KevinMD.com

Is it more dangerous for your baby to be born at home?

Conditions and Diseases

August 21, 2014

From time immemorial until about 75 years ago or so most babies were born at home. Now it’s around 1% in the USA, although it’s much higher than that in many Western European countries. The shift to hospital births paralleled the growth of hospitals, pediatrics, and obstetrics. With that shift there has been a perceived decrease in women’s autonomy over their healthcare decisions.

There has also been an unsurprising jump in …

Why do doctors ignore their own self-care needs?

Starla Fitch, MD

Physician

August 21, 2014

Most busy doctors completely forget (or ignore) the importance of integrating personal downtime and self-care into their schedules.

It’s no surprise so many doctors wrestle with overwhelm. Downtime is crucial for stress management.

What about you? Are you guilty of skipping your “you time?”

No, I don’t mean attending a seminar, reading an article, or talking about stress reduction at a staff meeting.

I mean, when is the last time you scheduled some real …

Missed opportunities give leverage to cancer

Kenneth D. Bishop, MD, PhD

Conditions and Diseases

August 21, 2014

Last week a patient said to me, “You live your whole life thinking you’re going to have time to enjoy life later on, and then this happens.” Then he started to cry because we had just reviewed his recent CT scans and some of his lab results and he had a new diagnosis of a type and stage of cancer that meant he likely had about eight months to live. …

How to move the needle on wellness

Dean Ornish, MD

Physician

August 21, 2014

When it comes to preserving health and prolonging life, study after study shows that prevention is essential. From type 2 diabetes to early-stage prostate cancer, clinical trials have demonstrated that countless diseases can be avoided or even reversed through (often simple) lifestyle changes. We know the solution. Yet the challenge is reaching it. For example, tens of millions of overweight Americans are dieting at any given moment, but only a …

Read more…

How to move the needle on wellness

How we cope with a cancer diagnosis starts in childhood

James C. Salwitz, MD

Physician

August 21, 2014

A baby’s smile reflects the purity in their heart. An infant’s world is a marvelous place of possibility and love. Children see themselves as special, capable, even omnipotent. Time teaches failure, loss, and mortality. How much we lose of that original perfection, that first excitement, that natural confidence, determines how we face the challenges and tragedies of life; whether we will be happy. It may even determine how we cope …

Top 10 ways to know it’s time to quit your job as a doctor

Pamela Wible, MD

Physician

August 21, 2014

QUIT-640x423

Attention all doctors: The first three are mine. The rest are from miserable colleagues. All true. And common. If you’re a doctor and you recognize anything on this list, please quit your job.

10. You feel nauseated when you see your clinic logo; you alter your commute to avoid streets with your clinic’s billboard.

9. Discouraged by the general despair among staff, you …

What a golf course taught me about patient satisfaction

Suneel Dhand, MD

Physician

August 20, 2014

Over the last year I’ve become rather addicted to golf. Having always been more into cardiovascular sports I’m actually quite surprised with how much I’ve taken to it. Fresh air, outdoors, lots of walking in beautiful nature and spending time with friends — what is there not to like?

Anyway, I’ve frequented several different courses in the Boston area in just the last few months. Last week, we were due to …

A physician reflects on Robin Williams

David L. Katz, MD

Physician

August 20, 2014

I was shocked and deeply saddened when my daughter announced at the dinner table that Robin Williams had died of an apparent suicide. My wife and I and the three of our children home at the time all pretty much gasped audibly in unison, and then for a moment after, you could have heard a pin drop.

For a bit after that, we talked about our shock and sorrow. And then after that, …

Read more…

A physician reflects on Robin Williams

Why do some patients go to the doctor in the first place?

Jordan Grumet, MD

Physician

August 20, 2014

William was doing great. His C. Diff was finally gone after a month taper of vancomycin. He was stronger. The nursing home staff reveled in how much progress was being made over such little time. It seemed every one was ecstatic, except for, of course his family. Every step this octogenarian took forward was accompanied by a litany of concerns and complaints from his daughter.

If he was not gaining weight, …

Being a good parent means being unpopular sometimes

Claire McCarthy, MD

Physician

August 20, 2014

I see it again and again in my practice: parents who seem to have forgotten that they are in charge.

