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Primary care is the missing link in global health

Physician

September 10, 2012

Sitting on a dusty wooden bench in the rural Sacred Valley in Peru with the Andean mountain range serving as a scenic backdrop, it dawned on me that I was the first physician that my 43-year-old Peruvian patient had ever seen.

After treating his acute diarrhea, I was faced with his elevated but asymptomatic 162/89 blood pressure. I knew he needed treatment, but my concern was whether or not to start …

A surgeon gets infected with West Nile virus and tells his story

Don Read, MD

Conditions and Diseases

September 10, 2012

Adapted from an interview from Me and My Doctor.

I will never be normal like I was before I got sick. I couldn’t run if it was an emergency. I cannot ride a bicycle, although I can sort of halfway dance with my wife. I can’t carry my grandchildren up the stairs.

I am never sick. I was a perfectly healthy surgeon, working 88.7 hours a week on average. I had missed …

A glimpse of dying from literary authors

Jim deMaine, MD

Physician

September 10, 2012

“Medical training rarely deals with helping the dying patient find peace and comfort. In fact, most physicians are uncomfortable with the entire subject. I believe it is one of the most neglected aspects of medical care. I have spent my career as a pulmonary and critical care physician, and I have cared for thousands of dying patients. In many cases, both the patients and I knew that they were dying. …

Learn to understand and interpret your body’s language

Susan Biali Haas, MD

Conditions and Diseases

September 9, 2012

A few weeks ago I was brought in to speak to the staff of a local university. I gave a two hour workshop, which is even more fun for me than giving a keynote as I get to interact personally with the audience and draw their stories out. One of the sections of the workshop was about listening to your body. Every person’s body “speaks” to them in a different …

When our health system works, it’s unbeatable

Stewart Segal, MD

Physician

September 9, 2012

Today was a great day. Despite the shortcomings of our medical complex, when it works right, it is a beautiful thing. Actually, it’s not just beautiful, it can deliver the best care available anywhere in the world. I know. I saw it happen today.

Today, Mr. X presented with a troublesome history and an even more threatening physical exam. I was afraid that the disease I was about to diagnose would …

The secret sauce of great health care organizations

Robert Allan Bear, MD

Health Policy

September 9, 2012

Greg Smith, formerly of Goldman Sachs, has described a positive organizational culture as being the “secret sauce of greatness.” What is the nature of this secret sauce? A simple, popular definition is that “organizational culture is the way we do things here.”

The relationship between organizational culture and organizational success is unassailable. In our commercial dealings, has not each of us easily recognized when a business culture is truly customer-focused, and …

Can digital medicine have a placebo effect?

Dike Drummond, MD

Health Technology

September 9, 2012

Is the placebo effect something that demands the presence of a living human – or can we program it into a cell phone app? What happens to healthcare if we can?

I must admit I have always been fascinated by the concept of placebos. You give a research subject with a documented medical condition a sugar pill – and they get better. They heal themselves despite the fact they have not …

The first 24 hours of being a medical resident

Brian J. Secemsky, MD

Medical Education

September 8, 2012

As this is the season for spanking-new physician trainees to flood hospitals around the U.S., I decided to chronicle my own very first 24 hours as a doctor so the reader can get a better insight into this annual event.

2000 hours, evening before: With my newly starched white coat, stethoscope and light pen packed neatly into my Tumi man-purse, I make believe that I am sufficiently prepared for the first …

Which hospital should I choose? How to use hospital rankings

Ashish Jha, MD, MPH

Physician

September 8, 2012

After years of breaking down, my sedan recently died. Finding myself in the market for a new car, I did what most Americans would do – went to the web. Reading reviews and checking rankings, it quickly became clear that each website emphasized something different: Some valued fuel-efficiency and reliability, while others made safety the primary concern. Others clearly put a premium on style and performance. It was enough to …

The delicate balance of supervising medical residents in clinic

Tabor Flickinger, MD

Physician

September 7, 2012

It was a challenging transition, when I shifted from being a medicine resident to supervising medicine residents. There is much to be said about this shift (and similar shifts of ever-increasing responsibility at various stages of doctors’ training). The aspect on my mind at the moment is the role of clinic preceptor.

