KevinMD.com

Physician assisted suicide is our moral indicator

Physician

October 31, 2015

On September 12, 2015, the California Legislature passed a controversial bill legalizing physician-assisted suicide. California would become the fifth state to allow doctors to prescribe lethal medication to terminally ill patients who request it, after Oregon, Washington, Vermont and Montana. During the debate over the passage of the bill, everybody weighed in: patient’s rights advocates, dying patients and their advocates, religious groups. The one group that I didn’t hear about …

A heartfelt thank you to my patients

Kathleen McFadden

Medical Education

October 31, 2015

To be a third year medical student is to enter a world that few understand. The pressure of constant evaluation, the stress of doing well in the field which you want to enter, and the fear of making a mistake often haunt the very long days and night which characterize the most physically exhausting year of medical school.

Yet quite frequently as I move through this year I find myself feeling …

Read more…

A heartfelt thank you to my patients

Share our stories and let the world know that health is primary

Jay W. Lee, MD, MPH

Physician

October 31, 2015

The U.S. health care system is under intense pressure to change from volume to value. Primary care physicians must become the leaders our health system needs us to be: finding solutions to the problems that continue to plague this system. Costs continue to rise, access to physicians is quite limited in many locations, care often remains fragmented, and quality is uneven. To provide excellent care across the country and ensure …

Real physician voices, twice a week

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

Test your medicine knowledge: 48-year-old woman with type 2 diabetes mellitus

mksap

Conditions and Diseases

October 31, 2015

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

A 48-year-old woman is evaluated during a follow-up visit. She has a 5-year history of type 2 diabetes mellitus. She has no other significant medical history. Medications are atorvastatin, metformin, and a multivitamin. She works as a mail carrier and has a walking route that takes 3 hours each day. She consumes a diet high …

An episode of low-value care delivered to my father

Victor Lee, MD

Physician

October 30, 2015

My father recently visited his internist with complaints of vague chest symptoms and was referred to a cardiologist who recommended coronary CT, ultrasonography, and angiography. A cardiac workup would seem to be a reasonable course of action given that he has a history of coronary artery disease (CAD) with prior angioplasty.

However, upon further exploration, I felt that his chest symptoms were due to stress and were not of cardiac origin. …

A cancer patient who had bad luck with clinical trials

Nathan A. Pennell, MD, PhD

Conditions and Diseases

October 30, 2015

I am superstitious, and I freely admit it. I don’t use the word “cure” with patients until the 5-year scan has come and gone cleanly. I don’t celebrate the scans showing tumor response until I see them myself and make sure I am not mixing up the new scan with the old. And one of my most closely held superstitions …

The unsettling incongruity of a medical student’s “lucky” day

Connie Shi

Medical Education

October 30, 2015

“She has a pneumothorax. You ever placed one of these before?”

The senior resident handed me a chest tube. An intern who had been standing nearby smiled and quipped, “It’s your lucky day.”

Three weeks into my surgery rotation — my first rotation of third year — I was taking a night shift in the emergency room when paramedics wheeled Ms. P into the trauma bay, frail and bruised, hardly breathing. Oftentimes, …

It’s time to rethink pink during Breast Cancer Awareness Month

Kathryn A. Hughes, MD

Conditions and Diseases

October 30, 2015

“Isn’t she … isn’t she pretty in pink?”
– Psychedelic Furs, Pretty in Pink

October in New England. The sky is a brilliant blue, the leaves on the trees are turning impossible shades of orange, yellow, and red.

October is Breast Cancer Awareness Month, so in addition to the brilliant fall colors all around, people are wearing pink clothing and pink ribbons, and products on …

Beyond the death count: The psychological casualties of mass violence

Cheryl Sharp, MSW

Conditions and Diseases

October 30, 2015

On October 9th , while President Obama was attempting to console the victims of the October 1st mass shooting at Umpqua Community College (UCC) in Oregon, two more students were killed, and five people were wounded at colleges in Arizona and Texas.

In Flagstaff, Arizona, a gunman opened fire at Northern Arizona University. Hours later, Texas Southern University (TSU) classes were canceled at the Houston school as the campus was locked down …

Why reform needs to start at cancer care

Brian Klepper, PhD

Medications

October 29, 2015

Recently, the clinically positive results from the CLEOPATRA oncology trial were released, showing that pertuzumab, when added to docetaxel and trastuzumab as first-line chemotherapy, produces an average survival benefit of 15.7 months in HER2 positive breast cancer patients.

