KevinMD.com

Dear health care administrator: Physicians are your friends

Physician

April 12, 2016

Dear health care administrator,

I am writing to you in a spirit of cooperation, because the way health care works today, it is too complex a business to manage on the side while also taking care of patients. And I hope you don’t have any illusions about medicine being so simple that non-physicians like yourself can manage patients’ health care without trained professionals who understand medical science and can adapt the …

Reducing health costs: Patients aren’t going to take the lead

Peter Ubel, MD

Health Policy

April 12, 2016

Lena Wright’s best friend was hunched over like a character from a French novel, with spinal bones so thin they would fracture with a fit of sneezing. Determined to avoid that fate, Wright (a pseudonym) asked her primary care doctor to test her for osteoporosis with a DEXA scan, also known as dual energy x-ray absorption. The scan would send two x-ray beams through her bones, one high-energy and the …

Most of the care you’re receiving isn’t patient-centered. Here’s why.

Rob Lamberts, MD

Physician

April 12, 2016

My last post discussed the wide gulf between health care and the rest of the world in the area of customer service. To sum up what took over 1,000 words to express: Customer service in health care totally sucks because the system promotes that suckiness and does nothing to penalize docs who make people wait, ignore what they say, rush through visits, and over-charge for their care. We …

Real physician voices, twice a week

Join 100,000+ subscribers. Free, and one click to unsubscribe.

A physician’s health policy advice to Donald Trump

Dr. Saurabh Jha

Health Policy

April 11, 2016

It is possible that in a few months from now, only Nate Silver’s prediction models will stand between Donald Trump and the White House. I will leave it to future anthropologists to write about the significance of that moment. For now, the question, “What will President Trump be doing when he is not building a wall?” has assumed salience.

This is relatively easy to answer when it comes to health policy. …

We are born with our arms wide open. We die in much the same way.

Jordan Grumet, MD

Conditions and Diseases

April 11, 2016

We are born with arms wide open, and we die in much the same way. It is that which we carry, in the time between, that defines us.

The newborn, caught in the primordial stew of beginnings, is unable to recognize the difference between self and other. She grasps and roots at inanimate objects with the same voracity she reaches for her mother. It is a time of differentiation, a time …

Who are the patients that stay in the hospital for a very long time?

Janice Boughton, MD

Physician

April 11, 2016

I just finished reading a very delightful A Piece of My Mind essay in JAMA. JAMA is primarily a research journal, filled with new scientific or semi-scientific studies and comments on those, plus reviews of the literature and editorials on science or politics. There are also letters and announcements and educational sections for doctors or patients, even poems, but the part I like to read all the way through is …

Inpatient vs. observation: We have created a monster of our own making

Suneel Dhand, MD

Health Policy

April 11, 2016

A few weeks ago I wrote a piece about my hero patient, a World War II veteran who landed on Normandy beach, and how he had been left in a difficult position by the whole observation versus inpatient situation while he was hospitalized.

My intention was to draw attention to these types of scenarios and how they cause intense anxiety and concern to our elderly. It’s a horrible …

How duty hour restrictions are hurting residency training

Anonymous

Medical Education

April 10, 2016

As I get near the completion of an intense 5-year orthopedic surgery residency program, I had an interesting interaction with our hospitals sub-committee specifically tasked to address duty hour and resident fatigue issues.

As they gave examples from other departments about changes made to their programs regarding duty hours, a clear-as-mud connection was continually made. They spoke of “improvements” made as the result of residents stepping up to serve as whistleblowers …

The moments that define the type of physician we become

Rohan M. Shah

Medical Education

April 10, 2016

“Son, just let me die.”

Those were the first words Mr. O. told me as I introduced myself. As a 75-year-old stage IV lung cancer patient with brain metastasis, Mr. O knew his time on this planet was limited — the last place he wanted to be was in a hospital with a newly minted clinical student. Mr. O’s neighbor had found him unconscious on his porch earlier this morning, and …

The best way male physicians can help their female colleagues

Will Flanary, MD

Physician

April 10, 2016

The consult was for “decreased vision and eye pain.” Inpatient consults at the VA hospital come up infrequently, but when they do, it’s inevitably something interesting. As soon as I access the patient’s medical record, a flashing rectangular box encasing a smattering of phrases such as “warning,” “inappropriate behavior,” and “female employees” pops up on the screen. I’m accompanied by one of our female residents, Dr. Smith. Once we leave …

