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Tort reform should not be controversial

Physician

April 23, 2014

I’ve been in the medical malpractice arena many times, and always walked away unharmed. If this system were presented in front of a fair minded and impartial jury, it would be dismantled. Sure, there are positive elements present, but they are dwarfed and suffocated by the drawbacks. The self-serving arguments supporting the current system are far outweighed by the financial and emotional costs that innocent physicians unfairly bear. Tort reform …

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Tort reform should not be controversial

Can high-tech medicine also be high value?

Karan Chhabra

Physician

April 23, 2014

“Can you hear it?” she asked with a smile. The thin, pleasant lady seemed as struck by her murmur as I was. She was calm, perhaps amused by the clumsy second-year medical student listening to her heart.

“Yes, yes I can,” I replied, barely concealing my excitement. We had just learned about the heart sounds in class. This was my first time hearing anything abnormal on a patient, though it was …

What do European doctors say about our guidelines for statins?

Janice Boughton, MD

Medications

April 23, 2014

In November of last year the American Heart Association released to recommendations on who should be taking statins (drugs like Lipitor/atorvastatin), the most common medicines we use to control cholesterol levels. High cholesterol levels are associated with higher risk of heart attacks and strokes, and taking statins, which lower cholesterol, can reduce those risks. The drugs have pretty significant side effects, though, and not everyone with high cholesterol …

Lessons learned during an unplanned EMR downtime

Yul Ejnes, MD

Health Technology

April 23, 2014

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

On a Thursday in April, my practice upgraded its electronic health record to the next version, the “latest and greatest” with more features, as well as compliance with meaningful uses 2 through infinity. That was the good news. The bad news was that it meant that our EHR …

Doctors and nurses are being overloaded with menial tasks

Jordan Grumet, MD

Physician

April 22, 2014

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I’m no economist. In fact, I have never taken any business or accounting classes in my life. But it doesn’t take a formal education to get this. We are speeding down the wrong path.

The call at three in the morning woke me from a deep sleep. I fumbled and strained to hear the whispered voice of the apologetic nurse. Apparently Mrs. …

Where are we losing America’s future primary care physicians?

Michael Bradfield, MPH

Medical Education

April 22, 2014

I know where America’s future primary care physicians are, and more importantly, where we are losing them. I am one of them, and I almost got lost.

Maybe I was naïve. I’d had no math or science classes as an undergraduate, and I’d never really thought about the mechanics of medical education. Even while jumping through all the prerequisite hoops before applying, it never occurred to me how inadequate my non-traditional …

7 steps to eliminating the war analogy in cancer care

Matthew Katz, MD

Conditions and Diseases

April 22, 2014

From a philosophical standpoint, one of the things I hate most about cancer is the use of “war” analogies. The “battle” may mobilize patients and families, but it may also interfere with education and informed decision making. And both patients and clinicians often take recurrence or disease progression personally as a failure. Even when everything is done perfectly, the outcomes aren’t. Why …

How a hospice model can save American health care

James C. Salwitz, MD

Health Policy

April 22, 2014

America is one of the sickest places on earth. We have the best diabetic care, but the most diabetes. First-rate cardiac care, but we are obese, hypertensive, inactive, and have high rates of heart disease. We are the world’s standard for cancer technology, innovation and access, but we have high cancer rates even while we waste most of the money from cigarette taxes on road repairs. At every socioeconomic level, …

How to fix the problem of patient handoffs

Val Jones, MD

Physician

April 22, 2014

One of my biggest pet peeves is taking over the care of a floor full of complicated patients without any explanation of their current conditions or plan of care from the physician who most recently treated them. Absent or inadequate verbal and written “handoffs” of patient care are alarmingly common in my experience. I work primarily as a locum tenens physician, traveling across the country to “cover” for my peers on vacation …

There are no quick fixes to hospital-acquired infections

Peter Pronovost, MD, PhD

Health Policy

April 22, 2014

Recently, the U.S. Centers for Disease Control and Prevention issued two reports that are simultaneously scary and encouraging.

First, the scary news: A national survey conducted in 2011 found that one in every 25 U.S. hospital patients experienced a healthcare-associated infection. That’s 648,000 patients with a combined 722,000 infections. About 75,000 of those patients died during their hospitalizations, although it’s unknown how many of those deaths resulted from the …

Measles and the media: Are parents are being duped?

