Part two of a series. See also part one.
Previously I’d discussed how most of the time diagnoses are relatively straightforward. But what do doctors do when a diagnosis isn’t immediately clear to them?
Likely one or more of the following:
1. Revert to “novice” thinking. Which, in fact, is completely appropriate. We’re taught in medical school that approximately 90% of all diagnoses are made from the history, so if we can’t …
Part one of a series.
The first patient I ever saw as a first year resident came in with a litany of complaints, not one of which I remember today except for one—he had headaches. The reason I remember he had headaches isn’t because I spent so much time discussing them but rather the opposite: at the time I knew next to nothing about headaches and somehow managed to end the …
Originally published in MedPage Today
by Kristina Fiore
Physicians tend to prefer intellectual hobbies — chess, reading, writing. Dr. Alfred Bove is no exception. His hobby often requires application of his expertise in physiology. You know him as the president of the American College of Cardiology. But you may not know that his heart belongs to the sea.
Bove’s interest in scuba diving …
by Michael Jaff, MD
Peripheral Arterial Disease (PAD), a condition commonly correlated with diabetes, also known as a “silent killer,” affects at least one in every three diabetics over the age of 50 and approximately eight million Americans in total over the age of 40. Although PAD is prolific among diabetic and senior populations, current data show that public and physician knowledge of the disease is startlingly low, with only 25 …
The current (first generation) Apple iPad probably won’t run a robust electronic health record (EHR).
However, it may run some iPhone/iPod touch EHR/EMR apps. I think most physicians will prefer to use a standard tablet PC instead of the iPad. However, given that a large percentage of physicians are not using the tablet in the outpatient office setting, perhaps …
Originally published in MedPage Today
by Kristina Fiore, MedPage Today Staff Writer
Physicians may be too quick to medicate children suspected of having attention deficit hyperactivity disorder (ADHD).
The etiology of the disease is not well understood, and while some cases may have neurological causes, children may respond to psychotherapy instead, Esther Fine, PhD, a psychoanalyst in private practice in Los Angeles, told …
Here are two vignettes illustrating the failure of doctors to master the obvious and maybe a window onto the future struggles to control medical costs.
A 90-year old is referred for care due to “end stage dementia.” End-stage dementia is medical speak and as such does not really convey the appropriate imagery. It means a skeletal man, in a wheelchair or mostly in bed, with diapers, who has does not know …
Early last year, my boss Talmadge King and I were at an ABIM meeting (we’re both on the board), and the group was debating a controversial topic. Another participant at the meeting, like Talmadge the chair of a prominent department of medicine, said, “We polled 250 people at our grand rounds last week, and they said ‘X’.” The audience gasped – ‘X’ was a completely unexpected …
Here are the top 10 preventive services. These items were chosen by the National Commission on Prevention Priorities, and highlight those preventive services including immunizations, screenings, preventive medications, and counseling that give “the most bang for the buck.”
For an in depth discussion of methods and results, read Am J Prev Med 2006;31(1):52–61
Discuss Daily Aspirin Use
This counseling does not mean everyone should take aspirin to prevent heart attack and stroke, but …
Medicare, the government insurance company for everyone over age 65 (and for the disabled), pays fees to primary care physicians that guarantee bankruptcy.
Additionally, 70 percent of hospitals in the United States lose money on Medicare patients. That’s right, for every patient over age 65, it costs the hospital more to deliver care than the government reimburses. That is why Mayo Clinic has said it will not accept Medicare payments for …
The majority of Americans have a great deal of personal health information in their physician’s medical record. Many of these physicians have an electronic healthcare record (EHR) to store this information.
Unless you are in an integrated healthcare system, and most Americans are not, this information is just not available to you or any physician seeing you who does not belong to the same physician group as your primary physician. Even …
The following is part of a series of original guest columns by the American College of Physicians.
by Steven Weinberger, MD, FACP
At times of calendar transitions, e.g., at the onset of a new year or a new decade, the popular press often takes a broad view in looking retrospectively at the outstanding or defining events and people of the past …
Originally published in HCPLive.com
by Ed Rabinowitz
When it comes to negotiating fees with health plans, practices and physicians have more leverage than they realize. The problem, says John Schmitt, a managed care expert with EthosPartners Healthcare Management Group, is that practices often don’t even try. “Groups negotiate an agreement with a payor and then, for whatever reason, just fi le it away. Most medical groups do not have a good, proactive …
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Originally published in MedPage Today
by John Gever, MedPage Today Senior Editor
Psychiatrists who prescribe drugs for their patients today usually give more than one at a time, often with little scientific basis, researchers said.
About 60% of patients with psychiatrist office visits leading to a drug prescription received at least two medications in 2005-2006, according to government survey data analyzed by Ramin …
It’s commonly thought that health care in the United States is heavily dependent on diagnostic testing.
But how do we compare with the rest of the world? Perhaps these graphs, courtesy of the New York Times can provide a stark illustration.
Here’s the data regarding CT scans, showing the number of tests per 1,000 people. Guess which country’s on top:
The rapid advance in digital video and still camera technology has found its way into the operating room.
There is the potential to capture and record just about every minute of every surgical procedure in some way. The newest endoscopic camera systems and operating microscopes have integrated systems to record video footage. Storing all that data is just the press of a button away.
The advantages for surgeons are obvious, like the …
As the first decade of the 21st century comes to an end, it is interesting to look back and reflect on the most significant medical advances we’ve seen. I’d like to present 12 medical advances that I consider to have been the most important over the past decade, and I’d like to ask you, the wider world, to contribute in two ways:
– Add your nomination in the comment field regarding …
It’s common knowledge that fewer medical students are entering primary care and that patients are having a hard time finding a primary care doctor. Part of the reason is that insurance companies place little value on much of the work that primary care doctors do.
Even though physicians’ complaints are seen in the medical and lay media, it is rare to see descriptions of a primary care physician’s “typical day” in …
Two years ago, I wrote about the case of Julie Thao, the Wisconsin nurse sent to prison for a medication error. I argued then that – although Julie bypassed some safety rules – she most certainly did not deserve jail time.
Along comes another case involving jail time for a medical mistake, this one featuring an Ohio pharmacist named Eric Cropp. I became aware of Eric’s case through the efforts of …
Originally posted in Insidermedicine
The eye is very similar to a camera. Both are optical systems that have lenses in the front to focus light rays onto a film. The retina is the eye’s film. It is a tissue that consists of 10 layers and is about 500 microns thick—or, half a millimeter. The main function of the retina is to trap light rays, convert them into electrical impulses, and send …
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