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Getting to a minimum viable product (MVP) health care app: Partner with physicians

Jenny Hyun, PhD, MPH and Joshua Tamayo-Sarver, MD, PhD

Health Technology

December 27, 2018

Over the course of several years, IBM’s fledgling Watson for Oncology program has received a wide range of reviews. Among them is a harsh critique published by Gizmodo. The article is filed under the keywords “AI,” “Watson,” “health,” “health care,” and “Doctor: This product is a piece of shit.” The last keyword is courtesy of a provider in Florida commenting on a highly publicized medication error.

While the …

Excellent surgeons are those who are quick to recognize their mistakes

Naeem Rahman, MD

Conditions and Diseases

December 27, 2018

“Dr. Rahman, this is the nurse in OR 12, Dr. H is doing a robotic/laparoscopic hysterectomy. He thinks he’s injured the ureter and is requesting help. Are you available?” I knew what came next was going to be complex — challenging surgically, disruptive to my schedule and potentially risky. I told the nurse that I would be over in about 10 minutes.

Under anesthesia was Michelle C, a 46-year-old African American …

KevinMD’s 2018 top posts: Highlighting the voices of practicing clinicians

Kevin Pho, MD

KevinMD

December 27, 2018

With over 22 million page views for the year, thank you for making 2018 such a success.

KevinMD continues to be the web’s leading platform that highlights the voice of the many who intersect with our health care system, but are rarely heard elsewhere: physicians, advanced practitioners, nurses, medical students, and patients who can share their insight and tell their stories.

This year, I’m …

How religious exemptions will affect Medicaid managed care

Ishaan Shah

Health Policy

December 27, 2018

In the United States, 25 million adult women are insured by their state Medicaid program. Medicaid covers 60 percent of all births in the United States as per federal law, and states must cover all pregnancy-related services for pregnant women with incomes up to 133 percent of the federal poverty line. There are two Medicaid insurance payment models: a fee-for-service model, where the state pays for individual services, and a …

We should not be in a hurry to label a sign or symptom pathognomonic

David Rinaldi, MD

Conditions and Diseases

December 26, 2018

“Pathognomonia.”

I do not believe this is a real word. That’s OK. I don’t care if it isn’t. I have wanted to write this little blurb several times over a period of a few years. My theme is related to what we physicians regard as pathognomonic — i.e., definitive proof of a particular condition based on one sign or symptom. Sometimes causing unwitting harm to our patients and families. Why haven’t …

The demonization of socialized medicine

Matthew Hahn, MD

Health Policy

December 26, 2018

Of late, doctor/friends on social media have taken to reposting news articles detailing the horrors taking place in other nations because of the evil scourge known as socialized medicine. In fact, the two words, alone or together, just don’t carry anything near the weight of the pain and suffering they imply, so I have taken to adding this exclamation point, in parentheses, to make it absolutely clear how terrible a …

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The demonization of socialized medicine

The day he stopped pretending to be sick

Ryan Nesbit

Conditions and Diseases

December 26, 2018

From second through fifth grade, I mastered the art of being sick. I got out of school, soccer practice and piano lessons so that I could be the child I wanted to be — not sick, but loved, cared for.

Here was my recipe:

1. Wake up.
2. Feel anxious about the day to come (this was natural).
3. Let the anxiety morph into a sickly pallor.
4. Bolster suspected illness with refusal to eat …

Does coffee lead to cardiac arrhythmias?

Larry Istrail, MD

Conditions and Diseases

December 26, 2018

Coffee —”because of the caffeine which it holds,” described Dr. Henry Elsner in a 1911 review article in the journal of Hypertension and Arteriosclerosis — causes “increased rapidity of the heart’s action. It makes the heart irritable, it increases the power of the heart’s contractions, it places an extra load upon the kidneys, increasing the urine flow. Because of these effects, I have for some time …

12 things you’ll need for a smooth credentialing process

Aalap Shah, MD

Physician

December 25, 2018

Physicians receive rigorous medical training for the better part of a decade. However, we emerge unprepared for the real-world job application process to which our friends in other professions are accustomed. One of these logistics includes credentialing and verification for hospitals and clinics where your group intends to practice — a process that can take up to three months.

