| KevinMD.com

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.

MKSAP image © 2010, American College of Physicians, Medical ...

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Medical school is hard, and other medical student thoughts

Josh Herigon, MPH

September 2, 2010Sep 2, 2010

Some reflections on my first semester of medical school. 1. Medical school is hard. Yes, it’s true -- medical school is as hard as people who have been through it make it out to be. I was skeptical when I…

Some reflections on my first semester of medical school.

1. Medical school is hard. Yes, it’s true — medical school is as hard as people who have been through it make it out to be.

I was skeptical when I started mostly because I felt I had challenged myself while doing my undergrad degree and in graduate school. I had taken heavy loads …

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Physician

Hospitalist: Long hospital stays are often due to poor planning

S. Irfan Ali, MD

September 2, 2010Sep 2, 2010

Being a hospitalist, I often see patients sitting in the hospital for days at length for no reason other than poor planning. Sometimes I feel that physicians who are involved in patient care are oblivious of each other. Everyone is…

Being a hospitalist, I often see patients sitting in the hospital for days at length for no reason other than poor planning.

Sometimes I feel that physicians who are involved in patient care are oblivious of each other. Everyone is in their own domain rather than working as a team. An increased length of stay in the hospital not only increases the cost of health care but also adds to the …

Physician

An advocate for patients might save your life in the hospital

Dennis Grace

September 2, 2010Sep 2, 2010

by Dennis Grace So, you have to go to the hospital. You’ve had an accident and the doctor wants to keep an eye on you for a few days. Maybe you need major surgery. Whatever the reason for the stay,…

by Dennis Grace

So, you have to go to the hospital. You’ve had an accident and the doctor wants to keep an eye on you for a few days. Maybe you need major surgery. Whatever the reason for the stay, a lot a people think you should have an advocate with you.

Why? In my life, I’ve had lots of hospital stays. Why is this suddenly a big …

Physician

Leading a hospital team of foreign trained doctors

John Schumann, MD

September 1, 2010Sep 1, 2010

Recently, I had the opportunity to decamp from the friendly confines of GlassHospital and trek a few miles to the north. GlassHospital has brokered a teaching and patient-sharing agreement with a nearby religiously-affiliated community hospital I’ll call Our Lady of…

Recently, I had the opportunity to decamp from the friendly confines of GlassHospital and trek a few miles to the north.

GlassHospital has brokered a teaching and patient-sharing agreement with a nearby religiously-affiliated community hospital I’ll call Our Lady of Blessed Proximity.

Our Lady has a residency training program, just like ours, with the major difference being that nearly all of the doctors come from foreign lands.

Something you should know about medicine in America …

Physician

Why pay for performance does not work and may impair patient care

Chris Rangel, MD

September 1, 2010Sep 1, 2010

In response to a recent article on the topic of economic motivation theory, Michael Kirsch sent me information about a very interesting study (May 2010 issue of the British Medical Journal) done to evaluate the effects of monetary incentives on…

In response to a recent article on the topic of economic motivation theory, Michael Kirsch sent me information about a very interesting study (May 2010 issue of the British Medical Journal) done to evaluate the effects of monetary incentives on clinic, physician, and staff work performance.

From 1999 to 2007, 35 medical facilities of Kaiser Permanente in NorthernCalifornia, were given financial incentives for ensuring that their patients got regular screening for …

Physician

Make your small private practice thrive in 4 steps

Susan Giurleo, PhD

September 1, 2010Sep 1, 2010

Health care is changing at lighting speed. If you don’t know this, or worse, don’t accept it you’re doomed. No. Really. It’s change or close shop. Whether you like it or not, health care reform is going to change the…

Many physicians are choosing to work for large group practices to buffer themselves from directly dealing with change. Mental health providers could do the same, …

Conditions and Diseases

The TPA time limit for acute stroke causes mass chaos in the ER

ER Stories, MD

September 1, 2010Sep 1, 2010

I hate acute strokes. There are several reasons for it. Most of them are logistical. First, everyone gets into a tizzy because of the 3 (or 4.5) hour time limit after the onset of symptoms that which TPA can be given and hopefully improve the patient’s outcome. Unfortunately, this time limit (and the data for TPA’s efficacy is only OK at best) causes mass chaos and annoyance.

First, one has to …

Health Policy

Health care reform controversy in both Europe and the United States

Anesthesioboist T., MD

August 31, 2010Aug 31, 2010

On my way onto the plane for my recent flight home from France I picked up a copy of Le Figaro thinking I might enjoy the article about actress Sophie Marceau, who was on the cover of everything while we…

On my way onto the plane for my recent flight home from France I picked up a copy of Le Figaro thinking I might enjoy the article about actress Sophie Marceau, who was on the cover of everything while we were in France in celebration of her turning 40.

I did enjoy catching up on Marceau – I still remembering watching La Boum in my high school French class – but …

Medications

Empiric antibiotics in the ICU

Paul Sax, MD

August 31, 2010Aug 31, 2010

Last year, I commented on the ironic sameness of ICU infectious diseases — that incredibly sick, complex patients entered the ICU with vastly different problems, then over time, seemed to converge, presenting similar kinds of clinical issues and management challenges…

Or, as a visiting medical student said to me, “My ICU attending said that every patient in the ICU should be on vancomycin and Zosyn.”

Which brings up …

Read more…

Empiric antibiotics in the ICU

Conditions and Diseases

What is Glenn Beck’s macular dystrophy?

