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Sleight of hand: The SGR bill’s important policy changes

Health Policy

April 8, 2014

What would you think if I told you that Medicare will require laboratories to disclose to CMS payment rates from private insurers? Or that they will identify physicians who order a high volume of CT tests and require them to pre-authorize those tests in 2020? How about that CMS will begin its own analysis of the time and cost of providing services in order to determine RVUs, a job currently …

When pediatricians write prescriptions for off-label use

Roy Benaroch, MD

Medications

April 7, 2014

You know those little packets of paper, folded over eight times, written in type that can’t possibly be seen? You’ve seen them glommed onto the side of stock bottles of medications, or shoved into the paper box alongside a tube of prescription ointment. That unreadable thing is the official “product information,” often called the “label,” required for every FDA-approved medication. It contains all sorts of information, including lists of Read more…

When pediatricians write prescriptions for off-label use

Why you should care about translational research

Harry Shamoon, MD

Medical Education

April 7, 2014

Translational research is a catchphrase in biomedical circles these days. But if you’re confused about what the term really means, you’re not alone.

It was 35 years ago when I first heard the term “translation” in a scientific context. It was about enabling basic research undertaken by the National Institutes of Health (NIH) to find its way into treatments for patients. Though that sounds pretty straightforward, I still have to explain …

Can narrative medicine inform quality of care?

Don S. Dizon, MD

Physician

April 7, 2014

As characterized by Dr. Rita Charon in her JAMA article almost 15 years ago, narrative medicine is “the ability to acknowledge, absorb, interpret, and act on the stories and plights of others.” It is the recognition that scientific knowledge alone is not enough — not enough for our patients, for ourselves, and for society. It stresses the importance of not only hearing what our …

An erosion of privacy in health care settings

Abigail Schildcrout, MD

Physician

April 7, 2014

Our privacy is eroding. Some of this erosion is our own fault — we post to Facebook, Twitter, and other social media with reckless abandon. Some is the nature of modern communication — electronic trails are just as easy to find as paper trails (if not easier). Some of the privacy erosion really doesn’t bother me so much — if Target knows that I buy a lot of Cheerios, I’m …

Physician report cards make no difference in referral patterns

David B. Nash, MD, MBA

Health Policy

April 6, 2014

Back in 1986, the Health Care Financing Administration launched the brave new era of quality reporting in this country by releasing “report cards” that detailed hospital-specific, risk-adjusted mortality rates for coronary artery bypass graft (CABG) surgery.

Since that time, the number and type of publicly reported quality outcomes has grown exponentially with the goal of helping patients make informed decisions when selecting doctors, thereby driving quality improvement by doctors and hospitals.

Has …

For all those executed, the cause of death is homicide

Joel Zivot, MD

Physician

April 6, 2014

On March 10, I found myself at the front gate of the Florida State Prison, stethoscope and blood pressure cuff in hand, to examine Robert Henry at the request of his public defender.

Henry is scheduled to be executed Thursday evening by lethal injection. His crime was the murder of two people during a robbery more than 30 years ago.

He’s a 55-year-old African-American man with hypertension, elevated cholesterol, and a history …

Feedback your patients wish you knew about portals

Dana Tee

Patient

April 6, 2014

I’m not a doctor. And sure, you know your patients better than I do. But, I have been a patient and as a patient, I know how we think. As someone who works in health IT helping to create software to better connect patients and providers, I like to think I have a hypersensitive pulse on what’s going on.

I know that as patients, sometimes we get frustrated trying to solve …

Is nerve block anesthesia better for surgery?

Susan G. Curling, MD

Conditions and Diseases

April 6, 2014

A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com.

