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Social prejudices may limit the accuracy of patient information

Jerome Groopman, MD and Pamela Hartzband, MD

Patient

December 9, 2010

Raghav Govindarajan, ACP Associate Member, a neurology resident at the Cleveland Clinic Florida, told us about a case he saw in India that has important lessons for clinicians everywhere. The patient was a 65-year-old man who presented with chronic symptoms of burning discomfort and weakness in his left leg.

His symptoms had started about seven years prior and he had been told that he had “neuritis.” He reported that he had …

AMA helps physicians care for patients

Cecil B. Wilson, MD

Patient

December 9, 2010

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

As the nation’s largest physician organization, the American Medical Association (AMA) is uniquely positioned to help physicians thrive in medical practice throughout the stages of their careers.

Because the AMA is led by physicians, we understand the many demands and rigors physicians face as they work to provide high-quality patient care, and we are proud to support physicians in their …

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AMA helps physicians care for patients

Health IT and doctors need to bridge the cultural gap

Mike Koriwchak, MD

Health Technology

December 9, 2010

The recent financial incentives offered by the government (HITECH) for EMR implementation are somewhat helpful but are also misleading.

Most fail to recognize that the biggest obstacles to EMR implementation are not financial, but are cultural. EMR adoption will require cooperation between two disparate cultures: the Health IT (HIT) culture and the medical culture. One needs only to read a few of the EMR debates in any health care blog to …

Evaluating a new drug is difficult for the pharmaceutical community

Hans Duvefelt, MD

Medications

December 9, 2010

New medicines are like new fashions in clothing. They are introduced with great fanfare. Most turn out to seem fairly ordinary after a few years. Some are quickly forgotten or discarded and make us say: “What was I thinking?”

Evaluating a new drug is difficult, for the pharmaceutical and scientific communities as well as for us clinicians. It often takes years of general use before a drug can really prove its …

Stercoral perforation as a deadly cause of colon rupture

Sid Schwab, MD

Physician

December 9, 2010

I got the call from the ER because I was the “no-doc” surgeon, meaning I was the guy to call when a patient showed up needing a surgeon, and who had no primary care doc to direct the referral. Usually it meant trouble. A drunk who smashed his car and himself, possibly others. Stab-wound, gun-shot. People who don’t have their own doctors include more than those down on their luck; …

Intuitive and algorithmic decision making and The Simpsons

Tim Richardson, PT

Physician

December 9, 2010

One of the most popular Simpsons episodes ever – MoneyBART – succinctly describes the struggle between intuitive and algorithmic decision making in physical therapy.

This struggle, catapulted to prominence in 2002 with the publication of Flynn’s manipulation rule, is not unique to physical therapists.

Physicians, too, resist the influence of decision rules and adhere poorly to clinical practice guidelines.

Physical therapists share some commonalities with physicians in that we overestimate our …

The internet and online health information trends

Susannah Fox

Patient

December 8, 2010

Ten years ago, I wrote the Pew Internet Project’s first report on the impact of the internet on health care, calling it “The Online Health Care Revolution.”

Back then, the idea that people were searching online for health information was revolutionary. All of a sudden, regular people had access to medical information that had always been locked up and out of reach.

Ten years later, I am ready to declare the access …

Tricks for helping patients save money on prescriptions

Leslie Ramirez, MD

Medications

December 8, 2010

As a primary care doctor, I have figured out many tricks for helping patients save money on prescriptions. Some of them I am sure you have never heard of, and others, well — you might have, but they bear repeating.

All of the prices quoted here are from Costco, unless otherwise specified.

1. Price compare between pharmacies. Can’t stress enough the potential differences in medicine prices between pharmacies. Generic medicine prices vary more than branded/trademarked …

Implementing site changes with Plan-Do-Check-Act

Donald Tex Bryant

Physician

December 8, 2010

Many healthcare organizations are contemplating making dramatic changes in the way they do business and treat patients. Some of these are driven by the recently passed Accountable Care Act and the Tarp Bill. They are planning on adopting electronic medical records, becoming Accountable Care Organizations or becoming Patient-Centered Medical homes.

Unfortunately, like many businesses, they will undergo a lot of stress and loss of resources in time and money in making …

A postmortem on the patient safety movement

Robert Donnell, MD

Patient

December 8, 2010

Are patients better off than they were ten years ago?

Just over a decade ago the Institute of Medicine (IOM) released its celebrated report on patient safety, To Err is Human. Many credit that report, which was released with great fanfare, with launching the patient safety movement. So it’s appropriate to assess the movement’s impact eleven years later. How did we do?

