| KevinMD.com

November 27, 2016Nov 27, 2016

Not long ago, I overheard a frustrated hospital leader ranting about the poor performance of a physician. It was not that the doctor was screwing up surgeries, ordering the wrong drugs or missing obvious diagnoses. Actually, the physician was rather…

The doctor’s failures concerned length of stay (far too long), sloppy medical records (incomplete, loaded with cut-and-paste) and a temper, which while not directly abusive …

Physician

The hospital is a microcosm of what I want the world to become

Jordan Messler, MD

November 27, 2016Nov 27, 2016

I often avoid putting my politics on my sleeve, as I don’t want that to get in the way of our relationship. I want you to know that I treat you as a fellow human being, no matter your race,…

I often avoid putting my politics on my sleeve, as I don’t want that to get in the way of our relationship. I want you to know that I treat you as a fellow human being, no matter your race, gender, sexual orientation. With the election results, what will change about how I treat you at the bedside? Nothing.

I may know about your criminal past. I see that tattoo underneath …

Physician

Can a Trump revolution happen in health care?

Suneel Dhand, MD

November 27, 2016Nov 27, 2016

The election result shook the world. As the vote counts started to come in, most of the country descended into a state of collective shock and disbelief -- even Mr. Trump’s own supporters. Nobody seemed more surprised than the political…

The election result shook the world. As the vote counts started to come in, most of the country descended into a state of collective shock and disbelief — even Mr. Trump’s own supporters. Nobody seemed more surprised than the political pundits on all the cable news channels, who had for months incorrectly predicted the opposite result.

Let me take a step back for a moment before I sound like somebody who …

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Physician

Where do patients search for online health care information?

Linda Girgis, MD

November 26, 2016Nov 26, 2016

The Internet revolutionized the way we search for information as well as how we conduct business in our everyday lives. Everything can be purchased online: cars, clothes, groceries, vacation packages. Just about anything. Most people now research products before committing to them, and that now includes health care. It is estimated that 87 percent of adults in the U.S. use the Internet. Approximately 72 percent of Internet users seek health …

Medications

With legal pot comes a problem: How do we weed out impaired drivers?

Igor Grant, MD

November 26, 2016Nov 26, 2016

On November 8, voters in California, Maine, Massachusetts and Nevada approved ballot measures to legalize recreational cannabis. It is now legal in a total of eight states. And this creates potential problems for road safety. How do we determine who’s…

The effects of alcohol vary based on a person’s size and weight, metabolism rate, related food intake and the type and amount of beverage consumed. Even so, …

Physician

Is independent practice better for doctors or patients?

Ira Nash, MD

November 26, 2016Nov 26, 2016

A recent story in Crain’s New York Business cited the difficulty small independent medical practices face coping “with declining reimbursement rates from insurers, rising overhead costs and a torrent of new regulations that have come into play in recent years.”…

According to the article, only 26 percent of New York state physicians now own their own practice, compared with national rates of physician ownership of 76 percent thirty years ago. …

Conditions and Diseases

MKSAP: 21-year-old woman with type 1 diabetes

mksap

November 26, 2016Nov 26, 2016

A 21-year-old woman is evaluated for management of type 1 diabetes. She was diagnosed 3 months ago after presenting to the emergency department with diabetic ketoacidosis. Her HbA1c level at the time of diagnosis was 15.2%. She was discharged from the hospital on a basal and prandial insulin regimen with minor adjustments required as an outpatient. Her blood glucose log demonstrates a recent change manifesting as frequent symptomatic episodes of …

Medical Education

Doctors should take care of teddy bears too

Natasha Abadilla

November 25, 2016Nov 25, 2016

I’m a first-year medical student who recently discovered the magnetic pull of surgery. As one might assume, on my first day scrubbing into the OR under a pediatric surgeon, I was beyond excited. The surgeon’s precision and expertise fascinated me,…

I’m a first-year medical student who recently discovered the magnetic pull of surgery.

As one might assume, on my first day scrubbing into the OR under a pediatric surgeon, I was beyond excited. The surgeon’s precision and expertise fascinated me, and the constant activity in the surgical suite was something I could definitely get used to. Adrenaline was as pervasive as anesthesia in the OR, and I knew I’d thrive there.

However, …

Health Technology

What will the Trump era bring to health IT?

John Halamka, MD

November 25, 2016Nov 25, 2016

Many organizations have asked me to comment on the impact of the Trump presidency on health care and health care IT. I served the Bush administration for four years and the Obama administration for six years. I know that change in Washington happens incrementally. There is always an evolution, not a revolution, regardless of speechmaking hyperbole.

What am I doing in Massachusetts? I’m staying the course, continuing …

Physician

Ignore the economists: Keep the yearly physical

Eric Beam, MD

November 25, 2016Nov 25, 2016

In the years since the medical community first got revved up on the idea of “value-based care” -- the conceptual antithesis of the “more is better” fee-for-service model -- a common target of criticism has been the routine physical, one…

In the years since the medical community first got revved up on the idea of “value-based care” — the conceptual antithesis of the “more is better” fee-for-service model — a common target of criticism has been the routine physical, one of the most time-honored traditions in medicine.

