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Hidden meanings behind the chief complaint

Physician

July 21, 2011

Any primary care clinic has a schedule that lists the appointments of the day in incremental time slots. There is a column for the name of the patient, the patient’s age, and always there is a place for the reason for the visit–the “chief complaint” according to medical parlance.

A quick review of the “chief complaints” for the day gives the physician a sense of how clinic will flow. There are the seemingly “quick” concerns, …

AMA: Health insurers’ denial rates are down, but error rates are up

Peter W. Carmel, MD

Health Policy

July 21, 2011

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

Billions of dollars in administrative waste would be eliminated each year if health insurers sent a timely, accurate and specific response to each physician claim, and while this year’s AMA National Health Insurer Report Card shows promising improvements in denial rates, more work needs to be done.

The AMA’s fourth annual check-up …

A model patient in physical exam class

Kate Land, MD

Medical Education

July 21, 2011

In the New York Times article “18 Stethoscopes, 1 Heart Murmur and Many Missed Connections,” Madeline Drexler tells her story of being a model patient. Not like a model citizen cooperative and pleasant but, a person with a medically interesting finding who is asked to help teach medical students. These “patients” are examined by small hoards of inexperienced medical students who have little knowledge, little skill and varying degrees …

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A model patient in physical exam class

Why children need more unstructured play

Avril Swan, MD

Patient

July 21, 2011

The nature of an average child’s free time has changed. For the past 25 years kids have been spending decreasing amounts of time outdoors. The time that our kids do spend outdoors is frequently a part of an organized sports activity. Other activities taking up our children’s time include indoor lessons and organized events such as music, art and dance lessons. Another big indoor activity, taking up to 7.5 …

How the landscape of physician hiring is changing

Jocelyn Clarke

Physician

July 21, 2011

The majority of new job openings for physicians are now as hospital employees, not in private practice.

This is the new reality for both residents facing the employment landscape and seasoned physicians looking for better opportunities. In their 2011 Review of Physician Recruiting Incentives, Texas-based national physician search firm Merritt Hawkins confirmed that private practice scenarios are giving way to doctors being directly employed by hospitals, large health systems, and medical groups.

As …

Advice to new interns from a nurse turned medical student

Albinoblackbear

Medical Education

July 21, 2011

If you’re a new intern you are hopefully a little afraid of the new found responsibility in your life. I say “hopefully” because there is nothing more frightening in healthcare than someone who is “unconsciously incompetent.” That is, someone that doesn’t even realizethey have no idea what they are doing.

Before starting medical school I was an emergency nurse. As an RN, I had the opportunity to see many medical …

A medical student with anxiety and depression

Action Potential

Medical Education

July 21, 2011

A strange thing happens on your first day of med school. Yesterday, you may have joked with old friends about upping your Paxil dose, but starting today, you are expected to be professional. And professional is suddenly a word that prevents you from being open with your new friends, a word that hints admitting to any real struggle could be a career-ending mistake.

I want to tell you that it isn’t, but the truth is, I’m …

Clinical competence, and whether a doctor is good, or not

Richard A. Foullon, MD

Physician

July 20, 2011

Is Dr. X a good doctor?

Being a doctor, I often hear this question being asked. More often than not, the response that I hear is a rather clear cut one, “oh yes, Dr. X is a great doctor,” or “oh no, Dr. X is not a good doctor,” making me wonder what such a definite response is based upon. Is it based on actual facts? Is it based on …

The confusion surrounding comparative effectiveness research (CER)

Richard Gliklich, MD

Health Policy

July 20, 2011

We all know, broadly speaking, the mission of comparative effectiveness research (CER), now sometimes called patient-centered outcomes research. Such studies should inform clinical and health policy decisions made by physicians, payers, and regulators to help determine treatment guidelines, coverage policies, and the therapeutic value of new therapies relative to standard-of-care in real-world settings.

