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Why medical errors can never be completely eliminated

Physician

July 24, 2018

A patient with progressive neurologic disorder had a gastrojejunal tube placed for feeding. In a nursing home, the tube fell out and was replaced with a Foley catheter. He was sent to the hospital for placement of a new tube. When he arrived in the interventional radiology suite, the Foley catheter was not visible. A new gastrojejunal tube was successfully placed, and the patient was sent back to the nursing …

The surprising secret to mental wellness

Marie Casey Olseth, MD

Conditions and Diseases

July 24, 2018

When did it become a bragging right to say that you only get four or five hours of sleep a night? We would think it is ridiculous for someone to brag that their labs came back with only half the normal hemoglobin level as we would recognize that as clearly unhealthy. So when did we start equating sleep-deprivation with some kind of superpower? Does it make sense for our society …

A case for paying doctors more

Ayden Jacob

Health Policy

July 23, 2018

Engaging in an economic conversation about the conventional compensation of a physician leads one to believe that doctors are well-to-do. In the minds of most citizens, school-tuition board members and even local neighbors, if you’re a physician the presumption is that you are economically prosperous, maybe even rich. This sociological assumption probably sounds false to most whom honorably don the white coat. Perhaps a decade or two ago, when medical …

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A case for paying doctors more

A physician’s group disability nightmare

Christopher Yerington, MD

Physician Finance

July 23, 2018

My last operative day was October 15, 2009. My last attempt at getting to understand my group disability policy was on May 10, 2018. I’m a disabled anesthesiologist who lost his career when my left median nerve stopped functioning properly. I had two disability policies, a private and a group. My dealings with these two companies have been day and night.

My group insurance carrier hammered my dignity for years. In …

Is there a case against shared decision making?

Michel Accad, MD

Physician

July 23, 2018

In a matter of less than a decade, “shared decision-making” (SDM) has emerged as the uncontested principle that must inform doctor-patient relationships everywhere. Consistently lauded by ethicists and medical academics alike, it has attracted the attention of the government which is now threatening to penalize doctors and patients who do not participate in SDM prior to providing certain treatments, even if the legal process of informed consent has been …

MKSAP: 55-year-old woman with an eating disorder

mksap

Conditions and Diseases

July 23, 2018

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

A 55-year-old woman is evaluated for a new-patient visit. Medical history is significant for an eating disorder. Although she has maintained a normal weight for the past 20 years, she notes that prior to that time her weight would fluctuate in a range correlating with BMIs of 17 to 19. She has otherwise …

Balancing stewardship and entitlement in health care

Hans Duvefelt, MD

Health Policy

July 23, 2018

Today’s news is full of commentary about work requirements for Medicaid. Is work a prerequisite for health care or is health a prerequisite for work?

Not to complicate things, but can we even agree on what health care is? I don’t think we can, and it largely falls back on what we want to share in paying for.

A patient with an ugly skin lesion can have it removed if it might …

What type of returns should you expect from the stock market in the future?

Wall Street Physician, MD

Physician Finance

July 23, 2018

No one can predict the future, but when making projections for things like retirement planning, what investment return should you expect?

What do we mean by “investment return?”

Before we get into the numbers, we need to go through a few definitions.

Nominal returns vs. real returns

These are just fancy words for before-inflation and after-inflation returns. Real returns (after-inflation) returns are equal to the nominal returns (before-inflation) minus the inflation rate. Real returns …

A return to the problem-oriented SOAP note

Robert Centor, MD

Physician

July 22, 2018

CMS is changing note requirements, among other changes. Bob Doherty has a wonderful summary: “Medicare’s historic proposal to change how it pays physicians.”

As always, we really will have a difficult time sorting out the unintended consequences of these changes, but they certainly seem like a move in the proper direction. To me the most important change is a focus on notes: “Allowing medical decision making to be …

Medicare’s historic proposal to change how it pays physicians

Bob Doherty

Health Policy

July 22, 2018

The word “historic” is often used by PR professionals to hype something that is, well, pretty run-of-the-mill. They figure that no one is going to read a news release that announces “[Name of organization] proposes small change that really won’t make much of a difference.” The problem is that when something is done that really measures up to being historic, the recipient is less likely to believe it, kind of …

What is proper work attire in medicine?

Michael Edmond, MD, MPH

Physician

July 22, 2018

I’m a creature of habit. My first activity every day is to read the New York Times. Depending on my schedule, some days I read more articles than others. This week I was away at a conference and found myself with some early morning extra time before the first meeting session, so I delved into the Arts section. I began to read the first article: “Women …

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What is proper work attire in medicine?

Being a commodity takes away the joy of medicine

Edwin Leap, MD

Physician

July 22, 2018

It’s peculiar, I think, that we live in a time of physician shortage and yet some things remain abundantly clear:

1. Physicians can’t work together to fight, either for their own good or the good of their patients.

2. Like hostages, or abused spouses, they just keep going back for more of whatever bad policies they endure.

3. They are devalued.

Now, this isn’t about money. I’m not enough of a medical economics expert …

What health care can learn from what’s happening at Target

Suneel Dhand, MD

Physician

July 21, 2018

I was recently doing some home shopping in Target. It was peak time and fairly busy. After I was done, I walked towards the front of the store and approached the counter area to pay. But alas, there appeared to be hardly any manned registers. Lots of people were strolling up and down, trying to do the same as me: find a real person to help us check out. We …

Never underestimate the power of a smile

Weijie Violet Lin

Conditions and Diseases

July 21, 2018

He was a young patient with AIDS and Pneumocystis jiroveci pneumonia (PJP). Maybe that should have scared me from the start, but it didn’t. In hindsight, I keep wondering when the fear really set in. But downstairs under the glaring lights and the swooshing bustle in the ER, I only remember that he looked slightly bored as he took shallow, quick breaths. There was no blood, no screams of pain. …

Who named our bones? And what were they thinking?

Roy A. Meals, MD

Conditions and Diseases

July 21, 2018

All of our 200+ bones have names, which facilitates describing them when we cannot actually hold them or point directly at them. It might be easier to remember the names if they were familiar ones like Robert, Sally, and Kevin, but no such luck. Latin was the original language of science, so the bones received Latin names. Some of those were …

MKSAP: 70-year-old man with heartburn

mksap

Conditions and Diseases

July 21, 2018

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

A 70-year-old man is evaluated in follow-up for heartburn of 7 years’ duration. He has frequent nocturnal reflux but has not had odynophagia or dysphagia, and his weight has been stable. He was recently started on once-daily omeprazole with good control of his symptoms. He has a 30-pack-year history of cigarette smoking and continues to …

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MKSAP: 70-year-old man with heartburn

Not all depression is alike. Here are the differences.

Wallace B. Mendelson, MD

Conditions and Diseases

July 20, 2018

Adapted from Understanding Antidepressants.

In his often-quoted beginning of Anna Karenina, Tolstoy wrote, “All happy families are alike; each unhappy family is unhappy in its own way.” If we stretch this notion a little — going from families to individuals, and from unhappiness to depression — we come up with an interesting question, which is the …

Tips to manage chronic pain on summer vacation

John Dombrowski, MD

Conditions and Diseases

July 20, 2018

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

It’s officially that time of year. Summer is in full-swing, and all of America is getting ready to take a much-needed holiday.

However, some Americans, particularly those who suffer from chronic pain, often dread getting away. They are afraid their chronic pain might prevent …

Burnout in the male physician

Nisha Mehta, MD

Physician

July 20, 2018

When I first started writing and speaking about physician burnout, I focused most of my efforts on the female physician — after all, most of my work stems from personal anecdotes, and I am of course a female physician. I could probably give a talk about women physicians and burnout in my sleep at this point.

Rightfully so, though, as my work spread to wider audiences, more and more men started …

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Burnout in the male physician

When someone claims something is healthy, be skeptical

Jamie Katuna

Conditions and Diseases

July 20, 2018

I stood in line at the grocery store waiting to pay for my items. The woman behind me, who would be categorized as obese, was eyeing some of the snacks so conveniently placed in the checkout aisle. She grabbed a meal bar and analyzed it for a few seconds, then said aloud to me: “You ever had one of these? They’re pretty good. And they’re gluten-free, that’s how you know they’re healthy.”

Healthy.

What …

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