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5 preventive services to do, and 5 to avoid

Physician

December 6, 2013

Early diagnosis, preventative care and aggressive disease management are mainstays of American medicine today. Proponents argue that early diagnosis and prevention are the keys to healthy living. Skeptics suspect that many of the screening tests for early asymptomatic disease and preventative treatments we undergo lead to overdiagnosis, unnecessary expense, exposure to diagnostic and therapeutic interventions which themselves have risks, and that often cause more harm than good.

As a physician and …

Change will happen when millennial doctors step into leadership roles

Davis Liu, MD

Physician

December 6, 2013

I recently stumbled across a blog post by Dr. Jay Parkinson, an entrepreneur and founder of Sherpaa, who reflected on a recent private breakfast with New Yorker and best selling author Dr. Atul Gawande.

The question posed by Gawande: Can technology be a change agent for health care?

The inevitable answer is yes, with one important caveat. It’s not the technology that will change the practice of medicine, it’s the doctors who …

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Change will happen when millennial doctors step into leadership roles

Healthcare.gov is fixed, or is it?

Robert Laszewski

Health Policy

December 6, 2013

From 27,000 enrollments in October to a reported 100,000 enrollments in November, the Affordable Care Act’s website is apparently working better and getting more people signed up.

But is it fixed well enough to handle the expected wave of at least many hundreds of thousands of people eager to get guarantee issue health insurance for the first time or replace a canceled policy by January 1?

Here are some of the press …

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Healthcare.gov is fixed, or is it?

We really need to give our outpatients palliative care

Anita Fry

Patient

December 6, 2013

Once upon a time, I was a newspaper journalist: I chased down sources and sweated over deadlines. Then, in mid-career, I switched to doing marketing and communications for a regional healthcare system. This consisted of a large hospital and many outpatient clinics, including a community cancer center.

Because I handled communications work for the cancer center, I also had a seat on the cancer committee — an oversight group of oncologists, …

A doctor quits the AMA and his state medical society

Mike Sevilla, MD

Health Policy

December 6, 2013

Everywhere in the news these days, you read of stories where physicians are being cancelled from insurance plans, and groups like the American Medical Association, and state based medical societies fighting to reverse these decisions. Does anyone think these actions will really make a difference? I certainly don’t.

Since this is the start of December, this is the time of year where I look at certain expenses and wonder if they are …

An anesthesia practice is sold, and a warning to young doctors

Karen S. Sibert, MD

Physician

December 6, 2013

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We were startled to learn recently that Sheridan Healthcare Inc., a physician services company based in Florida, has bought one of the largest private anesthesiology group practices in California, the Medical Anesthesia Consultants Medical Group Inc. (MAC) of San Ramon.

The deal, which closed November 14, is Sheridan’s first in California, and “provides a platform that will accelerate our expansion in the California …

The personal costs of a living donor liver transplantation

Meera Gupta, MD

Physician

December 5, 2013

Partial liver donation is the only life-saving deed that a non-surgeon can do for another person suffering from end stage liver disease. On the other hand, a major operation on a healthy individual with no indication for surgery has been viewed by society with caution and skepticism.

One could wonder why a young, healthy individual would succumb to an elective high risk procedure. Simple answer: they want to save a life. …

Rwanda provides primary care lessons we can learn from

Kenneth Lin, MD

Health Policy

December 5, 2013

As reviewed in many other sources, the relative underinvestment of resources in primary care in the U.S. has a great deal to do with the fact that we spend far more on health services than anywhere else in the world but rank near the back of the pack in key health metrics such as life expectancy, infant mortality, and disability compared to other high-income countries. Although economic inequality, lack …

Standardize drug names and reduce the risk of medication errors

John Schumann, MD

Medications

December 5, 2013

Ever get confused over the names of medicines?

I do.

There’s Zantac and Xanax. Zanaflex and Zaleplon.

But Zanaflex is also known as tizanidine. Tizanidine functions very differently than Zantac and its other name, ranitidine, even though they sound alike.

Every drug has (at least) two names — one proprietary, and one generic. Proprietary names are created to sound catchy by the original manufacturer, almost always under a patent. The generic names are more like chemical …

On the ultimate loss of control, living with uncertainty, reflecting on the future, and being a patient

Daniel Sands, MD, MPH

Physician

December 5, 2013

I don’t remember three days of my life.