Wendy Sue Swanson, MD

Conditions and Diseases

April 21, 2014

Something is in the air right now. There’s a strange mix of vaccine-preventable illness sweeping the country (measles) and a strange bump in media coverage for celebrities and vocal opponents to tested and recommended vaccine schedules. Part of me thought we might be done with that but pageviews, clicks, and views all sell.

My hope is the coincidence of coverage and outbreaks is just that, a coincidence. But as a mom, …

The relevance of physicians is dwindling rapidly

Luis Collar, MD

Physician

April 21, 2014

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I spend way too much time worrying about “silly” things, things I have no control over. I know this because my wife frequently catches me in the act and urges me to relax, to focus on what I can change. But despite her best efforts, I recently fell off the wagon again and became obsessed with a simple, seemingly innocuous question: Are physicians still …

The ICD-10 emperor has no clothes

Betsy Nicoletti, MS

Health Policy

April 21, 2014

The howling about the delay of ICD-10 was loud and fierce. It seems the quality of health care in the United States depends on our ability to use 68,000 diagnosis codes. The rest of the world has switched to ICD-10, and we alone insist on using an outdated coding system. Here’s a secret. The World Health Organization’s version of ICD-10 has about 16,000 codes, equivalent to ICD-9-CM. The rest of …

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The ICD-10 emperor has no clothes

Hospitals are part of who we are

Edwin Leap, MD

Physician

April 21, 2014

A Southerner at heart, I find myself in love with places. We are forever pining on about our family homes, our small town barbecue restaurant, the sound of some lake where catfish splash in the night, or the woods where our favorite treestand sits. Sometimes our afflictions for place become the stuff of novels; Scarlett O’Hara is always associated with her beloved Tara just as Faulkner is ever infused into …

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Hospitals are part of who we are

When the POLST form is controversial

Jim deMaine, MD

Physician

April 21, 2014

Susan was 76 and dying at home in the days before hospice and before the use of the POLST form. A neighbor came in the relieve Susan’s daughter who went to the store. Suddenly Susan stopped breathing and the neighbor called 911. The medics came and, not having instructions to the contrary, did CPR and brought her to our ER unconscious and intubated. The ER physician called me in the ICU saying, …

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When the POLST form is controversial

Physician suicide letters

Pamela Wible, MD

Physician

April 21, 2014

I asked why physicians were dying by suicide. Here’s what they told me:

“I definitely graduated from med school with PTSD. It has changed me forever. My mom’s friend that I have known since I was born saw me for the first time since I went to med school and she [told my mom], “She has changed so much. Was it worth …

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Physician suicide letters

Making the 15 minutes more valuable: It’s time to flip the clinic

Steve Downs

Health Technology

April 20, 2014

Fifteen minutes. Give or take. That’s about how long a patient typically spends with a primary care doctor during an office visit. If you’re lucky enough to be healthy, maybe that visit comes once every year or two. Or if you’re less healthy, maybe every few months. In either case, it’s not a lot of time. Not a lot of time to share all the relevant developments. Not a lot …

It’s about mental health, not mental illness

Jeff Rubin, EdD

Conditions and Diseases

April 20, 2014

In my 30 years as a practicing psychologist, I’ve seen a lot of patients with many diagnoses. In that time, I’ve seen treatment approaches evolve. Periodically, when news of a mass shooting makes the headlines, the dialogue about mental health will rise to the top of the national agenda, but — in general — we still have a long way to go in our attitudes toward mental illness.

I think it’s …

Being a whole doctor serves patients best

Chiduzie Madubata, MD

Medical Education

April 20, 2014

From an early age, I was encouraged by my family to consider a career in medicine. I was told it was a well-respected profession, offering financial security and community respect. Seeing the white coats, stethoscopes, and grateful patients at my childhood doctors’ visits made the field mysterious and intriguing, and these stuck with me as I grew older. I also developed a love for music at an early age; I …

Real men don’t leave their wives right after birth

Justin Morgan, MD

Physician

April 20, 2014

News broke recently that Daniel Murphy, second baseman for the New York Mets, recently took two days off for paternity leave, causing him to miss Major League Baseball’s opening day and the season’s second game to be with his wife and child.

Mike Francesa, a popular New York sports radio personality, devoted about 20 minutes of his Wednesday broadcast on WFAN to a rant against paternity leave. According to him, a …

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