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Cosmetic gynecology continues to grow during the recession

Conditions and Diseases

August 4, 2011

Though the recession has blunted overall demand for cosmetic surgeries, one subcategory appears to be entering a growth phase, at least judging from the fifth annual Congress on Aesthetic Vaginal Surgery, held late last year in a luxury resort outside Tucson. There, about 60 doctors, most of them OB-GYNs, converged to discuss the expanding field of “cosmetic GYN”—elective surgeries for women seeking to “rejuvenate” and/or “beautify” their vaginas. Attendance at …

Bullies in older adult communities

Frances Shani Parker

Patient

August 4, 2011

Bullies are terrorizing residents in long-term care and assisted living facilities, senior centers, and retirement communities around the country. The first time I witnessed older adults bullying others was at a senior center where, after a great deal of resistance from members, the age for joining the center had finally been lowered from 62 to 55 years old. Most local senior centers had already lowered their membership age years …

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Bullies in older adult communities

Hope and warnings to other states from California family physicians

Carol S. Havens, MD

Health Policy

August 4, 2011

A guest post from the California Academy of Family Physicians, exclusive to KevinMD.com.

Despite the slight upward tick in medical students opting for careers in family medicine over the last two years, efforts aimed at solving the primary care physician shortage are often thwarted by state and federal policy decisions.

There is reason for hope, however: The number of medical school applications in California is extraordinarily high. A higher proportion of …

Doctors diagnose diabetes 10 years later than the disease warrants

Roxanne B. Sukol, MD

Conditions and Diseases

August 4, 2011

I like my patients vertical. Not horizontal.

If I can help it, I want to make sure that nobody gets a disease that could have been prevented. Sure, accidents happen. And illnesses show up every day in the lives of people who did nothing to deserve them, and who could have done nothing to prevent them. But not all illnesses.

Physicians know that newly diagnosed diabetic patients present to the doctor …

Should Lipitor go OTC? A cardiologist says yes, an internist says no

Kevin Pho, MD

KevinMD

August 4, 2011

With the patent for Lipitor expiring, Pfizer is considering selling an OTC version of the statin.

It’s generated a firestorm of debate, with doctors speculating on the impact for patients.

According to Pharmalot, “an OTC version would allow Pfizer to capture some of the sales that will be lost when the Lipitor patent expires in November. In fact, Pfizer execs recently changed …

Experiencing the professionalism of nurses and medical residents

Ryan Madanick, MD

Physician

August 4, 2011

Today I became a patient. If you follow me on Twitter, then by now you know what happened. Yes, I am embarrassed by what happened, but I’ll relinquish my HIPAA right to privacy for this moment.

This afternoon I swam nose-first into the sidewall in the pool. (I haven’t been swimming in awhile and I forgot to bring goggles, so I wasn’t really looking. Laugh all you want …) It …

What is the best type of infant thermometer?

Dr. Charles

Conditions and Diseases

August 4, 2011

A fever in an infant can be the first sign of an illness. While a rise in body temperature above 100.4 degrees Fahrenheit is part of a healthy immune system response, it does signal potential danger and need for further evaluation. Since a reading may lead to a call or visit to the child’s doctor or emergency room, accuracy is key. What is the best type of infant thermometer?

A …

Educated online by people with diabetes

Steve Woodruff

Conditions and Diseases

August 4, 2011

Recently, I saw one of my sons blithely dipping a chip into salsa, happily munching away while multi-tasking at something else – not a care in the world about his food.

It brought a smile to my face – but there was a touch of sadness with it.

You see, my work has brought me into contact with a number of PWDs (People With Diabetes) who are active on-line. And as I’ve …

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Educated online by people with diabetes

Hospitalist care is more expensive but don’t blame hospitalists

Kevin Pho, MD

KevinMD

August 3, 2011

Hospitalists save money. Until the patient leaves the hospital, at least.

A recent study from the Annals of Internal Medicine ignited debate over the cost effectiveness of hospitalists. Looking at Medicare patients from 2001 to 2006, researchers found that “those who were followed by a primary care physician spent about half a day more at the hospital, costing Medicare …

What would a smart, compassionate, affordable health care system look like?

Maggie Kozel, MD

Health Policy

August 3, 2011

One year after passage of the Patient Protection and Affordable Care Act, the debate roars on, in Congress and everywhere else. And these debates often revolve around a big question, even when it is left unspoken or implied: Is health care a basic human right?