I have generally felt in control of my life and behavior. Although I understand the future is always uncertain, I do as much as I can to plan for it and minimize risk to myself and my family. This includes focusing on avoidance of stress, healthy eating, and daily exercise. Despite this, anything is subject to change at any time for no apparent …

I see chest pain all day, every day

Edwin Leap, MD

Conditions and Diseases

December 5, 2013

Sometimes I feel as if my entire emergency medicine career is dedicated to one patient complaint. And that one complaint is chest pain. It may be that the incidence and prevalence of chest pain was the same during my medical school and residency training as it is now. But I doubt it.

I recall how I struggled to learn the salient questions. ‘Where is your chest pain? Is it heavy, dull, …

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I see chest pain all day, every day

Car dealerships have something to teach hospitals

Suneel Dhand, MD

Health Technology

December 4, 2013

A couple of weeks ago I took my car in for its regular servicing. I’ve always had excellent service at this dealership and have gotten used to some pretty high standards. But on this particular visit, I was about to receive a dose of new technology as well. After I pulled my car into the garage, I was immediately greeted by a welcoming and friendly customer service agent. She had …

AMA: Repeal the flawed Medicare payment formula

Ardis D. Hoven, MD

Health Policy

December 4, 2013

A guest column by the American Medical Association, exclusive to KevinMD.com.

Last week’s release of the final 2014 Medicare payment rule serves as an urgent reminder to Congress that there are just 28 days before physicians who care for Medicare patients will face a steep 24 percent cut caused by the short-sighted, fatally flawed Medicare payment formula — the SGR.

Year after year for …

What happened to doctors serving as advocates for their patients?

Wes Fisher, MD

Physician

December 4, 2013

The Hippocratic Oath. Most medical students in America recite some version of this oath at their medical school graduation. Its text implies a sacred and overriding respect (ethic if you will) for the individual.

Doctors are currently witnessing the profession of medicine moving from the ethic of the individual to the ethic of the collective. The passage of the Affordable Care Act has solidified this treatment ethic and, as a consequence, …

How Obamacare will creatively destroy primary care as we know it

Margalit Gur-Arie

Health Policy

December 4, 2013

As Obamacare is winding its way through a hellish bureaucratic labyrinth of its own creation, accompanied by cheers and boos from the blood thirsty spectator crowds, confusion, fear, trepidation, despair and exhilaration, are gripping America’s doctors all at once, because whatever else is accomplished in the next decade, medicine will never be the same.

At the confluence of cutting edge technology, great poverty and unimaginable fortunes, a new vision for the practice of …

I can’t always cure, but I can always care

Pamela Wible, MD

Physician

December 4, 2013

LOU-ME1

I started kissing patients in med school. And I haven’t stopped.

During my third year pediatric rotation, I used to stay up late at night in the hospital, holding sick and dying children. I’d lift them from their cribs, kiss them, and sing to them, rocking them back and forth until they fell asleep. One day the head of the department pulled …

Where Obamacare is working well

Bob Doherty

Health Policy

December 4, 2013

Obamacare is working quite well, in some places, for quite a large number of people. But you wouldn’t know that from the constant media drumbeat about the problems with the healthcare.gov enrollment portal and the relatively small (fewer than 6%) of the population whose individual insurance policies have to be replaced because they don’t meet the law’s benefits and ratings standards.

Now, before I get a rash of comments about how I can …

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Where Obamacare is working well

How can our society regain respect?

Greg Smith, MD

Physician

December 3, 2013

“I don’t get no respect!”
-Rodney Dangerfield

He was a little guy, munching on the taco lunch that his mother had brought into my office for him, his younger sister and herself. I was a little miffed, I won’t lie, that the family knew they had an appointment with me right after lunch, but they decided to make the appointment itself lunch. I tried to concentrate on my interview questions and assessment, shredded lettuce …

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How can our society regain respect?

Does paying people to lose weight work?

Skeptical Scalpel, MD

Conditions and Diseases

December 3, 2013

A recent study looked at the effect of paying people to lose weight.

The authors randomized 100 people with BMIs ranging from 30 to 39.9 into four groups. Two groups received weight loss education, one group with and one without payment.

The other two groups received education plus behavior modification with again one group receiving financial incentives and the other not. To remain in the study, they were all supposed …

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Does paying people to lose weight work?

Health reform will close hospitals: Why that may not be a bad idea

Robert Pearl, MD

Health Policy

December 3, 2013

What first comes to mind when you hear the word “hospital”?

Your reaction may depend on your past experiences. You may feel gratitude for the birth of a child or the treatment of acute appendicitis. You may feel sorrow, remembering a loved one who passed away on a hospital bed.

Regardless of our experiences, many of us assume the closer our hospital is to where we live, the safer and better off …