How Edward Snowden and PRISM affect health care social media

Social Media in Medicine
June 19, 2013

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Edward Snowden’s whistleblowing on the NSA’s PRISM program raises some interesting questions regarding social media in healthcare. I had a few physicians both inside and outside of the community I manage ask, “Is the government watching what I say about my clinical experiences?” The answer is of course “Not yet,” but the sentiment weighs heavier than the question, and the weeklong dip …

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How Edward Snowden and PRISM affect health care social media

How exercise benefits kids with ADHD

Conditions and Diseases
June 19, 2013

Many years ago, I worked as a counselor at the city camp in North Miami Beach, Florida. Camp “No Mi Be” was attended by what seemed to be a countless number of very active, very inquisitive, and pretty-much-unstoppable 10-year-old boys.

We learned quickly that the best way to start the day was with running. Run, run, run. We’d make the kids run back and forth to the fence, or run around …

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How exercise benefits kids with ADHD

What I’ve learned from calling out my orthopedic colleagues

Physician
June 19, 2013

hipscrews

Six months ago I posted a story about a demented 94-year-old patient who’d fractured her hip. She’d lost more than thirty pounds in the preceding months and had already had a collarbone fracture from a previous fall.

Her son wanted her to be made comfort care only, and avoid a trip to the operating room since she was likely within …

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What I’ve learned from calling out my orthopedic colleagues

Psychiatric patients don’t fit the usual medical mold in the ED

Physician
June 18, 2013

The ED is a hectic place.

Sore throats. Heart attacks. Dog bites. Broken bones. Strokes. Major trauma. If you work in an ED, you see it all. And then some.

Is it any wonder then, with the potential for literally thousands of medical and surgical problems to stumble through the doors of an ED, that hospitals and the bodies that accredit them demand strict, regimented, standard, reproducible emergency assessments …

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Psychiatric patients don’t fit the usual medical mold in the ED

Sexual health issues should be normalized in the exam room

Physician
June 18, 2013

Sexual health, though fundamentally important to every human being, is rarely discussed between patients and their healthcare providers. It’s an important conversation and one that requires doctors and patients to venture into less-than-comfortable territory.

Who exactly should treat sexual health issues? Many assume that this should be the territory of a gynecologist for women or a urologist for men.

But because we see our patients more frequently than any other doctors, general …

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Sexual health issues should be normalized in the exam room

A good business school student makes for a good medical student

Medical Education
June 18, 2013

Medical education today requires students to assimilate lots of facts and amass an incredible fund of knowledge quickly. As medical science advances, more material must be mastered. Medical students must be able to organize facts and apply them to patient care. Medical care today is becoming more of a team effort. Successful physicians must be adept at both leadership roles and in the role of a team member (worker bee). …

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A good business school student makes for a good medical student

Consoling a family whom I’d never met

Physician
June 18, 2013

It’s painful enough to lose a patient. But I found it even more painful to try to console a family whom I’d never met.

Depending on your point of view, the limited patient contact afforded the anesthesiologist is a disappointment or a perk of the specialty. Anesthesiologists are steadily branching out into other areas of perioperative care where lengthier patient/family contact is necessitated but the preop encounter with the anesthesiologist is …

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Consoling a family whom I’d never met

Pulling me away from the seductive simplicity of cookbook medicine

Physician
June 18, 2013

Mind-Map

This, apparently, is a map of my mind.  It’s a little shocking to find out that my mind looks like a sea creature, a bug, or perhaps a vegetable.  Actually, “Rob’s mind” and “vegetable” are often used in the same sentence.

Someone suggested to me that I may benefit from mind mapping.  I don’t know how to describe it, but I think spatially; …

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Pulling me away from the seductive simplicity of cookbook medicine

The link between ADHD and obesity

Conditions and Diseases
June 17, 2013

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Last week I served lunch at my son’s school. It was a hoot, really, serving an entire K-8 school lunch. Dishing out lasagna, broccoli, pizza, and grilled cheese provided all sorts of insight into what lunch is like in 2013. My son didn’t choose exactly as I’d predict (see below). When a 33-year prospective study published recently which connects childhood ADHD with adult obesity, …

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The link between ADHD and obesity

Dying a hero’s death

Patient
June 17, 2013

Blanched by anemia, Mary rested quietly in the hospital bed. Her pallor made her barely visible amid the bleached bed linens–she seemed a mere shock of white hair against the pillowcase.

