmacists …

Read more…

Your metformin may smell like dead fish

Patient voices

A nurse practitioner is valuable in hospice and palliative care

Patrice Villars

February 28, 2010Feb 28, 201011

Recently, a physician colleague expressed her concern about signing routine hospice admission orders for her elderly patient with end stage heart failure. The routine ‘as needed’ (PRN) orders included phenobarbital, pentobarbital, haloperidol, lorazepam, and morphine. “The hospice nurses know more…

Yesterday, a longtime palliative care nurse told me she didn’t want to put her mother with end stage heart failure in …

Patient voices

A beautiful Valentine’s Day patient story

Dr. Charles

February 28, 2010Feb 28, 20103

“I’ll be back in a little while, Hon’. Will you be okay without me?” the frail old woman asked of her husband. She was standing at the front door and breathing heavily. “I’ll be fine,” her husband replied from his…

“I’ll be back in a little while, Hon’. Will you be okay without me?” the frail old woman asked of her husband. She was standing at the front door and breathing heavily.

“I’ll be fine,” her husband replied from his wheelchair. His voice sounded as weak as his body looked – emaciated, scaly, and full of cancer. “I’m sorry I can’t come with you.”

The woman opened the front door. A gust …

Physician voices

How patient comments will affect your physician practice

Kevin

February 27, 2010Feb 27, 201014

Originally published in HCPLive.com by Owen Dahl and Altamash Rahman “Her MA is very rude, uncompassionate. Dr. ABCD doesn’t return phone calls. They’re not helpful and not good with following up with the care plan for patients. We’re new seeing…

Originally published in HCPLive.com

by Owen Dahl and Altamash Rahman

“Her MA is very rude, uncompassionate. Dr. ABCD doesn’t return phone calls. They’re not helpful and not good with following up with the care plan for patients. We’re new seeing this doctor, but will never go back. I would not recommend this practice at all!!!!!!”

How would you handle a comment like this when …

Physician voices

The Haiti earthquake and its broken health infrastructure

Erin Marcus, MD

February 27, 2010Feb 27, 2010

Dr. Barth Green co-founded Project Medishare, which has worked in Haiti for two decades. He led the first team of U.S. physicians to Port-au-Prince after the earthquake and, together with the University of Miami’s Global Institute, spearheaded the development of a 240-bed tent hospital that is now the country’s largest functioning urgent care hospital. His group is working with the U.S. government to establish Haiti’s first rehabilitation hospital. Green …

Conditions and diseases

Why cancer screening is not a black or white decision

Shantanu Nundy, MD

February 26, 2010Feb 26, 201013

Last month I saw a 65 year-old woman with a mass in her kidney in clinic for follow up. She had recently transferred her medical care to our clinic after her insurance changed. She came with a few medical problems…

Last month I saw a 65 year-old woman with a mass in her kidney in clinic for follow up. She had recently transferred her medical care to our clinic after her insurance changed.

She came with a few medical problems including high blood pressure, tobacco use and arthritis — diseases which are the bread and butter of primary care medicine — but she also came with a history of a mass …

Physician voices

How patient satisfaction scores can affect physicians

Edwin Leap, MD

February 26, 2010Feb 26, 20105

I am very blessed. The hospital where I practice, while concerned with patient satisfaction, does not worship at its altar. That is, so far our administrators seem to understand that people will occasionally be angry or unsatisfied, and that such…

I am very blessed. The hospital where I practice, while concerned with patient satisfaction, does not worship at its altar.

That is, so far our administrators seem to understand that people will occasionally be angry or unsatisfied, and that such dissatisfaction is within the realm of real life. We still have people storm out of the emergency department, prattling on about lawyers and lawsuits, promising to go to another hospital in …

Patient voices

Condoms don’t work all the time, and here’s why

MedPage Today

February 26, 2010Feb 26, 2010

Originally published in MedPage Today by Chris Emery, MedPage Today Contributing Writer Condoms that don't fit properly are more likely to break, slip off, and decrease the pleasure of both partners during sex, which may discourage their use and undermine…

Originally published in MedPage Today

by Chris Emery, MedPage Today Contributing Writer

Condoms that don’t fit properly are more likely to break, slip off, and decrease the pleasure of both partners during sex, which may discourage their use and undermine their public health benefits, a survey found.

