| KevinMD.com

Why more cancer screening may not be productive

Conditions and Diseases

November 9, 2011

The longer I continue in practice, the more complex it becomes. I thought advances in our understanding of the molecular basis of cancer would clarify decision making; instead answers have led to more questions. In the spirit of the immortal Henny Youngman: Take the issue of cancer screening, please.

The story of screening for colorectal cancer (CRC) and prostate cancer has many similarities. The primary screening and diagnostic tool during my …

Why can’t the United States have a smarter health care system?

Maggie Kozel, MD

Health Policy

November 8, 2011

Why can’t the United States have a smarter health care system?

That was the frustrating question that kept poking through my train of thought as I read a study from the most recent issue of Pediatrics, the official journal of the American Academy of Pediatrics (AAP). The study, out of UCLA, examined the association between length of well-child visits and quality of the visits, including things like developmental screening and what …

No act of kindness is ever wasted

Jackie Fox

Patient

November 8, 2011

I see my oncologist for my twice-yearly checkup tomorrow, and while my visits have been blissfully mundane over the last three years, this time I actually have a list of questions and a couple of concerns over the lab results from my latest physical. It’s probably nothing, but once you’ve had cancer you can’t help but wonder which “nothing” is actually the edge of trouble’s long shadow. My family doctor sees no cause for …

Read more…

No act of kindness is ever wasted

Learning from patients at a geriatric adult home

Maria Yang, MD

Physician

November 8, 2011

During my time at PPOH, I spent one day a week working at a geriatric adult home.

An adult home is a residence that generally houses people with psychiatric conditions. They can be run by either public or private agencies. At best, they provide services and supports for the residents so they can live independently. At worst, they provide very little other than shelter; they just take people’s money. (The latter has …

How patient satisfaction scores reward rich hospitals

Kevin Pho, MD

KevinMD

November 8, 2011

Medicare is beginning to tie financial bonuses to hospital patient satisfaction scores.

Although patient satisfaction is important, I’ve voiced concern in the past about giving hospitals a financial incentive to cater to patient surveys.

In a previous USA Today column, I wrote, “already, more than 80% of doctors … said patient pressure influenced their medical decisions. And in primary care, linking …

Let’s stop degree creep in health care

Sharon Bahrych, PA-C, MPH

Physician

November 8, 2011

How long ago was it that we were all content with having the physician have a MD or DO title after their name, the clinic or hospital floor nurse having a RN after her name, the pharmacist having RPh after their name?

Now unless the pharmacist has PharmD after their name they can’t be a pharmacist. And for the nurse, unless they have RN, BSN or RN, MSN after their name …

Read more…

Let’s stop degree creep in health care

Personal responsibility in promoting individual health

Ishmael Bradley, MD

Health Policy

November 7, 2011

In March 2010 President Barack Obama and the Democratic-led Congress passed the single largest change in the American health care industry since the introduction of Medicare and Medicaid in 1965. The Patient Protection and Affordable Care Act (PPACA) aims to drastically change the way that health care is delivered and financed. It partially draws upon the idea of personal responsibility and its role in promoting individual health. Some states, notably …

Embarrassment is one reason why men don’t see the doctor

Joel Sherman, MD

Patient

November 7, 2011

It is well known that men see doctors much less frequently than women. The reasons are multifactorial and not all that well studied. It’s certainly not because men are healthier than women as they die on the average seven years before women. Clearly women are accustomed to seeing doctors at an earlier age than men for reasons relating to childbirth and birth control. Most accept the recommendations to get an …

Doctors and patients cannot win when it comes to chronic pain

Kevin Pho, MD

KevinMD

November 7, 2011

The following op-ed was published on September 18, 2011 in USA Today.

A fellow physician recently shared a frustrating clinic visit with me, in which a patient had left by saying, “You doctors need to wake up and realize that patients (who are) in pain are in a no-win situation.”

The patient was absolutely right. This summer, the Institute of Medicine released …

The fallacies of screening tests extend beyond false positives

Manoj Jain, MD, MPH

Conditions and Diseases

November 7, 2011

Several years ago, during an annual mammogram, my wife, who is in her 40s, was told a mass had been found in one of her breasts. Anxious and uncertain, she had a biopsy, and we braced for the worst.

My father-in-law, when in his 50s, went through a similarly harrowing experience when a prostate specific antigen (PSA) test given during a routine physical exam came out positive, and he underwent a …

Treating Adele’s vocal cord hemorrhage

Christopher Chang, MD

Conditions and Diseases

November 6, 2011

Before going any further, the title to a Los Angeles Times story was “Adele to have surgery to treat vocal cord hemorrhage. What is it?”