On November 25 the New England Journal of Medicine published …

Percy Harvin and how sleep apnea affected his migraine headaches

Diana E. Lee

Conditions and Diseases

December 7, 2010

by Diana E. Lee

It sounds like NFL Wide Receiver Percy Harvin (Minnesota Vikings) is one of the luckier chronic migraine patients out there.

He was actually able to identify a specific reason for his drastically increased number of migraine attacks (sleep apnea) and implement a treatment that seems to be helping (CPAP). He is performing solidly and confidently and taking contact without any issues.

I know a …

Commercially funded CME programs and whether bias can be removed

Thomas Sullivan

Medical Education

December 7, 2010

The growing criticism of industry funded continuing medical education (CME) over the past several years has had a number of significant effects on the CME community. As the Accreditation Council of Continuing Medical Education (ACCME) annual report showed, from 2007 to the present, commercial support of CME dropped 29.3%, and the number of directly sponsored CME activities decreased over 7% between 2008 and 2009.

CME funding is extremely important …

William Osler’s humor, and finding fun in medicine

Dr. Chris Nickson

Physician

December 7, 2010

In 1905 William Osler gave his farewell address as he prepared to leave Johns Hopkins for Oxford and England. After speaking to the assembled medical students about the tragic side of medicine he said:

The comedy, too, of life will be spread before you, and nobody laughs more often than the doctor at the pranks Puck plays upon the Titanias and the Bottoms among his patients. The humorous side is really …

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William Osler’s humor, and finding fun in medicine

Open dialogue on medical malpractice and patient safety

Kevin

Physician

December 7, 2010

A response to my recent post, The malpractice system doesn’t improve patient safety.

by Brian Nash

In his blog, Dr. Kevin acknowledges that in the “world of medical error, truth is often clouded in secrecy.” He then points out that “… taking the bold step of publicly describing your mistake is a brave one. Some would say it’s long overdue.”

Well so far, Dr. K, we’re on …

Playing hurt and when to return to football after a concussion

Gregory Bratton, MD

Conditions and Diseases

December 7, 2010

The September issue of Journal Watch General Medicine included an article from the American Academy of Pediatrics about new criteria for diagnosis and management of concussions in children and adolescents.

Shortly after this issue was published, a segment aired on ESPN regarding a confrontation between the head football coach at Texas Christian University and its team physician over holding a player out of the game due to a concussion.

As a sports …

Early detection and improving cancer cure rates

Richard Leff, MD

Conditions and Diseases

December 6, 2010

Reading the newspapers and watching the news lately would lead you to believe that screening for cancer is largely a waste of time.

Yet, in the same week that the NEJM published Norwegian data showing a remarkably small survival benefit of 2% associated with screening mammography, HealthDay reported a decrease in cancer incidence of almost 1% per year from 1999 to 2006 and a decrease in cancer deaths …

Temperament of perfectionism in anorexia nervosa

William R. Yates, MD

Conditions and Diseases

December 6, 2010

Temperament is generally defined as innate early emotional and behavioral characteristics that precede puberty and adult development. Felt to have significant genetic components, temperament is also potentially influenced by environmental factors.

There are a variety of temperament domains that have received significant attention in childhood, adolescent and adult populations.

Some of the most commonly studied domains include:

neuroticism
harm avoidance
novelty seeking
reward dependence
perfectionism (subdomains have included: concern about mistakes, personal standards, doubts about actions, organization

The …

$11,000 hospital bill from the emergency department

Kevin

Patient

December 6, 2010

by Steve Sanders, DO

“What am I going to do now Doc?” asked Mike, a down on his luck, 29 year–old recently unemployed truck driver, as he handed me his hospital bill.

Mike was seen at our local emergency department on a Friday evening with complaints of indigestion. Earlier that day he and his wife Susan celebrated their second anniversary by splitting a store bought pepperoni pizza. …

Choose your primary care physician with particular care

Colleen Kelly Mellor

Physician

December 6, 2010

I told a friend what I did recently to get in to see a dermatologist and she was shocked.

“You wrote a letter asking her to take you as patient?” “Wow!” “Yes,” I admitted. “I’d called her office for an appointment; she wasn’t taking new patients; I needed to resort to an over-the-top approach.”

You see, I’d researched her (ok, I Googled her) and after reading her background, schooling, and patient reviews, …

Medicare rates will be influenced by comparative effectiveness

Bob Doherty

Health Policy

December 5, 2010

From its inception, Medicare has been agnostic about the effectiveness of different treatments when it sets payment rates. Once a treatment is found to be “reasonable and necessary,” Medicare establishes a payment rate that takes into account complexity and other “inputs” that go into delivering the service. But it is prohibited by law from varying payments based on how well an intervention works.

This would change under a “dynamic pricing” approach …

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