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Dangerous online writing demands physician attention

Physician

August 14, 2013

Simply not factual. That’s really all that needs to be said in response to Michael Edwards’ opinion piece entitled “Vaccine Side Effects and Why You Shouldn’t Vaccinate” published in Organic Lifestyle Magazine recently. This is clearly a non-peer reviewed, non-fact-checked online publication that Mr. Edwards edits and owns.

That being said, Edwards’ piece is so egregious I’m unable to hold my breath. Although I’m no watchdog, the dangerous writing demands physician attention partly …

When surgeons and patients don’t tolerate ambiguity very well

Bruce Campbell, MD

Physician

August 14, 2013

Do not now look for the answers … At present you need to live the question. Perhaps you will gradually, without even noticing it, find yourself experiencing the answer.
-Rainer Maria Rilke

Two men, Ted and Ron, were long-term professional colleagues. I do not believe that they were particularly close, but they had been acquainted during their working lives. Each had retired.

In what was a remarkable coincidence, both men were diagnosed with …

With my son hospitalized, an opportunity to apply my teachings

Karen Libertoff Harrington

Patient

August 14, 2013

As a medical educator in a hospital setting, I often tell first-year medical students about disparities in health care and about the vastly different quality of care that hospitals deliver, depending on their resources.

I tell my students how important it is to advocate for patients, to learn to navigate the healthcare system and to work respectfully with health professionals in order to get optimal care for your patients.

When my own …

Make the difficult journey of cancer patients a bit easier

J. Leonard Lichtenfeld, MD

Conditions and Diseases

August 14, 2013

A newspaper story recently caught my eye when it headlined: “Senators Revive Push for End-of-Life-Care Planning.” It reported on new legislation making the rounds in Washington to address care planning for those with advanced illnesses.

You remember “end of life care planning,” don’t you? It was part of the Affordable Care Act debate several years ago, and quickly became translated into Read more…

Make the difficult journey of cancer patients a bit easier

Drug store retail clinics for primary care? Not so fast

Kevin Pho, MD

KevinMD

August 14, 2013

walgreens

A version of this column was published in USA Today on July 3, 2013.

One recent day in my primary care clinic, I had a full schedule and was unable to see a patient for her cough. She instead sought medical care at a local drugstore, where she was treated for bronchitis. Normally housed in pharmacies and department stores like Target or Walmart, …

AMA: Effective pain management with prevention of prescription drug abuse

Ardis D. Hoven, MD

Medications

August 14, 2013

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

Prescription drug abuse has reached crisis levels: overdoses and deaths from opioid analgesics have more than quadrupled in the U.S. since 1999. At the same time, a great deal of human pain and suffering remains inadequately treated. In fact, according to the Institute of Medicine, at least 100 million Americans suffer from …

After a medical mistake, an apology is both simple and difficult

Jim deMaine, MD

Physician

August 13, 2013

Elton John had it right: “It’s sad, so sad. Why can’t we talk it over. Oh, it seems to me that sorry seems to be the hardest word.”

Mistakes are all to common in medicine, but can we say the “hardest word” when we’re involved?

Example 1: There’s a diagnosis of recurrent lymphoma in the ICU. The oncologist gives a phone order for cytoxan, prednisone, and vincristine. The recorder, working a double shift, …

C difficile in children: Do probiotics help?

Christopher Johnson, MD

Conditions and Diseases

August 13, 2013

The intestines, particularly the large intestine, are teeming with bacteria. They are piled on each other as dense as the above photomicrograph shows. The huge majority of them are what we call friendly bacteria: they live inside us, feeding off the rich stew of food we eat, but cause no disease. In fact, their presence is important to our health because they crowd out bacteria that cause disease — the …

Inspiring a new generation of oncologists

Don S. Dizon, MD

Medical Education

August 13, 2013

One of the things I enjoy as an academic oncologist is the opportunity to teach. I like having students, residents, and fellows in my clinic and the opportunity for them to see what oncology is and what we do; how we “marry” the art and science of medicine in our routine care of patients with cancer.

For several years, I’ve co-directed an …

The blueprint for decreasing the cost of health care

Manoj Jain, MD, MPH

Health Policy

August 13, 2013

We have done it. We have decreased the increase in the cost of health care. Let us explain. For three decades (1980-2009), the cost of health care has been increasing each year at an average rate of 7.4 percent — double the rate of inflation. However, over the past three years, the increase in health care expenditure has remained at a low 3.1 percent.

Is this decline …

Is Osphena the new female Viagra?

