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The cheapest prescription that’s most beneficial to patients

Neil Baum, MD

Physician

September 3, 2014

I see nearly 100 patients a week. Of these, easily 35% are overweight and 15-20% are obese with a BMI greater than 30. I live in New Orleans, Louisiana, which along with Mississippi has the highest rate of hypertension, diabetes mellitus, arthritis, and other diseases commonly associated with obesity. There are many explanations for the obesity academic in America but certainly poor nutrition and lack of exercise are at the …

Ebola in the United States: A reason not to panic

Manoj Jain, MD, MPH

Conditions and Diseases

September 3, 2014

If an ill patient, who unexpectedly has Ebola, landed in Memphis, it is likely that my partner or I would see him. We work as infectious disease doctors at the hospital closest to the airport.

The Ebola patient would present with fever, nausea and vomiting, indistinguishable from a flu or a viral illness that hundreds of patients present with each day at our hospitals. But over a few days of the illness, …

Upcoding in Medicare Advantage: Transparency can clean the mess

Trudy Lieberman

Health Policy

September 3, 2014

That the government overpays sellers of Medicare Advantage plans is well known in Beltway circles even if much of the public remains unaware. Recently, two Department of Health and Human Services (HHS) researchers posted new findings on the Medicare and Medicaid Research Review, a peer-reviewed online journal supported by the Centers for Medicare and Medicaid Services (CMS), documenting how some insurance companies are overbilling the government and have been …

Set free: Thank you for the freedom to care for this sick patient

Rob Lamberts, MD

Physician

September 3, 2014

I got the following email a few weeks ago (details changed for confidentiality reasons):

Dear Sir,

I read about your unique practice online. I have an 91-year-old ambulatory father who will not go to a doctor. He definitely is not well and this is the only way I can get him the attention he needs. He is adamant about not wanting medical interventions, however he still needs to be seen …

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Set free: Thank you for the freedom to care for this sick patient

I never understood the loss of empathy during medical training. Until now.

Anonymous

Medical Education

September 2, 2014

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It was 4:30 a.m., and I was on the side of the road, drenched in sweat and tears. I had finally slowed my breathing to normal. I was going to be late for rounds. No time to obsess over possible questions. No time to memorize lab values, or practice regurgitating them.

I thought of home. My family and friend, who I hadn’t …

The desire to spoon-feed medical residents today

Wes Fisher, MD

Medical Education

September 2, 2014

As I begin another year teaching EKGs to our new residents, I find I am increasingly asking myself, “Where to teach?”

I do not mean to imply a geographic sense to the word “where” (although this is difficult, too, as residents move from hospital to hospital in large health care systems like ours as they change rotations), but rather as more of a “level.” What level do I teach our residents …

Is much of the annual physical a waste of time?

Michael Kirsch, MD

Physician

September 2, 2014

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So much in medicine and in life is done out of habit. We do stuff simply because that’s the way we always did it. Repetition leads to the belief that we are doing the right thing.

In this country, we traditionally eat three meals each day. Why not four or two?

We prefer soft drinks to be served iced cold. I’ve never tried …

Don’t be stupid, and other wise words to new college students

Edwin Leap, MD

Physician

September 2, 2014

Welcome to college, young people! It’s an amazing time in your lives. These years will impact your life dramatically if you use them well. So, to help you along the way, allow me to give you some wisdom.

First and foremost, get some wisdom. You are bright and capable, otherwise you probably wouldn’t be in college in the first place. But for all …

Price shop your prescriptions to dramatically reduce costs

Ali Khoshnevis, MD

Medications

September 2, 2014

My brother and I, both optometrists, had a heart-to-heart discussion about the loss of one of our patients. We discovered he was not taking his medications as prescribed, which was leading to vision loss. When pressed, the patient said he had a choice of eating, supporting his family, or purchasing his medication.

He was under the impression that the $150 price for his generic Lipitor was “about the same” at any …

A bystander to the evolution of plastic surgery

Miranda Fielding, MD

Physician

September 2, 2014

I have a new favorite doctor show, “The Knick” on Cinemax, airing on Friday nights. The show stars Clive Owen as the charismatic cocaine-addicted chief of surgery Dr. John Thackery at a fictitious New York City hospital called The Kickerbocker at a time when surgery was one foot out of the barbershop. The tagline is as they say, priceless: “Modern medicine had to start somewhere.”

