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Use the Janus principle in your medical practice

Neil Baum, MD

Physician

September 15, 2012

Janus is the Roman god of doors and gateways but also the god of beginnings. Interestingly, good beginnings and required for good endings. The Temple of Janus had doors facing east and west, which allowed illumination of the temple at the beginning and the end of the day. Most statues of Janus show him with two faces facing opposite directions.

The Janus principle in your medical practice is the idea of …

These are the reasons why nurse practitioners are special

Kim Sakovich, WHNP

Physician

September 15, 2012

By now most of us have heard of a nurse practitioner. But what exactly is a nurse practitioner? What can they do? How can they be incorporated into a medical practice?

A nurse practitioner is a registered nurse who has completed graduate-level education and advanced practice training. Nurse practitioners can see a wide range of patients, both well and sick, and perform many in-office procedures. Prescribing medications, ordering and interpreting tests, …

How baby boomers will change end of life care

Monica Williams-Murphy, MD

Physician

September 15, 2012

The baby boomers, the largest generation in American history, are now almost all in the last third of their lives (if average life expectancy is 78). They have spent the previous, early and middle thirds of their lives transforming cultural ideas, expectations and practices (e.g with the civil rights movement, environmental movement and women’s movement, etc).

The question now is, “Will the baby boomers also transform our cultural ideas, expectations, and …

Don’t blame the patients for long wait times

Chris Rangel, MD

Physician

September 14, 2012

Dr. Anthony Youn, a plastic surgeon practicing in Detroit places most of the blame for long office waiting times at the feet of the patients themselves. He comes up with three general categories; patients who arrive late for their appointments, emergencies that require the physician to leave the office, and “oh by-the-way” scenarios:

“Here is a typical scenario: It’s the end of a 10-minute office visit, scheduled as …

Does spanking control a child’s bad behavior?

Christopher Johnson, MD

Physician

September 14, 2012

As all of us know, there is a long, long tradition in our culture of disciplining or punishing children using physical means. “Spare the rod and spoil the child,” as the old saying goes. That explicit wording, by the way, does not come from the Bible, as most people think. Rather, it comes from a seventeenth century satirical poem by Samuel Butler. Still, The belief that …

No politician has to deal directly with Granny, but I do

Wes Fisher, MD

Health Policy

September 14, 2012

It’s impossible to watch the news these days. Whether you’re conservative, liberal, independent or non-committed, it’s impossible to avoid the political bickering these days as the US Presidential campaign enters its final countdown. As a physician, seeing the video of Granny being pushed off a cliff is about all I can handle.

Seriously?

No politician I know has to deal directly with Granny, but I do. I have to …

What breastfeeding and sex have in common

Amy Tuteur, MD

Physician

September 13, 2012

Breastfeeding and sex share something in common and it isn’t just breasts. It’s the apparently irresistible urge of some people to force their personal beliefs on other people.

The stated desire of lactivists, like those promoting the Latch On NYC breastfeeding program, to “protect” breastfeeding bears an uncomfortable resemblance to the stated desire of religious fundamentalists to “protect” virginity from the “dangers” of premarital sex, or to “protect” marriage from the …

Practices are getting larger to provide micropractice service

Lucy Hornstein, MD

Physician

September 13, 2012

Medicine has gone down Alice in Wonderland’s rabbit hole. Looking at the size of practices today, it seems like some of them have taken red pills and the rest have taken blue ones: most of them are getting bigger and bigger and bigger, while some are getting smaller and smaller. As the giant practices gobble up their competition to become ever more gargantuan, others are shrinking down into micropractices.

Everyone has …

AMA: Cuts to physicians who treat Medicare patients hurt jobs, patient access and Medicare modernization

Jeremy Lazarus, MD

Health Policy

September 13, 2012

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

Physicians contribute significantly to both the health of our patients and the economic health of our nation, and a new report shows that the 2 percent Medicare spending sequestration cut will put the jobs supported by the health care industry in jeopardy.

The AMA recently teamed up with the American Hospital …

Matching Medicaid payments to Medicare: From pitiful to pathetic

Rob Lamberts, MD

Health Policy

September 13, 2012

“The specialist rescheduled me again,” the patient told me, looking embarrassed. ”I think he doesn’t want to see me any more.”

“I’m sure that it isn’t that he doesn’t want to see you,” I replied. ”This has to be a miscommunication with the front desk. It happens all the time; it drives doctors crazy.”