When I was new to the role and new to the clinic, I was paired with a more experienced …

Would you accept obesity advice from a fat doctor?

Joyce Ho, MD

Conditions and Diseases

September 7, 2012

Something that has been on my mind recently is obesity, specifically obesity in doctors. This may be because we cover obesity in a high percentage of our stories (1 in 3 Americans is obese, after all) or because I recently discovered that I gained ten pounds since moving to New York City. Either way, after watching Dr. Snyderman speak her mind on national television about how obese leaders are unfit …

Lessons I’ve learned from a colon cancer patient

Allen Perkins, MD

Physician

September 7, 2012

I have been installed as President of the Alabama Academy of Family Physicians. The work should not be too hard and on occasion should be rewarding (or at least ego-boosting). Such was the case the other day when the executive director asked me to recall a patient from “my early days” that had made an impact so he could publish my thoughts, thus officially making me an old geezer. I …

Does PRP work for knee injuries?

Mandy Huggins, MD

Conditions and Diseases

September 6, 2012

If you follow sports media, you have no doubt heard of PRP by now. Hines Ward made it popular in 2009 when he received PRP treatment for a knee injury just before the Super Bowl. Kobe, Tiger, A-Rod, and many other high profile athletes have reportedly received PRP treatments. But what is it? Why are these athletes receiving it? Can you get it, too? Let’s discuss.

I’ll begin with the basics. …

Read more…

Does PRP work for knee injuries?

Why I’m thankful for my son’s surgery team

Anesthesioboist T., MD

Physician

September 6, 2012

My son had been having episodes of belly pain right around his belly button for several weeks. I watched and waited. Between these bouts of mild abdominal pain he was completely fine – healthy appetite, active, happy. But I had a feeling something was brewing. I was waiting for the other shoe to drop. The disease finally declared itself: several nights ago his belly pain was severe and unremitting. He …

ACP: My EHR report card

Yul Ejnes, MD

Health Technology

September 6, 2012

A guest column by the American College of Physicians, exclusive to KevinMD.com.

Even though September is “back to school month” and students won’t get their report cards for a while, I have a report card to share with you now. In September 2006, my practice went “live” with an EHR, so I thought that the sixth anniversary of this …

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ACP: My EHR report card

Striking the balance between the public good and patient privacy

Margalit Gur-Arie

Health Technology

September 6, 2012

Everybody has a shadow. Although as a small child you may have tried, you cannot separate yourself from your shadow no matter what you do. Electronic medical records may be the first tiny step on the road to attaching yet another indivisible part to your persona, a “panoramic, high-definition, relatively comprehensive view of a patient that doctors can use to assess and manage disease”, and this, in the words of …

Did Atul Gawande unwittingly support specialty hospitals?

Jaan Sidorov, MD

Physician

September 6, 2012

If you’re a fan of star surgeon overachiever Atul Gawande, then reading his New Yorker article “Big Med” is a must. The rest of us skeptics should still use the article to signal our health care adroitness by knowingly referring to the “Cheesecake Factory” in our policy medical meetings, conferences, PowerPoints and bloggery.

What he wrote

Dr. Gawande uses the successful restaurant chain to extract lessons and draw health system parallels, ultimately …

Mandatory breast density notification violates physicians’ free speech

Margaret Polaneczky, MD

Physician

September 5, 2012

Once again, legislators are meddling into healthcare. This time, it’s in my own home state, where Governor Cuomo has just signed a bill requiring radiologists to notify women when their normal mammogram also shows that they have dense breasts. In such cases, the following text must be included in the lay summary mammogram report given to the patient:

“Your mammogram shows that your breast tissue is dense. Dense breast tissue is very …

Any doctor can make the decision for mental capacity

Tamer Mahrous, MD

Physician

September 5, 2012

Many elderly patients get admitted to the hospital with profound weakness due to their acute and chronic medical conditions. Many of them will leave the hospital with profound weakness from their acute and chronic medical conditions (and unfortunately without a palliative care consult). In many situations, these patients will be too weak to take care of themselves. They will need extra help with their activities of daily living either from …

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