That good news notwithstanding, the authors calculated that Genentech’s price for adding pertuzumab to gain one quality adjusted life year is a breathtaking $713,219. In …

My patients have shown me that medicine is a universally spoken language

Sarah Mongiello Bernstein, MD

Medical Education

October 29, 2015

Lately, there seems to be a lot of negativity surrounding the practice of medicine. From the staggering student debt, to the grueling hours as a resident, to the high rate of burn out, it sometimes feels as though this profession is constantly under attack. To be honest, I’ve threatened to quit medicine so many times over the last decade that it’s become somewhat of a family joke. I even went …

The discovery period regarding the existence of life

Kevin Haselhorst, MD

Physician

October 29, 2015

What do I need to know as I age? While scientists ponder the questions of water existing on Mars and if it can essentially sustain life, my duty it to assess if there is life left in Oliver — a nursing home patient transferred to the ER. Oliver was not oxygenating well but appeared to be resting comfortably. Reportedly, Oliver had fallen that day and EMS discovered a sizeable bruise …

Why we need to pay attention to lung cancer

Gerard Silvestri, MD

Conditions and Diseases

October 29, 2015

In the past year, the CHEST Foundation, the foundation of the American College of Chest Physicians, has created public service announcements and surveyed fans at sporting events such as the Daytona 500, Green Bay Packers football games, and the Indy 500. We’ve asked them questions about lung cancer, and the answers we’ve received aren’t too surprising.

When asked, “What is the …

Ease the transition to hospice care in the family home

Regina Holliday

Patient

October 28, 2015

It is a pattern oft repeated in a lifetime:

You go to the doctor’s office, get a prescription, and go home.

You go to the urgent clinic, get care, and go home.

You go the hospital, get better, and go home.

But some people are very surprised when they go to inpatient hospice, are stabilized and told to go home.

Inpatient hospice could be within a hospital, nursing home, or a dedicated hospice facility. The …

What creates a toxic hospital culture?

Val Jones, MD

Physician

October 28, 2015

Hospital culture is largely influenced by the relationship between administrative and clinical staff leaders. In the “old days” the clinical staff (and physicians in particular) held most of the sway over patient care. Nowadays, the approach to patient care is significantly constricted by administrative rules, largely created by non-clinicians. An excellent description of what can result (i.e., disenfranchisement of medical staff, burn out, and joyless medical care) is presented Read more…

What creates a toxic hospital culture?

Bad data vs. no data: Defending ProPublica

Ashish Jha, MD, MPH

Health Policy

October 28, 2015

In July the investigative journalists at ProPublica released an analysis of 17,000 surgeons and their complication rates. Known as the Surgeon Scorecard, it set off a firestorm. In the months following, the primary objections to the scorecard have become clearer and were best distilled in a terrific piece by Lisa Rosenbaum. As anyone who follows me on Twitter knows, I am a big fan of Lisa — …

There are too many cooks in the health care kitchen

Suneel Dhand, MD

Physician

October 28, 2015

There’s a new epidemic sweeping American hospitals, and a cure is desperately needed. It’s highly contagious and causes the sufferer much anxiety and psychological suffering. It also costs the health care system millions, if not billions, of dollars a year. You may never have heard of it. You won’t find it in the medical textbooks nor will you hear any of the …

Will your anesthesiologist leave the OR? Patients deserve to know.

Karen S. Sibert, MD

Physician

October 27, 2015

“For some must watch, while some must sleep.”
– William Shakespeare, Hamlet

I admit, I was taken aback at the headline that ran in the Houston Press today: “Going under: What can happen if your anesthesiologist leaves the room during an operation.”

It’s bound to make the curious reader wonder why the anesthesiologist would leave the operating room in the first place.

Of course, reporter Dianna Wray explains that in many hospitals, …

Transparency in medicine can be misleading, but it’s necessary

Robert Wong, MD

Health Policy

October 27, 2015

Transparency in medicine is a good thing

When the Center for Medicare and Medicaid services (CMS) publicly disclosed the 2012 CMS reimbursements to physicians, the response was immediately felt throughout the medical community. As a practicing physician, we were warned of this day. Can’t say we prepared for it, but we sure did brace for it.

And sure enough, on April 9, 2014, the New York Times published on their website a …

A rotation in Uganda provides perspective to this medical student

Teagan L. Lukacs

Medical Education

October 27, 2015

In May 2014, I gave my Grandma Lou a call to say goodbye before heading to Guatemala for two months of research. She took the opportunity to tell me her cancer had relapsed, and she didn’t think she wanted treatment. I was so anxious the entire trip that that phone call would be my final goodbye to Grammy but she conceded to my family’s pleading to receive treatment that was …

Real physician voices, twice a week

The Podcast

Latest episodes

The Podcast

Latest episodes