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Patients will skip care with higher deductibles and copays

Davis Liu, MD

Health Policy

August 6, 2010

The Wall Street Journal reported that overall medical use fell as patients had fewer doctor office visits, lab testing, and maintenance medications possibly due to the recession or as a result of consumer driven healthcare in the way of higher deductibles and copays.

This is very worrisome. Certainly patients should have some financial responsibility for their care, but skimping on care will only result in Americans not becoming healthier, but sicker. …

Laughter and humor heals the soul in life’s most difficult times

Charles Bankhead

Patient

August 6, 2010

by Charles Bankhead

My oldest sister died recently. She spent the last three years of her life in a nursing home, trying to hold on to reality and her dignity as her mind and body betrayed her.

Barely five feet tall, my sister Peggy had a big heart and a vibrant personality that made her seem much taller. I have a lot of fond memories of her, many of which involve her …

MKSAP: A 35-year-old man with red eye and acute eye pain

mksap

Conditions and Diseases

August 6, 2010

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

A 35-year-old man is evaluated for red eye and acute onset of right eye pain. He wears contact lenses daily. Fluorescein staining is positive for corneal abrasion without a dendritic, or branching, pattern. He is instructed to stop wearing the contact …

Will Medicare really lose physicians because of the SGR?

Bob Doherty

Health Policy

August 6, 2010

For years, physicians have argued that the specter of annual cuts in Medicare will cause many of them to leave the program, or at the very least, to limit how many new Medicare patients they will accept in their practices. Yet, for the most part, measures of seniors’ access show that the vast majority enjoy good access to care.

For instance, in May of this year, the Medicare Payment Advisory Commission …

Attribution error in a patient with colon cancer

Jerome Groopman, MD and Pamela Hartzband, MD

Conditions and Diseases

August 5, 2010

Zahia Esber, ACP Associate Member, who practices at McKenzie-Willamette Medical Center in Eugene, Ore., told us about a case of a 71-year-old obese woman whose mental status deteriorated rapidly while in the hospital.

The patient had undergone a sigmoid resection in December 2009 for colon cancer. At that time, her mental status was intact. Three weeks after surgery, she returned to the hospital because of nausea and anorexia. She told the …

Metastatic cancer and the matching walkers

StorytellERdoc, MD

Patient

August 5, 2010

They made a regal couple, the elderly man and woman sitting in Room 19. She was the patient, he the supportive husband. She sat in the treatment cot while he sat in a chair pulled near her bedside. Together, they greeted me with their warm smiles as I walked into their room.

They both had full heads of healthy, silvery hair that shimmered from the overhead fluorescent bulbs. Their eyes were …

Commercial CME funding and the rise of medical errors

Thomas Sullivan

Medical Education

August 5, 2010

While the percentage of commercial support for continuing medical education (CME) has continued to drastically drop over the past few years (29% decrease from 2007 to 2009), recent data, which show an epidemic of medication errors in hospitals, make this decrease even more troublesome.

At a time when 30 million more patients will flood our hospitals, do we really need to …

How developing countries use foreign health aid matters

Yann Meunier, MD

Physician

August 5, 2010

Year: 1994

Setting: Port Moresby General Hospital, Papua New Guinea
Position: Chief medical officer for Chevron Oil Co.

The wife of an expatriate employee has injured her arm and, suspecting that she has fractured her left elbow, I accompany her to the Port Moresby hospital for further evaluation. The building looks good and new. In fact, it was recently donated to Papua New Guinea by the Japanese government.

While waiting for the X-rays, I …

Pharmaceutical sponsored dinners have educational value

Randall S. Bock, MD

Medications

August 5, 2010

It is insulting to think that doctors who are ostensibly smart enough to save one’s life are in fact so stupid, or merely gullible enough, to be swept away by what is in actuality only a very weak potion of sales-presentation intermixed with and embedded within generally informative and pharmaceutical-balanced subject-focused medical lectures.

Such lectures occur usually at a private function room at a restaurant or, in conjunction with a served …

Notes in the chart are helping patients less

Paul Sax, MD

Physician

August 4, 2010

What is the purpose of the note in the patient chart?

Depends who you’re asking.

The best guidance I ever received on how to write a good note came from my residency program director, who told us that a note needn’t be encyclopedic to be excellent; in fact, he urged us to get away from the “second-year medical student” style, which typically includes absolutely everything.

