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Obese patients present challenges in the ICU

Physician

June 25, 2010

Obesity is a huge healthcare problem in the United States.

It has reached the proportions of an epidemic and continues to get worse. Multiple medical problems including heart disease, hypertension, diabetes, sleep apnea and cancer are closely associated with obesity. The patients with extreme obesity can reach a body weight of five, six or seven hundred pounds and even higher. Riddled with chronic medical conditions, these patients often end up in …

Healthcare reform’s focus on outcome and how that affects doctors

David B. Nash, MD, MBA

Health Policy

June 25, 2010

With the signing of national healthcare reform into law, the U.S. healthcare system faces almost immediate — and substantial — transformation. I spent a recent Sunday reading all that I could find in order to get my arms around this massive piece of legislation and to understand its health policy implications.

Here is my view from 50,000 feet.

I needn’t list all of the aspects relating to expanded coverage and insurance reform …

Doctors are stuck in the same system as patients when they get sick

Jay Parkinson, MD

Patient

June 25, 2010

I’ve had disgusting congestion in my nose/sinuses for the past month or so.

I’ve never had a sinus infection in my life despite having horrible allergies to dust. I take Claritin every day for my allergies. But this time, the issues just wouldn’t go away. I needed to go see a doctor. So last night around 8pm I made an appointment with Dr. Samuel Grubman via ZocDoc for 9am this morning. …

Nurses are underappreciated but key to patient care

Alex Smith, MD

Patient

June 24, 2010

“No man, not even a doctor, ever gives any other definition of what a nurse should be than this — ‘devoted and obedient.’ This definition would do just as well for a porter. It might even do for a horse. It would not do for a policeman.”

-Florence Nightingale, 1859

Please take a moment to celebrate the nurses in your life. Florence Nightingale was the first to publicly decry the sorry …

7 disruptive changes that will affect medicine

Stephen C. Schimpff, MD

Health Policy

June 24, 2010

Generally we prefer calm seas but often they don’t get us anywhere.

We need disruptions, transformations to make the changes necessary for real progress in medicine. Sometimes it is a new technology; sometimes a cultural change. But then a refinement may occur. The refinement may not seem like a “disruption” but indeed it can be because the refinement may create a demand for change.

Here a few more disruptive changes or refinements …

Healthcare providers still aren’t washing their hands enough

MedPage Today

Physician

June 24, 2010

by Chris Emery

Nurses and other healthcare providers complied with hand hygiene guidelines less than half of the time before participating in medical procedures, results of a new study showed.

Compliance was better after procedures, with 72% following guidelines after procedures compared with 41.7% before procedures, according to a report published in the May issue of Applied Nursing Research.

Overall compliance with hand hygiene guidelines was just 34.3%.

“It is important to note that …

California pertussis epidemic may be caused by vaccine refusal

MedPage Today

Conditions and Diseases

June 24, 2010

by John Gever

California is facing what could be the state’s biggest outbreak of pertussis since 1958, its top public health official said.

“Whooping cough is now an epidemic in California,” said Mark Horton, MD, MSPH, director of the California Department of Public Health, in a statement. “Children should be vaccinated against the disease and parents, family members and caregivers of infants need a booster shot.”

As of June 15, 910 cases had …

Op-ed: Restrictions on physician hours may not improve patient safety

Kevin

Medical Education

June 23, 2010

A version of this op-ed was published on June 2nd, 2010 in USA Today.

During medical training, I routinely stayed awake for more than 30 hours straight to care for my patients in the hospital. I strove to be the tireless physician who would be with his patients until they went home. It turns out I may have jeopardized their safety instead.

For many years, the medical field has been rightfully …

Injectable heroin or methadone for addiction treatment

Charles Bankhead

Medications

June 23, 2010

by Charles Bankhead

Heroin addicts had almost a threefold increase in negative urine specimens when treated with supervised heroin injection rather than with oral methadone, data from a British study showed.

Overall, 72% of patients had negative specimens at least 50% of the time compared with 27% of patients assigned to oral methadone, according to the report published in the May 29 issue of The Lancet.

