| KevinMD.com

September 4, 2010Sep 4, 201014

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,…

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 officially proposed as …

Health policy

Don Berwick is a patient centric, consumer oriented radical

Joseph Paduda

September 4, 2010Sep 4, 201067

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, 20105

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, …

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Drugs and prescribing

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

Larry Husten, PhD

September 3, 2010Sep 3, 20102

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, 20109

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 voices

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

Colin Son, MD

September 3, 2010Sep 3, 201075

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 voices

Most doctors don’t like prescribing pills

Melanie Lane, MD

September 3, 2010Sep 3, 201035

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 …

Drugs and prescribing

Mail order pharmacies have cheap prices, but also problems

WhiteCoat, MD

September 2, 2010Sep 2, 201020

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, 201012

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.

…

Medical education

Medical school is hard, and other medical student thoughts

Josh Herigon, MPH

September 2, 2010Sep 2, 201014

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 …

Physician voices

Hospitalist: Long hospital stays are often due to poor planning

S. Irfan Ali, MD

September 2, 2010Sep 2, 20102

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 voices

An advocate for patients might save your life in the hospital

Dennis Grace

September 2, 2010Sep 2, 201034

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 voices

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 voices

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

Chris Rangel, MD

September 1, 2010Sep 1, 20108

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 voices

Make your small private practice thrive in 4 steps

Susan Giurleo, PhD

September 1, 2010Sep 1, 20108

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, 201014

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, 201031

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 …

Drugs and prescribing

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 …

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Empiric antibiotics in the ICU

Conditions and diseases

What is Glenn Beck’s macular dystrophy?

Michele R. Berman, MD

August 31, 2010Aug 31, 20104

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 …

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What is Glenn Beck’s macular dystrophy?