“You can say no,” I find myself saying to family after family. Which is kind of an amazing thing to have to say, if you think about it. You’d think that parents would know that they can say no when their child asks for yet another toy, to watch more television, …

Society’s mismanagement of the mentally ill is a disgrace

Allen Frances, MD

Conditions and Diseases

August 20, 2014

We are civilized people in the United States. We don’t set up leper colonies or concentration camps or psychiatric snake pits to banish people with severe mental illness. Instead we send them to jail or prison — almost 400,000 of them, more than 10 times the number receiving care in hospitals. And we also blithely ignore the fact that additional hundreds of thousands live homeless on the streets or in …

Teach the basics of practice management to medical students

Raymond Tsai, MD

Physician

August 20, 2014

For three years before I applied to medical school, I worked in post-Katrina New Orleans helping to rebuild school-based health centers. One of the main challenges, however, was how to create a sustainable safety net for at-risk youth to whom we were hoping to provide much needed health services — key word being “sustainable.”

All too often, there isn’t funding to carry out primary care’s mission of improving the health of communities and …

The dilemma of eating locally-sourced foods

Keith-Thomas Ayoob, EdD, RD

Conditions and Diseases

August 19, 2014

In my pediatric nutrition practice, I often preach about getting more fruits and vegetables into the diets of the children I see. Eating more vegetables is a proven way to fight obesity and promote better health.

Sometimes the question of where and how to find healthy food comes up during my conversations with parents. Many of my clients reside in the Bronx, where sometimes the closest vegetable is the pickle on …

Oncologist pay and chemotherapy: Buy and bill needs to stop

Robert Pearl, MD

Physician

August 19, 2014

Today’s article highlights the lingering problem of physicians buying and selling prescription medications to patients — at a profit.

The medical profession has struggled with this controversial practice for more than 150 years.

In George Eliot’s 1874 novel “Middlemarch,” an idealistic young doctor named Tertius Lydgate questions the ethics of fellow physicians who make handsome profits prescribing and dispensing their own remedies to the townsfolk. His medical colleagues shun him for it.

Around …

A pediatrician’s weight loss journey

Randy Rockney, MD

Physician

August 19, 2014

When I was in medical residency, more than thirty years ago, I ran with a pack of fellow residents, all guys who were fit to varying degrees. Once, on an outing, we discussed the — hopefully — hypothetical question: “If the need arose, which one of us would we eat first?”

“Randy!” my friends gleefully concluded.

“His meat would be the most marbled,” one added.

I’ve never been fat. More accurately, my body …

Read more…

A pediatrician’s weight loss journey

Selecting grittier surgeons is harder than you think

Skeptical Scalpel, MD

Medical Education

August 19, 2014

In case you haven’t noticed, a hot new topic in education is “grit.” In order to reduce the long-standing 20% attrition rate of surgical residents, some say we should select applicants who have more grit or conscientiousness.

A recent paper in Surgery reported residents who dropped out of programs had decreased levels of grit as measured by a short-form survey. But due to unexpectedly low attrition rates in the surgical programs …

The ethical dilemma of saving the American Ebola patients

Deep Ramachandran, MD

Conditions and Diseases

August 18, 2014

It was with much fanfare that two American aid workers were airlifted from across the world and brought to Emory University Medical Center where they began experimental treatment for Ebola. We hope for a full and speedy recovery for them and others like them who do God’s work.

But it appears to me that lost in this conversation are myriad others who need help but never get it. Right now, humanitarian work …

Vaginal video games: What to make of mobile Kegel apps

Jennifer Gunter, MD

Health Technology

August 18, 2014

k goal

There are two new high-tech ways that aim to help you with Kegel exercises, both with Kickstarter campaigns. There is the Skea (Smart Kegel Exercise Aid), basically a video game that proposes controlling the avatar with a vaginal probe that uses the pelvic floor muscles and kGoal, a vaginal insert that is meant to connect wirelessly with your smart phone and measures your squeeze …

Marcus Welby won’t survive today

Steve Jacob

Physician

August 18, 2014

An excerpt from So Long, Marcus Welby, M.D.: How Today’s Health Care Is Suffocating Independent Physicians – and How Some Changed to Thrive.

A 30-ish public-relations executive representing a large, modern physician practice was shaking her head in puzzlement.

Her physician client liked to talk about how his practice was not “a Marcus Welby shop,” meaning that its approach and technology reflected the best the 21st century had to …

Read more…

Marcus Welby won’t survive today