| KevinMD.com

September 7, 2016Sep 7, 2016

When I talk to my patients, one of the greatest concerns I hear is regarding the fear that they might get a cancer at some point in their life. It is a very reasonable fear, as cancers of the female reproductive tract and breasts are not as rare as we might like. Perhaps educated by Angelina Jolie’s announcement of her BRCA mutation in 2013, many women now ask me about …

Physician

How the integration of behavioral and primary care treats pain

Hans Duvefelt, MD

September 6, 2016Sep 6, 2016

We are witnessing a strange migration of restless tribes, moving between doctors and clinics, traveling great distances in search of what no one wants to give them any more. This eerie movement is steadily gaining momentum in our community, in…

We are witnessing a strange migration of restless tribes, moving between doctors and clinics, traveling great distances in search of what no one wants to give them any more.

This eerie movement is steadily gaining momentum in our community, in our state, and across the country. We can hear it in telephone calls, we can read it in records of patients looking to switch their care, and we can see it …

Physician

I do not care what you say. I have to try.

James C. Salwitz, MD

September 6, 2016Sep 6, 2016

Smoking and drinking caused the cancer, which Ed ignored for a long time. By the time a doctor looked at the hole in his neck, the mass had congealed the base of the tongue to the right side of the jaw and burst through the skin. A steady drip of pink tinged, foul saliva ran down the side of Ed’s neck. Ed, not being able to chew for months, was …

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Conditions and Diseases

What is the true utility of the DSM?

Steven Reidbord, MD

September 6, 2016Sep 6, 2016

Prior to the release of DSM-5 in 2013, I referred at times to the pocket copy of DSM-IV parked in my office bookcase. The main reason was to enter the right diagnostic codes on insurance forms. I also sometimes quoted DSM criteria to show a patient that ADHD can’t arise in adulthood, that daily mood swings are not characteristic of bipolar disorder, or that six months of sobriety is still “Read more…

What is the true utility of the DSM?

Health Policy

Accountable care organizations: Who are the winners and losers?

Ashish Jha, MD, MPH

September 6, 2016Sep 6, 2016

Recently, CMS sent out press releases touting over $1 billion in savings from Accountable Care Organizations. Here’s the tweet from Andy Slavitt, the acting Administrator of CMS: https://twitter.com/ASlavitt/status/768908822081667072 The link in the tweet is to a press release. The link…

Recently, CMS sent out press releases touting over $1 billion in savings from Accountable Care Organizations. Here’s the tweet from Andy Slavitt, the acting Administrator of CMS:

NEW ACO RESULTS: physicians are changing care, w better results for patients & are saving money. Over $1B. https://t.co/FEfe3QErb5

— Andy Slavitt 🇺🇦 (@ASlavitt) August 25, 2016

The link in the tweet is to a press release. The link in the press release citing more details is to another press release. There’s little in the way of analysis or data about how …

Medications

Your EpiPen is too expensive. These are your 4 options.

Roy Benaroch, MD

September 5, 2016Sep 5, 2016

EpiPens have gotten crazy expensive, yes: $600 for a two-pack. Here are some alternatives that might help you save a few bucks. 1. Wait a few weeks, and see what Mylan does. Mylan, the company that makes the “EpiPen” brand…

EpiPens have gotten crazy expensive, yes: $600 for a two-pack. Here are some alternatives that might help you save a few bucks.

1. Wait a few weeks, and see what Mylan does. Mylan, the company that makes the “EpiPen” brand of epinephrine auto-injector, has been under a lot of pressure lately to back off their unseemly price gouging. They’ve introduced a savings card that claims to lower your …

Conditions and Diseases

Bedpans to outcomes: Why can’t we quantify nursing care?

Amanda Anderson, RN

September 5, 2016Sep 5, 2016

“So, will you go get me a bedpan?” The bar was fancy, so I let it slide. This was not the first time my response to an occupational query was followed with a statement about bedside toileting; people just don’t…

“So, will you go get me a bedpan?”

The bar was fancy, so I let it slide. This was not the first time my response to an occupational query was followed with a statement about bedside toileting; people just don’t know what to do when an educated, confident woman says she’s a nurse.

I smiled tersely, as I have trained myself to. In past years, I’d offer varying responses: anger, heated debate. …

Physician

The psychiatrist as a double agent

Mark Rubinstein, MD

September 5, 2016Sep 5, 2016

I was treating John W., a psychiatric patient who was an insurance executive. He was angry about his work situation. He complained bitterly about his supervisor whom he felt singled him out for unfair criticism. Over the course of months, John’s complaints escalated to the point where he said, “I swear … if there was a chance I’d get away with it, I’d love to get rid of the guy.”

I …

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The psychiatrist as a double agent

Medical Education

Is burnout inevitable during medical training?

Anonymous

September 5, 2016Sep 5, 2016

Medical training in the United States is a long and tedious process. It begins in college, when one must complete the mandatory prerequisite curriculum and take a medical entrance exam; your score on which is directly compared to other applicants, immediately labeling you as a competitive candidate or not. The process of applying requires the completion of multiple comprehensive applications, the compilation of countless hours of research, clinical experience, letters …

Medical Education

The art of medicine cannot be measured by selecting letters on an exam

Amanda Breviu, MD

September 4, 2016Sep 4, 2016

You are currently on inpatient wards and notice your chief medical resident has been demonstrating erratic behavior, frequently muttering about MEN syndromes and antibodies associated with rheumatologic diseases and has been reciting gene translocations. What is the most likely cause…

A. Hospital-associated delirium
B. Conversion disorder
C. Symptoms related to completing an excess number of multiple choice questions in preparation for taking internal medicine boards

If you guessed C, you understand what I have been going …

Patient

The subtle arrogance of good health

Angelika Byczkowski

September 4, 2016Sep 4, 2016

Until my physical ailments began worsening rapidly in my late 40s, I was a high achiever, proud of my "kick ass" attitude, thinking I was so competent I could surmount any challenge life threw at me. Life appeared to be…

Until my physical ailments began worsening rapidly in my late 40s, I was a high achiever, proud of my “kick ass” attitude, thinking I was so competent I could surmount any challenge life threw at me. Life appeared to be straightforward, and I didn’t understand why this didn’t seem to be the case for so many other less fortunate folks.

