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Don’t land in the teaching hospital on a holiday weekend

Deb Discenza

Patient

September 30, 2015

“Don’t ever land in a teaching hospital on a holiday weekend, they always staff up with residents,” noted a close friend who was all too familiar with the inner workings of hospitals.

That statement sticks in my head heavily today as I prepare to visit my father’s year-old grave. My father, a man that was involved in the Department of Health & Human Services (HHS) and private sector research societies for decades, …

Bundled payments means the death of quality medical care

David Mokotoff, MD

Health Policy

September 30, 2015

A recent CMS proposal to bundle payments for doctors and hospitals for hip and knee replacements in 800 model centers has hit a roadblock. The five-year program would have begun January 1, 2016, and nearly 300 comments were received by CMS earlier this month. Apparently most of the comments were not, shall we say, favorable. Even the Federation of American Hospitals protested

For those who are unaware, “bundled payments” means that …

Don’t try to be your child’s friend. Here’s why.

Kathryn L. Moseley, MD

Conditions and Diseases

September 30, 2015

A piece of advice to all you parents reading this: Don’t try to be your child’s friend. Don’t get me wrong. You can be kind, you can be chummy, you can (and should) have fun with your kids — but you are not their friend.

I say this as a mom and a pediatrician who has seen way too many parents muck things up by trying to be a friend to their …

Doctors, parents, and spouses all rolled up into one person

Wendi Kitsteiner

Physician

September 30, 2015

As my husband’s pick-up truck rolls up the driveway, a long ER shift behind him, my four kids come running from wherever they are currently playing on our farm. My seven-year-old son was reading in a rocker on the front porch. His six-year-old brother was watching the new baby chicks scramble around our brooder. My four-year-old daughter was helping feed our ducks. And my two year old was getting into …

Is that bad? A difficult question doctors can answer in many ways.

Frederick Gandolfo, MD

Physician

September 29, 2015

Here is a question I get asked all the time by patients: “Is that bad?”

This is different than the similar, more appropriate question, “Is it bad?” which is usually asked after being given a specific diagnosis. For example, after a colonoscopy where a large polyp was discovered and removed I will tell the patient about the findings. He may ask, “Is it bad?” The answer is usually “No, the polyp …

Defining obesity: Disability or disease? Or neither?

Skeptical Scalpel, MD

Conditions and Diseases

September 29, 2015

In 2013, the American Medical Association recognized obesity as a disease. Dr. Peter Ubel, writing in his blog on the Forbes website, thought this was a bad idea. He feared that calling obesity a disease will result in people having less motivation to lose weight and cited a study which found that people who were told that obesity is a disease tended to be less concerned about their …

It’s time to remove EHR gag orders. For patient safety’s sake.

David Mann, MD

Health Technology

September 29, 2015

I recently read an article in Politico entitled “Doctors barred from discussing safety glitches in U.S.-funded software.” The article states that, despite massive public funding of electronic health records (EHR), the EHR corporations (including Epic Systems, Cerner, Siemens, Allscripts, eClinicalWorks and Meditech) routinely attach gag clauses to contracts with the hospitals and medical groups who purchase their systems. We are talking about gag clauses that prevent criticism by …

How to fix physician burnout? Start with a culture of acceptance and support.

Christopher Vercammen, MD

Physician

September 29, 2015

“Thou must be like a promontory of the sea, against which, though the waves beat continually, yet it both itself stands, and about it are those swelling waves stilled and quieted.”
– Marcus Aurelius

My reaction to this quote, which begins Osler’s Aequanimitas, has changed over the years. When I first heard it, I was filled with a sense of pride and anticipation. I would be that rock, for my patients, for …

ICD-10: No wonder why doctors are burnt out

Shirie Leng, MD

Physician

September 28, 2015

Attention graduates! If you’re looking for a career with a ton of job prospects, look no further than an international classification of diseases coder. This fun and fulfilling career will take you into new worlds of diagnosis, laterality, specificity, and nitpicky-ness as you dive into thousands of columns of numbers and qualifiers. You’ll even get to call doctors and harass them anytime you want. Sign up for your free brochure …

Medical Jeopardy is a terrible way to learn. Here’s why.

Jennifer Middleton, MD

Medical Education

September 28, 2015

Confession time: I despise presentations that involve the use of a PowerPoint Jeopardy! game. To be clear, I get uncomfortable when any game-like activity appears in a medical teaching presentation.

