KevinMD.com

Less time, more patients: The perverse incentives of medicine

Health Policy

March 27, 2015

As the Affordable Care Act continues to impact millions of Americans through its second year of implementation, many things have become clear to both patients and health care providers alike: nothing is as it seems. While the ACA has provided health care to millions of previously uninsured Americans, it has also robbed many patients of their doctors and has forced others into higher premium, lower service plans. Even those with …

Patient refuses ED discharge: Admitted to the hospital against medical advice

FirstWorldEM, MD

Physician

March 27, 2015

The following article is satire.

In the first application of a new “reverse AMA” system put into place to improve patient satisfaction, a patient was admitted to the hospital for the first time against the wishes of her treating ED physician. Constance Dolor, a 37-year-old morbidly obese patient with chronic unexplained pain and a frequent visitor to the emergency department, became the first person in known history to be admitted the …

Doctors being too nice leads to their burnout

Starla Fitch, MD

Physician

March 27, 2015

shutterstock_175876592

It came out of nowhere. One of those life lessons that I didn’t know I needed to learn. Until I did. There I was, at a weekend business retreat, hobnobbing with a group of women executives. Feeling only slightly out of my element. Trying to blend in.

There was a break in the meeting. And what happened next made me rethink how …

This is who is behind every doctor

Jordan Grumet, MD

Physician

March 27, 2015

Behind every doctor is a little boy or girl who once watched helplessly. Maybe it was her father or grandfather who suffered under the weight of a disease that was deemed all but incurable. Perhaps her own skin was battered and bruised by the repeated trauma of an unrelenting tourniquet. She swore that when (if) she got older she would protect the innocent from such things. Her vow was the …

Read more…

This is who is behind every doctor

Where does the doctor stop and computer begin?

James C. Salwitz, MD

Health Technology

March 26, 2015

shutterstock_233430226

Where does doctor stop and computer begin? Who is in charge? Do we care? Are these silly, academic questions from some sci-fi future or is it an onrushing tomorrow?

Consider:

Ten years ago, the EMR recorded the date you or your nurse gave Sam his flu shot.
Today, the EMR reminds you it is time to have your nurse give Sam his flu shot.
Soon, the EMR will order the flu …
Read more…

Where does the doctor stop and computer begin?

Digital natives: Implications on physician evaluation

Joshua Liao, MD

Medical Education

March 26, 2015

I recently had an interesting conversation with several co-residents about how our health care system should evaluate physician performance. If nothing else, the discussion highlighted how challenging this issue has been for almost all medical specialties, including internal medicine, where the controversy has been punctuated by debates about maintenance of certification (MOC) and licensure. It remains to be seen what will develop after the American Board of Internal Medicine recently …

Changing the way we think about cancer

Jack C. Westman, MD

Conditions and Diseases

March 26, 2015

The sun rises and the sun sets. It seems like the sun rotates around the Earth. Cancer cells rise and are killed by surgery, radiation and chemotherapy. It seems like cancer is a disease. But the sun does not rotate around the Earth, and cancer is not a disease. The many kinds of cancer cells are the products of the disease neoplasia that can emerge in our bodies’ organs and tissues.

Strange …

Read more…

Changing the way we think about cancer

The unsustainable SGR: It’s time to stop kicking the can

Josh Lesko

Health Policy

March 26, 2015

SGR has been the bane of my time in policy. And I want it to be yours.

SGR, formally known as the sustainable growth rate, is a formula developed under none other than the Balanced Budget Act (the same one that set the cap for GME-funded residency slots at 100,000) to determine the Centers for Medicare And Medicaid Services (CMS) reimbursement payments to physicians. And because the universe loves a good …

I’m not apologizing for my part-time role in medicine

Anonymous

Physician

March 26, 2015

Over the course of pre-professional and professional education, my colleagues and I have had numerous moments of self-doubt. Would the next organic chemistry exam eliminate my 3.99 GPA? Would the MCAT decide what medical schools would immediately ignore me without ever meeting me? Would the sheer volume of material weed out the persons sitting next to me in medical school or …

The obsession with numbers in medicine: It’s time to stop

Shirie Leng, MD

Physician

March 25, 2015

Medicine is obsessed with numbers. Or rather, journalists and medical administrators are. Here are two related examples of how large a grain of salt one must put on numbers.

