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Treating cancer should not be paved in our patients’ financial despair

Physician

April 24, 2014

Martha (name changed) had recurred yet again — her third in as many years. Despite our best attempts, remission proved fleeting. Fortunately, she had few (if any) symptoms of the cancer in her abdomen; no bloating, no nausea, no difficulty moving her bowels. Her concerns were more psychological — anxiety and frustration because her cancer refused to go away, and indeed, …

The Medicare spending we should be concerned about

Leslie Kernisan, MD, MPH

Health Policy

April 24, 2014

“Do patients care about how much money their doctors make?”

This is the headline of a recently published post by Trudy Lieberman, and was written in response to the recent New Your Times’ coverage of Medicare disclosing payments to individual providers.

Now, I found the Times story fascinating on many levels, but I’ll admit it hadn’t occurred to me that the main value of this data release is that patients can …

The Affordable Care Act has made restaurants more partisan

Peter Ubel, MD

Health Policy

April 24, 2014

Politics in the US is discouragingly partisan. National politics has become increasingly partisan since at least the late ’60s, when the passage of civil rights legislation influenced many conservative southern Democrats to join the Republican Party. Even state politics has become more partisan, where even famously nice people in Wisconsin have found themselves battling their neighbors across political divisions. Fortunately, most of life does not force us to confront our political differences, meaning …

The residency chances of offshore medical school graduates

Skeptical Scalpel, MD

Medical Education

April 24, 2014

A year ago in a post about law school applications decreasing, I speculated about whether a similar phenomenon would occur with medical schools.

In that post, I commented on the impending problem of too many medical school graduates and not enough residency training positions. I cited an article that appeared in the New England Journal of Medicine in 2011 in which the CEO of the Accreditation Council for Graduate Medical …

The deadly consequences of media distortion in health and medicine

David L. Katz, MD

Physician

April 24, 2014

The recent concentration of misleading media hooey about health has been excruciating, but the problem is perennial. I trust I needn’t make the case that you are under constant assault by distorted, contorted, titillating, and insipid headlines. This is certainly true in my domain of health and medicine; it may well be true more generally, but I tend to limit my commentary to the realm of my actual expertise. But to …

Those who watch a spectacle share in the guilt of those who create it

Anonymous

Medical Education

April 23, 2014

I stood right beside them as they slowly slid your head into a plastic bag, looped the coarse twine about your neck and tied it tightly. Like the amateurs they were, they double-knotted it to make sure nothing came loose or dripped out. Then they casually walked away, chatting about what would come next.

Within minutes the bag fogged up, and a clear red liquid pooled at the bottom.

That was just …

Sluggish cognitive tempo is a dangerous diagnostic idea

Allen Frances, MD

Conditions and Diseases

April 23, 2014

Sluggish cognitive tempo may possibly be the very dumbest and most dangerous diagnostic idea I have ever encountered.

And I have seen some beauts during my forty years of shooting down crazy new diagnostic dream lists. The wild suggestions are usually created by “experts” brim full with diagnostic exuberance — sometimes well meaning, sometimes influenced by extensive drug company affiliations — and always ungoverned by simple common sense, a respect for …

Tort reform should not be controversial

Michael Kirsch, MD

Physician

April 23, 2014

I’ve been in the medical malpractice arena many times, and always walked away unharmed. If this system were presented in front of a fair minded and impartial jury, it would be dismantled. Sure, there are positive elements present, but they are dwarfed and suffocated by the drawbacks. The self-serving arguments supporting the current system are far outweighed by the financial and emotional costs that innocent physicians unfairly bear. Tort reform …

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Tort reform should not be controversial

Can high-tech medicine also be high value?

Karan Chhabra

Physician

April 23, 2014

“Can you hear it?” she asked with a smile. The thin, pleasant lady seemed as struck by her murmur as I was. She was calm, perhaps amused by the clumsy second-year medical student listening to her heart.

“Yes, yes I can,” I replied, barely concealing my excitement. We had just learned about the heart sounds in class. This was my first time hearing anything abnormal on a patient, though it was …

What do European doctors say about our guidelines for statins?

Janice Boughton, MD

Medications

April 23, 2014

In November of last year the American Heart Association released to recommendations on who should be taking statins (drugs like Lipitor/atorvastatin), the most common medicines we use to control cholesterol levels. High cholesterol levels are associated with higher risk of heart attacks and strokes, and taking statins, which lower cholesterol, can reduce those risks. The drugs have pretty significant side effects, though, and not everyone with high cholesterol …

Lessons learned during an unplanned EMR downtime

Yul Ejnes, MD

Health Technology

April 23, 2014

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

On a Thursday in April, my practice upgraded its electronic health record to the next version, the “latest and greatest” with more features, as well as compliance with meaningful uses 2 through infinity. That was the good news. The bad news was that it meant that our EHR …

Doctors and nurses are being overloaded with menial tasks

Jordan Grumet, MD

Physician

April 22, 2014

I’m no economist. In fact, I have never taken any business or accounting classes in my life. But it doesn’t take a formal education to get this. We are speeding down the wrong path.

The call at three in the morning woke me from a deep sleep. I fumbled and strained to hear the whispered voice of the apologetic nurse. Apparently Mrs. …

Where are we losing America’s future primary care physicians?

Michael Bradfield, MPH

Medical Education

April 22, 2014

I know where America’s future primary care physicians are, and more importantly, where we are losing them. I am one of them, and I almost got lost.

Maybe I was naïve. I’d had no math or science classes as an undergraduate, and I’d never really thought about the mechanics of medical education. Even while jumping through all the prerequisite hoops before applying, it never occurred to me how inadequate my non-traditional …

7 steps to eliminating the war analogy in cancer care

Matthew Katz, MD

Conditions and Diseases

April 22, 2014

From a philosophical standpoint, one of the things I hate most about cancer is the use of “war” analogies. The “battle” may mobilize patients and families, but it may also interfere with education and informed decision making. And both patients and clinicians often take recurrence or disease progression personally as a failure. Even when everything is done perfectly, the outcomes aren’t. Why …

How a hospice model can save American health care

James C. Salwitz, MD

Health Policy

April 22, 2014

America is one of the sickest places on earth. We have the best diabetic care, but the most diabetes. First-rate cardiac care, but we are obese, hypertensive, inactive, and have high rates of heart disease. We are the world’s standard for cancer technology, innovation and access, but we have high cancer rates even while we waste most of the money from cigarette taxes on road repairs. At every socioeconomic level, …

How to fix the problem of patient handoffs

Val Jones, MD

Physician

April 22, 2014

One of my biggest pet peeves is taking over the care of a floor full of complicated patients without any explanation of their current conditions or plan of care from the physician who most recently treated them. Absent or inadequate verbal and written “handoffs” of patient care are alarmingly common in my experience. I work primarily as a locum tenens physician, traveling across the country to “cover” for my peers on vacation …

There are no quick fixes to hospital-acquired infections

Peter Pronovost, MD, PhD

Health Policy

April 22, 2014

Recently, the U.S. Centers for Disease Control and Prevention issued two reports that are simultaneously scary and encouraging.

First, the scary news: A national survey conducted in 2011 found that one in every 25 U.S. hospital patients experienced a healthcare-associated infection. That’s 648,000 patients with a combined 722,000 infections. About 75,000 of those patients died during their hospitalizations, although it’s unknown how many of those deaths resulted from the …

Measles and the media: Are parents are being duped?

Wendy Sue Swanson, MD

Conditions and Diseases

April 21, 2014

Something is in the air right now. There’s a strange mix of vaccine-preventable illness sweeping the country (measles) and a strange bump in media coverage for celebrities and vocal opponents to tested and recommended vaccine schedules. Part of me thought we might be done with that but pageviews, clicks, and views all sell.

My hope is the coincidence of coverage and outbreaks is just that, a coincidence. But as a mom, …

The relevance of physicians is dwindling rapidly

Luis Collar, MD

Physician

April 21, 2014

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I spend way too much time worrying about “silly” things, things I have no control over. I know this because my wife frequently catches me in the act and urges me to relax, to focus on what I can change. But despite her best efforts, I recently fell off the wagon again and became obsessed with a simple, seemingly innocuous question: Are physicians still …

The ICD-10 emperor has no clothes

Betsy Nicoletti, MS

Health Policy

April 21, 2014

The howling about the delay of ICD-10 was loud and fierce. It seems the quality of health care in the United States depends on our ability to use 68,000 diagnosis codes. The rest of the world has switched to ICD-10, and we alone insist on using an outdated coding system. Here’s a secret. The World Health Organization’s version of ICD-10 has about 16,000 codes, equivalent to ICD-9-CM. The rest of …

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The ICD-10 emperor has no clothes

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