| KevinMD.com

September 7, 2010Sep 7, 2010

"Dave" showed up at my office last week with neck pain, worsening weakness in his arms and legs, and changes in his bladder control. All signs pointed to something gone bad in his neck. His internist had already thought of…

“Dave” showed up at my office last week with neck pain, worsening weakness in his arms and legs, and changes in his bladder control. All signs pointed to something gone bad in his neck.

His internist had already thought of this, because he’d ordered the appropriate MRIs. And they’d all been read as normal, leaving me without a cause.

Here is where the problem began. Everything about Dave’s exam and story pointed …

Physician

Cosmetic foot surgery can have serious downsides

Howard Luks, MD

September 7, 2010Sep 7, 2010

How far will some women go to fit into high heels? The menu of services at Beverly Hills Aesthetic Foot Surgery in Studio City, Calif., provides a clue. There's the trademarked "Cinderella Procedure"—a preventive bunion correction that makes feet narrower.…

How far will some women go to fit into high heels? The menu of services at Beverly Hills Aesthetic Foot Surgery in Studio City, Calif., provides a clue.

There’s the trademarked “Cinderella Procedure”—a preventive bunion correction that makes feet narrower. The clinic also offers the “Perfect 10! Aesthetic Toe Shortening” that invisibly trims toes that hang over the end of sandals or have to be crushed into tight shoes. There’s also …

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Cosmetic foot surgery can have serious downsides

Physician

Defensive medicine costs less money than physicians think

Kevin Pho, MD

September 7, 2010Sep 7, 2010

Nothing polarizes the heath care debate more than defensive medicine. A recent study from Health Affairs will only add more fuel to the fire. Here's what I wrote a couple of years ago in USA Today: "When you consider that…

Nothing polarizes the heath care debate more than defensive medicine. A recent study from Health Affairs will only add more fuel to the fire.

Here’s what I wrote a couple of years ago in USA Today: “When you consider that rampant testing is a major driver of escalating health care dollars, addressing defensive medicine should be a primary goal of cost containment.”

Is that still true?

Well, yes and no.

MedPage Today summarizes …

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Conditions and Diseases

How to use your CPAP machine when traveling

Steven Y. Park, MD

September 6, 2010Sep 6, 2010

One of the most common excuses for not wanting to use CPAP is that "I travel a lot." Even after I explain that many people travel just fine with their CPAP machines, some people are stll reluctant. With advances in…

One of the most common excuses for not wanting to use CPAP is that “I travel a lot.” Even after I explain that many people travel just fine with their CPAP machines, some people are stll reluctant.

With advances in technology and increased awareness by the lay public, government officials and medical professionals about the importance of using CPAP for obstructive sleep apnea, traveling with CPAP, although initially a challenge, can be …

Health Policy

Insurance companies affect patients with paperwork for tests

Jeoffry B. Gordon, MD, MPH

September 6, 2010Sep 6, 2010

by Jeoffry B. Gordon, MD, MPH I have always considered it to be my professional responsibility and ethical imperative to fight for my patients with the insurance companies to get approval for every test and medication that I think is…

by Jeoffry B. Gordon, MD, MPH

I have always considered it to be my professional responsibility and ethical imperative to fight for my patients with the insurance companies to get approval for every test and medication that I think is medically necessary.

My batting average is close to 100% Lately, the insurance companies have been trying to draw the noose tighter and make the task of getting …

Conditions and Diseases

Multiple assessments are needed in the face of repeated testing

Jerome Groopman, MD and Pamela Hartzband, MD

September 6, 2010Sep 6, 2010

At a recent weekly case conference at our hospital, we heard about a young woman with an elevated testosterone level. The patient was evaluated by James Hennessey, FACP, prior ACP governor from Rhode Island and currently director of clinical endocrinology…

Case study: Polycystic ovarian syndrome suspected

The patient was a 19-year-old art student at a local university. She …

Patient

Moments of internal struggle in the ER

StorytellERdoc, MD

September 5, 2010Sep 5, 2010

I walked into Room 22 to find a very interesting patient who presented to our ER with complaints of abdominal pain and associated nausea and vomiting. The patient sat on her cot with her pant legs rolled up above her…

I walked into Room 22 to find a very interesting patient who presented to our ER with complaints of abdominal pain and associated nausea and vomiting.