Age ninety-three, she’d visited the hospital a half-dozen times in as many months, shuttling between nursing home and hospital as many elders unwittingly do in their last year of life. She may have preferred to stay put, but no one …

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Dying a hero’s death

EHRs need to talk to each other, but make sure they work first

Health Technology
June 17, 2013

I’ve written several times before about my love/hate status with my EMR. While I enjoy using mine, I long for it’s usefulness to get to the next level. While the EMR is useful at tracking data, it’s greatest handicap right now, is that it can’t talk to other systems. Data is still locked in individual systems and can’t be shared across platforms. This lack of interoperability has thus far been …

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EHRs need to talk to each other, but make sure they work first

ACP: Physicians around the world face similar non-clinical issues

Physician
June 17, 2013

acp-logoA guest column by the American College of Physicians, exclusive to KevinMD.com.

Over the past several years, I have had the honor of representing the American College of Physicians at scientific conferences and professional society meetings. In addition to hearing about the latest advances in internal medicine at these events, I learn what is on the minds of physicians in …

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ACP: Physicians around the world face similar non-clinical issues

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Palliative care has become the last bastion of health care sanity

Physician
June 17, 2013

I couldn’t really blame the social worker.  He was just doing his job.  The skilled nursing facility (SNF) connected to the hospital was full of flailing patients.  So he thought he would ask for a palliative care consult (after getting an okay from the primary team).  It was his third request of the day.  He spoke slowly as he tried to untangle the twisted path the patient had taken.

“Dr. X …

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Palliative care has become the last bastion of health care sanity

AMA: A significant redesign of undergraduate medical education

Medical Education
June 17, 2013

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

To close the gaps between how medical students are educated and how health care is delivered now and in the future, the American Medical Association (AMA) has awarded $11 million to 11 U.S. medical schools to fund their bold proposals that support a significant redesign of undergraduate medical education. This is just …

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AMA: A significant redesign of undergraduate medical education

Numbers fail to answer that one vital question

Physician
June 16, 2013

When I visited Allan in the hospital yesterday, I told him to get up and stroll the hall. However, when I checked in on him this afternoon, the nurses informed me that he refused to get up, even to the chair.  When I asked why, Allan told me he could not walk.  I was concerned, but when I examined him, I found his vital signs were fine, he had no …

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Numbers fail to answer that one vital question

Should medical resident training be limited to 40 hours per week?

Medical Education
June 16, 2013

Dr. Sam Ko says resident work hours should be limited to 40 per week. Via Twitter, I warned him that I would rebut his assertion.

Without any data or references except a tangential one, he bases his opinion on four premises.

1. Residents will be happier and nicer to patients because they will be less stressed. There is no proof that this is so. In fact, a recent Read more…

Should medical resident training be limited to 40 hours per week?

Use batch processing and stop working like a dog

Physician
June 16, 2013

Do you find yourself spending too much time on things that have nothing to do with seeing patients, and then getting home later than you would like?

Do you notice that for every 15 minutes you spend with a patient you spend way more than that messing around in the EMR and being distracted by things like prescription refills, test results and a hundred other forms of two bit clerical work …

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Use batch processing and stop working like a dog

The FDA is regulating the wrong things

Medications
June 16, 2013

The Food and Drug Administration was created in 1927 in order to carry out the mission of the Food and Drug Act put into effect by Theodore Roosevelt in 1906. In the early 1900’s and before, medicines killed and maimed people in gruesome ways and adding chemical substances to foods to mask the fact that they were rotten or substandard was felt to need some sort of legal response. The …

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The FDA is regulating the wrong things

Who’s truly responsible for the $2.7 trillion medical bill?

Health Policy
June 16, 2013

As someone who professionally closely tracks the debate over the transformation of the American health care clinical delivery system, I did not learn much new from the New York Times article: The $2.7 Trillion Medical Bill.  I did find the article’s approach useful in explaining how the wide variations in price for procedures contribute to the unnecessary high cost of American health care.

Although the article did document many procedures …

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Who’s truly responsible for the $2.7 trillion medical bill?

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