Jennifer Gunter, MD

Medications

August 13, 2013

Osphena (ospemifene) is an oral medication recently approved by the FDA for painful sex (dyspareunia) due to vaginal dryness for menopausal women. As typically happens when a new drug gets FDA approval the PR machine for the company goes into overdrive flooding the media with press releases. Since sex sells, well, Osphena received a fair amount of air time and print space. Headlines like FDA-Approved “Female” Viagra might lead someone to believe that Osphena is freaking amazing. Which, …

Read more…

Is Osphena the new female Viagra?

Atul Gawande provides clues on how to change doctor behavior

Kevin Pho, MD

KevinMD

August 13, 2013

We’re spending an inordinate amount of time and effort trying to convince doctors to change the way they practice.

Most recently, for instance, a study came out saying that doctors aren’t following back pain guidelines. Or from a broader perspective, consider the Choosing Wisely campaign, which lists scores of tests and treatments that are ordered too frequently.

Various carrots and sticks have been used to steer …

Hallways are no places for psychiatric evaluations

Greg Smith, MD

Physician

August 13, 2013

A commenter recently asked the other day about staging patients, especially mental health patients, in the hallways. This is sometimes done, along with triage and initial assessments, because of the very real lack of appropriate space in a busy, full emergency room. What do I mean by this?

Well, as any of you know who have ever been to the ED for anything at all, once you get through the front …

How do I live longer? Here are 10 ways backed by evidence

Alex Lickerman, MD

Conditions and Diseases

August 12, 2013

Patients often come to me seeking advice about what they can do to live longer. The number of things that have been proven to extend life, however, remains shockingly small. What follows are things that have enough support in the scientific literature that I generally recommend them (though the strength of the evidence varies even with these):

Take simvastatin (brand name Zocor). That is, if you have coronary artery disease. (This is one of …
Read more…

How do I live longer? Here are 10 ways backed by evidence

Parenting and families: Are we focusing on the wrong debate?

Claire McCarthy, MD

Physician

August 12, 2013

We have got to stop talking about stay-at-home vs. working mothers as if it were some sort of debate, as if it were the central issue of parenting and families. It’s not.

I am really annoyed by an installment in The Debate, a blog on Huffington Post in which Lisa Heffernan says that she regrets being a stay-at-home mom. She laments her loss of income (which she clearly didn’t need), and that …

Should intern boot camps be mandatory after medical school?

Skeptical Scalpel, MD

Medical Education

August 12, 2013

A concept that has been percolating in the medical literature boiled over into the mainstream as the New York Times published this story, “Chicago’s Intern ‘Boot Camp’ is a rehearsal for life or death medical issues.”

The article describes a new internal medicine intern having to deal with a simulated patient who is critically ill and has alarms going off.

Another intern had to tell a “patient” played by an actor …

How an iPhone improved patient care in the ICU

Iltifat Husain, MD

Health Technology

August 12, 2013

At iMedicalApps we have traditionally expounded on how smart phones can help us with patient care in regards to providing Physician centric tools at bedside. These range from drug reference tools to various clinical algorithm medical apps.

But there are also non-traditional methods where smartphones enable us to improve patient care at the bedside. These are subtle, but can be equally or more powerful.

When I was working in the ICU recently, there were …

Fish oil and prostate cancer: Go beyond the headlines

David L. Katz, MD

Conditions and Diseases

August 12, 2013

I suppose it may help diffuse any relevant tensions to get the punch line out of the way: I have a prostate, and in the context of my mostly-plant diet, will continue to eat fish and take a daily omega-3 supplement (krill oil in my case). We will, as well, continue using various omega-3 supplements in varying doses for specific therapeutic purposes in my clinic.

And now, let’s turn to the …

Thousands of dollars are put at risk with a single click of a button

Wes Fisher, MD

Health Policy

August 12, 2013

There is so much entropy in health care right now. So much finagling, so much shifting, so much arguing, so much uncertainty, so much shock. Shock at prices, shock at waiting times, shock that doctors don’t know how to increase referrals, shock that doctors aren’t doing more to help. What gives?

In triage, you don’t spend time with the expectant.

Doctors are keeping their heads down. They are still seeing patients. They …

We face an epidemic of excessive busyness

Suzanne Koven, MD

Conditions and Diseases

August 11, 2013

In the past few years, I’ve observed an epidemic of sorts: patient after patient suffering from the same condition. The symptoms of this condition include fatigue, irritability, insomnia, anxiety, headaches, heartburn, bowel disturbances, back pain, and weight gain. There are no blood tests or x-rays diagnostic of this condition, and yet it’s easy to recognize. The condition is excessive busyness. It’s one with which, as a fellow sufferer, I empathize …

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