| KevinMD.com

August 28, 2010Aug 28, 201015

A single mom juggling two jobs and four kids may be right in thinking her life is complicated - but it is certainly not complex - at least not in the scientific sense of the word. In medicine we also…

A single mom juggling two jobs and four kids may be right in thinking her life is complicated – but it is certainly not complex – at least not in the scientific sense of the word.

In medicine we also differentiate between procedures that are complicated (difficult, requiring skill) and complex (no clear solutions, unknown and incalculable risks, unpredictable outcome).

The best description of complexity was the “simplified” one I found in …

Patient voices

Contract pregnancy ethics and moral issues

Kevin

August 27, 2010Aug 27, 2010

An excerpt from Why Some Things Should Not Be for Sale: The Moral Limits of Markets. by Debra Satz Sometimes what critics of pregnancy contracts have in mind is not the effect of such contracts on the relationship between reproductive…

An excerpt from Why Some Things Should Not Be for Sale: The Moral Limits of Markets.

by Debra Satz

Sometimes what critics of pregnancy contracts have in mind is not the effect of such contracts on the relationship between reproductive labor and a woman’s sense of self, but their effect on her views (and ours) of the mother-fetus and mother-child bond.

On this

…

Conditions and diseases

Treating vitamin D deficiency requires caution

Kenneth Lin, MD

August 27, 2010Aug 27, 201012

Vitamin D seems to be all the rage in medicine these days. A family physician colleague commented to me recently that the laboratory test for vitamin D deficiency is becoming the most frequently ordered test in his practice. This clinical…

This clinical bandwagon is likely a response to data from multiple recent studies that found low vitamin D levels in the majority of children and adults of all ages. While vitamin D has …

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Drugs and prescribing

Statins for heart disease and stroke, and debunking statin myths

Eric Van De Graaff, MD

August 27, 2010Aug 27, 201022

There is no class of medications in the history of the world that has been better studied that statins. This class of drugs is more properly termed HMG CoA reductase (3-hydroxy-3-methyl-glutaryl co-enzyme A reductase) inhibitors, but with a name like…

There is no class of medications in the history of the world that has been better studied that statins.

This class of drugs is more properly termed HMG CoA reductase (3-hydroxy-3-methyl-glutaryl co-enzyme A reductase) inhibitors, but with a name like that a terser nickname is almost mandatory (the name statin comes from the suffix of the members of this class: lovastatin, pravastatin, etc.).

Simply …

Conditions and diseases

For women with endometriosis, motherhood is elusive

MedPage Today

August 27, 2010Aug 27, 2010

by Lone Hummelshoj Earlier this year, we finished a month dedicated to women and mothers. In the U.S., we celebrated "National Women's Health Week" and before it Mother's Day. One study suggested Americans would spend a total of $14.6 billion…

by Lone Hummelshoj

Earlier this year, we finished a month dedicated to women and mothers. In the U.S., we celebrated “National Women’s Health Week” and before it Mother’s Day. One study suggested Americans would spend a total of $14.6 billion in May alone to honor our mothers. And we should honor our mothers!

However, for millions of women with endometriosis, motherhood is elusive. In fact, an estimated …

Patient voices

Assumptions in medicine can inhibit care

Patrick W. Hisel, MD

August 27, 2010Aug 27, 201020

Assumptions are ubiquitous. Neither patients nor physicians are exempt. Sometimes they are justified, other times entirely misguided. Webster’s defines "assume" as "to take as granted or true." The cliché’s have probably always existed: Doctors are greedy and paid too much,…

Assumptions are ubiquitous. Neither patients nor physicians are exempt. Sometimes they are justified, other times entirely misguided.

