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Overdiagnosis: When health services harm more than help

Physician

December 24, 2013

“First, do no harm,” as suggested by Hippocrates, is a vital principle that should always guide physicians, but they are also well aware that in modern health care, whether in the form of drugs, operations, radiotherapy or any other form of treatment, there is always the possibility of causing harm to their patients. All drugs have potential adverse side effects and all surgery carries risk. Doctors and patients need to …

Could we exhale, my children and I?

Pam Kress-Dunn

Patient

December 24, 2013

When he was five, my son Daniel went through a rough patch with his asthma. Both he and his sister Allison had been diagnosed the year before, when we were living in Colorado. I never knew if it was the fault of the pollution that too often smeared our view of the mountains, or my then-husband’s two-pack-daily cigarette habit. Or was it the unspoken shriek of anxiety?

After I divorced my …

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Could we exhale, my children and I?

In the wake of Trayvon: A pediatric resident’s search for answers

Kendra McDow, MD, MPH

Physician

December 24, 2013

I heard the verdict in my car, driving from my birth home, Washington, DC to my new home, Baltimore, MD. I was stunned, my mouth agape and my mind muddled.

Not guilty.

Thoughts raced that hot July night, but mostly I cried and prayed. That Sunday morning I awoke with some clarity, but more sadness and more determination to try to fix this perceived wrong. Reaching out for stability and peace that …

The memories we have during the holidays

Greg Smith, MD

Physician

December 24, 2013

It happened out of the blue, as such experiences often do.

I had parked my car and was walking a short distance from the public parking deck on a covered concrete sidewalk, past the open expanse of lawn and twinkling Christmas lights in front of the hospital. I was going to visit a friend who had just had surgery, and it had been quite some time since I had been in …

What is it about today’s medical care system that isn’t working?

Starla Fitch, MD

Physician

December 23, 2013

The first thing we need to do is analyze what’s broken.

Let’s approach this problem as if it were a patient in our office. It’s our job to deliver a diagnosis based on the patient’s problem.

That’s easy; we’re doctors, after all.

“So, what seems to be the problem today, Mrs. Smith? How can I help you?”

“Well, it seems that no matter how hard I try, I can’t make progress. I want to …

The sense of abandonment from my society

Robert Fogerty, MD

Health Policy

December 23, 2013

“You look nice today. People don’t come to chemo in suits very often.” The friendly and familiar receptionist mentioned as I was checking out, the always full jar of lemon flavored hard candy on the shelf between us. As I pocketed a few of the candies, I managed to swallow the nausea and metallic taste just enough to say, “Thanks. I have a job interview today.”

During my senior year in …

After grieving and healing: Transformation

Taruni Tan

Patient

December 23, 2013

When I first started facilitating a grief support group shortly after moving to New York, my aim was simply to create a supportive environment for members to heal from their grief and to form long lasting bonds of friendship. In the course of five months however, I’ve begun to wonder whether emotional and psychological healing can be contained into an end goal with a finish line.

For the most part, authors …

Evidence-based medicine and the limitations of research

Elana Miller, MD

Conditions and Diseases

December 23, 2013

Before medical school I worked in a research lab investigating the relationship between stress and memory. As a research assistant, I dutifully administered memory test and collected saliva samples to test for cortisol levels.

My boss sent the data to her statistician for analysis, and was thrilled to find that despite the lack of connection between most of the variables of stress and memory studied, there was one positive finding — a …

Stop asking radiologists to rule out disease

Dr. Saurabh Jha

Physician

December 23, 2013

When you get frustrated with my interpreting a chest x-ray as “atelectasis at the right lung base, pneumonia can’t be excluded,” trust me, I don’t enjoy it. But when you ask me to rule out pneumonia you leave me no choice but to tell you that pneumonia can’t be ruled out.

To rule out a disease a test must have a sensitivity of 100%, meaning there should be no false negatives. …

Building the medical home requires incremental steps

Fred N. Pelzman, MD

Physician

December 22, 2013

Recently a colleague from IT who is working with us on our patient-centered medical home asked me, “when is the rollout date for your patient-centered medical home?”

As we have gone through this process for the past six months, I can definitely answer that there is no one day when this is going to happen. We are not going to close the door one night, turn out the lights, shut down …

A manifesto for nephrologists

James M. Pritsiolas, MD

Physician

December 22, 2013

Much has been made about the steady decrease in the number of U.S. medical school graduates choosing to pursue nephrology as a career. Even among nephrologists, both those in private practice as well as academia, there has been substantial hand-wringing on this issue.