In 1990 I made a quantum leap from practicing in the Navy’s single-payer, universal-coverage health care system into civilian pediatrics. Having been insulated from …

Partnership for Patients to improve patient safety

David B. Nash, MD, MBA

Patient

August 3, 2011

When physician blogger Kevin Pho wrote about involving patients in healthcare reform in a recent article in USA Today, one thing he failed to mention is a novel government initiative that has been flying below most of our radar screens — the “Partnership for Patients: Better Care — Lower Costs.”

Why was it necessary to call out patient centeredness as a separate initiative?

Although no one disputes that those of us …

Patients lose when insurers cut reimbursement for immunizations

Stewart Segal, MD

Medications

August 3, 2011

I recently received a declaration of war from one of the major healthcare insurers. Not happy with its current record profits, this insurer has decided to reduce its reimbursement on immunizations and injectable medications by 40%. I do not have a 40% margin on immunizations and injectable medications. My margin is at most 10%. This means that with a 40% reduction, I will have to pay at least 30% …

Can Medicaid be saved with better care coordination?

Benjamin Geisler, MD, MPH

Health Policy

August 3, 2011

Recently, we marked the 66^th birthday of Medicaid, the jointly funded but State-run program that supports health care for the poor. Medicaid plays a huge role in selected populations: 70% of nursing home inhabitants, 56% of low-income children and 42% of adults, and 44% of people living with HIV/AIDS all have their health care paid for by Medicaid. Medicaid is much talked about these days, and the reason is of course …

The different ways hysterectomy can be performed

Suzanne Hall, MD

Conditions and Diseases

August 3, 2011

When you and your gynecologist have decided on hysterectomy as the treatment of choice for your gynecologic diagnosis, there are several routes by which a hysterectomy may be accomplished. A total hysterectomy is the surgical removal of the uterus, and when indicated, the additional removal of the fallopian tubes and ovaries (termed salpingoophorectomy) may be recommended.

There are several routes by which a hysterectomy can be performed. You and your gynecologist …

What a psychiatrist learned during therapy sessions with mothers

Srini Pillay, MD

Patient

August 3, 2011

I’ve noticed a certain dilemma that enters into therapy sessions with mothers over the years. Mothers often feel in a bind and sometimes this bind distorts the way they think about their lives … or is it that their thinking distorts the way they feel? The sequence of events generally runs like this – the strong urge to have a family – the joy of being pregnant – the horror …

The choices after getting diagnosed with breast cancer can be overwhelming

Jackie Fox

Patient

August 3, 2011

One of the many things I didn’t know about breast cancer before I got a front-row seat was just how many choices it entails. I didn’t realize that so much of the experience wouldn’t have clear-cut, yes/no answers.

You’re confronted by your first choice before you even know you have cancer. When my mammogram revealed suspicious specks, I was presented the choice of a stereotactic or surgical biopsy. I opted for the …

Pay for performance doesn’t work in difficult patient populations

Kohar Jones, MD

Physician

August 2, 2011

Pay for performance. It’s a lovely sounding concept. If you’re a good doctor, defined by having healthy patients who meet predetermined quality indicators, then you get paid more.

What could be simpler, right?

Wrong.

Not all patients are created equal. Some are highly educated, highly literate, highly motivated to prioritize health. They have good jobs with health insurance, so critical medical care isn’t prohibitively expensive. They don’t need to choose between paying …

To help patients, physicians must rely on systems

Maria Yang, MD

Physician

August 2, 2011

I recently spoke with some people about medical systems—the actual processes involved in providing health care to patients. Story ideas involving systems sparked in my head: What about the guy who makes your sandwich at the deli? What if he had to grow the tomatoes? and cure the meats? and chop down trees to fashion the cutting boards? and weld the freezer parts together? etc.

All the ideas looked much better …

The benefit of prostate cancer screening is controversial

Caprice Cadacio, MD

Patient

August 2, 2011

A good screening test is relatively inexpensive and noninvasive. In addition, effective treatment should be available if the disease being screened for is confirmed. Lastly, detecting the disease before a patient becomes symptomatic must be more beneficial than detection after the patient experiences signs or symptoms.

The latter point is often debated in prostate cancer screening, which is done by obtaining a serum prostate specific antigen (PSA) and performing a …

Sports physicals often includes no provisions for privacy

Joel Sherman, MD

Patient

August 2, 2011

Sports physicals are universally required in the U.S. on an annual or seasonal basis for students wishing to participate in sports. All states have requirements covering public schools. The reason for the exams is to ensure that the athletes can participate safely. These exams are not intended to replace a regular physical. There are no absolute standards for what should be included in these exams. Most would agree that …

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