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Rebutting a physician’s plea to declare independence

Health Policy

May 22, 2014

Writing in the Wall Street Journal, Daniel F. Craviotto Jr. an orthopedist, made a plea to physicians to declare independence from third parties and emancipate themselves from servitude to payers, mandates and electronic health records (EHR).

As rants go, this was a first class rant. But its effect was that of a Charles de Gaulle’s whisper to Vichy France rather than a Churchillian oratory at the finest hour.

The article went viral (it has …

Psychiatric hospitals need meaningful use incentives

Edmund Billings, MD

Health Technology

May 22, 2014

Imagine you go to work one day and your boss says all employees will be evaluated based on the performance of a new set of job skills that require additional training and, perhaps, new computer hardware and software. The boss also announces that some employees will be reimbursed for the cost of acquiring these skills and tools. You aren’t among this privileged group.

In government, this is called an unfunded …

It’s time for doctors to say no to drugs

James C. Salwitz, MD

Medications

May 22, 2014

The United States of America is addicted to narcotics. I do not mean the millions of individuals who are hooked. I mean the whole nation is jonesing for the stuff. I also do not mean the junk that slips into our nation in coffee cans or across midnight borders. I mean the billions of pills pouring off assembly lines. I could blame pharma or the FDA, but the truth is …

An $8,000 hospital bill added to my already growing debt

Sammy Ta

Patient

May 21, 2014

The clock read 9:30pm and in front of me was dozens of notes, PowerPoint slides, and practice exams to review before 8am. The all-too-familiar finals week all-nighter beckoned, and though I’ve had my fair share of experiences with studying until the sun rose, I decided to forgo the typical mug of coffee and take some over-the-counter caffeine pills instead. My friend proclaimed that they would help more than any energy …

Digital health and its role in the changing health care landscape

Kevin R. Campbell, MD

Health Technology

May 21, 2014

The digital age of medicine is upon us. Recently at the opening plenary session at the annual Heart Rhythm Society meetings, we heard Dr. Eric Topol and others tell us that we must embrace social networking in order to engage patients and improve care. The Affordable Care Act has now changed the landscape of medical practice in the US: We must do more to focus on preventative care and work harder to curtail costs. …

Is this the end of rheumatology as we know it?

Jonathan S. Hausmann, MD

Conditions and Diseases

May 21, 2014

Recently, an international research team led by Xavier Rodó published a fascinating study in PNAS suggesting that Kawasaki disease is caused by an agent transported by wind from farms in Northeast China. This agent, possibly a fungal toxin, is responsible for triggering an exuberant immune response in children, causing the typical manifestation of the disease: fevers, rash, conjunctivitis, “strawberry tongue,” enlarged lymph nodes, and swelling of the extremities. Untreated, Kawasaki disease can cause aneurysms of the …

How to save my son’s life: 20 high-stakes minutes

Susannah Fox

Patient

May 21, 2014

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Once a year, I give a high-stakes presentation in front of a single audience member: my son’s teacher. I have 20 minutes to teach her how to save his life.

I need to explain the science of food allergy, list all of his many allergens, accurately describe the symptoms of anaphylactic shock, instill an appropriate sense of urgency and responsibility with one …

Why the VA scandal is a red flag for single-payer advocates

Kevin Pho, MD

KevinMD

May 21, 2014

va health care scandal

“I will not stand for it.”

That’s what President Obama said about the deepening VA health care crisis. It’s also a lightening rod for how partisans want to frame the ongoing health debate.

Some are eager to link the VA scandal to Obamacare, and more broadly, government-run health care.

Others extol the virtues of the VA, holding it …

A holistic view on integrative medicine

David L. Katz, MD

Medications

May 21, 2014

I was recently on the Katie Couric Show to discuss integrative medicine. Somewhat ironically, I returned from Manhattan that same day to a waiting email from a colleague, forwarding me a rather excoriating critique of integrative medicine and asking me for my opinion.

