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A call to retract the JNC-8 hypertension guidelines

Conditions and Diseases

January 4, 2014

JAMA published the long-awaited Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure-8 (JNC-8) guidelines December 18, 2013. They recommended blood pressure lowering drug treatment for patients 60 years old and over with systolic blood pressure (SBP) 150 or higher or diastolic blood pressure (DBP) 90 mm Hg or higher. For patients under 60 years old, they recommended medications for DBP 90 mm Hg or …

Real market reforms for health care

Duncan Cross

Health Policy

January 4, 2014

Whatever the problems with the roll out of Healthcare.gov, the fact is that the government take-over of health care has been happening for more than a century. If we want a truly free market for health care, we have to think in broader and bolder terms than simply rolling back the ACA. With that in mind, here is a short list of patient-focused ways to get the government out of …

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Real market reforms for health care

Medicine should welcome the fact that it’s a business

Richard Bottner, PA-C

Health Policy

January 4, 2014

At the end of each day during my primary care rotation, my preceptor and I sat together and reviewed patient charts. Simon Craig, MD*, built his internal medicine practice from the ground up and is a pillar of the Connecticut community he has served for more than two decades. He is a physician, a clinician and a scientist. While he manages the day-to-day operations of his practice, he avidly denies …

Death has made me more resilient

Taruni Tan

Patient

January 4, 2014

Silence — it’s deafening. I look around at this empty apartment and take in the sinking feeling that I’m alone.

New Yorkers seem to crave “alone time.” I see individuals sitting on park benches all over the city, stealing moments, staring into space, encased in an invisible aura of solitude. It’s quite a feat actually to do this amidst the noise and tidal wave of humanity that ebbs and flows through …

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Death has made me more resilient

When health care adopts best practices from other industries

Peter Pronovost, MD, PhD

Health Policy

January 4, 2014

Last fall, the Armstrong Institute, along with our partners at the World Health Organization, had the privilege of hosting more than 200 clinicians, patient advocates, health care leaders and policy makers for our inaugural Forum on Emerging Topics in Patient Safety in Baltimore.

The event featured presentations by international experts in a dozen different industries, including aviation safety expert Captain Chesley “Sully” Sullenberger, a former space shuttle commander and the …

MKSAP: 76-year-old woman with left knee pain

mksap

Conditions and Diseases

January 4, 2014

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

A 76-year-old woman is evaluated for a 3-month history of left knee pain of moderate intensity that worsens with ambulation. She reports minimal pain at rest and no nocturnal pain. There are no clicking or locking symptoms. She has tried naproxen and ibuprofen but developed dyspepsia; acetaminophen provides mild to moderate relief. …

The dynamics of global health in hospital medicine

Robert Wachter, MD

Physician

January 3, 2014

As my Division of Hospital Medicine has grown — now to about 60 faculty — I spend part of my time figuring out what direction we should go in. At times, the path is obvious. It didn’t take Wayne Gretzky to recognize that we needed expertise in healthcare IT a decade ago, or in cost reduction more recently.

The story of how we became the nation’s leading program for “global health hospitalists” is a very …

The impact of Obamacare on small business

Stephen C. Schimpff, MD

Health Policy

January 3, 2014

The Affordable Care Act is not so affordable if you own or if you are an employee of a small business. Here is why.

Consider the owner of a small service business with one or multiple outlets (e.g., a large restaurant or a small chain of sit down restaurants, a chain of barber shops, a taxi company.) The owner has more than 50 employees but the business is still “small” with …

Why Medicaid patients use the emergency department for primary care

Kevin Pho, MD

KevinMD

January 3, 2014

A study from Science found that those on Medicaid in Oregon made 40% more visits to the emergency department.

The Oregon Health Insurance Experiment included about 90,000 low-income people and assigned 30,000 of them to Medicaid by lottery. It’s essentially a naturally-occurring randomized controlled trial.

The result seems to have caught the public policy experts by off guard:

“I suspect that the finding will be surprising to many in the …

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Why Medicaid patients use the emergency department for primary care

Holding children back a grade and ADHD: A problem or solution?

Roy Benaroch, MD

Conditions and Diseases

January 3, 2014

I’ve been skeptical of the trend of “holding back” children with late birthdays. These are kids, usually born in the summer, who are just a few months short of the next grade cut-off. Some parents wonder whether it would be wise to hold them back a few months, so they end up one of the oldest (rather than youngest) kids in their class. This might seem to confer an advantage …

How to talk to your doctor about cholesterol

Zackary Berger, MD, PhD

Conditions and Diseases

January 3, 2014

I’m not going to discuss the entire subject of cholesterol in this post, but one part of it: specifically, how to discuss with your doctor how much cholesterol should matter to you.