The patient sat on her cot with her pant legs rolled up above her knees, refusing, according to her nurse, Gwen, to put on a treatment gown. Her left leg hung in the air, her ankle crossed over the knee of her right leg. Her …

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Moments of internal struggle in the ER

Conditions and Diseases

Acute gonorrhea in Congo

Yann Meunier, MD

September 5, 2010Sep 5, 2010

Year: 1984 Setting: Ouesso, Congo Position: Timber consortium medical expert We landed in Brazzaville and took a private jet to Pointe Noire where we spent the night. The next day, the group is assigned six 4x4 Toyotas to take through…

Year: 1984

Setting: Ouesso, Congo
Position: Timber consortium medical expert

We landed in Brazzaville and took a private jet to Pointe Noire where we spent the night. The next day, the group is assigned six 4×4 Toyotas to take through the Mayombe Mountains, Brazzaville and the plateau to reach Ouesso near the Cameroon border.

The journey is eventful, particularly when I drove the pickup truck into a river from a bridge to avoid children …

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Acute gonorrhea in Congo

Physician

Wound infections and the Surgical Care Improvement Project (SCIP)

Skeptical Scalpel, MD

September 5, 2010Sep 5, 2010

The Surgical Care Improvement Project (SCIP) and its antecedent, the Surgical Infection Prevention project, have been around for several years. In short, these consist of several rules issued by various self-appointed agencies with important-sounding names and the Centers for Medicare…

The Surgical Care Improvement Project (SCIP) and its antecedent, the Surgical Infection Prevention project, have been around for several years.

In short, these consist of several rules issued by various self-appointed agencies with important-sounding names and the Centers for Medicare and Medicaid Services (CMS), a federal agency. The main rules are 1) administer the correct prophylactic antibiotic before surgery, 2) give the antibiotic within one hour before the skin is incised …

Physician

Are physicians today active in the arts?

Jan Henderson, PhD

September 4, 2010Sep 4, 2010

Physician/poets such as William Carlos Williams are an honorable tradition in the history of medicine, following in the footsteps of Keats, Schiller, and Oliver Wendell Holmes (of “Chambered Nautilus” fame). Physicians have also been writers, painters, musicians, philosophers, and –…

Yet in 1980 the historian G.S. Rousseau expressed concern that modern physicians no longer embodied the humanist tradition of their predecessors. Now that medicine …

Medications

Are opioids any less safe or effective in non cancer patients?

Kevin

September 4, 2010Sep 4, 2010

by Drew Rosielle, MD Recently, the New York Times reported of the movement in Washington State to officially do something about prescription opioid abuse, coming on the heels of course of the FDA rejecting the current risk evaluation and mitigation…

by Drew Rosielle, MD

Recently, the New York Times reported of the movement in Washington State to officially do something about prescription opioid abuse, coming on the heels of course of the FDA rejecting the current risk evaluation and mitigation strategy plan as, essentially, not going far enough.

The article basically discusses the discussion in Washington about what to do; no formal new plans have been …

Health Policy

Don Berwick is a patient centric, consumer oriented radical

Joseph Paduda

September 4, 2010Sep 4, 2010

The recess appointment of Dr. Donald Berwick as head of CMS has incited a furor among politicians outraged at what they claim are his advocacy for rationing and fondness for Britain's National Health Service. To support their claims, these politicians…

To support their claims, these politicians are using Berwick’s own words, in a way eerily reminiscent of the recent Shirley Sherrod debacle.

