| KevinMD.com

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 …

Physician voices

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 …

Real physician voices, twice a week

Free, and one click to unsubscribe.

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 …

Health policy

Insurance does not have incentives to lower costs or improve quality

Stephen C. Schimpff, MD

August 23, 2010Aug 23, 20106

Whether we have commercial insurance through our employer or Medicare, the incentives are poorly aligned to lower costs and improve quality. In fact, they actually encourage greater and greater expenditures. In most instances, our insurance covers everything from prevention to…

Whether we have commercial insurance through our employer or Medicare, the incentives are poorly aligned to lower costs and improve quality.

In fact, they actually encourage greater and greater expenditures. In most instances, our insurance covers everything from prevention to basic routine care to complex care of serious illness. Coverage may not be all that good for some things like preventive care and our primary care …

Conditions and diseases

Is placebo a therapy, like surgery or medication?

PalMD

August 23, 2010Aug 23, 20102

The New England Journal of Medicine recently published a troubling article on acupuncture, which was ably deconstructed by Dr. Mark Crislip. This incident has reignited a discussion of what, exactly, “placebo” is. A common argument is that placebo is like…

The New England Journal of Medicine recently published a troubling article on acupuncture, which was ably deconstructed by Dr. Mark Crislip. This incident has reignited a discussion of what, exactly, “placebo” is.

A common argument is that placebo is like any other intervention, something that can be intentionally harnessed for the benefit of patients. This is both true and overly simplistic.

First, we must review what “placebo” …

Conditions and diseases

Fetal heart rate monitoring is given too much importance

Nicholas Fogelson, MD

August 23, 2010Aug 23, 2010

Continuous fetal heart rate monitoring is at its core an almost laughable idea. We are checking a single vital sign and using that vital sign to extrapolate a host of ideas and meanings. OBs that have read strips for years…

Continuous fetal heart rate monitoring is at its core an almost laughable idea.

We are checking a single vital sign and using that vital sign to extrapolate a host of ideas and meanings. OBs that have read strips for years can make some sense of them, but would we give so much meaning to any other single vital sign? Would we do it with an adult? Of course not, but …

Physician voices

Balancing a surgeon’s beliefs with the needs of the practice

Peter J. Polack, MD

August 20, 2010Aug 20, 201011

Not long ago, we interviewed a physician for possible partnership in our practice. After showing him around our town, some of us partners had dinner with him to discuss business. He was a quite pleasant fellow, well trained, and seemed to be a good ‘fit’ for our practice. As dessert was being served, he said he needed to get one more thing off his chest: he prays aloud in the …

Health policy

Americans will need doctors but physicians are leaving primary care

Davis Liu, MD

August 20, 2010Aug 20, 201021

Everyone understands the need for a robust primary care workforce in making healthcare more affordable and accessible while keeping those in our care healthy. With the aging of America and healthcare reform, even more Americans will need primary care doctors at precisely the same time doctors are leaving the specialty in droves and medical students shun the career choice. So as a practicing primary care doctor, I’ve watched with …

Health technology

Why nurses need better EMR design to care for patients

Jared Sinclair, RN

August 19, 2010Aug 19, 201010

There’s always a lot of stink from physicians over usability problems with EHRs: too many clicks, too many contextual menus, etc. The gist of these complaints is, “Physicians aren’t data entry clerks!” The computer is getting in the way of…

Everybody has a finite amount of mental space available at any given moment. Imagine having to transcribe a conversation in real-time. If half of your mental

…

Physician voices

Family doctors cannot be obsolete, for patients’ sake

Pepi Granat, MD

August 19, 2010Aug 19, 20103

Yesterday, and every day, in my office we had one or two patients we call our "Oldie Goldies". People who have been with us since 1971 when I opened my practice, 39 years ago. People whose progress, medical and personal,…

Yesterday, and every day, in my office we had one or two patients we call our “Oldie Goldies”.

People who have been with us since 1971 when I opened my practice, 39 years ago. People whose progress, medical and personal, I’ve shared, and who share mine. We know their parents, kids and cousins either because they call us in crisis, or they’re our ongoing patients. And every …

Physician voices

Why primary care is like air traffic control

angienadia, MD

August 18, 2010Aug 18, 20109

Recently I had an interesting conversation with a few young doctors regarding the new health care reform that had been passed in the United States. One future specialist asked me why primary care doctors should receive more money than they…

And this is an important question that I think sheds light on the suboptimal state of our current health care system. It is important to specialists because …

Patient voices

“I’m a patient, not a consumer”

Jackie Fox

August 17, 2010Aug 17, 201075

I’ve been hearing and reading a lot lately about how the doctor-patient relationship is under siege. There are many reasons for this, ranging from care decisions increasingly being made by insurers to the shortage of primary care physicians, to patient empowerment. I didn’t quite understand how patient empowerment could be a threat, until I started thinking about the recent perceptual shift from patients to health-care consumers.

I agree with the consumer …

Read more…

“I’m a patient, not a consumer”

Health technology

AMA: A roadmap to qualifying for EHR incentives

American Medical Association & Steven J. Stack, MD

August 12, 2010Aug 12, 2010

A guest column by the American Medical Association, exclusive to KevinMD.com. by Steven J. Stack, MD The high cost of an electronic health record (EHR) system, the often challenging process of implementing new technology into a physician practice, and the…

A guest column by the American Medical Association, exclusive to KevinMD.com.

by Steven J. Stack, MD

The high cost of an electronic health record (EHR) system, the often challenging process of implementing new technology into a physician practice, and the difficulty in deciding which system best meets a practice’s needs have deterred many physicians from embracing EHRs.

But with the recent release of the final …