Cardiac surgical procedures, like everything else in medicine, have quality indicators. One of these is what we doctors call “30-day mortality.” What this term means is that surgeons are evaluated in part on how many of the patients they operated on died …

Remember the psychological harms of cancer screening

Kenneth Lin, MD

Conditions and Diseases

March 25, 2015

Several years ago, a few colleagues and I performed a systematic evidence review to help update the U.S. Preventive Services Task Force’s recommendations on screening for prostate cancer. One of our key questions asked about the harms associated with prostate cancer screening, other than the overdiagnosis (and resulting unnecessary treatment) of clinically insignificant tumors. Since routine prostate-specific antigen screening had been going on for nearly two decades by then, we expected to …

Coping with a move: A medical marriage Q&A

Kim Blackham

Physician

March 25, 2015

Question:

My family (including two small children) and I are relocating this summer for my husband’s new job after seven years of living in the same area for residency and fellowship to a city where I know no one. I am scared about leaving our support network of friends and family nearby. Can you offer advice on starting over in a new place?

Answer:

I would guess that almost every physician family has …

Why I started a cuddling program in the NICU

Jessie Evangelista

Conditions and Diseases

March 25, 2015

When I was in kindergarten, my school bus used to drop me off at the hospital where my mother worked. My older sister and I would sit quietly in my mom’s office and do our homework while she finished up her work. Most of my friends would get stickers or McDonald’s for their good behavior, but if my sister and I were on our best behavior, my mom would reward …

Health disparities are glaring, but the solutions aren’t obvious

Robert Pearl, MD

Health Policy

March 25, 2015

The country is in a state of health care denial. Politicians, pundits, and executives proudly declare America’s medical care is the best in the world. But it isn’t.

The U.S. lags behind other industrialized nations in many important health measures — partly because citizens of certain races, ethnicities and incomes experience poorer versions of U.S. health care than others. The disparities are glaring. The solutions aren’t nearly as obvious — but we’ll explore some …

Heal the ill but don’t hound the well

Dr. Saurabh Jha

Physician

March 25, 2015

An iconoclast must not only have abundant common sense but the gift of the gab to state the obvious. Simply stating won’t do. You must rub it in.

My favorite iconoclasts are Peter Skrabanek and Thomas Szasz. Skrabanek was a general practitioner who authored Death of Humane Medicine and Rise of Coercive Healthism. Szasz, a psychiatrist, who volunteered that he entered psychiatry to unveil its pseudoscience, is the Voldermort …

Read more…

Heal the ill but don’t hound the well

The day that I truly became a cardiology fellow

Chiduzie Madubata, MD

Physician

March 24, 2015

As a fellow in cardiology, you sign up to be part of a specialty that can involve emergencies.

As a first-year fellow, usually you are running things by other senior fellows and attendings, and typically you are not the first person to make a decision on a plan. At times, though, there can be an exception to that rule, and it is …

The last breath can be seen as a the passage into eternity

Kathryn A. Hughes, MD

Physician

March 24, 2015

Eonia I Mnimi (Eternal Memory)
– Greek Orthodox Funeral Blessing

“Have you ever seen anyone die before?” my cousin asked me, from across the bed.

“Sure I have, plenty of times,” I answered.

We were flanking her father, my uncle (really, my mother’s cousin, but extended Greek families are complicated; suffice it to say that our families are very close). He had just taken his last breath.

***

My uncle had been declining for several years with Lewy …

Sometimes, the very best medicine is a listening ear

Sanyu Janardan

Conditions and Diseases

March 24, 2015

I was a first-year medical student, starting my first afternoon at an outpatient clinic as part of an introductory course in clinical medicine. My white coat was freshly washed; I had a rainbow of pens in one coat pocket, and my shiny name tag dangled from the other. I only hoped that I was as prepared as I looked.

I entered Mrs. Carr’s room. A fifty-five-year-old woman, she sat gingerly at …

One of the greatest rewards in health care

Maria Yang, MD

Physician

March 24, 2015

When he and I first met, he told me that he had a doctoral degree in psychology, was the CEO of the jail, and could speak 13 languages. To demonstrate, he said, “Hong tong ching chong lai tai!” He then punched the door to his cell and shouted, “GET THE F-CK OUT OF HERE, B-TCH!”

I did.

The next week, he answered my questions about the pencil drawings on his walls.

“My name …

Television ruins your sleep. Here are 5 ways how.

Deep Ramachandran, MD

Conditions and Diseases

March 24, 2015

As a sleep physician, I spend a lot of time educating patients about what sleep is and how it works. Sleep, as I often explain, is not simply the lack of being awake; any more than landing a plane is simply the lack of flying. It’s becoming increasingly understood that sleep is an actively generated state, created by a series of …

Most Popular

Past Week

Past 6 Months

Recent Posts

Subscribe to KevinMD and never miss a story!

Most Popular

Past Week

Past 6 Months

Recent Posts