Webster’s defines “assume” as “to take as granted or true.” The cliché’s have probably always existed: Doctors are greedy and paid too much, and are uncaring. Some patients believe doctors do care and that their doctor actually likes them. That’s an assumption too. Some assumptions are newer. Patients assume doctors will substitute their prescription …

Drugs and prescribing

How drug companies sell psychiatrists on their drugs

Daniel J. Carlat, MD

August 26, 2010Aug 26, 201020

An excerpt from Unhinged: The trouble with psychiatry- a doctor’s revelations about a profession in crisis. Copyright © 2010 Daniel Carlat. Excerpted with permission by Free Press, a Division of Simon & Schuster, Inc. In 1993, the FDA approved Neurontin…

An excerpt from Unhinged: The trouble with psychiatry- a doctor’s revelations about a profession in crisis. Copyright © 2010 Daniel Carlat. Excerpted with permission by Free Press, a Division of Simon & Schuster, Inc.

In 1993, the FDA approved Neurontin for the treatment of epilepsy. This should have been a cause for celebration at Warner-Lambert, the drug company that introduced it, but the celebration was muted. The FDA …

Health policy

Checks and balances in health reform

Richard Reece, MD

August 26, 2010Aug 26, 20104

What follows are ten thoughts on checks and balances in health reform. I am writing from Oak Ridge, Tennessee, where I am attending a high school class reunion. My son Spencer, a nationally known poet and a candidate for the…

What follows are ten thoughts on checks and balances in health reform.

I am writing from Oak Ridge, Tennessee, where I am attending a high school class reunion. My son Spencer, a nationally known poet and a candidate for the Episcopal priesthood, is with me. He is checking on my past, and I am trying to provide balance so he can understand his father’s legacy.

There …

Read more…

Checks and balances in health reform

Health technology

Converting from paper chart to an EMR: Keep daily use in mind

Rosemarie Nelson

August 26, 2010Aug 26, 20102

Maybe you've been assuming that when it comes time to go live on your EMR, you'll simply scan each patient's old paper chart into the electronic system. Maybe you haven't given it much thought because you're focusing on the change…

Maybe you’ve been assuming that when it comes time to go live on your EMR, you’ll simply scan each patient’s old paper chart into the electronic system.

Maybe you haven’t given it much thought because you’re focusing on the change in your work flow when you start to use the EMR to document patient encounters.

Well, it’s time to pay attention to the transfer, because the conversion of the paper chart can …

Health policy

The medical system Donald Berwick prefers in the United States

James Gaulte, MD

August 26, 2010Aug 26, 201038

Apart from some apparently radically contradictory expressed views on patient "centeredness" and patients being in control, the newly appointed head of CMS, Dr. Donald Berwick, has made it clear what sort of medical system he would have for the United…

Apart from some apparently radically contradictory expressed views on patient “centeredness” and patients being in control, the newly appointed head of CMS, Dr. Donald Berwick, has made it clear what sort of medical system he would have for the United States.

What he wants is well explained in this commentary from National Review Online as is the authors’ reasoning of why that sort of …

Medical education

Fix the July Effect for incoming interns and residents

a medical resident, MD

August 25, 2010Aug 25, 20105

According to an article published in the Journal of General Internal Medicine, counties with teaching medical hospitals experienced a 10% increase in fatal medication errors as compared to counties without teaching medical hospitals. First, what is the July Effect? It…

According to an article published in the Journal of General Internal Medicine, counties with teaching medical hospitals experienced a 10% increase in fatal medication errors as compared to counties without teaching medical hospitals.

First, what is the July Effect? It represents an entire transition in the hospital, during which medical students become interns, interns become senior residents, and second or third-year residents become chief residents. …

Conditions and diseases

Tamoxifen for breast cancer prevention is not routinely used

Shantanu Nundy, MD

August 25, 2010Aug 25, 20103

Cancer prevention is built around screening. In screening, the hope is to catch cancer at an earlier stage than it would be found otherwise and increase options for treatment and chances of cure. In some cases, screening prevents cancer — for example, when a precancerous polyp is removed from the colon during colonoscopy — but generally it is aimed at early detection.

What if instead we could prevent cancer from developing …

Burnout in doctors and stressed physicians hurt patients

Kevin Pho, MD

August 25, 2010Aug 25, 20104

The following op-ed was published on July 18th, 2010 in USA Today. A new patient recently said he was referred to me after his last doctor had left medicine. His old doctor always looked unhappy and burned out, he noted.…

The following op-ed was published on July 18th, 2010 in USA Today.

