Most of us will not have the opportunity to just die of “old age” or to simply fall to sleep one night never to wake again. Most often, we develop an illness which causes our death. These have changed markedly over the years. For the pioneers, accidents, infections, childbirth were times and causes of great likelihood of death. A century ago, infections were the leading causes of death. Today, we …
The dramatic change in the causes of death
“I swear to God, if you come any closer, I will kill you,” said the 30-something year old, arms as wide as bazookas, eyes as piercing as the very needles I was about to stick him with. He was hooked up to IVs on every limb, had tubes coming out of his nose and going down his throat, but other than that, he was about as physically fit as anyone I’d …
Learning about patients as a phlebotomist
Most of the attention given to the nascent state health insurance exchanges has largely focused on their role in improving access to insurance for individuals and small employers, not on the role they can play in improving health care quality.
As envisioned by the Affordable Care Act, health insurance exchanges provide an opportunity to create more organized and competitive insurance markets by offering a choice of plans, establishing rules on the …
How health insurance exchanges can improve quality
When I see patients in the office, I try to guess their occupations from their demeanor and mannerisms. Salesmen are the easiest to ID. In general, they are gregarious males with manly handshakes. They laugh loudly and like to tell jokes. Teachers are more reserved and often give their narrative in a logical and chronological order, as would be expected. Another clue that the patient is an educator is that …
How should physicians give bad news to patients?
Full disclosure. I have 4 board certifications and dutifully do all of the required reading, continuing medical education (CME) and recertification exams to maintain my status (I am board certified in OB/GYN in both the US and Canada as well as board certified in pain medicine by both the American Board of Pain Medicine, ABPM, and the American Board of Physical Medicine and Rehabilitation).
I would never go to a non-board …
Why I would never go to a non-board certified physician
I love my new EMR, which I’ve been using for about 18 months now. I love having all my patients’ information at my fingertips in and out of the office. I don’t miss the piles of paper charts all over the place at all! In short, there’s really nothing about it I don’t like.
My staff, on the other hand, hates it.
Now that they’re not jumping up and down all the …
I love my new EMR, but my staff hates it
In my behavioral pediatrics practice, it is not uncommon for parents to go to great lengths to put up a good front. They feel terrible shame about moments of out-of-control behavior, and also fear that I will blame them for their child’s troubles. They focus primarily on “what to do” about their child’s difficult behavior. However with time, and the realization that I am interested in understanding, not shaming or …
Eliminate the guilt in parenting
In the summer of 2007, then-U.S. Preventive Services Task Force member Russ Harris, MD, MPH approached me about taking on what he suggested would be a fairly quick and straightforward project: summarizing the small amount of medical literature on the benefits and harms of the prostate-specific antigen (PSA) test that is commonly used to screen asymptomatic men for prostate cancer.
Little did I know that this research and its implications would …
Reaching the end of PSA screening
I had an unexpected gift this week: a not-so-sick sick day with my 5 year-old. And it really couldn’t have come at a better time.
We’ve never had a sick day like this before and he’s off to Kindergarten in September so the days were running out for preschool stolen-away sick leave.
In the past when he’s been ill he’s been well enough for me to head off to clinic or work …
Sick days: When our children show us the way
An article in the New York Times sheds a little light in a dark corner of medicine, the world of workers’ compensation. In particular, it highlights a world of doctors that dispense drugs in their offices, which improves both patient satisfaction and profits.
Though fraudulent insurance claims are always easy headline-grabbers, the real world of workers’ comp is complex and not always so tailor-made for sound bites.
Add to this …
Workers’ comp: The dark corner of medicine
The practice of medicine has changed enormously in just the last few years. While the upcoming implementation of the Affordable Care Act promises even further—and more dramatic—change, one topic which has received little popular attention is the question of exactly who provides medical services. Throughout medicine, physicians (i.e., those with MD or DO degrees) are being replaced by others, whenever possible, in an attempt to cut costs and improve access …
What could bring psychiatry to its knees, or save it
Recently a physician reporter for the New York Times, Elisabeth Rosenthal, argued in the cover article of the Sunday Review that routine physicals are in many ways pointless, and perhaps even dangerous.
In the article, entitled “Let’s Not Get Physicals,” Dr. Rosenthal goes on to point out that many routine tests performed during physicals — EKG’s, pap smears and blood work, are unnecessary. In my opinion, Dr. Rosenthal’s front page …
Let’s not get rid of the annual physical
I was talking to some new friends over lunch recently, at the nationally renowned Hominy Cafe, in Charleston, SC. Any place with a fried green tomato BLT, and shrimp and grits for breakfast, has my vote!
To the point: my question to these esteemed emergency medicine educators was this: “Do you ever have irrational fears about the people you love, because of …
Doctors experience trauma to their hearts and stress to their souls
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A silent pattern of discrimination persists today in healthcare institutions in the United States, according to a number of hepatitis B experts and advocates. A number of doctors have been recently dismissed or threatened with dismissal when they were discovered to carry the hepatitis B virus (HBV). Infected medical and dental students have had their acceptances deferred or rescinded altogether. These are nefarious instances of defensive medicine, based on an …
Discrimination against providers and students with hepatitis B
The ACA passed and is already in trouble. The Republicans are up in arms, calling the ACA an overreach of a totalitarian governmental regime. The Democrats are defending it, promoting its cost-saving measures as a progressive step forward for America.
To say the rhetoric has heated would be an understatement.
I’m not here to debate politics though. In the run up to the Supreme Court’s ruling on the ACA and the recent aftermath, …
A review of NY Med, and fixing health care’s public image
As a project manager working with hospitals on a daily basis, it can sometimes feel like I’m on an episode of “MythBusters.” Consistently, I work with hospital executives, nurses, clinicians and IT staff that have been told “one-size-fits-all” when it comes to various technology implementations. And, in my experience, it typically doesn’t take long before the truth is exposed.
For hospitals entertaining a technology implementation like medical device connectivity, there is …
Medical device connectivity in hospitals: One size does not fit all
A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com.
As a critical care anesthesiologist, I care for patients when they are most vulnerable. Critical care patients require intravenous (I.V.) fluids and medications, frequently through central venous access. These are catheters inserted into larger veins with a special procedure. I believe managing I.V. lines requires procedural skills, …
The role of IVs and central lines in critical care
Too often, bedbugs prevent cost-effective and quality health care – both literally and figuratively.
In the literal sense, consider the case of an elderly woman we’ll call Mary. A frequent visitor to emergency rooms in Northern Colorado, Mary has a long list of medical and behavioral health problems.
Recently, a pilot project implemented by the North Colorado Health Alliance brings together a team of providers representing different walks of the health care …
How hot-spotting stops bedbugs and other social ills
Most of the American public doesn’t know that different pharmacies can and do charge drastically different prices for their prescription drugs. Does that surprise you? It sure surprised me when I found this out a few months ago in my medical school class.
I consider myself well educated. I’m a college graduate and in the throes of professional school — in healthcare nonetheless. I have an open mind and I read quite …
Pharmacies can charge different prices for their prescription drugs
The dream of reason did not take power into account – modern medicine is one of those extraordinary works of reason – but medicine is also a world of power.
-Paul Starr, The Social Transformation of American Medicine, 1984
How can primary care’s position be reasserted as a policy leader rather than follower? Even though it is a linchpin discipline within America’s health system and its larger economy – …
How can primary care be a policy leader?
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