“I don’t know,” he continued. ”I just got on Medicare, and I wonder if maybe he doesn’t want …

Can you really be a doctor today and have it all?

Greg Smith, MD

Physician

September 13, 2012

I am so glad that I’m only a partially conflicted, semi-neurotic, intermittently confused middle-aged psychiatrist. It would be so much harder to be a young guy, just coming out of residency, trying to decide what to do and how and where to do it. The stress!

When I finished training, career paths were relatively easy to research, vet, and decide upon. You could go into private practice, in a group or …

The ethics of conducting a pelvic exam on an anesthetized woman

Peter Ubel, MD

Physician

September 12, 2012

I felt a woman’s uterus without her permission. How this happened, and why I thought I had done the right thing at the time, tells us something important about medical education and shows us why doctor/patient interactions often play out like conversations between earthlings and aliens.

To understand my inappropriate actions, you need to know something about the physical exams that we physicians conduct on our patients. More specifically, about the …

When patients stray from the common sense approach to health care

James C. Salwitz, MD

Physician

September 12, 2012

It turns out that the practice of medicine is just common sense. If someone has fallen and their hip hurts, it is probably related. If someone does not have an infection, do not give an antibiotic. Exercise and good food are, well, good for you. If it is not broken, do not fix it.

Usually, patients understand this basic idea. The best chance of becoming and staying healthy is the simplest …

Care delivery transformation requires an upfront investment

Kyle Bradford Jones, MD

Health Policy

September 12, 2012

When I was traveling around the country interviewing for a residency spot in family medicine in the fall of 2008, I was eager to find a patient-centered medical home (PCMH). At every interview, I asked whether the program’s clinic was a certified PCMH or whether it was moving in that direction. “Well, we don’t yet know what that looks like” was the answer that I heard at nearly every destination. …

The well woman visit: An easy way to obtain preventive services

Leana Wen, MD

Physician

September 12, 2012

As an emergency physician, I tend to work on the other side of preventive care services. I see what happens when women don’t know about safer sex and birth control, and end up with complications from sexually transmitted infections. I see what happens when women do not get routine screening for cervical cancer and struggle with life-threatening cancer. I see what happens with out-of-control hypertension and diabetes, and the heart attacks and strokes that …

How to tell your friends and family that you have cancer

Andrew Griffith

Patient

September 11, 2012

One of the hardest things after a cancer diagnosis is telling others: family, friends and colleagues. I preferred to a more open approach for a number of reasons.

Keeping everything inside was harder, talking and writing was a form of release. People close to you need to know to help them support you. Letting people know avoids awkward questions, providing an invitation for support. Previous experience with others who did not share …

Antibiotic overuse: Physicians and patients enable each other

Michael Kirsch, MD

Medications

September 11, 2012

With regard to antibiotics, physicians and the public have each been enablers of the other. Patients want them and we doctors supply them. There’s nothing evil about this arrangement. Antibiotics are one of medicine’s towering achievements and have saved millions of lives. Shouldn’t we prescribe them to patients who need them? Of course we should. But why do we prescribe them to patients who don’t?

Before you race to the comment …

When the fear of needles paralyzes medical care

Suzanne Koven, MD

Conditions and Diseases

September 11, 2012

When I was a kid, my pediatrician was a friend of my parents who practiced out of a first floor office in his home across the street from ours. He was a wonderful man and doctor, I’m sure, but I was terrified of him because I associated him with the injections he gave me periodically. Even when he and his wife came to our house for dinner I hid–just in …

An OpenTable approach to hospital discharge planning

Jessie Gruman, PhD

Patient

September 11, 2012

Have you ever sat on your bed after being discharged from a hospital stay and suddenly felt – along with the relief of being home – overwhelmed by what you have just been told that you and your loved ones must now do? Similarly, have you ever walked out of an appointment with your clinician and said, “HUH? Exactly what did we agree I am going to do about this …

The only thing I had to do was to help Jerry and I failed

angienadia, MD

Physician

September 10, 2012

I have failed Jerry, and now I’m replaying every word I ever said in my head, over and over, the whole exercise consuming my being.

Jerry was not old. He just turned sixty, a good few decades of retirement awaiting him. Then, he was diagnosed with stage 4 esophageal cancer. It seemed that he had spent his entire life working up to that moment, only to be stolen away unjustly, by …

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