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Let physician assistants be part of the primary care answer

Physician

December 19, 2011

There has been so much change in medicine, physicians are leaving primary care, and new ideas are being bantered about such as patient centered medical homes (PCMH) and accountable care organizations (ACO), in an attempt to try to address the problem. To add to this strain, is the knowledge that medicine is going to have to be ready to absorb thousands of additional patients in the near future …

Advance planning should be a public health issue

Jim deMaine, MD

Physician

December 18, 2011

“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. …

Making tailored health education standard of care

Shantanu Nundy, MD

Patient

December 18, 2011

The recently instituted 30-hour-shift work restrictions placed on medical residents have created a need for “dayfloat” services to safeguard potentially unsafe handoffs in patient care and help residents adhere to duty hour limits. The past two weeks I’ve been the dayfloat resident for the cardiology inpatient service. My job is to round with the post-call team, help them get out of the hospital on time, and then take care of their …

How many parents are failing their children

Stephen C. Schimpff, MD

Patient

December 18, 2011

Our children (and grandchildren) are the future and we are responsible for their growth and development. As responsible parties, we are clearly failing.

That is my interpretation of the report issued a few days ago by the Centers for Disease Control (CDC) on seven criteria known to the associate with ideal cardiovascular health as part of the National Health and Nutrition Examinination Survey. They are defined, briefly, as 1) a diet …

Doctor, why is your hospital better than any other?

Zackary Berger, MD, PhD

Physician

December 17, 2011

I took a deep breath. I had to think carefully. It’s not that this was unexpected – Johns Hopkins has been anointed the country’s best hospital for 21 years running by US News. But I wanted to tell the patient the truth without alienating them or failing to mention the many admirable aspects of my institution.

One truth, however, cannot be denied: to call one hospital the best is not simple.

Let’s start with …

Did hospital politics lead to physician suicide?

Skeptical Scalpel, MD

Physician

December 17, 2011

What causes a doctor to commit suicide?

A story about a radiation oncologist from Springfield, IL brought this strange case to my attention. Dr. Thomas G. Shanahan committed suicide by cutting his throat in November of 2011. He was respected in his field, having published many research papers and traveled the world helping to set up brachytherapy clinics in several countries. He also had been an acting alderman in his …

MKSAP: 38-year-old woman with increasingly frequent headache

mksap

Conditions and Diseases

December 17, 2011

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

A 38-year-old woman is evaluated in the office for a 10-month history of increasingly frequent headache. The headache is often worse in the morning on awakening. She has recently started keeping a headache diary, which reveals episodes on approximately 25 days of each month. The headache …

The possibility of zebras in primary care

Emily Gibson, MD

Physician

December 16, 2011

It is critical for physicians to share unusual patient diagnoses that present to clinic with routine type symptoms. In a hospital setting, these are cases for discussion and debate at Grand Rounds. In a primary care setting, we do case reviews when we can with informal sharing for the purpose of teaching and learning. The bottom line, whether in a formal academic setting, or an informal setting around the lunch …

The powerful connection of emotions in healthcare

Joyce Hyam, RN

Patient

December 16, 2011

I remember like it was yesterday. My patient was a young blond female with two beautiful Samoan dogs. Her name was Margaret. I was only two years younger than she was. The diagnosis was poor. She was friendly when I introduced myself. And she proceeded to tell me about her health issues, how she was diagnosed and what treatment she was receiving. Marge as she wanted to be called was …

A medical student meets Donald Berwick

Taylor J. Christensen, MD

Health Policy

December 16, 2011

While attending the Institute for Healthcare Improvement Annual Forum recently, my friend, Jared Conley, and I had the good fortune of finding ourselves standing a table away from Don Berwick in a relatively empty conference room. As MD/PhD in Health Policy students, we were interested in asking him a question about ACOs, so we approached him and introduced ourselves, hastily adding, “We know you’re busy, so we just have …

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A medical student meets Donald Berwick

The emergency department in an ACO world

Mark Crockett, MD

Health Policy

December 16, 2011

In the era of accountable care, you’ll notice that many hospitals and health systems are already driving towards more collaborative workflow. The integrated delivery network (IDN) is changing significantly, and for the better. But in high-acuity care areas, like the emergency department (ED), the challenge of treating patients more holistically in what is already a fast-paced environment is concerning for physicians evaluating the pay-for-performance model.

