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Is personalized medicine mostly marketing and hype?

Conditions and Diseases

January 29, 2019

“Personalized” medicine sounds appealing. Rather than just guessing at what medication to try, a genetic test can figure out, in advance, which medications will be effective and which medications are more likely to make you sicker.

Except it doesn’t work. It’s mostly marketing and hype.

The FDA has officially warned consumers and physicians that genetic tests sold to predict patient responses to medications shouldn’t be used. They’re not FDA approved, and in most cases, …

Doctors: Never forget the importance of eye contact

Suneel Dhand, MD

Patient

January 29, 2019

Eye contact is one of the most basic mammalian traits that signals an interaction. Anybody who has a dog or cat at home sees on a daily basis how much animals value eye contact (and with dogs, it signals you’ve lost the battle!). In the case of health care, during frequent emotional exchanges between two human beings, it naturally follows then that simple eye contact has to be at the …

Geriatric medicine is a calling

Nicole Clark, MD

Physician

January 29, 2019

Often people (mostly residents and medical students) ask why on earth did I choose to do a geriatric fellowship? My response is because it is the medicine of the future. While we are all aging, the fastest growing age groups are those born between 1946 to 1964. The Baby Boomers. The Silver Tsunami. The Grey Hoard. Call it what you will, but estimates are that by 2060, 98 million (24 …

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Geriatric medicine is a calling

Sometimes, the biggest challenge to eliminate health disparities is geography

Hans Duvefelt, MD

Physician

January 29, 2019

Driving north in a snowstorm Tuesday of Thanksgiving week I certainly took my time. I left after our Suboxone clinic wrap-up conference, around 7:30 p.m., and arrived at my unplowed driveway in Caribou about 1 a.m.

On the way up, I saw two ambulances, one from Caribou and one from Presque Isle, on their way back home from Bangor. I’ve got a large SUV with all-wheel drive and studded Finnish snow …

When a child dies, this pediatrician grieves

Lauren Gambill, MD

Physician

January 28, 2019

I found his obituary today. Kids do not always have obituaries. I am not sure why. Perhaps it is because children are not supposed to die and no one quite knows what to say. Still, I always look for them.

He loved the color green.

His death was so unexpected. I have never seen a child become so sick so fast. I was the pediatrician covering the hospital ward that night. He …

What advocacy means to this physician

Deborah L. Benzil, MD

Physician

January 28, 2019

Patients first

Patient care brings me enormous satisfaction. Nearly 40 years ago, when I chose medicine as a career, this was a driving force. Within moments of patients coming into my office, they often share aspects of their life history known only to their closest friends and family. Bestowing this trust is a huge honor that I cherish beyond words. I have the opportunity to help them at a time of …

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What advocacy means to this physician

Before you vent about your doctor on social media, read this

Wendi Kitsteiner

Patient

January 28, 2019

John and I met as young children and were high-school sweethearts. We married and put him through college and had four children during the process. He joined the Air Force to pay for medical school, and we spent four years overseas to help pay off the costs of his education.

We recently counted how many years of his life were spent being educated. If you go back to the beginning and …

Are clinically integrated networks a cure for checkbox medicine?

Jaan Sidorov, MD

Health Policy

January 28, 2019

Years ago, I was contacted by a health plan about an elderly nursing home patient who had not been screened for osteoporosis. While brittle bones are a big problem in skilled nursing settings, the real problem for this health plan was its low HEDIS score for “osteoporosis testing and management.” Because of the underlying financial stakes and the marketing advantages that …

The problem with abbreviations in the medical record

Fred N. Pelzman, MD

Physician

January 28, 2019

Several patients seen in our practice recently were significantly and dramatically transformed by the electronic health record (EHR). And not in a good way.

Take, for instance, the patient whose outside chart was reviewed when she showed up in our office for a follow-up appointment after an emergency department visit.

The notes from the emergency department providers, including a scribe and the …

Why doctors-in-training need better nutritional education

Abeer Arain, MD, MPH

Medical Education

January 27, 2019

Obesity is a global epidemic, and its prevalence is increasing in every part of the world. While we have new medications and complex surgical techniques that promote weight loss, the awareness of healthy eating habits and dietary education are still the most important factors in helping control body weight.

