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Health care is about relationships. Health IT fails to understand that.

Health Technology

January 28, 2016

The promise that information technology holds for health care is, quite literally, amazing. So far, it has enabled us to get rid of paper charts (not to mention the age-old problem of illegible doctors’ handwriting), negated the need to trawl through mountains of files to find old clinical data, and introduced much-needed safety improvements such as medication alerts.

But anyone practicing at the frontlines of medicine over the last few years …

The straight face test of our health care system

Hans Duvefelt, MD

Health Policy

January 27, 2016

Health care in America is fracturing right down the middle, and doctors are going to have to figure out if or how long they can straddle the divide between what patients want and what the government and corporate America want them to have.

Up until this point, the momentum has been with the payers, Medicare, and the insurance industry. But the more heavy-handed they become, the more inevitable the public backlash …

It shouldn’t be so hard for patients to correct their medical record

Peter Elias, MD

Health Technology

January 27, 2016

This past summer an article in USA Today talked about Regina Holliday’s efforts to make the medical record more easily and promptly available to patients, so it becomes as a tool patients use as they engage in co-managing their own care. Her cause is just, and her story is compelling, so I was dismayed at the pushback saying: Not so fast. There are lots of errors and ambiguities in the record, …

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The nightmare of medicine is the absurd price we have to pay

Manoj Jain, MD, MPH

Medications

January 27, 2016

A grandmother develops a boil that turns out to be a difficult-to-treat staph infection (MRSA). She needs high-powered antibiotics. A middle-aged man who received a blood transfusion decades ago now has hepatitis C and needs anti-viral medicine. A young woman with HIV develops golf-ball-size lesions in her brain, has toxoplasmosis and needs anti-parasite medicine.

The marvel of medicine today is that we can treat all three infections, and save the lives …

The choreography of care is etched in my muscles

Amrapali Maitra

Medical Education

January 27, 2016

In neurology clinic, I was asked to see a young man with epilepsy — a seizure disorder — due to cerebral palsy from birth. It was one of my first clinical encounters of my first rotation of medical school, the tenuous transition from knowledge-absorber to translator and caretaker. I walked in to find a patient who was wheelchair-bound and largely non-verbal, and who interacted with the world by tracking gaze …

Dying is a vexing problem for the medical profession

Dr. Saurabh Jha

Physician

January 26, 2016

Thomas Hobbes described life as pitifully “nasty, brutish, and short.” Thanks to the free market and the state, life is no longer a Hobbesian nightmare. But death has become nasty, brutish, and long.

Surgeon and writer, Atul Gawande, explores the medicalization of ageing and death in Being Mortal. Gawande points to a glaring deficiency in medical education. Taught to save lives and fight death, doctors don’t bow out gracefully and …

A routine visit with a transgender patient

Nat Fondell

Medical Education

January 26, 2016

“Hey, Rick. They warned you about me, I hope?”

My routine med student opening line elicits a slight smile from my balding forty-two-year-old patient and the patient’s wife. As we shake hands, I continue the script.

“I’m Nat — the medical student. What brings you in today?”

“Well, I’d like to transfer my care to this clinic. We’ve brought my medical records.”

Together, they heave stacks of papers onto the desk. Rick’s hands slide …

Will the real doctor please stand up?

Kristin Prentiss Ott, MD

Physician

January 26, 2016

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In 2006, graduate nursing programs started granting doctorates of nursing practice (DNP degrees). In a media fact sheet, the American Association of Colleges of Nursing (AACN) explains the thrust for the change this way:

Some of the many factors building momentum for change in nursing education at the graduate level include: the rapid expansion of knowledge underlying practice; increased complexity of …

Read more…

Will the real doctor please stand up?

Is it the doctor’s fault if a patient doesn’t want to come in?

Michael Kirsch, MD

Conditions and Diseases

January 26, 2016

A patient came to the office and refused to see me, although I was quite willing to see him. I’ll present the scenario followed by the patient’s reason he took an abrupt U-turn. Then, if you are inclined, you may offer your own advice and comment.

I performed a colonoscopy on this patient and found a large polyp in the upper part of the large intestine, or colon. The upper part …

Gastroenterologists are the tattoo artists of medicine

Frederick Gandolfo, MD

Conditions and Diseases

January 25, 2016

Everywhere you go, you can see people from all walks of life sporting some pretty cool tattoos. Tattoos are so popular nowadays that they’re almost conformist. I consider myself really hip since I don’t have any tattoos; how avant-garde! However, that doesn’t mean I don’t appreciate good ink when I see it. As a matter of fact, I even dabble as a tattooist sometimes.