Michele R. Berman, MD

August 31, 2010Aug 31, 2010

During a recent speech from his American Revival tour, Glenn Beck, 46, announced that he has an eye condition called macular dystrophy that could cause him to go blind. Speaking in front of a large group at his “Revival America”…

During a recent speech from his American Revival tour, Glenn Beck, 46, announced that he has an eye condition called macular dystrophy that could cause him to go blind. Speaking in front of a large group at his “Revival America” tour, the Fox News pundit told the crowd:

“A couple of weeks ago I went to the doctor because of my eyes, I can’t focus my eyes…he did all kinds of …

Read more…

What is Glenn Beck’s macular dystrophy?

Physician

How JetBlue can improve your medical practice

Brandon Betancourt

August 31, 2010Aug 31, 2010

I got a chance to fly JetBlue for the first time recently. Since I had heard so many good things about the airline, I was looking forward to experiencing the JetBlue, well, experience. I took four flights in total with…

I got a chance to fly JetBlue for the first time recently. Since I had heard so many good things about the airline, I was looking forward to experiencing the JetBlue, well, experience.

I took four flights in total with them. While outbound, they lost my bag. While inbound to Chicago, my last leg was delayed about 2 hours. I then I had to wait another 80 minutes for my bag …

Physician

Should physicians undergo random drug testing?

Jeffrey Parks, MD

August 30, 2010Aug 30, 2010

Lucian Leape MD, a public health professor at Harvard, wants to subject doctors in America to strict random and periodic drug testing to help identify those physicians who are impaired. All in the name of patient safety, of course: "I'm…

“I’m very much in favor of random testing,” Dr. Leape says. “We have a responsibility to identify problem doctors and bring them into treatment.” And to protect patients in the process.

Ok, I …

Conditions and Diseases

Watchful waiting pays off for a torn ACL

Merrill Goozner

August 30, 2010Aug 30, 2010

"Why golf," my friends often ask. They, like too many Americans, assume it is a sport for the country club set, and have a hard time fathoming why someone like me -- liberal, somewhat intellectual, decidedly anti-elitist -- would passionately…

“Why golf,” my friends often ask. They, like too many Americans, assume it is a sport for the country club set, and have a hard time fathoming why someone like me — liberal, somewhat intellectual, decidedly anti-elitist — would passionately embrace the game.

My answer is always brief and direct. When I was 35, I tore my right knee’s anterior cruciate ligament during one of my twice-weekly pick-up basketball games in …

Conditions and Diseases

Whooping cough and pertussis tips you need to know

Jan Gurley, MD

August 30, 2010Aug 30, 2010

As a whooping cough epidemic hits California, you may be asking yourself, “hey, weren’t we all vaccinated for that?” Even as the headlines imply a Victorian-level outbreak of hacking and coughing, perhaps you’re looking around and wondering where, exactly, this…

Here are some fun, weird, and sometimes worrying tidbits to know about whooping cough. Pass …

Health Policy

Southern states may block the government from delivering health care

Allen Perkins, MD

August 30, 2010Aug 30, 2010

I have lived on the Gulf Coast for all but 5 of my 50 years. I grew up in Baton Rouge, Louisiana and now live in Mobile Alabama. I was educated in the public schools during the height of the…

I have lived on the Gulf Coast for all but 5 of my 50 years. I grew up in Baton Rouge, Louisiana and now live in Mobile Alabama.

I was educated in the public schools during the height of the desegregation battles and my experiences were colored by those battles in a number of ways. I ran track in high school and was in the racial minority on that team (as …

Conditions and Diseases

Root beer bonds a chemotherapy patient with his oncologist

Kevin

August 30, 2010Aug 30, 2010

by Krupali Tejura, MD I am treating a patient for head and neck cancer -- which can be one of the most harrowing therapies. To receive chemotherapy and radiation concurrently can be pretty debilitating. Swallowing foods can be next to…

by Krupali Tejura, MD

I am treating a patient for head and neck cancer — which can be one of the most harrowing therapies.

To receive chemotherapy and radiation concurrently can be pretty debilitating. Swallowing foods can be next to impossible, and the taste changes and saliva changes are brutal. It’s one of the harshest areas to treat … and I warn the patients beforehand: …

Health Policy

Why the sustainable growth rate formula (SGR) is here to stay

Jaan Sidorov, MD

August 29, 2010Aug 29, 2010

According to the Washington Post, it is highly unlikely that Congress will undo the planned "sustainable growth rate formula" (SGR) mandated Medicare fee schedule cuts. While there's an outside chance of a fix, the American Medical Association, as well as…

According to the Washington Post, it is highly unlikely that Congress will undo the planned “sustainable growth rate formula” (SGR) mandated Medicare fee schedule cuts. While there’s an outside chance of a fix, the American Medical Association, as well as other organized physician groups, can’t be happy about the constant threat of the 20% payment reductions.

Recall that the SGR was signed into law back in 1998. It was designed to …

Medications

Effect of the Massachusetts Gift Ban law on area restaurants

Daniel J. Carlat, MD

August 29, 2010Aug 29, 2010

I recently debated Steve DiFillippo, owner of Davio's and Avila's restaurants, on the WGBH program Greater Boston, hosted by Emily Rooney. The topic? The effect of the Massachusetts Gift Ban law on area restaurants. On one level, it was a…

I recently debated Steve DiFillippo, owner of Davio’s and Avila’s restaurants, on the WGBH program Greater Boston, hosted by Emily Rooney. The topic? The effect of the Massachusetts Gift Ban law on area restaurants.

On one level, it was a friendly debate on the economic impact of the law on those restaurants that depend on drug company sponsored dinners for a chunk of their income.

But on another level, this is a …