The attacks come from all angles: The annual check-up isn’t cost-effective, it doesn’t lead to better outcomes, it actually might lead …

Physician

Death and dying: Do dogs have it better?

Brittney Culp, MD

November 25, 2016Nov 25, 2016

Today I saw a news story about Walnut, an 18-year-old whippet in the UK, who had his last "walk" on the beach with his owner who had asked social media followers to join them. Shortly after that walk, surrounded by…

Today I saw a news story about Walnut, an 18-year-old whippet in the UK, who had his last “walk” on the beach with his owner who had asked social media followers to join them. Shortly after that walk, surrounded by hundreds of family, friends, and supporters (human and canine alike), Walnut was put down. His last moments were spent as near to Heaven on earth as his owner could create …

Physician

How this physician embraces diversity and acceptance in medicine

Dominic Wu, MD

November 24, 2016Nov 24, 2016

My new patient looked around dodging my eye contact, scanning the ceiling, the room, and me. I felt that she was hiding something. In my clinic, I often find it one of the most difficult challenges to get new patients to open up, and one of the most beautiful moments when they finally do. I stopped interviewing midsentence and took a step back.

“Let’s just get to know each other. I’m …

Physician

What is essential professional dress in health care?

Karen Hickman

November 24, 2016Nov 24, 2016

While visiting a family member in the hospital recently, I noticed the unkempt attire of one of the lab people coming in to draw blood. As she knelt down to better reach my family member’s arm, I noticed her scrub…

Shortly after I made note of this, one of her co-workers came in the room to see …

Physician

Warning: Medical school may kill your child

Pamela Wible, MD

November 23, 2016Nov 23, 2016

Cheryl lost her son Sean to suicide in medical school. Just a few months ago. Her only child. Cheryl didn’t know that medical students were at high risk of suicide -- until her son was dead. Nobody warned her. Rhonda…

Cheryl lost her son Sean to suicide in medical school. Just a few months ago. Her only child. Cheryl didn’t know that medical students were at high risk of suicide — until her son was dead. Nobody warned her.

Rhonda lost her daughter Kaitlyn to suicide in medical school. Unable to recuperate from the pain of her daughter’s suicide, Rhonda died by suicide …

Physician

3 things that make doctors successful

Robert Wong, MD

November 23, 2016Nov 23, 2016

Part of being a resident or fellow is to be on call overnight and on the weekends. As any new resident, you’ll be nervous the first time because you think you don’t know anything. Over time, you’ll gain the knowledge…

Part of being a resident or fellow is to be on call overnight and on the weekends. As any new resident, you’ll be nervous the first time because you think you don’t know anything.

Over time, you’ll gain the knowledge and expertise to be able to ask the right questions, improve your exam skills and make the right clinical decisions. Trust that you know more than you think you do.

Throughout your …

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3 things that make doctors successful

Physician

Yes, cancer kills oncologists too

Anne Katz, RN, PhD

November 23, 2016Nov 23, 2016

I was sitting in a meeting, listening and participating, but at the same time keeping an eye on my email. I always do this, sometimes to my peril. Email is distracting, and more than once I have been called on to say something and I have no clue where the discussion had gone as I glanced at my inbox. At this …

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Yes, cancer kills oncologists too

Medical Education

Don’t call me a provider

Jacob Chevlen

November 23, 2016Nov 23, 2016

“Pregnancy termination” and “infanticide” are two different words, used by two very different kinds of people, to describe the one exact same thing: abortion. The source of an argument is found by looking at the words used to frame it;…

I am a medical school student. Like many of you reading this, my life is spent between the walls of the library and the walls of the …

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Don’t call me a provider

Physician

How do we deal with change in medicine?

Tracy Asamoah, MD

November 22, 2016Nov 22, 2016

Early in my career, I learned that keeping my focus on patients would help me define the physician I wanted to be. One of my first offices was in a cell of a repurposed juvenile detention unit with cinder block walls painted pasty white. Occasionally, I had to apologize to my patients as I explained that the smell was sewage from the toilets backing up. In that cold, harsh room, …

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How do we deal with change in medicine?

Health Policy

The good, bad, and the ugly of repealing the Affordable Care Act

Ilene Benator, MD

November 22, 2016Nov 22, 2016

With the election of Trump and a Republican Congress, it looks like the ACA is doomed. Will it be repealed in whole or in part? Will something replace it? None of us, including the new administration, know exactly what will…

The ACA was never a full health care overhaul. It was a form of insurance reform that used subsidies …

Physician

A post-election physician’s letter to his patients

Gregory B. Dodell, MD

November 22, 2016Nov 22, 2016

To my dear patients, This has been a difficult time to be an American. I will never forget my walk through Central Park on the morning after the election; I have never felt New York so flat and somber. This…

To my dear patients,

This has been a difficult time to be an American. I will never forget my walk through Central Park on the morning after the election; I have never felt New York so flat and somber. This election has brought out the worst in many. I have seen its ramifications in people’s health and fear that it may continue to have an impact. I want to express my …