It is common practice to leave a permanent tattoo at …

Your vagina doesn’t need a herbal cleanse. Here’s why.

Jennifer Gunter, MD

Conditions and Diseases

January 25, 2016

I woke up to someone forwarding this tweet.

Yes, some company is selling tiny bags of herbs (they call them pearls) to stuff in the vagina for three days to cleanse your uterus or shrink your fibroids or treat bacterial vaginosis or tighten your vagina.

This is not only pointless it could be very dangerous. Here’s why.

Your uterus and vagina want you to leave them alone.

Your uterus isn’t tired …

A story of how small things really can make a big difference

Anne Katz, RN, PhD

Conditions and Diseases

January 25, 2016

I run a dilator program for women with rectal or anal cancer where I educate patients about the need for and correct use of vaginal dilators to mitigate the effects of radiation on the vaginal wall. Many women don’t understand the need for dilators after radiation for this cancer, so I always start with a description of the anatomy and …

True confessions of a surgeon: What’s the best question you can ask her?

Starla Fitch, MD

Physician

January 25, 2016

Picture this: You’re in the operating room, performing a challenging procedure. (If you’re not a doctor, roll with me here and play along. You’ll get it soon.)

You’re feeling pretty good about how the surgery is going.

You’re grateful that your usual team is with you, because that always makes you feel more confident.

Then something happens …

Right at the most critical part of the procedure, crisis ensues and the instrument you’re using …

The physician’s ultimate calling faces pressure

James C. Salwitz, MD

Physician

January 24, 2016

In the fall of 1980, in my final year of medical school, I sat in the main ward of Saint Vincent’s Hospital, Greenwich Village, Manhattan. Filling the vast space were twenty-four beds, in four rows, with twenty-four patients. The prow of the open nursing station thrust from one wall into the center. A high ceiling vanished above. Yellow light filtered through ancient rippled glass windows and distant fluorescent bulbs made …

The unintended consequences of the night float rotation

Elaine Khoong, MD

Medical Education

January 24, 2016

This past month has been a particularly difficult one for me because I’ve been on our float rotation. I have worked only night and swing shifts throughout our hospitals; this means my work hours are primarily from 8 p.m. to 10 a.m.

There are certainly other rotations during which I worked longer hours and had more emotionally draining conversations, but I have never felt as burned out as I have this …

The triple aim must turn into the quadruple aim. Here’s why.

Yul Ejnes, MD

Health Policy

January 24, 2016

A guest column by the American College of Physicians, exclusive to KevinMD.com.

The election year has finally arrived. Even though the candidates have been on the trail for what seems like forever, I wanted to wait until the traditional time to announce the launch of my campaign.

Don’t worry, I’m not running for office. My campaign is an initiative to get us to start talking about the “quadruple aim” …

The heartbreak of physician mommies. How this doctor learned to let it go.

Wendy Woolley, DO

Physician

January 24, 2016

After a stressful morning, a physician colleague receives a note from her 4 year old that read, “MOMYOUFORGOTTOGIVEMEAKISSTODAY” in classic large, space less toddler scrawl. She shared it knowing that other physician mommies can relate.

We’ve all been there. The heartbreak that is a part of life as a physician mommy takes many forms. Whether a pout, a stare, a cry, a comment, a scowl or a note, no one can …

Solving burnout requires wholesale change in medical education

Tyler Cooke

Medical Education

January 23, 2016

Post-apocalyptic portrayals of medical school. Depressive symptoms in 43.2 percent of resident physicians. 34.1 percent of medical students experience burnout by third year, and that percentage increases during residency, ranging from 41 percent to 74 percent by specialty.

We lose hundreds of doctors each year to suicide, at a rate that is twice as high as the national average. Burnout increases the risk that a physician will make a mistake, which …

How this doctor beat burnout. You can, too.

Vania Manipod, DO

Physician

January 23, 2016

2015 was a year to regroup and reassess my professional goals. Immediately after residency, I did as most physicians do — apply and hope to get a job that pays well and is in a good location. Similar to the personalities of most physicians, I am a workaholic and overachiever. Therefore, since graduating residency, I strove to perform well at my job, treated my patients to the best of my ability, passed my …

A side of doctors patients usually don’t see

Dhruv Desai, MD

Physician

January 23, 2016

“What is your personal experience with human suffering?” he asked. Fellowship interview season. Interviewing for pulmonary and critical care, one may expect such a question. I thought I was ready for it. But the simple truth is that I didn’t really have the right answer; I probably never will.

During the morning rounds, my attending physician heaved a weary sigh: “150,000 people die every day!” Out of the blue. I quizzingly …