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The gun violence epidemic is a traumatic injury epidemic

Physician

March 16, 2015

“What brings you in today?” I asked my new patient, a healthy appearing clean cut 35-year-old married man with kids.

“Check me out, doc.” (STD check? chronic disease screen?) “My brother was just diagnosed with diabetes; I want to make sure I’m OK.” (OK, easy — sugar and cholesterol check)

No prior medical problems for him.

Prior surgeries? At this question, he paused.

“I was shot in the leg last summer leaving work,” he said. “I lost …

We are overprescribing statin medications for high cholesterol. Here’s why.

Richard Young, MD

Medications

March 16, 2015

The American Heart Association (AHA) recently proposed new guidelines for all doctors to screen and treat for high cholesterol. For doctors and patients to follow, this would result in a large increase in the number of Americans taking statins.

One of the things I like about the new proposal is that there is no more chasing a number. This was frustrating for doctors and patients to keep having lab draws and medication …

The paradox of physician communication

Kathryn A. Hughes, MD

Physician

March 16, 2015

Physicians have so many ways to communicate. Yet why are they so far apart?

Communication Breakdown, It’s always the same, I’m having a nervous breakdown, Drive me insane!
– Communication Breakdown, Led Zeppelin

Oh why can’t we talk again? Don’t leave me hanging on the telephone!
– Hanging on the Telephone, Blondie

I honestly don’t know how they did it, how doctors practiced and communicated effectively in the days before our modern technology, with computers, …

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The paradox of physician communication

Will cuts to Medicare Advantage reduce quality?

Tanya Feke, MD

Health Policy

March 15, 2015

The feds are at it again. Medicare is in the cross hairs with an anticipated 0.9 percent cut to Medicare Advantage plan payments in 2016. The final decision is to be made on April 6 of this year.

Medicare Advantage plans are an alternative to traditional Medicare. Traditional Medicare consists of Part A (hospital) and Part B (medical) coverage. Medicare Advantage plans (Part C) can be chosen in place of the …

Using algorithms to beat down our physician colleagues

Luis Collar, MD

Physician

March 15, 2015

An excerpt from A Quiet Death.

Even as I lay perfectly still in the near-complete silence of my car, I could hear Dr. Tierney’s adenoidal voice in my mind. He always seized every opportunity to assure us that his diagnostic or therapeutic approach to patients was firmly supported by the literature. That, at least in the sense he intended it, was pure bullshit.

The medical literature had grown exponentially …

Data-based medicine: The end of evidence-based medicine?

Wenjay Sung, DPM

Health Technology

March 15, 2015

As all kinds of information are being collected about every aspect of our lives, the data generated at this exorbitant rate can lead to advancements in research and health care. That is the idea behind big data” and it’s disruptive benefits for the health care industry. The term encompasses a searchable vast data collection for relative information in order to quickly identify trends. Like all other disruptive innovations, the focus …

Targeting physician salaries: I speak for the ten-percenters

Rocky Bilhartz, MD

Health Policy

March 14, 2015

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I’m a cardiologist. But if you believe the news, you will assume my entire medical specialty is shady and full of morally suspect physicians. Let me tell you why.

Recently, two articles surfaced in the lay press, one published by the New York Times and the other by U.S. News & World Report. Like the majority …

The insufferable patient: You know the one

Jennifer Chevinsky, MD

Medical Education

March 14, 2015

He is that new patient to the clinic.

You know the one.

He is the “multiple chronic conditions” patient. Diabetes, hypertension, COPD, chronic kidney disease, congestive heart failure, arthritis — it would probably be quicker to name the conditions he doesn’t have. You let out a deep sigh before entering the room.

You know the one.

He is the “non-native English speaker.” English isn’t his first language, perhaps not even his second. You try …

Don’t fall victim to health insurance denials

Jane Arnoff Logsdon, LSW

Patient

March 14, 2015

I consider myself a pretty savvy and resourceful consumer. I know how to solve problems that come up in the day to day situations we all face. I have navigated my way through more than a few complicated and sensitive financial situations. Add to that my ability to be persistent, and you would think that I could figure out a simple denial of an insurance claim with ease, right? In …

MKSAP: 66-year-old man with a persistent rash for 6 years’ duration

mksap

Conditions and Diseases

March 14, 2015

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

A 66-year-old man is evaluated for a persistent rash for 6 years’ duration. The rash waxes and wanes in severity, and it becomes pruritic only after he becomes hot and sweating, such as when he mows the lawn or exercises. It has always been limited to his back and lower chest. He …

What does a technology optimist think about the future of health care?

