| KevinMD.com

Can connected health improve the lifestyle challenges patients face?

Health Technology

December 9, 2014

My dad was a wonderful guy who could fill the room with his personality. He grew up during the Great Depression and was a World War II veteran. I was thinking of him recently while considering how much health care delivery has changed in the last 100 years.

When asked about his health, my dad would always say, “I feel great. I don’t have any aches or pains.” This is telling. …

The 80-20 rule: Apply Pareto’s principle to hospital medicine

Suneel Dhand, MD

Physician

December 9, 2014

There are certain universal laws that appear to govern the broader workings of the world around us. For those of you unfamiliar with Pareto’s principle, it’s a concept that was first applied in economics and then found to be a governing rule in a whole host of different arenas. It’s no understatement to say that understanding and acting upon this concept can be transformative, not just in your work but …

Analyzing the new treatment recommendations for bronchiolitis

Christopher Johnson, MD

Conditions and Diseases

December 9, 2014

Every fall I write about bronchiolitis because it is one of the most common respiratory ailments affecting infants and children under about two years of age. It is the most common reason infants end up in the hospital during the winter and early spring months. Every year we get severe cases in the PICU. Pediatricians have struggled for decades to figure out how to treat bronchiolitis but we don’t have …

Hospitals have to strive for zero harm

Peter Pronovost, MD, PhD

Physician

December 9, 2014

The safety concerns that keep clinicians awake at night often aren’t issues that you could fit onto a safety and quality dashboard. They aren’t the kinds of things that feed metrics on the CMS Hospital Compare website or any of the other sources of publicly reported quality measures. They are intensely local, and no less important for being so.

This reminder came to me recently during a quarterly meeting of Comprehensive Unit-based …

Read more…

Hospitals have to strive for zero harm

Don’t look back to how medicine used to be

Starla Fitch, MD

Physician

December 8, 2014

shutterstock_122907892

Is it just me, or is the world of medicine getting way more complicated?

Sometimes I long for the good old days of practicing medicine.

First, the hospital switched over to electronic medical records, which required us to attend Saturday morning classes to learn how to tell the nurses our patients could go home after surgery.

Next, our office got an insurance memo that …

Death is not a failure of the health care system

Elizabeth McKinnon, MD

Physician

December 8, 2014

Two weeks ago, I went on an awesome vacation to Las Vegas. It was my first paid vacation of my medical career and by all accounts it went very well. I won $50 on the penny slots and got to see my old friend, the Hoover Dam. Many “Vegas vacation” lines were uttered as we walked across the dam bridge and asked all the dam questions we could think of. …

Postpartum depression may be a misnomer

Claudia M. Gold, MD

Conditions and Diseases

December 8, 2014

Postpartum depression may be a misnomer. A more accurate term might be postpartum neglect — not by mothers, but of mothers.

The human infant is uniquely helpless in the early weeks and months of life. His arms fly up over his head at random moments in a primitive “startle reflex.” His sleep patterns have no rhyme or reason. He eats and poops round the clock. Serving an evolutionary purpose, in part to achieve an upright …

Read more…

Postpartum depression may be a misnomer

Holidays in the ER: What you’ll see is a lot of humanity

Edwin Leap, MD

Physician

December 8, 2014

shutterstock_229011745 People ran to the church for refuge in Medieval times. It was considered a place of safety, a sanctuary from civil punishment. In the church, one could claim a right to justice, food, water and shelter. That role was recognized by church and government authorities alike; doubtless sometimes grudgingly as the wanted escaped harsh punishments.

These days, America’s emergency rooms have filled …

We must listen to and assist all young victims of sexual assaults

Victoria Dooley, MD

Physician

December 8, 2014

Recently, allegations have been spread by women who claim that as teenagers, they were sexually assaulted by Bill Cosby. Some have not made any mention of these crimes until decades later; while others have said that they did report the allegations at the time of the assault, but were not believed. Due to Cosby’s notoriety as a celebrity, this has fueled …

The time I almost got fired for saving a young woman’s life

Carolyn Messere, MD

Physician

December 8, 2014

I was a fourth-year surgery resident, on the transplant team. It was a difficult rotation, because the doctor who ran it was sexist and got along better with you if you flirted with him. He made innumerable sexual wisecracks in the OR while we were working, and preferred to round with his arm around me as he made further innuendoes.

