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This is a historic time for American health care

Health Policy

July 16, 2012

My initial reaction to the Supreme Court’s ruling to uphold The Affordable Care Act was to breathe a sigh of relief. The law, particularly the individual mandate – the cornerstone provision – is constitutional and now we can get on with the real task at hand of transforming the U.S. health care system into one in which high-quality and safe care is delivered in an effective, timely, and patient-centered manner. …

Mainstream media can foster an engaged public on health issues

John Mandrola, MD

Health Policy

July 16, 2012

On the surface, two Wall Street Journal articles painted a gloomy and depressing picture of US healthcare, now and beyond.

That wasn’t my take. I felt a rush of optimism. Let me explain.

In, ObamaCare’s Lost Tribe: Doctors, deputy WSJ editor, Daniel Henninger wrote about the (forgotten) plight of doctors in the Affordable Care Act. He critiqued the mainstream media coverage of the Supreme Court decision because it left out mention of …

ACP: A Senate intern turned internist seeks solutions to better patient care

Fred Ralston Jr., MD

Health Policy

July 16, 2012

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

In early June I participated in ACP Services 2012 Leadership Day on Capitol Hill in Washington, D.C. I sincerely believe that we have an obligation to share our experiences with elected representatives. Internists through ACP have been doing this for years and have raised awareness of the high …

The New York medical malpractice crisis: Who’s to blame?

Kevin Pho, MD

KevinMD

July 16, 2012

Is this the endgame for the medical malpractice crisis?

A recent cover story in the New York Times describes how some financially struggling hospitals are “going bare,” meaning they are partially or completely forgoing malpractice coverage.

From an economic standpoint, it’s a rational thing to do. Malpractice insurance costs are skyrocketing, forcing these hospitals into uncomfortable choices.

As one administrator bluntly puts …

If the government was a physician

Jordan Grumet, MD

Health Policy

July 16, 2012

If the government was a physician, it wouldn’t be an ordinary doctor like you or I.

It would be a sexy actor like the ones we see on those medical melodramas that have become so popular over the last few years. His hair coiffed, his jacket pressed and free of stains, and his manor confident he would rush into the trauma bay. As the beeping monitor flat lines, he would sweep the nurses …

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If the government was a physician

5 reasons that prevent doctors from using mobile apps

David Lee Scher, MD

Health Technology

July 15, 2012

The Jackson Coker Special Report on Apps, Doctors, and Digital Devices, originally published in October 2011, was featured in a recent online article with the headline “80% of Doctors Use Smartphones and Medical Apps in Everyday Medical Practice.”

If one delves a bit more into the facts, the 80% quoted in the Jackson and Coker report is derived from yet another study by Aptilon reported in April, 2011 by mobihealthnews stating that …

Is measuring Body Mass Index (BMI) obsolete?

James Haddad

Conditions and Diseases

July 15, 2012

I’ve been interested in health and nutrition since I started playing high school sports. During my 3 year stint as a personal trainer, I developed a distinct opinion of the Body Mass Index (or BMI – the most widely used anthropomorphic measurement in medicine): it’s not a very good tool.

My issue with BMI began here – it doesn’t actually measure a person’s body fat or lean mass, but rather is …

MKSAP: 25-year-old woman with bloating and abdominal cramping

mksap

Conditions and Diseases

July 15, 2012

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 25-year-old woman is evaluated for a 2-year history of almost daily bloating and lower abdominal cramping; the symptoms are associated with constipation, relieved with bowel movements, and seem worse when she is under stress. She has one or two small bowel movements a week and often has a feeling of incomplete evacuation. She …

Thought blocking and the privilege of becoming a doctor

Reflex Hammer

Medical Education

July 14, 2012

Years ago, I spotted an acquaintance I hadn’t seen in a while. The conversation was odd. A few times, I would ask a question and he would begin to respond, only to trail off into silence and stare blankly into space. He would remain frozen until the moment I said something else, whereupon he would act normally. He seemed completely oblivious to the fact that he had trailed off and …

All health care providers are not created equally

Marni Nicholas, MD

Physician

July 14, 2012

I’m a physician. I’m not a “health care provider.” I hate that term.

The insurance companies call me a “provider.” In a sense, it’s true. I provide health care services. However, over the past few years I’ve noticed that the lines between different types of “providers” are getting more and more blurred. Sometimes they’re blurred to the point that patients don’t even know what kind of “provider” they are seeing.

