| KevinMD.com

Haunted by an autism diagnosis: A sense of closure after 20 years

Conditions and Diseases

July 27, 2013

I believe most physicians have cases that haunt them, often patients whose treatment courses do not go ideally and who leave a mark on the physician, altering the way he or she practices ever after. When the physician is a surgeon, it might be a patient who died on the table. For a hematologist, it might be a patient with cancer who could not be cured. For a developmental pediatrician, …

Why you should never order a herpes IgM blood test

Jennifer Gunter, MD

Conditions and Diseases

July 27, 2013

Routine screening blood tests for herpes are not recommended by the Centers for Disease Control. When I say routine screening I mean a scenario such as, “I want to get checked for everything, ok?”

Blood tests for herpes do have a place in specific clinical situations, but that’s for another post.

But say you did get a herpes blood test (even though it’s not recommended many people seem to get it done) …

A watershed moment in my lifetime of treating cancer patients

Miranda Fielding, MD

Physician

July 26, 2013

I have had patients and their families do strange things during a consultation. Patients taking notes and recording what the doctor says are pretty commonplace these days, as are answering a cell phone and arguing with a spouse over what really happened while giving a history.

Some patients go to great lengths to disconnect from the process, filing their nails, or flipping through a magazine. I’ve watched babies’ diapers being changed, …

The societal cost of low health literacy

Mary S. Kelly, PhD

Patient

July 26, 2013

The mother, clearly agitated, came to my office holding a bottle of liquid antibiotic prescribed for her daughter’s ear infection. She asked, “How the hell am I supposed to get this into her ear?”

She could not read the directions, which said to give the medication by mouth.

A survey conducted between 2008 and 2010 by the Adult Literacy Program at Einstein’s Fisher Landau Center for the Treatment of Learning Disabilities found …

The Supreme Court on Myriad: Will it stifle innovation?

Nicole D. Kling, PhD

Medications

July 26, 2013

brca-box-1

The recent ruling by the U.S. Supreme Court brought Association for Molecular Pathology v. Myriad Genetics back to the headlines, with interest being stoked by Angelina Jolie’s recent disclosure of her double mastectomy.

The lawsuit revolved around patents owned by Myriad related to its BRACAnalysis test, which assesses the likelihood that a person will develop certain cancers, including breast cancer, by searching the DNA for disease-causing …

We are spending billions to train the wrong kind of doctors

Kenneth Lin, MD

Medical Education

July 26, 2013

Earlier this year, the physicians at my academic family medicine practice met with two senior officials from our parent health care organization to be oriented to its new initiatives and projects. Their presentation documented the organization’s ongoing investments of many millions of dollars into renovating subspecialty care suites and purchasing new radiology equipment that was likely to be highly profitable, but provide dubious benefits to patients.

Two of my colleagues asked …

Move the placebo debate beyond the discussion of ethics

Ian Hsu

Medications

July 26, 2013

placebo

“Promising new drug shown to be no better than placebo” – and so the careers of countless drugs in development have terminated, from pain medicines to chemotherapies to antidepressants. The success of investigational drugs depends on their capacity to outperform the pesky placebo effect, so researchers are often trying to control or minimize the placebo effect so they can demonstrate more clearly …

The wacky world of prescription prior authorizations

Lucy Hornstein, MD

Medications

July 26, 2013

It’s happened at last: the epitome of ridiculousness in the already pretty ridiculous world of drug prior authorizations. I wish I could say that I made this up.

I got a fax from a pharmacy requesting a prior authorization for a brand name drug called Protonix, one of a family of medications used to treat ulcers, acid reflux, and other forms of tummy ache. This happens. Because there are five different …

Why Congress should be responsible to fix mental health

Allen Frances, MD

Physician

July 25, 2013

The past months have been disastrous for mental health. One embarrassment has followed another — leading to a crisis of confidence that is potentially dangerous for those who rely on psychiatric care.

Most damaging were the negative reviews of DSM-5, the new diagnostic manual. It was justly panned for introducing many unsafe and scientifically unsound diagnoses that will worsen the already existing over-treatment of the worried well and the shameful neglect …

Cockpit culture and using the two challenge rule in the OR

Marjorie Stiegler, MD

Physician

July 25, 2013

With the crash of the Asiana 777, we’re hearing a lot about cockpit culture and how communication across a hierarchy sometimes fails, even when the very lives of the folks communicating (or failing to do so) are on the line. This isn’t a new concept, and isn’t unique to aviation. Many parallels have been drawn between aviation communication and healthcare team communications, …

Injections for back pain: The evidence is weak

John Mandrola, MD

Conditions and Diseases

July 25, 2013

It’s been a while since I did a cycling topic.

