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Physicians the government wants to see

Edwin Leap, MD

Medical Education

November 15, 2010

I was talking with a pre-med student recently. He had completed his very first medical school interview and was, understandably, excited. But he told me the interviewer had asked him what he thought would be the outcome of the current health-care reform measures.

I laughed to myself. After 17 years in practice, even I don’t know the outcome, though I have my suspicions. It seemed a loaded, almost unfair question. After …

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Physicians the government wants to see

First aid rules that everyone needs to know

Alex Lickerman, MD

Patient

November 14, 2010

First aid is defined as the immediate care given to an acutely injured or ill person. It can literally be life-saving so it behooves all of us to know some basic principles.

What follows are some rules that cover common conditions and general practices:

Don’t panic. Panic clouds thinking and causes mistakes. When I was an intern and learning what to do when confronted with an unresponsive patient, a wise resident advised …
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First aid rules that everyone needs to know

Medical students taking a mandatory rotation in geriatrics

Eric Widera, MD

Medical Education

November 14, 2010

What happens when you randomly assign medical students to either a mandatory two week rotation in specialized geriatric training or to a traditional non-geriatric clerkship that sees a lot of old people?

Will there be any difference in the knowledge of geriatric conditions, the attitudes toward older adults, or geriatric clinical skills between the two groups? Or does mere exposure to an aging patient population give students the training they need to …

Side effects of medication sometimes confuse patients

WarmSocks

Medications

November 14, 2010

Side effects. Every medication has them. Some are mild, some are annoying, and some are downright dangerous.

When doctors write a prescription, they mention that some people experience side effects, and if certain bizarre things happen, the patient should phone the doctor.

How do we keep track?

If you get one antibiotic to take for two weeks, it isn’t so hard. First, because it’s for a short time period, and also because it’s …

How dietary guidelines can help prevent disease

Stephen C. Schimpff, MD

Physician

November 13, 2010

Most of the illnesses that occur today are chronic like diabetes, heart disease, cancer or kidney disease.

These stay with us for the rest of our lives, are debilitating, and are expensive to treat. But in many cases they are not all that difficult to prevent. Unfortunately, our dietary guidelines are of little or no help in this regard but could be.

In 1941, following studies that demonstrated …

Making the decision to go to medical school

PalMD

Medical Education

November 13, 2010

First, this piece is not a how-to guide for getting into medical school.

But I use this ploy for good, and not for evil. Through conversations with a number of non-medical colleagues, I’ve been forced to think a bit more about premedical and medical education. A letter from a reader (which is presented in a highly altered version below) made me decide to more thoroughly and …

Get a straight answer from your doctor

Doctor D, MD

Patient

November 13, 2010

How can patients get a straight answer from a doctor?

The answer is really very simple: Don’t accept a non-answer answer from a doctor on a question that really matters to you!

If you get a dodgy, vague, or useless answer don’t take it lying down. Politely insist that the doctor elaborate and clarify until you get a reply that you understand.

We doctors are totally scary, but if you have to have …

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Get a straight answer from your doctor

Preventive care as a cost saving measure is a fallacy

Lucy Hornstein, MD

Health Policy

November 12, 2010

I like reading Maggie Mahar’s Health Beat.

She usually gets it, from the function of insurance to the complexities of assorted payment systems, I get the sense that she is generally rational when it comes to paying for health care. This doesn’t mean there aren’t times when she gets it wrong. Her embrace of primary care provided by nurse practitioners shows a truly spectacular …

Help patients synchronize their prescription drugs

Michael Aaronson, MD

Medications

November 12, 2010

Here’s the scenario: on the 2nd of the month, a patient with diabetes on metformin and high blood pressure on benazepril sees her family physician for a routine follow up.

The patient’s blood pressure is elevated and the decision is made to add carvedilol to help get the blood pressure to goal. The patient’s metformin and benazepril “drop” (are renewed) at the pharmacy on the 18th of every month, a date …

Autonomy versus supervision for residents is a fine line

Nicholas Fogelson, MD

Medical Education

November 12, 2010

When one is a medical student, pretty much everything one does is directly supervised. Though a student is allowed to assess patients and make recommendations, rarely is a student given the autonomy to make decisions that will affect patients. They practice these decisions, but there is always someone more senior ratifying them.