If you have read any health news recently, you know that the American College of Cardiology and the American Health Association issued new guidelines to help doctors advise patients about cholesterol medications. The new recommendations are accompanied by a …

When concierge care is reserved for pets

Deborah Pierce, MD

Physician

January 3, 2014

I am a family physician. Like most of my colleagues, though, I must sometimes step out of the comfort of my clinical role to take on the role of patient or family caregiver.

Generally, these trips to the other side of the exam table inspire a fair amount of anxiety.

During visits to the doctor, I find myself noticing many details and comparing the quality of care to that in my own …

The best gift of all: When the sickest patients feel better

Miranda Fielding, MD

Conditions and Diseases

January 2, 2014

Ex-marines are some of the toughest patients I ever see, when it comes to dealing with pain from cancer. And career ex-Marines have the market cornered on toughness.

Take for example, an elderly friend in Kansas who woke up one morning with severe upper back pain, feeling faint, and decided as was his Marine Corps habit that a cold shower would be “just the thing.” The cold shower likely saved his …

Mental, not behavioral, health care: Why it matters

Claudia M. Gold, MD

Conditions and Diseases

January 2, 2014

A colleague of mine recently pointed out a study by the Center for Health Care Strategies (CHCS) about mental health care for children. Among their findings was this: Almost 50 percent of children enrolled in Medicaid who are prescribed psychotropic medications receive no identifiable behavioral health treatment.

This is a disturbing, though not surprising, statistic given that these medications are commonly prescribed by primary care clinicians. Children living in poverty often experience greater environmental stress and may …

Alarm fatigue symbolizes the limits of technology

Shirie Leng, MD

Physician

January 2, 2014

A few months ago while I was working in the interventional gastrointestinal unit I noticed something because it was driving me nuts. One of the monitors in the holding area that slaved to one of the procedure rooms was beeping. Just a low, constant blip blip blip blip. The screen read, “no data.”

So I asked one of the nurses “can we turn that monitor off? No one is using procedure …

Why it’s hard to keep your New Year’s resolution

David L. Katz, MD

Physician

January 2, 2014

Relevant research and conventional wisdom alike suggest that, despite their irresistible perennial tug on our collective conscience, New Year’s resolutions generally have about the staying power of champagne bubbles. Pledged to ourselves and one another in the short, dark days of late December, sorrowfully few survive to see the crocuses come up. Some studies suggest 20 percent or so live that long. Frankly, I’m surprised the numbers are that good.

The …

Is arthroscopic surgery for a partial meniscal tear unnecessary?

Jennifer Gunter, MD

Conditions and Diseases

January 2, 2014

Arthroscopic knee surgery is big business in the United States. Arthroscopic partial meniscectomies alone cost $4 billion per year. Yes, billion. But do they work?

I’ve written previously about arthroscopic surgery for a torn meniscus and how it adds nothing above and beyond physical therapy for people with arthritis. We also know that arthroscopic knee surgery for arthritis isn’t effective either. Given the poor performance of these other arthroscopic surgeries, answering the …

Our spiritual state can influence how physical ailments feel

James Marroquin, MD

Physician

January 1, 2014

The pediatrician Margaret Mohrmann tells the story of caring for a young girl in the ICU who developed a devastating case of meningitis. One day when she came to check on her patient, the girl’s mother asked Mohrmann why her daughter had become sick. As Mohrmann began to explain what meningitis is and how it is transmitted, it quickly became clear to her she was missing the meaning of …

The consequences of zero tolerance: Why HIPAA is overkill

Michael Kirsch, MD

Physician

January 1, 2014

Everyone is familiar with the acronym HIPAA, which is the 1996 edict called the Health Insurance Portability and Accountability Act. Isn’t that a smooth and melodious name?

These are and regulations that are designed to protect your confidential protected medical information. I support the mission. I don’t think that your medical records should be deliberately or inadvertently shared with those who are not lawfully permitted to view them.

Medical charts (remember when …
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The consequences of zero tolerance: Why HIPAA is overkill

When does false hope become malpractice?

James C. Salwitz, MD

Physician

January 1, 2014

10:11am Tuesday, June 5, 2006: This was the moment Marge was told the mammogram showed a mass, which was probably breast cancer. “But, don’t worry, the tumor is very small and with surgery and radiation, you will be fine.”

1:55pm Wednesday, March 25, 2009: This was the moment Marge was told that the breast cancer had spread to her ribs. “But, don’t worry, the tumors are small, and with hormones, you …

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