As I was skimming thorough the Journal of the American Medical Association recently, I came across this review article on spinal injection therapy for low back pain. It was a shocker.

Two factors brought my attention to the article. First, almost all the cyclists or runners I know have been beset with either back pain or sciatica (referred pain or weakness down the leg). In …

Doctor bashing has become a national sport: How to stop it

Carla J. Rotering, MD

Physician

July 25, 2013

Doctors used to be among the most admired and respected persons in the community; now just a mention of this formerly revered title in a social setting will generate a totally different response.

Patients far too often will pour out stories of traumatic healthcare experiences, insults suffered, acts of disrespect or poor bedside manners, and disappointments in a system and in doctors who let them down. Doctor bashing has become a …

Is obesity really a disease?

Suzanne Koven, MD

Conditions and Diseases

July 25, 2013

A few years ago, while I was teaching in the hospital, a medical student presented the case of a man with coronary artery disease, diabetes, hypertension, and hyperlipidemia. When we entered the man’s room I was surprised that the student had omitted a certain fact from his presentation: the man weighed well over 400 pounds.

No one argues that diabetes and blocked coronary arteries are diseases. And nobody argues that obesity, …

Read more…

Is obesity really a disease?

The stigma experienced by patients with psychiatric disorders

Julia Frank, MD

Conditions and Diseases

July 24, 2013

“It don’t matter how many men you shot in Memphis,” the saying goes, “if your name is Sierra or Sequoia, you can’t sing the blues”. In a sense, this adage reworks an older, more bitter joke from the civil rights era, the one that begins “some of my best friends are …” and ends with “but you wouldn’t want your sister to marry one.” Both statements embody stigma, the social effects …

Weighing the cost of technology advances in medical devices

Wes Fisher, MD

Health Technology

July 24, 2013

A New York Times op-ed entitled “In Cancer Care, Cost Matters,” described what may be one of the earliest accounts where doctors at Sloan-Kettering decided not to use a new cancer drug because of its extra cost when they were already using equally-effective drugs for their cancer treatments. The article piqued my interest. These days for any doctor who uses expensive technologies, it is easy to see where this evaluation …

Discovering medicine’s unrehearsed harmony

Ron Li

Medical Education

July 24, 2013

There is something deeply satisfying about hitting the right note on the violin. On the rare occasion when my left hand is perfectly positioned and my bow arm is applying the perfect amount of pressure on the violin string, the resulting note that resonates from the wooden belly of the instrument is, for lack of a better word, perfect.

My favorite piece that …

Reform creates new incentives in health care

Kohar Jones, MD

Health Policy

July 24, 2013

I advocated for the Affordable Care Act, and celebrated when it was passed.

It’s good to have everyone covered, I thought.

Insurance for everyone is the first step to health care for all.

Alas, access to health insurance isn’t the same as access to health care.

First there is the niggling detail of providers. We already have a primary care provider shortage. Internists, pediatricians, family physicians are already working at full capacity in caring for …

Separating work from home life makes for happier doctors

Arsheeya Mashaw, MD

Physician

July 24, 2013

One tired early morning, during my residency, I had been up all night in the ICU with a sick patient. Exhausted I sat in the cafeteria for a quick breakfast before rounds with my attending physician. I was explaining to her how I couldn’t leave my patients side I was so worried. She looked at me like Obi-Wan Kenobi: “The sign of a good doctor is when you can’t go to sleep at night worrying about …

5 reasons why music would be great for digital health

David Lee Scher, MD

Health Technology

July 24, 2013

Music as a healing mechanism has been accepted for over 50 years. Music is a source of primal memory similar to that of smell. It has been used in brain injury patient management, as well as to promote wellness, manage stress alleviate pain, promote physical rehabilitation, and enhance memory in Alzheimer’s Disease patients. I have appreciated the power of music my whole life and as a physician and …

Are Cadillac plans responsible for rising health costs?

Chris Rangel, MD

Health Policy

July 23, 2013

If there’s anything that liberals hate it’s inequality – unless it’s the Federal tax code – and health care is a prime offender. The liberal mantra is that everyone should have the same access to basic health care. But this doesn’t just involve improving health care access and affordability for millions of uninsured Americans. It also involves limiting or impairing (through taxes) those health care plans liberals have decided are …

Most Popular

Past Week

Past 6 Months

Recent Posts

Subscribe to KevinMD and never miss a story!

Most Popular

Past Week

Past 6 Months

Recent Posts