Treatment with injectable heroin almost doubled the …

Shop for benefits, not premiums, when looking for health insurance

Kevin

Health Policy

June 23, 2010

by Ray Carlson

When discussing health insurance plan strategies with clients, there can sometimes be an awkward pause in the conversation after asking the client if they checked to see if their own doctor is in the network of the health insurance company whose plan they are applying for.

It’s possible that many first time shoppers for individual health coverage are applying for health plans without first verifying if a family physician …

Choose primary care and follow your heart, not your brain

Lucy Hornstein, MD

Physician

June 22, 2010

Reams have been written on how medical students ought to select their field of medicine.

There are even personality-type tests that ask questions about what kinds of situations you like, how you react to problems, and your working style that purport to predict for which specialty you are suited. (I came up as an oncologist or a nephrologist.)

Others have opined that once you crunch the lifetime salary numbers, and then compare …

A patient in chief is what American healthcare needs

Dave deBronkart

Patient

June 22, 2010

“These are exciting and very promising times for the widespread application of information technology to improve the quality of healthcare delivery, while also reducing costs, but there is much yet to do, and in my comments I want to note especially the importance of the resource that is most often under-utilized in our information systems – our patients.”
– Charles Safran MD, testimony to the House Ways & Means subcommittee on health [Emphasis …

Read more…

A patient in chief is what American healthcare needs

How healthcare reform will affect Medicaid

MedPage Today

Health Policy

June 22, 2010

by Cole Petrochko

Medicaid expansion under new healthcare reform laws could add millions of participants to the program over the next nine years and greatly decrease the number of uninsured Americans — with the federal government picking up most of the tab, according to a Kaiser Family Foundation report.

One set of projections in the report, prepared by the Urban Institute for the Kaiser Commission on Medicaid and the Uninsured, estimates that …

How transparency reduces malpractice and defensive medicine

Brad Wright, PhD

Physician

June 22, 2010

Physician errors have been the subject of discussions about both health care costs and health care quality.

We are told that if we reform the malpractice system — capping damages — that physicians will practice medicine less defensively and costs will go down as a result. We are also told that the quality of care delivered by our health care providers is less than optimal — there are estimates that nearly …

ACP: Increasing the attractiveness of general internal medicine

American College of Physicians

Health Policy

June 21, 2010

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

by Steven Weinberger, MD, FACP

In this era of health care reform, much has been written and discussed about the shortage of primary care physicians in the United States, which is projected to get substantially worse over the coming years.

A number of different types of physicians have been …

Treating friends, and when worlds collide in the hospital

Bruce Campbell, MD

Physician

June 21, 2010

All the world is a stage,
And all the men and women merely players.
They have their exits and entrances;
Each man in his time plays many parts.
-Shakespeare

“There’s a consult downstairs, Campbell. Go check it out and I’ll catch up with you later.”

“Sure, OK.” I was a third-year medical student fumbling through my first clinical rotations. The resident headed off to whatever he needed to accomplish and I trotted down the back …

Screening studies that blur the mortality and case fatality line

Marya Zilberberg, MD, MPH

Conditions and Diseases

June 21, 2010

When do tests improve mortality?

This is a question well worth asking, particularly as we argue about the merits of mammography screening. The USPSTF has really stirred up the hornet’s nest with this one, and the politicians cannot help but get on their populist pulpit, ignoring the facts completely.

But the question remains, do screening or diagnostic tests that are more sensitive save lives? We all hear that mortality from many diseases …

Citalopram and other SSRI drugs can reduce hot flashes

Charles Bankhead

Medications

June 21, 2010

by Charles Bankhead

Hot-flash frequency and severity declined by 50% in postmenopausal women treated for six weeks with the antidepressant citalopram, according to data from a placebo-controlled, randomized clinical trial.

The trial, conducted among 254 women with frequent hot flashes (at least 14 hot flashes a week for a month or longer), found that the lowest of three citalopram doses was as effective as the highest for dousing hot flashes, but the …

Clinical trial conflict of interest for doctors

Paul Levy

Physician

June 21, 2010

This is a painful story to write.

A close friend of mine, in his 40’s, had a persistent light cough for many months. Finally, when he had an X-ray taken, it showed a large tumor on his lungs. He was diagnosed with stage 4 lung cancer. As a non-smoker and strapping, physically fit man, he was shocked, as you can imagine.

He went to his non-Boston-based medical practice, and he was told …