It started with Glenn Beck, master of the one-word quote, and then slipped over into more …

Health Policy

Health care reform provides a chance that we can do the right thing

Joe Flower

September 3, 2010Sep 3, 2010

The rapidly ramifying crisis in health care may (we can pray) end all delusions. It may at least begin to weaken them by exposing them to the light, to the sobering effects of reality. The reform act has not brought…

The rapidly ramifying crisis in health care may (we can pray) end all delusions. It may at least begin to weaken them by exposing them to the light, to the sobering effects of reality.

The reform act has not brought us to the Promised Land. By bringing us access without capacity, fierce restrictions coupled with vague language and loopholes, mandates coupled with fines low enough to become the cheap way out, …

Medications

Why a marketing study for Niaspan was published in a medical journal

Larry Husten, PhD

September 3, 2010Sep 3, 2010

The authors call it “an in-office linguistic study” and write that it “was conducted to assess physician–patient discussions of mixed dyslipidemia.” But it’s really an Abbott marketing study for Niaspan, the company’s long-acting niacin product, and the question is: why…

The study involves the recorded conversations of 12 cardiologists and 12 PCPs with 45 patients with low levels of HDL. The …

Health Technology

We need a better way to share information to care for patients

Edward Pullen, MD

September 3, 2010Sep 3, 2010

This evening I went to a meeting of many of the independent physicians in our community who came together to discuss ways we can help each other to remain viable as relatively small independent practices of medicine. Two things about…

First is how seldom I get to meet socially with my fellow physicians in the community. Now that many of us use hospitalists to take care …

Physician

The primary care specialist pay gap shouldn’t be squeezed too hard

Colin Son, MD

September 3, 2010Sep 3, 2010

The primary care-specialist pay gap is a popular target for those eager for reform. The gap is hailed independently as an example of and a cause of the lack of focus on primary care and prevention in the United States.…

There is no doubt that the United States treats primary care, preventative care and triage much differently than most of the rest of the developed world. The distribution of primary care …

Physician

Most doctors don’t like prescribing pills

Melanie Lane, MD

September 3, 2010Sep 3, 2010

I am a medical doctor. I am also called an allopath, someone who practices “Western medicine.” We allopaths like data, proof, science, randomized, double-blind, placebo-controlled trials. We want to know the “mechanism of action.” We want someone to prove that…

I am a medical doctor. I am also called an allopath, someone who practices “Western medicine.”

We allopaths like data, proof, science, randomized, double-blind, placebo-controlled trials. We want to know the “mechanism of action.” We want someone to prove that yoga or medication or some procedure actually helps your depression or blood pressure or back pain and that these treatments are safe before we prescribe them. We feel more confident about …

Medications

Mail order pharmacies have cheap prices, but also problems

WhiteCoat, MD

September 2, 2010Sep 2, 2010

After seeing Mrs. WhiteCoat argue on the phone with Medco representatives for 20 minutes about why one of her 80+ year old patients hadn’t received her medicine despite three lost faxes to Medco, I had to write this post to…

If you’re like most Americans, you want to try to save some money. One of the ways that …

Conditions and Diseases

Preparing for gastric bypass surgery by eating more

Douglas Perednia, MD

September 2, 2010Sep 2, 2010

Thinking is hard work. This is why so few people bother. At least voluntarily. So whenever it seems like the threat of brainwork looms in modern American medicine, we can thank our lucky stars for the geniuses behind healthcare reform…

This comes up as a result of a conversation that I had with a patient the other day. A pleasant, obese gentleman. He had been struggling with …

Conditions and Diseases

MKSAP: 62-year-old man is evaluated for an asymptomatic nodule

mksap

September 2, 2010Sep 2, 2010

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 62-year-old man is evaluated for an asymptomatic nodule on his shoulder that has been present for more than 1 year. Skin findings are…

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

A 62-year-old man is evaluated for an asymptomatic nodule on his shoulder that has been present for more than 1 year. Skin findings are shown.