Not that I don’t think games can have an important role in education — far from it. Heck, I once worked on a presentation that turned our residency conference room into a giant Game of Life board with …

Legalize medical marijuana? See how a decision can affect this cancer patient.

James C. Salwitz, MD

Medications

September 28, 2015

What is not to like about medical marijuana? It treats pain, vomiting, fatigue, anxiety, depression, insomnia, seizures, muscle spasms, Crohn’s disease and allows many cancer patients to resume remarkably normal lives. It is not addictive. It does not interact with other medicines. It acts quickly and is easy to adjust. It can be consumed in numerous ways. It is safer than essentially any other drug: 1,500 Tylenol deaths in the …

Health inspectors should be trained to do what doctors do

Rocky Bilhartz, MD

Physician

September 28, 2015

This story is a great one.

It’s about a female dog with only three legs. Her fourth leg was amputated following a traumatic accident as a puppy.

Now, when she walks, she has a hitch in her step. And, when she hitches, she kicks the stump of her injured leg outward.

Step, step, hitch. Step, step, hitch.

One day, the female dog has puppies. And, her puppies do what all puppies do. They nurse. They watch. …

Just like driving lessons, parenthood is terrifying

Claire McCarthy, MD

Physician

September 27, 2015

I did something really death-defying with my daughter this summer.

I taught her to drive.

Truly, teaching a teen to drive is scarier than just about anything else we do as a parent. It’s scarier than giving birth, as there are usually skilled people around during labor who can take over if things go awry. It’s way scarier than first days of school or first dates, scarier than most illnesses and injuries …

It’s time for hospitals to take nutrition seriously

Suneel Dhand, MD

Physician

September 27, 2015

I remember the day like it was yesterday. I was a medical student, rounding with my team, and we had just talked to a diabetic patient who was recovering from a myocardial infarction. The attending looked over at the side and saw some chocolate donuts and cakes lying on the tray table, which had been brought in by the patient’s relatives. The attending shook his head disapprovingly and said, “I don’t think those are going to …

How call rooms reflect the personality of residency programs

Katie Lockwood, MD

Physician

September 27, 2015

An intern pushed open the call room door so that twelve medical students could crowd their eager faces together to see where we might sleep for the next three years. Only a few months away from medical school herself, the intern acted as if sleeping in such quarters were second nature. She gestured to the fluffy quilts the residents had brought from home to adorn their beds and giggled about …

3 tips to help physicians manage online criticism

Kevin Pho, MD

KevinMD

September 27, 2015

A continuing series on physician online reputation. Created in partnership with the Doctors Company as part of their social media resources for physicians.

Patients have more avenues than ever to express themselves online, whether it’s through a physician rating site or through social media. It’s inevitable that every single doctor eventually will be faced with criticism on the web, so you need to know what …

Tips to meet challenges of administering and tracking immunizations

Yul Ejnes, MD

Physician

September 26, 2015

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

When I entered practice over 25 years ago, planning for influenza vaccination season was straightforward. Every late spring, we looked at how many doses we gave out the previous year, added a few doses, ordered the vaccine, and immunized our patients in the fall. If …

Patient autonomy is held to be sacrosanct. A doctor reconsiders this view.

Anonymous

Conditions and Diseases

September 26, 2015

The refusal of blood products by the Jehovah’s witnesses has often been cited as a great example of patient religious freedom triumphing over the traditional paternalism of medicine. Patients are free to refuse transfusion even at the risk of death. Many hospital-based physicians have, at one time or another, been witness to the demise of a patient refusing blood products, perhaps a preventable demise. Patient autonomy is held to be …

Conversations lead to better health, not interrogations

Matthew Walvick, DO

Physician

September 26, 2015

Most patients think they need to come to their doctor’s visits with a strict agenda. It’s a habit forged out of wanting to get quick fix and a by-product of time constraints. This paradigm seems logical and can sometimes accomplish its goal, but too often, this approach falls short in harnessing the immense value that can result from a connected physician-patient relationship.

I can vividly remember the days when the idea …

Test your medicine knowledge: 27-year-old woman with an intensely pruritic rash

mksap

Conditions and Diseases

September 26, 2015

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

A 27-year-old woman is evaluated for a 1-week history of an intensely pruritic rash on her eyelids. She applied a new brand of eye makeup just prior to the onset of the rash. She immediately discontinued its use and has been applying a moisturizing lotion to both eyelids since then without improvement in her symptoms. …

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