Two big studies have been published in the last few weeks, both of which have confirmed previous data: home birth is not as safe as hospital birth. These studies show that having a baby at home increases the risk of your baby dying by about 4 times. That really is a big increased risk — especially considering that most home births are supposedly low-risk pregnancies. Those babies …
Where is the safest place to have a baby?
Doctors are tough critics — as well they should be. The news that CVS Caremark pharmacies will no longer sell tobacco brought about quite a bit of rapid online dialogue. Even President Obama chimed-in with praise, a response that some in the business world say is worth billions for CVS. Having a good reputation, particularly when you’re in the business of delivering health care and lending health advice, seems essential. In my …
CVS stops selling tobacco: Let’s keep it in perspective
Are you a practicing primary care physician, board-certified in either family medicine or internal medicine, and in good standing with your state licensing board? Do you have concerns about the relative lack of primary care professionals, especially now that 40 million new patients have been added to the U.S. health care system this year?
What if I told you that you, simply by carrying on with your usual daily …
Reentry physicians are an invisible minority in American medicine
The goal of the Affordable Care Act is to make affordable, quality health care coverage available to more Americans. But how many physicians will America need to satisfy this new demand?
The debate over doctor supply rages on with very little conclusive evidence to prove one case or the other.
Those experts who see a shortage point to America’s aging population — and their growing medical needs — as evidence of a …
Do we really need more physicians?
Alzheimer’s disease is the uninvited guest that crashes all of my family gatherings. It relentlessly pursues my grandfather’s brain, unraveling more threads from the tapestry of his memory each year. Although it causes him no physical pain, it sows guilt, sorrow, frustration, and a sense of deep loss in all of us.
Like all diseases, this one seems entirely unfair. My grandfather was a sharp attorney, a witty, silly champion of …
Alzheimer’s disease is the uninvited guest
Next in a series.
Primary care physicians (PCPs) are becoming extinct. It’s true. Not many medical students choose primary care as their career path. Older PCPs are retiring early. Many others are closing their practices or seeking employment at the local hospital. And there has always been a shortage of primary care physicians in rural and urban poor areas. Today only 30% of all physicians practice primary care (compared to …
Why is there a shortage of primary care physicians?
As the patient-centered medical homes (PCMHs) train charges forward along with implementation of the Affordable Care Act, dollars are taken directly out of our health care system to certify providers in a method with no proven benefit. And, while there is a marked shortage of primary care providers nationwide, funds that could be used toward providing the direct provision of, or access to, health care are instead devoted to accreditation, …
The data behind the medical home: High costs without a benefit?
It started with a dead laptop. For the first time in more than 3 years I felt like a doctor again. I had forgotten what it was like.
Having neglected to plug in my laptop the night before, it was without power. (Without power!) An opportunity for an uprising, of consciousness if not full revolt.
For the first 1½ hours of clinic I entered each exam room without the weight of the …
Entering the exam room without the weight of the computer
There are few professional careers centered around protecting and caring for others that garner so much verbal and physical abuse than a career in emergency medicine. Mental health workers, police, fire, and EMS personnel are the other fields that come to mind when I think of a service that “helps” people yet gets abuse dished upon them on nearly a daily basis.
A 2006 survey of emergency nurses showed that 25% …
When patients abuse emergency department workers
In the past 84 days, I have traveled to eleven different cities, been left stranded in two unfamiliar airports by cancelled flights, met approximately 124 new people and briefly recited the more interesting parts of my life story far too many times to count — all for the purpose of matching to a residency program in March. Exhausting doesn’t come close to summing it up.
And yet, this process has also …
Why I am grateful for Match Day
Recently, CVS Caremark announced that starting October 1, they will no longer be selling tobacco products, including cigarettes, in their CVS stores. Taking a bold and unexpected stance on the issue, CVS’s CEO Larry Merlo reasoned to ABC News that “We’ve come to the conclusion that cigarettes have no place in a setting where health care is being delivered.”
What does he mean by that?
Here, he is referring to CVS’s robust market of …
Banning cigarettes is a start but CVS still has a long way to go
Let’s get the disclaimer out of the way: We love Uber.
As physicians with roots in the Bay Area, we use Uber all the time. The service is convenient, (usually) swift and consistently pleasant. With a few taps of a smartphone, we know where and when we’ll be picked up — and we can see the Uber driver coming to get us in real time. When the vagaries of San Francisco …
What Uber can teach health care delivery
In fall of 1994, I was sixteen years old and sick. I had lost a lot of weight, reduced my diet to BRAT and roast chicken, filled a half-dozen stool samples, even tried a few prescriptions — and nothing seemed to help.
By that point I was seeing a gastroenterologist, Dr. C. After a pointless barium enema and follow-through, Dr. C performed a colonoscopy. From that, he gave me a definitive …
The best thing a doctor ever did to me
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As I finished surgery on a beautiful 10-year-old girl from a local orphanage with a secondary cleft lip deformity, I did not realize how this tiny little Filipino girl was about to humanize me and my entire team involved in her care. When I met her the day before with her caretaker from the orphanage, it was obvious that she had …
A version of column was published in USA Today on January 19, 2014.
Over half of physicians today use electronic medical records, thanks to the federal government spending more than $22 billion dollars incentivizing providers to transition away from paper charts. Supporters of digital records, including President Obama, say they improve patient care and reduce health costs. Having navigated a transition from paper charts to electronic records in my own practice, …
Electronic medical records obstruct patient interaction
A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com.
February is American Heart Month. Unfortunately, heart disease is a major problem in the United States that can result in surgery. In addition to discussing your procedure with your surgeon, you want to be sure to discuss your anesthesia care with your physician anesthesiologist.
Here are …
10 things to know about anesthesia and heart surgery
I was 8-years-old in June 1963 when the Readers’ Digest arrived in the mail inside its little brown paper wrapper. As usual, I sat down in my favorite overstuffed chair with my skinny legs dangling over the side arm and started at the beginning, reading the jokes, the short articles and stories on harrowing adventures and rescues, pets that had been …
The influence of Janis Babson can be felt by many physicians
He does not want to talk to me, that much is clear. He has had enough of doctors. He is a man of few words. His eyes do not meet mine. His coarse, calloused farmer’s hands play purposelessly with the starched white of the hospital bed sheet. The gentle hiss of his oxygen is barely heard over the hum of the city traffic below. Out of his element.
“Tell me, what …
Palliative care: The first conversation
I came across a really good post on the Daily Beast written by a pediatrician in New England, griping (appropriately) about parents who were unwilling to trust his judgment about vaccinating their children.
Why have so many patients lost trust in their doctors?
You might challenge the assumption that patients used to trust their doctors more, and that would be a fair question. I haven’t …
Why patients have lost trust in their doctors
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 50-year-old man is evaluated for persistent heartburn and regurgitation despite taking a high-dose proton-pump inhibitor twice a day for 6 months. His symptoms have improved, but he continues to have symptoms many times a week. He has not had dysphagia, chest pain or weight loss. He has significantly modified his diet. …
MKSAP: 50-year-old man is evaluated for persistent heartburn
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