There are a number of items that are requested during the credentialing …

A physician was barred from attending any future IT meetings

Calvin J. Maestro, MD

Physician

December 25, 2018

In the mid-1990s, I was working as the medical director for a national computer processing company that had the medical policy and utilization review contract for many Medicaid programs in the United States. Within the first few weeks of being hired, I was invited to attend an IT meeting where the computer project supervisor was going to show off a beta medical reporting program the company had developed for an …

Take care of you so that you can make a difference for others

Michelle Ramirez, MD

Physician

December 25, 2018

A few years ago, after doing the work and mom thing for five-plus years, I noticed I was becoming increasingly cynical. I was, more often than not, in a bad mood — and I felt exhausted. One day I sat down and asked myself: “What the hell is going on with you?” I realized that I was working all day, only to come home (when I wasn’t working nights) to …

The 3 goals of clinical documentation

Nagendra Gupta, MD

Physician

December 25, 2018

A lot has been spoken and written about clinical documentation already. In spite of that, many hospitals still struggle in getting the best out of their doctors when it comes to documentation quality. And although we can cite various reasons for this, we can all safely agree that the hospital EMR is the single biggest influence when outcomes to efficiency and quality of documentation — both in terms of compliance …

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The 3 goals of clinical documentation

5 reasons why physicians are prized financial targets

James Turner, MD

Physician Finance

December 24, 2018

Doctors are notoriously bad with money. Part of this has to do with the fact that the schools that prepare our future doctors are ill equipped to teach them about money. When I was a fourth-year medical student, my school had a financial group come and talk to us about money. Not only was their advice conflicted, but the lawyer who owned the financial group would later end up going to …

When consumerism and convenience goes wild for no good reason

Steven Reznick, MD

Physician

December 24, 2018

I have received several phone calls in the last few weeks from young adults requesting information about their last vaccinations. They are traveling to areas of the world that suggest or require certain vaccines and do not remember if they had them or not. Others are applying for positions of employment which require travel and the employer’s human resources department needs the patient’s updated vaccination records.

When we tell them that …

A physician’s defense of active income

James M. Dahle, MD

Physician Finance

December 24, 2018

There are many blog posts, books, and podcasts out in the world celebrating “passive” income. I’ve even got a partner blog in the WCI Network completely dedicated to passive income. It’s time somebody stood up for the other side — active or earned income. Is it really all that bad to have earned income? Of course not. Let me explain why.

#1 It’s called opportunity

Thomas Edison famously said, “Opportunity is …

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A physician’s defense of active income

When a physician attends the funeral of a patient

Andrea Eisenberg, MD

Physician

December 24, 2018

I stood at the doorway of the funeral home, a 26-year-old woman lying in the open casket off to the side. Standing out among the crowd of mourners was a tall man holding his one-year-old daughter, her curly locks of hair bouncing as he moved.

It was only two years ago that I first met her. “We were just married a couple months ago. I must have gotten pregnant on our …

3 lessons this physician learned from her patients

Ellen Poulose Redger, MD

Physician

December 23, 2018

I recently completed my internal medicine residency training. Three years, thousands of hours, thousands of patients, thousands of decisions. I certainly learned a lot from the past three years: everything from what “HFrEF” means and how to manage it, to treating recurrent C. difficile colitis, to how to share decision-making with patients about whether or not to start anticoagulation in atrial fibrillation. Despite the multitude of lessons I have learned from my co-residents, …

A patient sues when a DNR is ignored

Skeptical Scalpel, MD

Physician

December 23, 2018

A New Mexico woman, suffering from Dercum’s disease (adiposis dolorosa) which causes painful fatty tumors, is suing a Santa Fe hospital and an emergency physician claiming she was the victim of two negligent acts in 2016.

One, according to the Albuquerque Journal, she told hospital personnel she was allergic to Dilaudid but went into cardiac arrest after receiving an injection of the drug.

Two, despite the presence of a lawfully …

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A patient sues when a DNR is ignored

A medical student after an OB/GYN rotation: Here’s what he learned

Nathaniel Fleming

Medical Education

December 23, 2018

On one of my first days on the labor and delivery ward, one of the attending obstetricians asked me what area of medicine I was interested in. When I said that I was applying into neurology this year, she said, “Ah! The other end of the body!” After a pause, she continued, “Well, this rotation will be … different.”

It wasn’t the first, or last, time I had heard a similar refrain during …

Electronic health records: Separating the signal from the noise

Fred N. Pelzman, MD

Physician

December 23, 2018

5,177.

That’s the current number of “cc’ed charts” as of this morning in my electronic health record in-basket.

While it might sound like a lot, this is not at all an unusual accumulation, partly due to the fact that I receive a notation every time a patient at our practice gets a flu shot, and also every time one of my patients or …

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