Once a student becomes a resident, things start to change. As residents are physicians, they have the power to write …

Why patients in Grand Junction, Colorado have better health outcomes

Gary Levin, MD

Health Policy

November 12, 2010

The New England Journal of Medicine analyzed Medicare statistics from the beloved Dartmouth Atlas of Health Care study revealing a wide disparity in the number of coronary bypass procedures in Golden Colorado compared to other areas.

The report reveals a 60% reduction in the number of procedures as compared to Miami, Florida. The Dartmouth Atlas Study has been used to justify changes in payment systems by Medicare. The study has …

Using the internet for health information before surgery

Lisa Gualtieri, PhD

Patient

November 11, 2010

Diana Cole told me, “The internet saved my life,” and recounted a story about using the internet to identify a bat bite and learn about rabies in bats, leading to an emergency room trip.

She later introduced me to her sister, Carolyn Kingston, who attributed her successful outcome from hip replacement surgery to her use of the internet. I asked Carolyn about her general use of the internet for health, her …

AMA: Patients and physicians call on Congress to stop Medicare cut

Cecil B. Wilson, MD

Health Policy

November 11, 2010

A guest column by the American Medical Association, exclusive to KevinMD.com.

Medicare physician payment cuts are once again looming in the immediate future, with a cut of 25 percent now threatening to hurt access to care for seniors and military families. As many doctors know all too well, the looming cut is forcing physicians to make difficult decisions about the continuing role Medicare can play in their practices.

The AMA is working on …

Using servant leadership to teach medical students

Robert Centor, MD

Medical Education

November 11, 2010

I spend much time talking with medical students. It is part of my job, but more than that I like medical students.

What should be the goal of medical schools? I believe we have an obligation to help our students grow into great physicians. What philosophical principles should we use?

Perhaps the answer to success is Servant Leadership. As I learn more about this concept, I hope that have become a servant …

Why moral hazard fails in health care

Aaron E. Carroll, MD

Health Policy

November 11, 2010

I’m going to take the time to review a topic that is one my pet peeves, one you hear bandied about all the time in discussions of more consumer directed health care. It’s a topic I came back to repeatedly on my old blog – the moral hazard.

Basically, the moral hazard is the idea that people insulated from risk behave differently than people exposed to risk. For instance, …

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Why moral hazard fails in health care

Medical malpractice reform in exchange for paying doctors less

Kevin Pho, MD

KevinMD

November 11, 2010

The bipartisan debt commission appointed by President Obama recently released its recommendations on how to pare the country’s debt.

Of interest to doctors is the suggestion to change the way doctors are paid. Physician lobbies have been advocating for removal of the Sustainable Growth Rate formula — the flawed method by which Medicare, and subsequently private insurers, pays doctors.

According to this method, physicians are due for a pay cut of …

How medical students can improve our health system

Aaron J. Stupple, MD

Medical Education

November 11, 2010

Many fellow medical students are eager to improve “the system.”

However, an overeager attitude offers both promise and peril — promise that budding physicians are inspired to improve the inner workings of their chosen field, peril in that our naiveté may simply clutter the very complexities we seek to improve.

How do we strike a balance between getting involved and getting in the way?

I found guidance in law professors Raustiala’s and Sprigman’s …

The patient experience needs to be improved: here’s how

Kevin

Patient

November 10, 2010

by James Merlino, MD

The patient experience is the right thing to do, and a business necessity. But improving it is not necessarily easy.

The fact is, large medical centers are at a real disadvantage when it comes to performing well on HCAHPS. The Centers for Medicare & Medicaid Services (CMS) do not discriminate or differentiate the scores of small community hospitals from those of large academic tertiary care …

MKSAP: 44-year-old man with chronic joint pain

mksap

Conditions and Diseases

November 10, 2010

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

A 44-year-old man is evaluated for a 2-year history of joint pain in the wrists, hands, knees, ankles, and feet. He also has a 12-year history of plaque psoriasis. His current medications include acetaminophen for joint pain, topical hydrocortisone and calcipotriene ointments, and a …

Patients seeing the visit notes their primary physicians entered

Dave deBronkart

Patient

November 10, 2010

This item has nothing to do with OpenNotes itself – it’s what I’m seeing now that I’ve started accessing my doctor’s notes. In short, I see the clinical impact of not viewing my record as a shared working document.

Here’s the story.

In OpenNotes, patient participants can see the visit notes their primary physicians entered. Note – primary, not specialists. I imagine they needed to keep the study design simple.

So, …

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