On the third episode, last Friday …

Cancer screening in the elderly: Don’t be stupid

Kenneth Lin, MD

Conditions and Diseases

September 1, 2014

The electronic medical record that my office uses features a clinical protocol button that we are encouraged to click during patient visits to remind us about potentially indicated preventive services, such as obesity and tobacco counseling and cancer screenings. I once tried it out while seeing a 90-year-old with four chronic health problems. The computer suggested breast cancer, colorectal cancer, and cervical cancer screenings: three totally inappropriate tests for the …

Allowing medicine to become a commodity would be a disaster

James C. Salwitz, MD

Physician

September 1, 2014

What do eggs, roofing nails, men’s haircuts and plastic cups have in common? A bizarre fraternity ritual or my Saturday morning honey-do list? Gasoline, copying paper and paperclips? Shopping for a mobile accounting office? Nope. What these items share is that who ever makes them, wherever you buy them, they are essentially the same. They are commodities. They do not vary significantly in construction or quality. The only way to …

Employer-sponsored insurance or Medicaid? An ideological debate.

Dr. Saurabh Jha

Health Policy

September 1, 2014

The recent disagreement between Uwe Reinhardt and Sally Pipes in Forbes is a teachable moment. There’s a dearth of confrontational debates in health policy, and education is worse off for it.

Crux of the issue is the more efficient system: employer-sponsored insurance (ESI) or Medicaid. Sally Pipes, president of the market-leaning Pacific Research Institute, believes it is ESI. Employers spend 60% less than the government, per person: $3,430 versus $9,130, …

Dissent and cynicism: Learning from listening to doctors

Jack Cochran, MD

Physician

September 1, 2014

An excerpt from The Doctor Crisis: How Physicians Can, and Must, Lead the Way to Better Health Care.

I just listened. They were very unhappy and angry.

I was elected executive medical director in November 1998 but would not assume the leadership role until January 2000. This was fortunate. I knew that I needed time to prepare for a job that was about as radically different from my twenty-plus …

What every college freshmen ought to know about sexual assault

Natasha Burgert, MD

Physician

September 1, 2014

Dear college freshman,

I just saw you in clinic a few weeks ago; your last check up before college. We talked about a lot of stuff, updated shots, filled out forms, hugged good-bye; crammed in what we could in just a few minutes. It was a great to see you.

Now that you are out of the office, away from the distractions of a buzzing …

The health care turf battles: It’s time to work together

Kevin R. Campbell, MD

Physician

September 1, 2014

MedPage Today recently tackled a very controversial issue in medical practice. The piece explored the ongoing battle between dermatologists and allied health professionals (AHPs) over the performance of dermatologic procedures. As independent NPs and PAs begin to bill for more and more procedures (thus potentially talking revenue away from board certified dermatologists) specialists are beginning to argue that the AHPs are practicing beyond their scope of practice.

According to the Read more…

The health care turf battles: It’s time to work together

What being overwhelmed by rules and regulations looks like

Fred N. Pelzman, MD

Physician

August 31, 2014

My morning practice session started out with a few patients arriving early, so I was able to get a jump on the day, and it looked like I was going to actually be running on time.

As I was walking from one exam room to the other, my administrator came down the hallway, grabbed my arm and said, “Can I have you for a minute?”

It seems that a group of systems …

Direct primary care: A response to your comments

Stephen C. Schimpff, MD

Physician

August 31, 2014

Part of a series.

Over the past few months KevinMD.com has posted a series of articles by me on what I call the “crisis in primary care.” Most recently have been a few posts related to direct primary care. They have generated many comments: some pro and some con. I have greatly appreciated everyone’s interest; it makes it worth the time to write. I am also working on a book on …

This surprising request brought an emergency doctor to tears

Monica Williams-Murphy, MD

Physician

August 31, 2014

Most of the time I feel as though I am running in quicksand attempting to bring patients to a place of grace and dignity in dying. On occasion, there is someone who jerks me out of my quicksand and plants me squarely on stable shore and then proceeds to show me what grace and dignity in the face of death really look and feel like.

Please meet Mr. Jefferson.

Mr. Jefferson had long, lacy …

Was the death of Robin Williams preventable?

James Katz, MD, MPH

Conditions and Diseases

August 31, 2014

In his piece on Robin Williams, Andrew Solomon of the New Yorker states that every 40 seconds, someone commits suicide. Actually, it’s every second of every day, as people choose the action, or inaction, that will end their lives sooner. When the patient with metastatic melanoma, who is quite capable of getting to the refrigerator, refuses to take food or liquids, she is taking her life. Her body will …

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