Why I stopped prescribing narcotics, and never looked back

Alan G. Berg, DO

Physician

April 10, 2016

I was never a big prescriber of narcotics. I grew up “country,” in a tougher world where your parents taught you to accept pain as a part of life. Pain is how you know you’re still alive. They’d tell me, “if you’re hurtin’ you ain’t dead yet.” You fell down; it was going to hurt. You learned not to fall. Twisted your ankle doing something stupid (and it was always …

The racism in medical education cannot be ignored

Anonymous

Medical Education

April 9, 2016

The abandoned retractor clatters dangerously close to the other edge of the sterile field, saved only by the quick reflexes of the scrub nurse. The attending lets out a brief laugh, “I guess we’re using the Madagascar technique,” then it’s back to the operation at hand. Minutes pass as I continue to stand in my assigned place at the attending’s side, prepared to offer whatever meager contribution I can to …

Making your own infant formula at home is a recipe for disaster

Alexandra Sowa, MD

Physician

April 9, 2016

Recently, former reality television star Kristin Cavallari released a potentially lethal recipe for homemade baby formula in her new lifestyle book, Balancing in Heels. Cavallari, who rose to fame as high-schooler on MTV’s Laguna Beach, is attempting to rebrand herself as an all-organic Suzy homemaker and offering dangerous medical advice along the way.

In her book, Cavallari goes against all conventional medical wisdom, advocating for feeding young babies a homemade concoction instead …

Women surgeons can do it all

Brittany Bankhead-Kendall, MD

Physician

April 9, 2016

“Beautiful girl, you can do hard things.”

I saw that quote on my favorite Facebook group recently, called Physician Moms Group (or PMG). This is a group of women who, like all of us, are just trying to “do” life every day. Because of our integrity and intellect, we are trying to do it better than anyone else. I think that’s from a Type A personality, combined with leadership and wanting …

Read more…

Women surgeons can do it all

MKSAP: 30-year-old woman with right antecubital fossa and biceps pain

mksap

Conditions and Diseases

April 9, 2016

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

A 30-year-old woman is evaluated for a 2-day history of increasing pain in the right antecubital fossa and biceps. She reports daily injection drug use. Medical history is otherwise unremarkable, and she takes no prescription medications.

On physical examination, temperature is 39.7 °C (103.5 °F), blood pressure is 90/56 mm Hg, pulse rate is 120/min, and …

After Match Day: A bittersweet reflection

Kathy May Tran

Medical Education

April 8, 2016

It was recently Match Day.

At 12 noon EST, medical students all over the United States simultaneously opened envelopes which revealed the destination of their residency training. The tradition is an exhilarating and emotional event for everyone involved. For medical students, it is a milestone that symbolizes a dramatic life change and a new adventure. It marks the culmination of years of hard …

If all we talk about are pills for pain, we are having the wrong conversation

Stefan Kertesz, MD

Medications

April 8, 2016

“Does anyone have thoughts about Mr. Jones?” I ask around the table. My primary care team sees veterans who were recently homeless. Many have been severely injured, and half have chronic pain. We have wise nurses, a committed social worker, and something else: time to focus on a vulnerable group.

And here we are today we have Mr. Jones. A bit about his case. He has a history of shoulder pain dating …

All primary care doctors need a buprenorphine waiver. Here’s why.

Alicia Agnoli, MD, MPH

Medications

April 8, 2016

Over 2 million Americans abuse or are dependent on prescription pain medications. These patients are in the office of every physician in the country, but only 3 percent of primary care providers offer them treatment.

Many patients are being given a sympathetic apology, a hotline to call, or a dead-end referral. Some of them are being sent to methadone clinics, which are often impractical, already-full, or deeply stigmatized. Others make their …

Primary care has a dual meaning

Megan Chock, MD

Physician

April 8, 2016

One year ago (read: before intern year), pretty much the most exciting part of my fourth-year emergency medicine rotation was having my pager go off. BZZZZ! I leapt into action, excitingly reading the text page: “Leg lac in E9.” I was on it.

Suture kit in hand, I burst through E9’s thin emergency department curtains with abandon; I was going to fix this. The “leg lac” turned out to be a …

Read more…

Primary care has a dual meaning

American health care has a customer service problem

Rob Lamberts, MD

Physician

April 7, 2016

No, customer service in the U.S. is terrible when it comes to health care. No, the customer service in the U.S. health care system is horrendous. No, health care has the worst customer service of any industry in the U.S.

There. That seems about right.

What makes me utter such a bold statement? Experience. I regularly hear the following from people when they come to my practice: