Administrators who don’t see patients often make the most important decisions

Health Policy
August 27, 2017

I was browsing the latest issue of the Journal of the American Medical Association, as I often do, and an article by one Andy Slavitt, MBA, and Gail Wilensky, PhD, titled “Reforming Medicaid,” caught my eye. From 2015 to 2017, Mr. Slavitt served as the Acting Administrator for the Centers for Medicare & Medicaid Services (CMS). In that role, he oversaw the government’s awful Meaningful Use EHR program, and helped …

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Administrators who don’t see patients often make the most important decisions

What health reform can learn from United Airlines

Health Policy
August 26, 2017

Obamacare repeal and replace is going nowhere, despite seven years of promises by Republican members of Congress. For the foreseeable future, it will remain the law of the land, along with rising insurance premiums and deductibles and fewer plans to choose from. It’s worth remembering the next time someone asks you for money to support Republican incumbents.

What if the airline industry could light the runway toward fixing one of the …

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What health reform can learn from United Airlines

After Charlottesville: What are physicians responsible for?

Physician
August 26, 2017

White nationalists and neo-Nazis marched through Charlottesville, President Trump addressed the nation in what should have been a straightforward call for unity against racism and bigotry. Instead, he left us perplexed, wondering if he had just insinuated anti-racist counter-demonstrators were to blame for the violence that ensued. Trump then made explicit his intentions by attempting to spin an argument of moral equivalence between white supremacists and racial justice advocates. He …

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After Charlottesville: What are physicians responsible for?

What I learned as a hospice director

Physician
August 26, 2017

We all practice medicine for different reasons. Of course, it’s almost reflexive to say we practice medicine because we care about people. I’m sure this is true for many physicians. However, if I were being honest, I think I went into medicine more because of the educational challenge. In addition, the profession yielded respect, status, money (back in the day!) and yes, an opportunity to help. I won’t challenge my …

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What I learned as a hospice director

MKSAP: 58-year-old man with cancer of the ascending colon

Conditions and Diseases
August 26, 2017

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

A 58-year-old man undergoes follow-up evaluation for cancer of the ascending colon diagnosed 3 weeks ago. Colonoscopy at that time revealed a fungating mass in the ascending colon. Biopsy revealed adenocarcinoma, and additional studies showed no evidence of metastatic disease. Right hemicolectomy was performed. The pathology report showed a 4-cm primary adenocarcinoma …

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MKSAP: 58-year-old man with cancer of the ascending colon

Doctors must stop fat shaming their patients

Physician
August 25, 2017

We are all guilty of having biases. Some of them we know about and proudly flaunt. Some of them have been ingrained so deeply that we do not even know they exist. Weight is an issue that brings out strong biases, and multiple studies have demonstrated a high level of bias from physicians against overweight and obese patients. Obese patients are often treated rudely and are not given the same …

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Doctors must stop fat shaming their patients

Good clinical care takes more than medical acumen

Physician
August 25, 2017

When I finished my medical training almost sixty years ago, I was like many new graduates: I thought I knew it all.

I opened a private office in Los Angeles and paid courtesy calls on the local physicians to let them know my qualifications and my availability for consultation, as both an internist and a nephrologist. (The treatment of kidney disease was then in its infancy, and I was the area’s …

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Good clinical care takes more than medical acumen

4 reasons to choose emergency medicine

Physician
August 25, 2017

There is a definite finality to the decision of which specialty a physician pursues. The reasons are as vast as they are individual. Hopefully, the med student has done due diligence and has a solid grasp on what their future entails, at least for the future as far as anyone can confidently foresee. Here is my story.

1. Challenge. No day is quite like another, and life as an emergency medicine (EM) …

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4 reasons to choose emergency medicine

A surgeon makes a mistake, and couldn’t stop crying

Physician
August 25, 2017

“F*ck!”

I pried my eyes open and had the realization of exactly what time it was. I was going to be late — again. I jumped out of bed as fast as my stiff and weary body would allow, threw scrubs on I was mostly sure were clean, ran a brush through my hair so I didn’t look totally disheveled when I had to look like professional in a few minutes …

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A surgeon makes a mistake, and couldn’t stop crying

48 hours in the life of an on-call gynecologist

Physician
August 25, 2017

An on-call weekend: 48 hours of being at any moment “on,” of being edgy, of being exhausted. This weekend included a full house of patients to see in the hospital, a patient list of three pages to be exact. As I went from patient to patient, room to room, each held its own unique story filled with the yin and yang of life. I realize too, this may be a …

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48 hours in the life of an on-call gynecologist

A teacher’s job is to show love first

Medical Education
August 25, 2017

A couple of weeks ago, I met my new medical students. These 10-12 trainees will be my small group for the next two years. We will meet monthly to discuss the soft stuff of medical training — hierarchy, tribalism, death and dying, medical errors, difficult patients, etc. Some call it “third-year medical student support group.” This is my 6th year of the pleasure and privilege (I inherited my first group …

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A teacher’s job is to show love first

Health care at the N of 1

Patient
August 24, 2017

In the past few weeks, there has been a question regarding my use of the hashtag #Nof1 along with how I end the majority of my posts and tweets: Health care is delivered at the N of 1.

One person even believed there might be a trademark infringement with the company N-of-1 who provides molecular testing for patients and then delivers evidenced-based medical recommendations for oncology patients. The reality is that, …

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Health care at the N of 1

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Want to stop the opioid epidemic? Stop prescribing opioids.

Medications
August 24, 2017

What is it like living in pain? Those of us who have ever experienced unremitting pain for months or years know that it is enveloping and all consuming. I struggled with intractable pain for several difficult years, and I am fortunate because my pain finally got better — what if your pain never did?

That is a horrible reality millions of people are living in right now. The chronic pain population …

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Want to stop the opioid epidemic? Stop prescribing opioids.

Help me help doctors in recovery

Physician
August 24, 2017

Approximately 12 years ago, I hired my first physician in recovery. He had temporarily lost his license following a bout with alcohol. After a stint in a rehabilitation clinic, he was ultimately reinstated. My journey to hire this physician was arduous at best. During the interviewing process, I narrowed the field down to two candidates: one with a past and one without. I wrestled with the “in recovery” situation and …

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Help me help doctors in recovery

A history of health care reform

Health Policy
August 24, 2017

Health care reform continues to make national headlines as Republican senators have failed to pass a bill in the Senate with enough support to repeal and replace the Affordable Care Act (ACA). How did we get here, and why do so many Republicans want to make the ACA go away badly? To answer this question, you have to first understand the history of health care reform in the United States …

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A history of health care reform

Stop the patient leakage in primary care practices

Physician
August 24, 2017

Yesterday, we had a meeting about leakage.

No, it was not about urinary or fecal incontinence, but it was about care that could have been provided within our institution that ended up, for a multitude of reasons, happening with providers beyond the walls of our institution.

Representatives from our accountable care organization had requested a meeting to go over some issues they’ve been having with our practice, including low levels of usage …

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Stop the patient leakage in primary care practices

Concussions and CTE are more complicated than even the experts know

Conditions and Diseases
August 23, 2017

For many, American football is a beautiful game that is simple to enjoy but complex to master. Choreographed with a mixture of artistry and brutality, it features the occasional “big hit” or bone-jarring tackle, forcing a fumble and turning the tide of the game.

But with this part of football comes justified concern about the long-term health effects of engaging in this type of activity over time, concerns that abound in …

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Concussions and CTE are more complicated than even the experts know

Improving physician satisfaction by eliminating unnecessary practice burdens

Health Policy
August 23, 2017

acp new logoA guest column by the American College of Physicians, exclusive to KevinMD.com.

In April, the American College of Physicians (ACP) released a position paper titled Putting Patients First by Reducing Administrative Tasks in Health Care, published in the Annals of Internal Medicine. The paper, part of ACP’s Patients Before …

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Improving physician satisfaction by eliminating unnecessary practice burdens

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