My more pessimistic colleagues see a subspecialty in decline, which they attribute to a myriad of factors. These include the encroachment on our “turf” by other sub-specialists (intensivists …

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A manifesto for nephrologists

Anesthesiologist assistants should be able to practice in every state

Karen S. Sibert, MD

Physician

December 22, 2013

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

When you need anesthesia for surgery or a diagnostic procedure, of course you want to know who’ll be giving you anesthesia. If you live in Texas, Florida, the District of Columbia, or 14 other states, you may be lucky enough to have an anesthesia team taking …

Stop the Medicare cuts to senior citizens and the disabled in pain

Scott Mayhew, MD

Health Policy

December 22, 2013

As a pain physician, I would like to personally explain to President Barack Obama, Kathleen Sebelius, senior citizens and any disabled American suffering in pain, the devastating effects that will result from the drastic Medicare cuts in chronic pain care that are scheduled to take effect January 1, 2014. These cuts will severely, drastically and unfairly cut access to chronic pain care for senior citizens and other Medicare beneficiaries and …

ICD-10 will lead to the perfect storm in health care

Edmund Billings, MD

Health Technology

December 22, 2013

Let me concede from the outset that I lean toward the negative — dire predictions, worst-case scenarios, a bit of doom and gloom, etc.

But I ask you, oh gentle, patient reader, how could I not?

Let’s go to the satellite. You can see warm air from a low-pressure system (meaningful use stage 2, not changed dramatically by the one-year extension) collide with cool, dry air from a high-pressure area (the turmoil …

Another take on the statin issue: Can lifestyle changes kill?

Dinah Miller, MD

Conditions and Diseases

December 22, 2013

First a disclaimer: I’m a psychiatrist, not a cardiologist, but I’ve followed with personal interest the discussions about calculating cardiac risk and indications for statin treatment. Risk is an interesting word, because risk is about populations; it loses the individual.

And it seems that statin treatment has taken on a bit of stigma — something we’re used to in psychiatry — now you can eat your cake and have low cholesterol, …

The cheapest form of health care is to let sick people die

John F. Hunt, MD

Health Policy

December 21, 2013

If you learn nothing else today, I would ask you to learn that moral hazard is the cause of medical price hyperinflation.

Moral hazard is not just two words that don’t seem to go together. Moral hazard is when the person who bears the economic burden of a decision is not the decision maker. In the health care setting, moral hazard is when the third party payer (insurance/government) bears the …

Fax machines represent medical waste, error, and expense

Jason Theobald

Medical Education

December 21, 2013

In a scene from the 1999 cult classic “Office Space,” three burned-out cubicle drones take a baseball bat to a malfunctioning printer. While I do not condone violence against innocent peripheral hardware, I admit I secretly fantasize about destroying medical center fax machines.

Recently, a chronically non-compliant end stage kidney disease patient on dialysis was admitted for minimally elevated troponins and non-ST segment EKG changes in the setting of a hypertensive …

MKSAP: 70-year-old man with night sweats, weight loss, and cough

mksap

Conditions and Diseases

December 21, 2013

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

A 70-year-old man is evaluated for a 3-month history of night sweats, weight loss, and increasing cough. He is a retired miner, and his medical history is significant for a diagnosis of pulmonary silicosis made 15 years ago based on exposure history and characteristic chest radiographic findings. He is a lifelong nonsmoker.

On …

Will the real hero please stand up?

Rob Burnside

Physician

December 21, 2013

On a recent cross-country flight, I feigned sleep and overheard the following conversation between my seatmates: a radiation oncologist (I’ll call her “Dr. M”), and a former firefighter/paramedic called, “Captain.” Thought you’d like to listen in.

DR. M: You guys have been my heroes for a long time, the way you constantly put your lives on the line.

CAPTAIN: We’re in serious danger 10% of the time, at most. Moderate danger another …

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Will the real hero please stand up?

The Affordable Care Act perpetuates a myth of health insurance

Luis Collar, MD

Health Policy

December 21, 2013

Whenever a discussion of health care policy is initiated, the importance of health insurance, of extending coverage, takes center stage. The need for insurance quickly becomes an undeniable truth, a universal imperative. And we never seem to question this premise enough before getting more patients fitted with shiny, new policies. This was precisely the case with the Affordable Care Act. But where is the evidence insurance plays any role in …

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