The juxtaposition, it turns out, was something other than happenstance. The Cleveland Clinic has recently introduced the use of herbal medicines as an option for its patients, generating considerable media attention. Some of …

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A holistic view on integrative medicine

The resurgent interest in primary care

Anoop Raman, MD, MBA

Physician

May 21, 2014

Much of the news we hear about primary care is disheartening at best, frightening at worst. Most of us have heard that there is a shortage of primary doctors, and with over seven million new patients enrolled (and counting) through Obamacare health exchanges, that shortage is going to get much worse. On the horizon, while medical schools are increasing their enrollment, there continues to be a dearth of students willing to apply to …

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The resurgent interest in primary care

Obamacare is up for grabs: Who wins in November?

Robert Laszewski

Health Policy

May 21, 2014

House Energy and Commerce Committee Republicans seemed surprised recently when representatives of the insurance industry reported that they didn’t have enough data yet to forecast prices for next year’s health insurance exchanges, the market was not about to blow up, and that so far at least 80% of consumers have paid for the health insurance policies they purchased on the exchanges. The executives also reported there are still …

A mission trip to Kenya: Challenge, success and heartbreak

Donna-Ann Thomas, MD

Physician

May 20, 2014

A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com.

Mission must have always been in my blood, but it took me a while to discover it. I considered going on a mission trip to Bungoma, Kenya, in 2009, but the timing coincided with one of the major conferences at the New York State Society of …

Lethal injection perverts the ethics of practicing medicine

Karen S. Sibert, MD

Medications

May 20, 2014

I give what could be lethal injections for a living.

That’s right. Nearly every day I give someone an injection of midazolam, vecuronium, and an IV solution containing potassium chloride–the three drugs in the “cocktail” that was supposed to kill convicted murderer Clayton Lockett quickly and humanely in Oklahoma.

Here’s the difference between an executioner and me. I use those medications as they are intended to be used, giving anesthesia to my …

The day my brother became a statistic

Ivan Oransky, MD

Physician

May 20, 2014

This article was originally published on May 12, 2014 in MedPage Today’s Ivan Today.

My brother would have turned 37 today.

But he didn’t. On January 9, 1995, he died in a car accident, at the age of 17.

That was the day he became a statistic.

I don’t usually need any reminders this time of year. If I somehow forget, May 12 is …

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The day my brother became a statistic

Who watches those watching physicians?

Edwin Leap, MD

Physician

May 20, 2014

Who watches the watchers? It’s an old Roman saying from the poet Juvenal, and it had to do with infidelity. But over the years it has been applied to politics as well. It means, “How do I know that the people guarding me are worthy?” It has also been translated, “Who guards the guards?”

But it seems to me that it applies to medicine quite appropriately. Who watches those watching physicians? We …

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Who watches those watching physicians?

Can appendicitis be managed without surgery?

Skeptical Scalpel, MD

Conditions and Diseases

May 20, 2014

Two recent papers have added more fuel to the debate about whether appendicitis can be managed without surgery.

The first paper is a prospective observational study from Italy involving 159 patients over the age of 14 who were thought to have uncomplicated appendicitis. Nonoperative management with oral antibiotics was planned for all of the patients.

Nonoperative management failed within 7 days in 19 (11.9%) patients, all of whom underwent immediate surgery. Appendicitis …

Having an epidural doesn’t mean you’re any less of a mom

Jennifer Gunter, MD

Conditions and Diseases

May 19, 2014

Reports that Mila Kunis, the actress, plans on a “natural” delivery is all over the Internet. As a celebrity she is clearly a medical expert and somehow it is relevant to hear how an actress with no financial concerns, doesn’t need to work on her feet until she goes into labor, has a BMI of 19 (OK, that’s a guess) who has never delivered before is planning to have her …

Addressing death is an important aspect of public health

Craig Chen, MD

Physician

May 19, 2014

We will all someday die. No matter how good our doctors are, how many scans we get, how compliant we are with medications, how many cutting-edge surgeries we undergo, we will all die. That scares us. Most of us fear death: We do everything we can to avoid it, and when it inevitably comes, we struggle and refuse it. Similarly, when someone we love is dying, we want to do …

After the botched execution: It’s time to lift the veil of secrecy

Ruth Macklin, PhD

Physician

May 19, 2014

With new revelations emerging every day about the botched execution of a prisoner in Oklahoma, even those who favor the death penalty (I am a strong opponent) may have some reservations about the way it is carried out. Despite the uproar from both sides, I believe there are some major ethical considerations that have been overlooked in this case.

Setting aside for a …

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