Instead, he urged us to write, as concisely …

ABIM: Patient centered care is crucial in health reform

Christine K. Cassel, MD

Health Policy

August 4, 2010

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

The concept of patient-centered care was catapulted into the mainstream by the publication in 2001 of the seminal Institute of Medicine report Crossing the Quality Chasm: A New Health System for the 21st Century. This report identified six aims of improvement for the U.S. …

Bacterial resistance to chronic antibiotics, and why it’s a problem

Jan Henderson, PhD

Conditions and Diseases

August 4, 2010

Unlike climate change, where there’s a large contingent of denialists who spread doubt about the scientific evidence, no one denies that antibiotic resistance is a problem. There is controversy, however, on the question of just how much the widespread use of antibiotics contributes to the problem.

The mechanism is not in dispute: If you expose bacteria to antibiotics, they will mutate to become resistant. But “overuse” of antibiotics is not the …

Minimize patient waiting after a potential cancer diagnosis

Howard Luks, MD

Conditions and Diseases

August 4, 2010

I received a very troubling phone call from a close friend recently. He underwent a study, at the age of 40, and the physician came out of the procedure and said, “you have a large tumor, do you want me to call a surgeon for you.”

The purpose of this post is not to comment on the physician’s behavior or delivery techniques, but to define this very precarious and anxiety producing …

Obesity in American children and adults continues to grow

Emily P. Walker

Conditions and Diseases

August 4, 2010

by Emily P. Walker

The number of obese adults in the U.S. continues to rise, despite a growing number of federal anti-obesity initiatives in the past two years, according to a new report.

The seventh annual “F as in Fat” report, released Tuesday by the nonprofit Trust for America’s Health and the Robert Wood Johnson Foundation, found that obesity rates continued to rise in 28 states from 2007 through 2009.

Nationally, two-thirds of …

Breathe properly at night and learn to sleep better

Steven Y. Park, MD

Conditions and Diseases

August 4, 2010

Every time you see a depiction of someone sleeping on TV or in the movies, you’ll see the person sleeping on his or her back, and oftentimes, snoring.

The lay public, doctors, and even alternative and complementary practitioners naturally assume that you’re able to breathe properly at night. This couldn’t be further from the truth.

Evolutionary biologists and comparative anatomists have stated that speech and language development was ultimately detrimental to humans. …

Android and iPhone pros and cons for healthcare

Kevin

Health Technology

August 4, 2010

by Jeff Brandt

I wrote an article for KevinMD.com several months ago discussing the benefits of Android for the healthcare market. I also compared Android with the iPhone. I listed the iPhone’s technical shortcomings and really angered the “believers of all things Apple”. That was not my intent.

Apple’s latest release of iPhone 4.0 and their new operating system (OS) 4.0 corrects many of …

How to say goodbye to patients

Christian Sinclair, MD

Patient

August 3, 2010

OncRN is a wonderful blog written by an anonymous author sharing stories and insights in her line of work that many times speak to palliative themes. S/he says it best in her blog description,

my life gets intermittantly (sic) rocked by the wonders/horrors of being an oncology nurse. i just need to talk it all through sometimes.

A recent post is about how to say good-bye to our patients, particularly …

Read more…

How to say goodbye to patients

Unread echocardiogram fallout at Harlem Hospital Center

Larry Husten, PhD

Conditions and Diseases

August 3, 2010

Recently, the New York Times reported that Harlem Hospital Center had finally completed its investigation into thousands of echocardiograms that after receiving an initial reading by a technician had never been read by a physician.

It turns out that out of 7,000 tests that went unread, only 14 patients “might have been misdiagnosed because their tests had not been handled properly,” according to the hospital spokeswoman quoted in the story. …

Create a family practice mystique in medical school

Skeptical Scalpel, MD

Physician

August 3, 2010

For at least the last 20 years, graduates of U.S. medical schools have resisted pleas from organized and disorganized medicine to become primary care physicians (PCPs). Since there is already a severe shortage of PCPs, pundits are wondering who is going to take care of the hordes of newly insured by 2014. Many have speculated about the possible reasons for this dilemma such as the relatively paltry earning potential of …

Was JUPITER trial data influenced by AstraZeneca to favor Crestor?

Charles Bankhead

Medications

August 3, 2010

by Charles Bankhead

Reanalysis of a landmark cholesterol-lowering trial of people typically considered at low risk for heart attacks indicated that the results are flawed — and do not support the primary-prevention benefits that made headlines, authors of the review asserted.

The reanalysis of the massive JUPITER trial involving almost 18,000 people with low or normal cholesterol but elevated levels of the inflammatory biomarker C-reactive protein (CRP) — turned up no evidence …

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