I wasn’t …

5 ways how doctors can round with nurses

Val Jones, MD

Physician

December 7, 2014

Whenever possible I make a point of rounding on patients with their nurses present. I rely on nurses to be my eyes and ears when I’m not at the bedside. I need their input to confirm patient self-reports of everything from bowel and bladder habits to pain control, not to mention catching early warning signs of infection, mental status changes, or …

Stay human in medicine: Lessons from The House of God

Stephen Bergman, MD

Physician

December 7, 2014

In 1978, under the pseudonym Samuel Shem, psychiatrist Stephen Bergman published “The House of God,” an iconic novel drawn from his medical internship in Boston in the early 1970s. Earlier this year, Dr. Bergman spoke at the commencement of the New York University School of Medicine. With his permission, the following is adapted from those remarks.

I began writing The House of God as a catharsis, to make sense of what seemed like the worst year of my life.

These are …

Our health care system makes no sense. But what if it did?

Jordan Grumet, MD

Physician

December 7, 2014

The conversation was almost comical, until I thought more deeply about it later. Apparently I was on “the list.” Insurers make such lists for customers who are searching for a doctor who accepts their coverage. Every so often my name comes up on these lists, and I get a smattering of phone calls from perspective patients. Maybe a few times a …

Physicians must expand the vision of their role

James C. Salwitz, MD

Physician

December 7, 2014

Once upon a time, in a medical school far far away, I was taught that my sacred oath was to the patient. The one patient; not the patient down the hall, in the next town, or in a country halfway around the world. I would commit my heart, soul, sweat and blood to the suffering and healing of the person directly, immediately in my care. This was a noble calling …

Why does treating heart attacks cost so much money?

Janice Boughton, MD

Physician

December 7, 2014

An article from the JAMA has been gnawing at my consciousness for the last couple of weeks. Dr. Prashant Kaul and colleagues out of the University of North Carolina reviewed records from hospitals in the state of California from 2008 through 2011, looking for patients who had been hospitalized with heart attacks. Specifically, they were looking for patients with ST elevation …

The origins of HIV and the making of an AIDS scapegoat

Rod Tanchanco, MD

Conditions and Diseases

December 6, 2014

The cherry trees are still there, blossoming every spring, on a patch of land near Stanley Park in Vancouver. They were planted in 1985 by a group of volunteers from AIDS Vancouver, to honor the memory of three Canadian sons who were among the early victims of AIDS. One of these men was Gaetan Dugas, who died in 1984. During this same period in San Francisco, Randy Shilts, a reporter …

8 tips to save money on generic drugs

Martine Ehrenclou, MA

Medications

December 6, 2014

80 percent of prescriptions in the U.S. are for generic medications. Generics are supposed to be less expensive alternatives to brand name drugs. However, prices for certain generics are rapidly increasing. 50 percent of generic medications increased in price in the last year and 10 percent more than doubled in cost during the same time period. Among them are thyroid replacement hormone, doxycycline, digoxin and other heart medications, tetracycline, …

Read more…

8 tips to save money on generic drugs

After a miscarriage: Answers to your difficult questions

Brian Enggano, MD

Conditions and Diseases

December 6, 2014

I chose to become an OB/GYN because I love delivering babies and bringing joy to expectant parents. It is by far the most rewarding part of my job. Seeing the sense of pride on a new dad’s face, the joyful tears in a happy mother’s eyes, or the inquisitive look of a young big brother or sister is priceless and makes my “job” feel more like a privilege. Bringing a new …

Learn to use a fax machine, and other medical student tips

Mike Logan

Medical Education

December 6, 2014

Before starting third year, we had a week-long course that taught basic skills not learned in our first two years of medical school: suturing, knot tying, injections, note writing, etc. One critical skill they left out was how to use a fax machine and how to deal with medical record offices.

To outsiders, it probably seems pointless to learn how to operate an archaic communication tool like a fax machine in …