Ill-fitting condoms were reported by 44.7% of the men polled. They were more likely than …

Physician voices

Can doctors learn medicine from physician lounges?

Vineet Arora, MD

February 25, 2010Feb 25, 20103

I just finished rotating at a community hospital where one of the most interesting things I’ve enjoyed is stopping by the Doctor’s Lounge. I can always count on a getting coffee there and hearing some good conversation – doctors asking for input on interesting cases, laughing, sharing stories, both personal and professional, and catching up on each other’s busy lives. In fact, I ran into an old friend of mine …

Physician voices

Value doctors as listeners to prevent primary care burn out

Claudia M. Gold, MD

February 25, 2010Feb 25, 20102

A recent editorial in the Boston Globe addressed the dearth of primary care physicians. The piece concluded: “Federal funding for new residency slots should follow reforms that address the underlying reasons - principally money - that lead doctors to choose…

A recent editorial in the Boston Globe addressed the dearth of primary care physicians. The piece concluded: “Federal funding for new residency slots should follow reforms that address the underlying reasons – principally money – that lead doctors to choose to specialize.”

Money is certainly important. But there is another obstacle to attracting primary care doctors that is more subtle, though perhaps equally important. Consider the following story.

Recently I had …

Health policy

Never events in hospitals depend on patient risk

MedPage Today

February 25, 2010Feb 25, 20109

Originally published in MedPage Today by John Gever, MedPage Today Senior Editor Occurrence of some so-called "never events" in hospitals may depend partly on unmodifiable risk factors such as patient characteristics, undermining the rationale for denying Medicare payment for their…

Originally published in MedPage Today

by John Gever, MedPage Today Senior Editor

Occurrence of some so-called “never events” in hospitals may depend partly on unmodifiable risk factors such as patient characteristics, undermining the rationale for denying Medicare payment for their treatment, researchers said.

Analysis of some 890,000 surgeries performed in 1,368 hospitals showed that patient age and pre-existing conditions such as weight …

Patient voices

How doctors can improve patient interactions

Lockup Doc, MD

February 24, 2010Feb 24, 201013

by Lockup Doc Physicians learn a lot about many different topics, both in medical training and in practice. However, there are some life lessons that we never learn as well as when we become patients ourselves. When I was 13…

by Lockup Doc

Physicians learn a lot about many different topics, both in medical training and in practice. However, there are some life lessons that we never learn as well as when we become patients ourselves.

When I was 13 or 14 years old, I regularly interacted with 2 different physicians with disparate interpersonal styles. Little did I know then that these seemingly meaningless encounters would indelibly shape my own beliefs about …

Physician voices

Atul Gawande’s The Checklist Manifesto reviewed

Robert Wachter, MD

February 24, 2010Feb 24, 20107

Every now and then, I read and enjoy a book, but only later fully appreciate it as its lessons and insights slowly become apparent. Judging by the number of times I’ve said, “That reminds me of Gawande’s observations about ___”…

In this short, deceptively simple volume, Atul (who I count as both friend and inspiration) discusses the …

Patient voices

Why being President of the United States is a health hazard

MedPage Today

February 24, 2010Feb 24, 2010

Originally published in MedPage Today by Liz O'Brien Exactly whom are we honoring on Presidents (or is it President's) Day? A. George Washington B. George Washington and Abraham Lincoln C. All presidents The answer is more complicated than you'd ever…

Originally published in MedPage Today

by Liz O’Brien

Exactly whom are we honoring on Presidents (or is it President’s) Day?

A. George Washington
B. George Washington and Abraham Lincoln
C. All presidents

The answer is more complicated than you’d ever expect. Probably A is most correct, but if it were up to me, I’d pick C.

Certainly every one of these 43 men has earned the …

Health technology

Is Google Android or the iPhone the future of mobile smartphones?

Felasfa Wodajo, MD

February 23, 2010Feb 23, 20106

Over the last few months, a great deal of time has been expended on the “hot competition” between Apple and Google in relation to smart phones. Much of this interest probably had to do with a partially imagined story of…

Over the last few months, a great deal of time has been expended on the “hot competition” between Apple and Google in relation to smart phones.

Much of this interest probably had to do with a partially imagined story of a once close friendship between Apple and Google, founded on their mutual enmity of Microsoft, now fractured on the rocks of competition and greed. While the truth probably isn’t as dramatic, …

2010

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