I sincerely hope that whomever her surgeon is knows not to perform surgery when the vocal cord is in the middle of a hemorrhage. You do the surgery when the hemorrhage is gone and the culprit blood vessel is left behind which likely is the reason …

Read more…

Treating Adele’s vocal cord hemorrhage

Is it possible to implement a list of essential health benefits?

George Lundberg, MD

Health Policy

November 6, 2011

What is an essential health benefit? I suppose that is a health or medical action, product, or process that should be paid for by someone other than the patient, in a society that provides so-called “third party coverage.”

Many very smart people and strong organizations have struggled with this issue for many decades.

Prior answers, such as they are, have come from staff model HMOs like Kaiser Permanente, the Veterans Health Administration, …

When sentimentality is lost

Jordan Grumet, MD

Physician

November 6, 2011

I don’t know when I lost my sentimentality.

Whaaap.

With a thud the fish stops flopping up and down. It lays still on the floor of the boat. My camp counselor, a tanned college student, carefully places the paddle on the seat and cuts the fishing line. The hook remains dangling from the lifeless mouth.

He grabs the fish with his bare hand and throws it back into the water. He talks slightly …

Read more…

When sentimentality is lost

Neuropsychologists in the evaluation of ADHD

Dominic A. Carone, PhD

Conditions and Diseases

November 6, 2011

Recently, the media has reported that the American Academy of Pediatrics (AAP) has broadened its 2000-2001 guidelines for the diagnosis of and treatment of ADHD. While the prior guidelines focused on children from ages 6 to 12, the new guidelines cover ages 4 to 18. The story is being covered by the media with lead-ins such as saying that AAP is “expanding the age range for diagnosis and treatment.”

This is …

When doctors have to be reminded how to act like human beings

Linda Burke, MD

Physician

November 5, 2011

It’s a sad commentary when human beings have to be reminded how to act like human beings, especially when they’re in the helping profession.

Loni Hildebrandt was a 29-year old certified nursing assistant who was pregnant with her first baby. Make that two babies because she was pregnant with twins. Hildebrandt considered her pregnancy miraculous because she had infertility and was a diabetic since the age of one. Together, she and …

The ability to quantify empathy

Norman Silverman, MD

Patient

November 5, 2011

The public gets much of its health-related news from lay-oriented synopses of scientific papers published in refereed medical journals or presentations at major medical conventions. Longer, more detailed commentary is published in the print media, but the majority are short pieces posted on many websites or blogs. I try to familiarize myself with information pertaining to cardiovascular disease as well as predisposing conditions such as diabetes and hyperlipidemia with the …

Read more…

The ability to quantify empathy

Medicine is slowly facing the issue of futile care

Jim deMaine, MD

Physician

November 5, 2011

The voice on the phone is demanding, quavering, pleading; “Dr. deMaine you are going to be the attending critical care doctor when our mother is transferred to your hospital today. She needs to be taken off the respirator and allowed to die. We have been pleading with the doctors at the burn center, but they keep doing more procedures. We want her off life support as soon as she gets …

MKSAP: 32-year-old man with abdominal pain

mksap

Conditions and Diseases

November 5, 2011

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

A 32-year-old man is evaluated in the emergency department for a 5-day history of worsening crampy abdominal pain and eight to ten loose bowel movements a day. The patient has a 5-year history of ulcerative colitis treated with azathioprine and topical mesalamine; before this episode, he had one or two bowel movements of well-formed stool …

Would patients benefit from experts who never meet them?

Adam B. Cohen, MD

Physician

November 4, 2011

One recent morning, my grandma awoke with abdominal pain. She was taken to a good, local community hospital and diagnosed with acute ischemic bowel. There are various causes of ischemic bowel, but regardless of cause, getting the right care quickly determines whether such patients live or die.

After speaking with her physicians, I called some friends. A quick discussion with colleagues in radiology, surgery, and gastroenterology helped me know that the …

The unspoken assumption that doctors are well

Samyukta Mullangi

Physician

November 4, 2011

We heard from a patient during our dermatology week, who worked as a medical laboratory technician, running hundreds of blood samples every day, and frequently using her own blood as the negative control. Then she began to notice that the numbers stopped making sense. Her ANA had shot through the roof and her white blood cells started dropping.

“I couldn’t use my blood as the negative control anymore,” she said, shrugging …