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The difference between playing doctor and being a doctor

Physician

December 13, 2013

I have outstanding, compassionate and dedicated partners; rarely goes by a day that they fail to teach me by their intelligence and example. Nonetheless, yesterday, in the middle of 30+ patient office hours, one of them said, “You know there are times when I just can’t stand to listen to another complaint.” He took a deep breath, straightened his coat, and opened the exam room door and, smiling, greeted the …

Why Regina Benjamin was an ineffective Surgeon General

Mike Sevilla, MD

Physician

December 13, 2013

Recently, way beneath all the press about Obamacare, there have been articles panning the president’s pick as the next Surgeon General of the United States. Wait a minute. What happened to the last Surgeon General?

Six months ago, family physician Dr. Regina Benjamin stepped down as the first Surgeon General under President Obama. Quick! Name one accomplishment under Dr. Benjamin. I can’t either. What happened?

Dr. Benjamin was a rising star in the …

Doctors need to do a better job in the PR department

Abigail Schildcrout, MD

Physician

December 13, 2013

I use my computer a lot, so I see a lot of advertisements. Many of them are for the latest two or three items I’ve priced online (which I find somewhat creepy but fairly easy to ignore). Many of them are generic, casting a wide net. These generic ads frequently talk about “one ridiculously easy trick” to halve your car insurance payments, lose 50 pounds, learn a foreign language, look …

Patient experience is about the people behind the statistics

Suneel Dhand, MD

Physician

December 13, 2013

Improving patient experience is all the rage these days. Hospital administrators across the land are talking about it. This can only be good for our patients and for the health care system at large. Satisfied customers are what every industry strives for. It is a bit sad however that it has taken the threat of looming financial penalties to make this happen.

Now that hospital reimbursements are directly tied to HCAHPS …

Genetic counseling: The missing piece for 23andMe

Joyce Ho, MD

Health Technology

December 13, 2013

On November 22, the FDA sent Silicon Valley’s leading personalized genetics company 23andMe a warning letter after six months of radio silence and recent increased efforts in marketing.

Excerpts from the chastising letter read: “As part of our interactions with you, including more than 14 face-to-face and teleconference meetings, hundreds of email exchanges, and dozens of written communications, we provided you with specific feedback on study protocols and clinical and analytical validation requirements …

Health care costs are slowing: Is Obamacare responsible?

Robert Laszewski

Health Policy

December 13, 2013

Is Obamacare even partly responsible for the slowdown in health care costs?

That is silly.

First, Obamacare is not a health care reform law; it is a health insurance reform law. No one on either side of the debate has ever argued anything different.

Does the law have some limited cost containment features in it?

Yes. But these are either pilot projects or are years from being fully implemented.

I have heard the …

The conversations can be more difficult than the procedures

Vipul Kella, MD

Physician

December 12, 2013

When I graduated residency and started my first job, I walked around the ED confidently, chest slightly pumped up at all times. I knew I was well-trained. If there was a sick patient, I was going to resuscitate them. If there was an impossible central line that was needed – I was going to get it. Difficult intubation? No problem. There was no procedure that was too difficult for me.

Many …

N. meningitidis: Mother Nature is usually trying to kill us

Albert Fuchs, MD

Conditions and Diseases

December 12, 2013

Those of us who believe in the unvarying beneficence of Mother Nature have yet to contemplate Neisseria meningitidis. N. meningitidis is a bacterium that can live harmlessly in the throats of healthy people.

But about 500 times a year in the US it causes bacterial meningitis, a life-threatening infection in which the membranes lining the brain and spinal cord become inflamed. Bacterial meningitis is treatable with antibiotics but even with treatment patients sometime suffer …

Recognize the blessings that you previously overlooked

Maria Yang, MD

Physician

December 12, 2013

As a fourth year medical student I did my “sub-internship” in oncology. I hoped that this rotation would help me choose what specialty to pursue: internal medicine or psychiatry.

One of “my” patients was a woman with breast cancer that had spread to her liver and lungs. Fluffy brown hair fell to her shoulders. Wrinkles surrounded her puffy eyes that held jade green irises. Though she was in pain, she was …

Teach caring people how to be caring doctors

Shirie Leng, MD

Medical Education

December 12, 2013

Let’s talk for a moment about medical education. I went to a work-related party recently and rode in the elevator with a dear friend who is my contemporary, and a more senior and highly regarded faculty member known for her work in medical education. Both were afraid for the future of medical education in different ways.