I often have …

MKSAP: 45-year-old woman is seen for diabetes follow-up

mksap

Conditions and Diseases

July 14, 2012

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 45-year-old woman is seen for routine follow-up. She has type 2 diabetes mellitus, diagnosed 5 years ago; initial treatment included metformin and glimepiride. A daily injection of insulin glargine was added to her regimen 1 year ago.

At present, her hemoglobin A_1c value is 8.1%. Mean blood glucose values derived from the past 4 …

Health promotion needs to start in medical school

Rich Joseph

Medical Education

July 13, 2012

I recently took an exam focused on the pathophysiology and clinical risks factors of cardiovascular disease, the number one cause of morbidity and mortality in the developed world. Atherosclerosis, hypertension, and smoking were all there, front and center. Ironically enough, since it was the final exam of our first year of medical school, the instructors decided to reward us with dozens of Krispy Kreme donuts to enjoy during the exam. …

Belviq: What to do when patients ask

Edward Pullen, MD

Medications

July 13, 2012

I am acutely aware of the obesity epidemic in this country. I’ve posted previously about how obesity may have surpassed smoking as the #1 preventable cause of death in the U.S. Still the FDA approval today of Belviq, a sertonergic drug that brings back memories of Fen-Phen, Meridia and Redux (dexfenfluoramine) over concerns with their association with valvular heart disease, pulmonary hypertension and other concerns. The studies to date have been …

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Belviq: What to do when patients ask

You deserve superb integrative health care

Stephen C. Schimpff, MD

Health Policy

July 13, 2012

Is it possible that health care can become more effective, more personalized, more attuned to real health and wellness in a manner that truly benefits the patient as a customer/client?

The answer is “yes” but it will require understanding the dysfunction in the delivery system today, dealing with the growing shortage of primary care physicians and their non-sustainable business model, changing the insurance paradigm from prepaid medical care to (high deductible) …

Embrace a basic truth about health care reform

Leonard J. Marcus, PhD, Barry C. Dorn, MD, and Eric J. McNulty

Health Policy

July 13, 2012

The Supreme Court has spoken. The Affordable Care Act is upheld. So what does this mean for those of us actually involved in health care?

First, there is a lot of work to do. The Court has reached its decision with regard to the legal issues; what remains are the challenges of improving the quality of care, lowering its cost, providing access to those who need the care, integrating technology into …

The first person entrusted to my care

John Marigliano

Medical Education

July 12, 2012

With the passage of each summer’s day I am getting closer and closer to starting medical school, and with that the beginning of the rite of passage that is gross anatomy. Each Fall, first years across the country walk with a mixture of nervousness and excitement into a room full of covered cadavers and are introduced to the first person placed in their care – their “first patient.”

The men and …

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The first person entrusted to my care

The first step to changing the culture in healthcare

Vipan Nikore, MD

Physician

July 12, 2012

“Look left, look right”, our group leader told us. No, I was not learning to cross the street. Rather it was my first day of employee orientation at the IBM Software Lab over a decade ago. I was fortunate that our CEO was Lou Gerstner, arguably one of the greatest CEOs who has ever existed. Gerstner stepped into IBM in the early 1990s when the company was struggling. One of …

Medical education needs to get a passport

Michael Mank

Medical Education

July 12, 2012

I participated in a medical mission to Haiti with the Hope for Tomorrow Foundation. The trip only lasted a week, but the impression it made will stay with me forever. I experienced a culture shock stepping off the plane: “tent cities” sprawled the streets, sewage and garbage piled up to no end, and the people had nowhere to go.

Upon arriving to the hospital in Les Cayes, there were hundreds of …

How ObamaCare affects critically ill children

Christopher Johnson, MD

Health Policy

July 12, 2012

The drama surrounding the Supreme Court decision upholding the ACA as constitutional has ended. As legions of reporters and bloggers have written, the law has far-reaching effects. In my corner of medicine it will greatly help (already has, really) a small but not insignificant number of children and families. These families are those who have a child with a severe chronic medical condition. Many of these children spend time in …

The reality of marriage equality and health care

Suzanne Koven, MD

Physician

July 11, 2012

Not long ago I fractured my shoulder and needed surgery. After the operation, my husband of 30 years did all the things a loving spouse would be expected to do: He fluffed my pillows and put toothpaste on my toothbrush (try doing that with one arm!) and overlooked my crankiness.

My husband also helped me in ways so fundamental to our status as a married couple that I barely registered them. …