| KevinMD.com

August 31, 2010Aug 31, 201011

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 voices

Should physicians undergo random drug testing?

Jeffrey Parks, MD

August 30, 2010Aug 30, 201033

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, 20105

"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 …

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Conditions and diseases

Whooping cough and pertussis tips you need to know

Jan Gurley, MD

August 30, 2010Aug 30, 20105

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, 20107

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

Krupali Tejura, MD

August 30, 2010Aug 30, 20104

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…

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: they are in …

Health policy

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

Jaan Sidorov, MD

August 29, 2010Aug 29, 20108

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 …

Drugs and prescribing

Effect of the Massachusetts Gift Ban law on area restaurants

Daniel J. Carlat, MD

August 29, 2010Aug 29, 201013

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 …

Health technology

Computerized Physician Order Entry (CPOE) affects patient safety

Margalit Gur-Arie

August 29, 2010Aug 29, 20106

Recently, yet another alarming Computerized Physician Order Entry (CPOE) study made headlines. According to Healthcare IT News, The Leapfrog Group, a staunch advocate of CPOE, is now sounding the alarm on untested CPOE as their new study "points to jeopardy…

Recently, yet another alarming Computerized Physician Order Entry (CPOE) study made headlines.

According to Healthcare IT News, The Leapfrog Group, a staunch advocate of CPOE, is now sounding the alarm on untested CPOE as their new study “points to jeopardy to patients when using health IT.” Up until now we had inconclusive studies pointing to increased and also decreased mortality in one hospital or another following CPOE implementation, but …

Drugs and prescribing

Too many young children are medicated with powerful drugs

Claudia M. Gold, MD

August 28, 2010Aug 28, 20107

Recently while cleaning out my office in anticipation of my new job, I discovered that I had unknowingly been witness to an historic moment in child psychiatry. I found a binder from a course I had taken in June of 2001 sponsored by Harvard Medical School on Major Psychiatric Illnesses in Children and Adolescents.

Though I did not remember until I looked at my scrawled notes in the margins, on Saturday …

Physician voices

Does a stereotypical surgical personality exist?

Shawn Vuong

August 28, 2010Aug 28, 20108

Recently, our class learned and practiced how to correctly 'scrub' for surgery. During this little lab activity, we were all gowned up and washing our hands when a couple of classmates asked if I was going to be a surgeon.…

Recently, our class learned and practiced how to correctly ‘scrub’ for surgery. During this little lab activity, we were all gowned up and washing our hands when a couple of classmates asked if I was going to be a surgeon.

I said I didn’t really know yet, although I did find surgery pretty fascinating. With that, they told me that they thought I would make a good surgeon. due to the …

Conditions and diseases

Obesity is a complex problem that may not have simple solutions

Arya M. Sharma, MD

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 …

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 …