In the first recent piece of good news about the child obesity epidemic, the latest statistics on preschoolers — those 2- to 5-year-old bundles of joy whom we worry about so much — suggest that they’re less obese than they used to be.
Between 2003/2004 and 2011/2012, according to the Centers for Disease Control (CDC), there was a huge drop in the …
A reduction in child obesity should be interpreted with caution
Recently, a patient I have known for several years called my office and spoke to my nurse. She said that while she was driving, her vision had gone blank for one second and then she was fine. My schedule was already overbooked. Almost all of the slots were filled with patients with the usual array of multiple chronic medical problems for follow-up and management of what were, for the most …
Primary care: The importance of a doctor who knows you
A guest column by the American College of Physicians, exclusive to KevinMD.com.
In the annual cycle of a medical practice, there are seasons. For example, we have “flu season,” “poison ivy season,” “camp or school physical season,” “snowbirds back from Florida season,” and in my part of the world, “Lyme disease season.” There are other seasons that physicians must endure that have …
Deductibles and donuts change the flavor of health care
The administration has confirmed that the individual policies that were supposed to be cancelled because of Obamacare can now remain in force another two years.
For months I have been saying millions of individual health insurance policies will be cancelled by year-end — most deferred until December because of the carriers’ early renewal programs and because of President Obama’s request the policies be extended in the states that have allowed it.
The …
Even supporters need to realize that Obamacare needs a fundamental fix
I went to see my oncologist for my six-month checkup yesterday. All was routine, other than my blood pressure being 131 over something when it’s usually in the 115 range, even when I see my family doctor. No anxiety there.
When he asked what had changed in the last six months, I told him about the endoscopy I had in December, which turned out to be normal. But what prompted it …
Residual fear after a cancer diagnosis
The other day at an interdisciplinary rounds meeting at the hospital, one of our nurses who is also an emergency medical technician mentioned that in Britain injured patients receive tranexamic acid before arriving at the hospital because it reduces death from bleeding.
“What’s that?” I said.
I kind of barely remembered hearing this medication’s name associated with the treatment of a rare disease, but not treatment of trauma. So I was guessing …
Why isn’t tranexamic acid used more often in routine practice?
More than a century of American medical history was turned on its ear recently by the announcement that the groups that accredit medical residencies will unify their standards. Don’t be too hard on yourself if you failed to understand the significance (or notice at all). But this should be viewed as good news across the land. As someone who trains doctors from both traditions, I certainly welcome a more level playing field.
First, …
The merging of MDs and DOs: A unification of training standards
I still remember being taken aback by how young she was. “She” was Mary — a 28-year-old woman who had completed chemotherapy for stage II breast cancer. She was treated elsewhere and had moved cities when her husband got a promotion.
“I’m still getting used to this area, but I am happy my hair came back before we had to move. I …
When patients ignore the evidence: Try to understand their values
Sorry for the long gap between blog posts. I have been distracted by the volume of work that I have had to do. Is that a good thing? Yes. Is it a bad thing? Certainly.
I recently heard an interview of Mark Cuban, the owner of the Dallas Mavericks basketball team, billionaire entrepreneur, and one of the “sharks” on the show “Shark Tank.” The show involves entrepreneurs the opportunity to pitch …
Growing a new kind of practice: Success is based on executing ideas
News reports covering a prostate cancer study recently in the New England Journal of Medicine have all pretty much come out with the same message: men diagnosed with prostate cancer who had radical surgery did much better than men who were assigned to “watchful waiting” after they were diagnosed.
But guess what? There’s a critical fact that seemed to be missing in much of the coverage I saw. And that fact …
Watchful waiting for prostate cancer: Implications of a new study
When I read news articles about caring for elderly parents at a distance, I sometimes shake my head. There’s a tendency to put the best spin on the experience: As long as you contact the right people, get the right information and treat the ups and downs as just part of life’s challenges, you’ll be fine. You can do this!
I find myself wondering when the author last talked to a caregiver …
Family caregiving is hard and imperfect
Much has been written about how Web 2.0 tools can change the healthcare landscape. It would appear a recent set of circumstances has upped the ante.
This story begins with a recent study that attempted to tackle the problem of ICU infections. ICU infections are a challenging problem, patients who are admitted to the ICU are at risk of worsening illness and death from infections such as MRSA which can be …
How social media facilitates peer review
As part of a family medicine rotation, we recently discussed the importance of bringing spirituality into the hospital. The conversation was led by Stanford Hospital’s chaplain, Dr. Bruce Feldstein, an ER doctor in a former life. We began with definitions of spirituality, discussed personal experiences surrounding a spiritual moment, and concluded with how to take a “spiritual history,” a series of questions that explore patients’ spiritual or religious beliefs.
We even …
Is there a place for religion in the exam room?
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March 2nd through the 8th was National Patient Safety Awareness Week — I don’t really know what that means either. We seem to have a lot of these kinds of days and weeks — my daughters pointed out that March 4 was National Pancake Day — with resultant implications for our family meals.
But back to patient safety and National Patient Safety Awareness Week. In recognition, I thought it would be useful to …
Patient safety and the human toll of inaction
It was probably the most awkward question I had been asked before, and I did not have an answer.
He was a middle-aged gentleman, neatly dressed — very simple and unassuming. He blended like a lifeless statue in the waiting area. What sparked my notice of him was his accompanying robust file, crammed with familiar pink discharge slips from the ED. He was clearly what we call a “frequent flyer,” but …
I have been a way from blogging for a bit and tried to clear my head a bit with a vacation skiing. I left the computer at home, disconnected (as best I could), and had the luxury of feeling the knees working less fluidly than they had before, but still had some fun for a brief 3 day stint. It was nice to notice that there’s a whole world out …
Physician time means nothing to programmers and policy makers
One of my goals is to help doctors be happier in their day jobs. This does not mean you put on a fake smile, and grin and bear it through your day. What it does mean is you consciously set your boundaries for what you need. Stick with them and let others know. Because the truth is, you teach people how to treat you.
This is not only reserved for your …
Stop being a doormat for your patients
What an amazing time to be a champion of new health care delivery models. Three megatrends are driving change at a pace that I only wished for 20 years ago. Back then, I first had the insight that care could be improved, in some instances, if we separate doctor and patient in time and space.
The first trend is provider reimbursement reform. For provider organizations going at risk with their payers, these are …
Can the pharmaceutical industry move beyond the pill?
An innovative study in JAMA Internal Medicine on surrogate decision making has profound implications for how we take care of older hospitalized patients. The study, by Lexy Torke and colleagues at Indiana University, systematically described the involvement of surrogates in decision making for hospitalized patients.
Surrogate decision making refers to the phenomenon in which someone other than the patient is making or helping to make the key medical decisions. In older …
Surrogate decision making: Families are much more than visitors
Since becoming a full-time medical school faculty member again, I’ve volunteered to interview about two applicants each month from September through March. When I first started doing this, I was surprised that the admissions office did not provide me with a copy of the applicant’s resume and essay until the time of the interview, carried in a manila folder by the applicant.
But I quickly realized that it wasn’t necessary to …
The impersonal nature of medical school personal statements
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