In today’s ED, patients may …

Patient identity fraud in the emergency department

Sean Scorvo, MD

Physician

December 15, 2011

Almost four years ago now, I left my practice as an emergency medicine physician to enter the business world. However, the medical world isn’t easy to escape. I just couldn’t seem to forget some of the problems I used to face in the emergency department. So, when I had the chance to fix one of them, I took it.

The most intractable problem for me was fraud, especially as it related …

Lessons from applying to medical school

Amir Razmjou

Medical Education

December 15, 2011

I’ve heard applying to medical schools can be a soul crushing process, but I didn’t really quite get it until I got hurled into the process myself. Although I still wouldn’t describe this as “soul crushing,” it has certainly brought out a lot of insecurities in me and my accomplishments. Do they not like my stated reasons for pursuing medicine? Do my extracurricular activities seem phony and under-whelming? Is this …

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Lessons from applying to medical school

How medications are like vehicles

Stewart Segal, MD

Medications

December 15, 2011

I usually cringe when I see a pharmaceutical company ad on TV. I think most pharma commercials do more harm than good. The ads scare patients out of taking medications they need.

Actor: Do you have uncontrollable diarrhea? I did, and then my doctor prescribed “No-More-Poop!” Now I feel great and don’t have to worry about embarrassing accidents.

Commentator: Clinical studies done at a leading university prove that “No-More-Poop” cures 99% of …

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How medications are like vehicles

Solving distracted doctoring from smartphones and tablets

Kevin Pho, MD

KevinMD

December 15, 2011

Imagine that your neurosurgeon, during surgery, was talking on his cellphone using a headset.

Unthinkable?

Well, no. A recent article in the New York Times cites a case where a patient was left paralyzed and the neurosurgeon was sued, in part, for being distracted. He made 10 personal calls during the operation.

The proliferation of portable electronic devices, smartphones, tablets, and the …

Taking the knife to doctor-drug company relationships

Nagarathna Manjappa, MD

Medications

December 15, 2011

With health care industry reaching unsustainable lows, media attention is on physician’s relationship with the pharmaceutical industry. A Google search will give results that paints doctors as culprits, leading to a prejudiced opinion where doctors are thought of as co-conspirators with drug companies. This article teases this tainted relationship, from a typical doctor’s perspective.

Pharmaceutical companies have strategies not only to survive, but also to grow with general public investing in …

Mobile health and the globalization of medicine

David Lee Scher, MD

Health Technology

December 14, 2011

The term globalization loosely refers to the increasing unification of order. It has been traditionally applied to the economic sector. As the world is progressively intertwined from financial and cultural perspectives, it is not surprising that it is occurring in the medical arena. There have been international professional medical societies for many decades, and the medical device and pharmaceutical industries have consolidated on a global scale.

However, the way medicine is …

How political correctness interferes with healthcare

Dominic A. Carone, PhD

Physician

December 14, 2011

Political correctness and sensitivity training are interfering with medicine and healthcare. In a recent article published in the journal, Pediatrics, a group of researchers published their findings regarding parental perceptions of the terminology that doctors use to describe childhood obesity (ages 2 to 18). The researchers found that it was undesirable to use the term “fat,” “obese,” or “morbidly obese” because they were stigmatizing, blaming, and the least motivating to …

Health quality requires looking at our caregivers

Jordan Grumet, MD

Physician

December 14, 2011

Sonia struggled to express herself through broken English. Her lively facial expressions and exuberance betrayed by her inability to string the words together fluently. One hand gesticulated widely while the other rested gently on the elderly woman’s hair.

She somehow managed to coo quietly in her companions ear, calming her, as she continued the conversation with me. Sonia’s eyes opened and closed in an exaggerated blinking manner as she questioned me …

AMA: New policies that will impact the future of medicine

Peter W. Carmel, MD

Health Policy

December 14, 2011

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

Last month, physicians from all states and specialties came together for the American Medical Association’s (AMA) semi-annual policy-making meeting to adopt new policies that will impact the future of medicine. Of the new policies, some of the many noteworthy topics include national drug shortages, health insurance exchanges, private contracting and the …

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