But dive deeper, and it’s clear there remains an uncomfortable level of confusion as to what CER …

Implications when technology catches up with medical practice

Dr. Martin Young

Physician

July 20, 2011

In 2009 I posted a blog here on videotaping of surgeries and the issues and challenges this would present. I did not say I am in favor of this as a means of policing medical practice, but for documenting surgeries the technology can be very useful. I do video as many of my surgeries as I can, and I offer to show these recordings when appropriate to my patients. …

A TV should not be allowed in a child’s bedroom

Wendy Sue Swanson, MD

Patient

July 20, 2011

I was getting ready for the day, my 2 1/2 year old was watching Sesame Street. In the show, the segments change every few minutes or so and seem to weave old-school 1970′s content (familiar to me) with newly created vignettes that have a modern feel and construction. I like it nearly as much as the boys. One of the stories this morning was about tooth fairies. An animated group …

Grocery store tips to avoid poor dietary and financial decisions

James Haddad

Patient

July 19, 2011

Taking a trip to the grocery store can be more dangerous than you’d think.

Waiting for you in each and every aisle are marketing ploys aimed at suppressing your better reasoning, the ultimate result being you making poor dietary or financial decisions – whether you know it or not (enter the 100 calorie pack, my arch nemesis, right behind diet soda). But it doesn’t have to be that way – …

Vaccines on the horizon and vaccine economics

Stephen C. Schimpff, MD

Medications

July 19, 2011

What else is on the horizon? There is progress to develop vaccines to control addiction to both nicotine and to opioids. Vaccination may be the best route to get control of the bacteria having a major impact on methicillin resistant Staphylococcus aureus (MRSA) and other highly pathogenic antibiotic resistant bacteria that have become endemic in hospital ICUs.

A vaccine for dengue is likely within the next five years. The World Health Organization …

Using technology to completely rethink the patient encounter

Gary Patterson

Health Technology

July 19, 2011

It’s time that we rethink the doctor’s office encounter. It’s inefficient for doctor and patient, and doesn’t optimize care for those that need it most. Everyone is treated the same, even though not every illness or medical need has the same urgency.

To get to see a doctor I have to make an appointment days or even weeks in advance. I have to drive over to the complex, find parking or …

Why patients should change their doctor

Steve Wilkins, MPH

Patient

July 19, 2011

Sure you are comfortable with your current doctor, after all you are still alive and kicking. Besides it has taken you years to figure out what you can safely tell your doctor and when it’s ok to speak up.

Yes, the fact that your doctor is often late and never seems to listen to you bothers you just a little. You aren’t displeased enough to stop giving your doctor high Read more…

Why patients should change their doctor

The best defense against skin cancer is prevention

Joshua Zeichner, MD

Conditions and Diseases

July 19, 2011

Skin cancer is the most common kind of cancer in the United States, affecting more than 2 million Americans every year. It is estimated that one in five Americans will develop a skin cancer in their lifetime.

There are three main types of skin cancer. Melanoma is the most serious form of skin cancer, which can be fatal if not treated early. While melanoma accounts for a very small percentage …

Domestic medical tourism saving employers money and improving outcomes

Dave Chase

Patient

July 19, 2011

Over 1.5 million Americans travel abroad each year for medical procedures.

Services typically sought by travelers include elective procedures as well as complex specialized surgeries such as cardiac surgery, dental surgery, joint replacement, and cosmetic surgeries. However, virtually every type of health care, including alternative treatments, psychiatry, convalescent care and even burial services are available.

U.S. based healthcare providers have taken notice as have self-funded employers and health plans. The …

ACOs and the modern day leper

Stewart Segal, MD

Health Policy

July 19, 2011

In the Chicago Tribune recently, Bruce Japsen has an excellent article addressing Accountable Care Organizations, quality of care issues, and the change in how physicians will be paid in the future.

Clearly, the government and insurers have decided that physicians will not be paid for services rendered. Physicians will be paid based on patient outcomes and will share in any losses insurers sustain due to poor patient outcomes. There are …

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ACOs and the modern day leper

7 tips for students applying to medical school

Jennifer Adaeze Anyaegbunam

Medical Education

July 18, 2011

Applying to medical school is really annoying, expensive, and hard for no reason. I’d like to share some wisdom I picked up along the interview trail.

Become an expert stalker. You have had plenty of practice stalking your friends on Facebook. Use those skills to find out everything you can about the school. Admissions officers tend to ask you why you would like to attend their institution. In order to …

Eric Appelt and his extraordinary commitment to medicine

Sunjay Devarajan

Physician

July 18, 2011

Dr. Eric Appelt was born to be a superstar. During his career, he has redefined what it means to be committed to medicine, and he embodies the practice of perseverance on a daily basis. I am proud to say that he is one of my role models as I continue my medical education.

As a young man growing up in Brenham, TX, Appelt was the kind of son every parent …