More needles … who wants that? You probably do! Nerve block anesthesia, also called regional anesthesia, requires localized numbing and additional needle sticks, but it has many advantages. Primarily, it can have a profound effect on your pain after surgery, and improve your rehabilitation and decrease …

The boundaries of caring and empathy are moving targets

Tim Mosher, EMT-P, RN

Conditions and Diseases

April 6, 2014

As a life-long dedicated health care provider, caring about those in physical and mental need is always a presumed requirement of the field. You’re ill, I act. You’re hurt, I act. I care enough to help educate about prevention of injury and disease. I’ve sacrificed a great deal of comfort, sleep, and mental energy to care enough to help those in need — even for those who …

Differences between banning bossy and true leadership in health care

Alene Nitzky, RN, PhD

Health Policy

April 5, 2014

There’s been a lot of hype about the “Ban Bossy” campaign in the news lately, and the talk is all over the map. I was thinking about it in regards to health care, especially nursing, since nurses are notoriously “bossy,” or at least referred to as such.

I can remember being a nursing student and talking with a physician about a patient during my clinicals. He told me, “You …

ICD-10 and the problem of interobserver variability

Michael Slade

Health Policy

April 5, 2014

I first heard about the ICD-10 when I was working at a small start-up, trying to develop an EMR for a string of dialysis clinics. It was always spoken of with a certain gravity, like the ominous visit from an aunt that nobody in the family likes, but feels obligated to see. Practical (read: business) people hate ICD-10. It’s giant and unwieldy. Doctors think it’ll be an excuse to bilk …

The Ten Commandments of good psychiatry

Shaili Jain, MD

Conditions and Diseases

April 5, 2014

Recently, I gave a lecture entitled, “Treating Depression in Primary Care,” at an annual conference for physician assistants. I spent a good portion of the talk on the fundamentals that have been essential to me during my 15 years of practice. When things go awry in mental health care, the majority of the time it is because one or more of these fundamental principles was neglected.

My fear is …

Read more…

The Ten Commandments of good psychiatry

Will bronchial thermoplasty for asthma be more widely used?

Denitza Blagev, MD

Conditions and Diseases

April 5, 2014

I first met Carol* (name and identifying details have been changed) when she came to my clinic after a severe asthma attack had sent her to the intensive care unit. After a few days, she had been extubated and had acquired a new diagnosis: asthma. When she saw me in clinic, she felt better than she had when she had come to the hospital, but she continued to complain of …

The choice between supportive and insight psychotherapy

Steven Reidbord, MD

Conditions and Diseases

April 5, 2014

For more than a decade I’ve taught a seminar in dynamic psychotherapy to psychiatry residents. One tricky issue that arises every year is the apparent choice between conducting a “supportive” psychotherapy, versus an “analytic” or “insight-oriented” one. I developed a sailing analogy to clarify this issue, and to teach an important point about it.

Most patients appreciate emotionally comforting support. Many seek a therapist who will provide a listening ear, who …

MKSAP: 24-year-old woman with increasing asthma symptoms

mksap

Conditions and Diseases

April 5, 2014

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

A 24-year-old woman is evaluated for increasing asthma symptoms. Her symptoms now require her to use her as-needed albuterol inhaler two to three times per week, and she has been waking up at night at least once a week with asthma symptoms that require her inhaler. She is still able to perform …

The choice between family medicine and internal medicine

Hugo Torres, MD

Physician

April 4, 2014

My third year of medical school cemented the passion for primary care I developed as a volunteer in a clinic for undocumented immigrants in San Francisco. Relationship building, continuity of care, and seeing the impact a primary care physician can have on a patient’s health all ignited my passion more than any angioplasty or neurosurgery ever could. But one question continued to nag me as I filled in the bubbles …

Don’t forget those where cancer screening didn’t make a difference

J. Leonard Lichtenfeld, MD

Conditions and Diseases

April 4, 2014

I had the opportunity recently to participate in a Twitter chat on the topic of colorectal cancer awareness. The chat was intended to bring attention to a nationwide campaign called “80 by 2018” designed to increase colorectal cancer screening rates to 80% of the population over the next 4 years. If it is successful, we should see a decline in both incidence and deaths …

Doctor and patient: Insecurity meets insecurity

Rob Lamberts, MD

Physician

April 4, 2014

She looked at me, eyes pleading, telling me without needing to say a word: I am not lying to you. I am not crazy. I am not making this up.

I sighed. “We’ve done the work-up and know this is not your heart. I don’t think there are a lot more tests that can be run.” I studied her expression, trying to discern what she wanted to hear from me.

I’ve come …

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