My contemporary was concerned that the emphasis on the use of advanced technologies like ultrasound …

Treating pain without addressing suffering

Hans Duvefelt, MD

Physician

December 12, 2013

Suffering ceases to be suffering in some way at the moment it finds a meaning.
-Viktor Frankl

It is much more important to know what sort of a patient has a disease than what sort of a disease a patient has.
-William Osler

Back in the 1990s when pain was the newest vital sign, physicians were mandated to treat it, often with powerful medications and without truly understanding the cause and significance of the …

ACP: Increase screening for second leading cause of cancer-related deaths

Yul Ejnes, MD

Conditions and Diseases

December 12, 2013

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

According to the Centers for Disease Control (CDC), in 2012, 65% of U.S. adults ages 50-75 were current with screening for colorectal cancer. Almost 28% were never screened. Despite the availability of multiple methods for detecting precancerous polyps or early cancers, the number of people who take advantage of …

Why the Affordable Care Act is worth fighting for

Bob Doherty

Health Policy

December 11, 2013

Readers of my posts know that I am a passionate advocate for the Affordable Care Act, or Obamacare if you prefer. It isn’t that I have a pollyannaish view of the law itself, or the tortured political process that produced it — far from it. The ACA is an imperfect law, created by imperfect people through an imperfect process, with imperfect results. After almost 34 years of experience in …

Defining the patient’s goals of care

Michelle Nall, MPH, ANP-BC

Patient

December 11, 2013

I moved to Florida three months ago to take a job as a primary care nurse practitioner in a clinic for the underserved and uninsured. This position followed four years spent as a home-visiting nurse practitioner working with high acuity, chronically ill patients in the Boston area. I didn’t realize it would be such a transition to go back to taking care of patients in the clinic setting after spending …

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Defining the patient’s goals of care

Katie Couric brings attention to the HPV vaccine

Natasha Burgert, MD

Medications

December 11, 2013

The HPV vaccine is in the news again. This time it is Katie Couric’s daytime talk show that is shining the spotlight. And, I am thankful.

A medicine that prevents cancer is worth giving airtime.

In the segment, Couric chose to highlight the experience of 3 mother-daughter duos and their experience with the HPV vaccine. One story ended in loss, one in pain, and one in quiet confidence. Couric also highlighted advice from …

Technology and baby monitors: Why this pediatrician worries

Claire McCarthy, MD

Health Technology

December 11, 2013

It’s scary being a parent, especially a first-time parent. I mean, talk about the responsibility: an actual human being is relying on you for survival. And basically, you have no idea what you are doing. Sometimes, it seems amazing that our species has made it this far.

So why not turn to technology? Why not wire your …

Performance measuring tools aren’t up to the task

Ira Nash, MD

Physician

December 11, 2013

I was invited to give a talk about patient satisfaction at a recent grand rounds. I have written previously that satisfaction is a pretty low bar, and so I spoke instead about the patient experience.

I opened my talk with the cartoon above.

As I anticipated (and intended), it got a few chuckles from the audience, and I pointed out …

What happens when doctors lose their calling?

Wes Fisher, MD

Physician

December 10, 2013

The field of medicine is one of the most rewarding occupations out there. Few occupations allow such an incredible opportunity to directly impact the life of a fellow human being and see the amazing results of something you did. Few occupations are allowed inside the most intimate and vulnerable moments of the human condition. In a word: amazing.

But medicine for people has quickly given way to medicine for business.

Business needs …

Lifestyle is the blockbuster drug few people take

David L. Katz, MD

Conditions and Diseases

December 10, 2013

Hippocrates recognized the power of lifestyle as medicine some 2,500 years ago, testimony to his wisdom and prescience. As president-elect of the American College of Lifestyle Medicine, I celebrate the possibility of finding our way back to a future informed by such insight.

But for now, in the immediate aftermath of announcement and ongoing debate about just how many of us should take statins, let’s consider …

Doctors should hone their abilities to recognize visual patterns

Paul Bergl, MD

Medical Education

December 10, 2013

Nothing puts more fear into the heart of an internist than a dermatologic chief complaint. And for good reason: we have very little exposure to the breadth of the field. To us, all rashes seem to be maculopapular, all bumps are pustules … or was that nodules?

It’s not that we internists don’t care about the skin or don’t appreciate its complexity. Rather, we simply haven’t seen enough bumps, rashes, and …