Though I worked hard for my accomplishments and sometimes struggled, there …

Read more…

The subtle arrogance of good health

Medical Education

NEJM vs. the NYT: Which should medical professionals read?

Preeta Gupta

September 4, 2016Sep 4, 2016

Ever since I started medical school, my friends and family will often ask my opinion on a new medical recommendation they recently read online or heard on the radio. The trouble is, many times their query falls upon my clueless ears, as it is the first I am hearing about that medical study. In this last year, as I diligently pour through my medical textbooks, or almost exclusively answer my …

Physician

The cure for a poor historian? A good medical record

Eric Beam, MD

September 4, 2016Sep 4, 2016

Think keeping your life organized is hard? Try keeping your doctors organized. In this era of fragmented health care, patients find themselves in the impossible position of having to coordinate their care themselves -- a task that many can’t meet.…

Think keeping your life organized is hard? Try keeping your doctors organized.

In this era of fragmented health care, patients find themselves in the impossible position of having to coordinate their care themselves — a task that many can’t meet. Having multiple chronic medical conditions often means being subjected to a dizzying assortment of specialists, medical terminology, and tests that can quickly overwhelm patients.

How many times have you found yourself in …

Physician

A simple suggestion to doctors: Subscribe to a newspaper

John Biemer, MD

September 3, 2016Sep 3, 2016

I recently was speaking to two doctors about newspapers. Neither of them subscribed anymore. “Who has time to read the paper?” they agreed. “And any news you need is free online anyway.” No big news there, right? Plenty of people…

I recently was speaking to two doctors about newspapers. Neither of them subscribed anymore. “Who has time to read the paper?” they agreed. “And any news you need is free online anyway.”

No big news there, right? Plenty of people — in medicine and otherwise — have made similar decisions since the rise of the Internet in the mid-1990s. But what was striking to me is that these were not millennial …

Medications

A medicine for poor people

Kellie Wilding, MD

September 3, 2016Sep 3, 2016

Last week I had an appointment with one of my well-controlled diabetics. She has been in my care for the last six years. Our usual cheery interaction turned sour when she stated in an accusing tone, “My husband is diabetic, and I talked to his doctor about the medication you have me on. He says it is junk, and he only writes it for poor people, and he doesn’t understand …

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A medicine for poor people

Medications

An open letter to Heather Bresch: What is legal is not always ethical

Anonymous

September 3, 2016Sep 3, 2016

Dear Ms. Bresch, I couldn’t help but notice the barrage of negative press you’ve received lately regarding the significant price increases in EpiPens. A 461 percent increase since 2007, to be exact. People who require this medication for themselves or…

Dear Ms. Bresch,

I couldn’t help but notice the barrage of negative press you’ve received lately regarding the significant price increases in EpiPens. A 461 percent increase since 2007, to be exact. People who require this medication for themselves or their children are up in arms about spending over $600 for a twin pack of autoinjectors. Most of these people have life-threatening anaphylaxis if they are exposed to certain allergens. To …

Conditions and Diseases

MKSAP: 74-year-old woman with peripheral arterial disease

mksap

September 3, 2016Sep 3, 2016

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 74-year-old woman is evaluated during a routine examination. Her medical history is significant for hypertension and obesity. She is a former smoker, stopping…

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

A 74-year-old woman is evaluated during a routine examination. Her medical history is significant for hypertension and obesity. She is a former smoker, stopping 5 years ago. Medications are amlodipine, lisinopril, and aspirin.

On physical examination, she is afebrile, blood pressure is 136/78 mm Hg, pulse rate is 68/min, and respiration rate is 15/min. …

Medications

What physicians can do about EpiPen

Kristen Maguire, MD

September 2, 2016Sep 2, 2016

When I found out my daughter was allergic to peanuts, she was a year old. She couldn’t have cared less. She was smiling and happy, sitting on my lap in the allergist’s office, blissfully unaware of the big red mark on the side of her face. And I was crying and sad, crushed for that moment that the first challenge had been put in her path. I wasn’t sad that she was different, that …

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What physicians can do about EpiPen

Physician

Direct primary care physicians are trying to rescue other doctors

W. Ryan Neuhofel, DO, MPH

September 2, 2016Sep 2, 2016

In a recent interview, Dr. Farzad Mostashari (former national coordinator for health IT and current CEO, Aledade ACO) gave some advice to physicians on how to avoid burnout and “restore their role as caregivers”: The key is two things. One,…

The key is two things. One, if you’re in a kayak in the rapids, you have to lean in and dig your paddle in and push ahead. If you lean back, you’re done. You’re going to flip …

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Direct primary care physicians are trying to rescue other doctors

Medical Education

Inside every presidential candidate is a medical student

Augie Lindmark

September 2, 2016Sep 2, 2016

Ten male students crowded around a clean-shaven instructor who asked a series of questions. The students had meticulously prepared and would maintain close proximity to well-rehearsed answers. “Hopefully, the questions are simple,” they thought. One by one, they answered, at times stumbling through their responses. This was expected. The students were learning and the incorrect answers allowed room for humility. Such a scene could easily describe an American teaching hospital, …