Unfortunately, nutrition knowledge appears confined largely to books and exams; as the doctors barely engage in nutrition counseling with patients. In teaching …

Your patients are counting on you

Adam Striker, MD

Medications

January 27, 2019

A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com.

I recently attended a state medical society’s annual meeting where the agenda consisted of an awards program, several speakers and a keynote address. The highlight of the evening, however, was listening to patients share their stories with the local medical community. We’ve all heard …

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Your patients are counting on you

Get ready for health care disruption

Praveen Suthrum

Health Policy

January 27, 2019

Just like you, I’m trying to make sense of the world around me. But there are no templates for the bridge that health care’s building for its future.

All we can do is listen to weak signals and amplify them.

Recently (and finally), CVS bought Aetna for $69 billion. I spoke to someone intimately familiar with the deal. He called it “vertical stacking” — to expand what CVS customers can get — …

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Get ready for health care disruption

In medicine, what’s in a name?

Megan L. Baker, MD

Physician

January 27, 2019

Before I could see her, I could hear her. My patient, a young woman with messy braided hair, was grunting with every effort to breathe. The noises quieted slightly when I reached her bedside, but her tears continued to fall between gasps. Her body movements were exaggerated, rooted in the rhythm of her labored breathing — several violent shudders with every expansive inhale, and a wave of quivers with every …

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In medicine, what’s in a name?

Another chance to practice self-compassion

Amy Cowan, MD

Physician

January 26, 2019

It’s Monday morning, and I’m the attending physician starting a week of inpatient service in the hospital. On my patient list is a man named Earl, age ninety-one. He’s outlived his siblings, his first and second wives and all of his peers. After seven decades of smoking, his lungs are failing; he carries a diagnosis that reads “severe emphysema.”

The sign-out note from Earl’s previous doctor reads: “Daughter and son-in-law met …

6 things learned from being rejected from medical school

Anonymous

Medical Education

January 26, 2019

I have spent the greater portion of my 20s enduring a premature quarter-life crisis. Patterns of self-doubt and debilitating anxiety became my new normal.

I was rejected from medical school — again.

After taking time to process the reality that I would have to wait another year to re-apply, I fervently journeyed through a messy jungle of introspection that led me to these six lessons. Although I learned more than I could …

Do smaller, independent practices have happier doctors?

Health eCareers

Physician

January 26, 2019

This article is sponsored by Careers by KevinMD.com.

Physician burnout is not a novel topic within the health care industry. Numerous studies have been done on the increasing prevalence of its symptoms — from emotional exhaustion and loss of empathy to doubt that one’s work even makes a difference — among today’s practitioners. In fact, a recent …

MKSAP: 65-year-old woman with a cardiac murmur

mksap

Conditions and Diseases

January 26, 2019

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 65-year-old woman is evaluated during a routine examination. She was diagnosed with a cardiac murmur in early adulthood. She is active, healthy, and without symptoms. She takes no medications.

On physical examination, vital signs are normal. A grade 3/6 holosystolic murmur preceded by multiple clicks is present at the …

Do huddles really help in primary care?

Hans Duvefelt, MD

Physician

January 25, 2019

I’ve huddled since before we used the word for it: You want to be prepared for the patients coming in that day. “Followup MRI” – did they have it and what did it show? “Ankle pain” – do we have X-ray today? “Eye pain” – be sure to check her acuity and put her in a windowless room, and did the new fluorescein strips come in? All fast-paced, to the …

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Do huddles really help in primary care?

Patients are an integral part of medical student education

Orly Farber

Medical Education

January 25, 2019

A face feels nothing like a frozen pig’s foot, I thought, as I guided a curved needle into the woman’s cheek, drawing the absorbable thread across her still-bleeding wound. Two wraps around the needle driver and I pulled the nearly invisible thread through, bringing the edges of her skin back together, securing my first knot.

“Hey, have you ever sutured?” the ER doctor had asked, just minutes before.

“Only in class,” I replied, …