A new patient recently said he was referred to me after his last doctor had left medicine. His old doctor always looked unhappy and burned out, he noted.

Burnout affects more than half of doctors, according to researchers at the University of Rochester School of Medicine. Beyond mere job dissatisfaction, these doctors are emotionally exhausted to the …

Drugs and prescribing

Doctors are often preferred to market a drug to other physicians

Carl Elliott, MD, PhD

August 25, 2010Aug 25, 20107

An excerpt from White Coat, Black Hat. by Carl Elliott A few years ago a small group of first-year medical students at the University of Minnesota spoke to me about a lecture on erectile dysfunction that had just been given…

An excerpt from White Coat, Black Hat.

by Carl Elliott

A few years ago a small group of first-year medical students at the University of Minnesota spoke to me about a lecture on erectile dysfunction that had just been given by a member of the urology department.

The doctor’s PowerPoint slides had a large, watermarked logo in the corner. At one point during the lecture …

Physician voices

Implementing patient centered medical home pilot projects

Robert Graham, MD

August 25, 2010Aug 25, 20106

by Robert Graham, MD As the nation works to reinvigorate primary care, a lot is riding on the medical home. Some see it as an answer to a fragmented health care system that is not responsive to patients’ needs for…

by Robert Graham, MD

As the nation works to reinvigorate primary care, a lot is riding on the medical home.

Some see it as an answer to a fragmented health care system that is not responsive to patients’ needs for coordinated, comprehensive care. Others have invested in it as a vehicle to improve both the quality of care and control costs. While we work to address …

Patient voices

Applying the minimally invasive concept to patient management

Ralph Gordon, MD

August 24, 2010Aug 24, 20105

Every time you subject the patient to an invasive procedure you take the risk of causing complication. I have done hundreds if not thousands of procedures which makes me even more aware of the risk I take every time I stick a needle or cut into the patient. We can do everything possible to enhance the safety, yet we cannot completely eradicate the risk of adverse events.

With the recent progress …

Physician voices

Positive reinforcement can motivate preventive behaviors

Alex Lickerman, MD

August 24, 2010Aug 24, 20104

Eating right, exercising, avoiding the sun or using sunscreen, moderating alcohol consumption, abstaining from tobacco use, getting mammograms, Pap smears, colonoscopies—almost every measure we’re asked to take to safeguard our future health is difficult. It’s a strange paradox that we…

Wouldn’t it be nice if the most pleasurable things …

Patient voices

Why OpenNotes and access to the medical chart is important

Wendy S. Harpham, MD

August 24, 2010Aug 24, 20103

Have you ever read what your physicians and nurses have written in your medical chart? If not, would you want to? The OpenNotes project is a recently launched observational research study that involves 100 primary care doctors and about 25,000…

Have you ever read what your physicians and nurses have written in your medical chart? If not, would you want to?

The OpenNotes project is a recently launched observational research study that involves 100 primary care doctors and about 25,000 patients. Lead author Dr. Tom Delbacoa, a primary care physician at the Beth Israel Deaconess Medical Center, poses the research question succinctly: “After a year, will the patients and doctors still want to continue sharing notes?”

In the study, …

Patient voices

Adults living with dementia and disability need research funding

Alex Smith, MD

August 23, 2010Aug 23, 2010

I heard a prominent speaker talk about studies at the National Institute of Aging. The speaker described several new large and well funded trials aimed at preventing illnesses associated with aging, such as dementia and disability. These studies are terrific,…

I was disappointed, however, that little was said about funding for studies of older adults already living with dementia and disability. Research in prevention will not help these patients. I asked: where is the …

Patient voices

How patients can stop doctors from blaming them for their health

WarmSocks

August 23, 2010Aug 23, 201014

If doctors need to listen to patients to figure out what’s going on, patients need to tell doctors what’s going on. Why is that so hard sometimes? It’s hard to speak up when you feel rushed, but have doctors ever…

Sometimes doctors blame the patient

Years ago I got a terrible abdominal pain. I could only explain that it felt like …