Robert Wachter, MD

Health Technology

March 13, 2015

Andy McAfee is the associate director of the Center for Digital Business at MIT’s Sloan School of Management. He is also coauthor (with his MIT colleague Erik Brynjolfsson) of the 2014 book, The Second Machine Age: Work, Progress, and Prosperity in a Time of Brilliant Technologies, one of my favorite books on technology. While he sits squarely in the camp of “technology optimists,” he is thoughtful, appreciates the downsides of IT, and …

What would truly personalized oncology look like?

Amy Abernethy, MD, PhD

Conditions and Diseases

March 13, 2015

The concept of “personalized medicine” gets thrown around a lot these days. And as an oncologist and a palliative care doctor, who advocates for using data to get information that can provide more personalized cancer care, I believe strongly in it. But what would truly personalized oncology look like?

More than 14 million people are living with cancer in the United States, according to the National Cancer Institute — and some 1.7 …

A letter to physicians refusing to see vaccine-hesitant families

Natasha Burgert, MD

Physician

March 13, 2015

Dear doctor no longer seeing vaccine-hesitant families,

I know that creating your “no tolerance” office-wide vaccine policy was not easy or came without soul-searching. I can only imagine the heated boardroom meetings and passionate arguments throughout the weeks the policy was being drafted. I trust it is because of your support and love for the families you currently care for that you felt the need to create the policy, and it …

10 secrets to success as a female surgeon

Lauren Crawford, MD

Physician

March 13, 2015

I bolted through the conference room door on the first day of residency orientation. The room full of interns shifted in their seats. All one dozen of the faces looking up at me were male. I got some crooked, goofy grins. So began my introduction to the world of surgery.

So, what would I tell my daughter about how to survive and …

The ABIM response to Newsweek determines how far anti-MOC sentiment will spread

Kevin Pho, MD

KevinMD

March 13, 2015

Regular readers here are well-versed on the controversy surrounding maintenance of certification (MOC) and the American Board of Internal Medicine (ABIM).

The story recently made mainstream news, with a comprehensive recap by Newsweek senior writer Kurt Eichenwald: The Ugly Civil War in American Medicine. Go read it.

The ABIM subsequently released a strongly-worded statement. They are clearly not happy with the mainstream media spread …

3 surprising vaccine myths

Roy Benaroch, MD

Medications

March 13, 2015

Myth #1: Vaccines work by preventing disease in individuals who are vaccinated. Nope, that’s not actually true — it’s quite wrong, but in a subtle way. And a misunderstanding of this concept, I think, has led to a lot of mischief. If people understood how vaccines really work, how they can best protect us from disease, it might help overcome some skepticism.

Vaccines do indeed prevent diseases in individuals, but that’s …

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3 surprising vaccine myths

Cupcakes are being banned from school parties. And that’s not a bad idea.

Claire McCarthy, MD

Physician

March 13, 2015

When my older children were in elementary school, I sent in cupcakes for their birthdays or for class parties.

My youngest is in elementary school now, and for his birthday, I sent in pencils and temporary tattoos for classmates — because the school doesn’t allow us to send in sweets anymore.

When the change was first made, my reaction was: For real? Banning …

The phenomenon of the flipped patient

Kerri Vincenti, MD

Physician

March 12, 2015

In a recent article posted in JAMA, authors presented a viewpoint about the phenomenon of the flipped patient when describing the increasing reliance that millennial trainees place on getting to know the electronic health record (EHR) of patients rather than the patients themselves. As I read through the text, I found myself agreeing with the points made by the contributing writers that EHRs are increasingly used as the first line of …

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The phenomenon of the flipped patient

How corrosive cynicism is destroying professional relationships in medicine

Jeffrey Parks, MD

Physician

March 12, 2015

One of the obligations of a medical or surgical specialist is to communicate with the referring primary care provider. This can take many forms: a phone call, texting via smartphone, email, messages sent via EMR, and dictated letters. The format is pretty standard no matter what medium is chosen. You thank the referring doc for the consult request, you give some brief background info about the patient in question, and …