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Cough medicines shouldn’t be used in small children

Medications

December 17, 2013

It’s once more cold season, bringing up the question parents commonly face. Should they buy one of those rows and rows of cough, sneeze, and runny nose medicines one finds in every drug store and supermarket?

In a nutshell, no — none of the preparations sold over-the-counter to treat upper respiratory infections in children work, and all could be dangerous. That’s the conclusion of a report some years ago by the Food and Drug Administration, …

How to talk to your child about obesity

Keith-Thomas Ayoob, EdD, RD

Conditions and Diseases

December 17, 2013

The conversation parents dread even more than the one about the birds and the bees? It’s the one about their kids’ weight.

Sure, the facts-of-life talk is awkward and needs to be age-appropriate and you want your facts straight, but it’s different when you’re talking to your kids about what they weigh. Your children never view such talks as positive, only as being about what’s “wrong” with them. But you can have this …

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How to talk to your child about obesity

3 ways Medicare can reduce overtreatment

Jim Sabin, MD

Physician

December 16, 2013

If we in the U.S. ever hope to get a grip on Medicare costs, our society will first have to navigate a steep learning curve. That’s the lesson to take from three recent publications.

Despite the fact that Medicare is expected to represent 18% of the federal budget in 2020 (up from 15% in 2010), and that the Medicare Part A trust fund is projected to have insufficient funds to cover …

Dear lawmakers: Why aren’t doctors involved in health care reform?

Matthew Moeller, MD

Health Policy

December 16, 2013

As I was watching CNN news recently, I noted in the headlines different ways Obamacare is failing. Current problems discussed were the customers’ sticker shock of high deductible plans (up to $12,700 for families), the president blaming the insurance companies for having substandard plans, and the people blaming the president for losing their current insurance.

One patient even complained, “My new health care plan tripled in price, and now, it is …

Lessons learned from far exceeding the expected prognosis

Kenneth Zeitler, MD

Conditions and Diseases

December 16, 2013

In 1996, visiting a mall during an out-of-town trip, I suddenly felt dizzy while descending on the escalator. The sensation rapidly resolved, but to be on the safe side, I went to a local emergency room. My evaluation included a CT scan of my head; the results, I was told, were “normal.”

Shortly after returning home I received another call. The CT results were not normal, and I should see a …

Herbal supplements may be natural, but that doesn’t mean they’re safe

Kevin Pho, MD

KevinMD

December 16, 2013

A version of column was published in USA Today on November 20, 2013.

I once diagnosed a patient with high cholesterol, and prescribed him a medicine commonly known as a statin. When I saw him months later for follow-up, he admitted that he didn’t fill the prescription.

“I took red yeast rice capsules instead,” he said.

When I asked him why, he told me that he was wary of statins’ long list of side effects …

The downward spiral of the stubborn patient

Val Jones, MD

Physician

December 16, 2013

Over the years that I’ve worked in acute inpatient rehab centers, I have been truly vexed by a particular type of patient. Namely, the stubborn patient (usually an elderly gentleman with a military or armed forces background). I know that it’s not completely fair to generalize about personality types, but it seems that the very nature of their work has either developed in them a steely resolve, or they were …

There is only one reason why I still accept Medicaid

Tiredoc, MD

Physician

December 15, 2013

To err is human. To really screw things up, you need government.

One half of my patient population and one fourth of my receipts are from Medicaid patients. My state has a mandatory balanced budget, which means in this age of perpetual recession Medicaid runs out of money every year.

Last year, my state capped the monthly brand name prescriptions to 1 for the summer. Apparently the information that asthma inhalers and …

Student-run free clinics: A pure form of medicine

Justin Berk, MPH, MBA

Medical Education

December 15, 2013

The culture of medicine has changed and a new generation of medical students has noticed this insidious path to disgruntlement. Reimbursement rates dominate conversations among health care professionals. Physicians are slowly burning out while younger faces are tempted away from humanitarianism by lucrative lifestyle specialties. Bureaucrats, technology, and increasing health-care costs have transformed the doctor-patient relationship, and students pick up on the increasing frustration in the profession.

The few oases of …

How the medical home can spur academic research

Fred N. Pelzman, MD

Physician

December 15, 2013

As we’ve gone through the process of building our patient-centered medical home, we have brought along a little bit of the scientific method.

As part of the medical home rollout, we developed an expanded quality improvement curriculum for our internal medicine residents. A series of talks on key topics of the patient-centered medical home has been developed, and several faculty experts have been delivering these to the residents. As a part …

What you should know about your primary care physician

Brian J. Secemsky, MD

Physician

December 15, 2013

If you haven’t already, you will someday see a primary care physician (PCP).

It’s practically unavoidable.

The reason for this self-declared truth is that PCPs are the shape shifters of medicine, assuming various roles at different stages of an adult’s life and wellbeing.

These responsibilities range from treating various health conditions, ushering patients in and out of hospitals, coordinating long-term medical decisions, and consulting with other specialists to better optimize patient care.

Given that …

The problems with the BRCA test from 23andMe

Nitin Roper, MD

Conditions and Diseases

December 15, 2013

It’s been very interesting to read the range of responses to the recent FDA recent crackdown on the personal genetic service company 23andMe. Some have decried the FDA as too paternalistic while others have said the FDA is rightfully protecting the health of the public.

The evidence, I believe, shows the FDA is correct: 23andMe should not be doing genetic tests that have serious medical implications. Let’s look at …

Medical trainees have access to far too many resources

Sharon Rikin, MD

Medical Education

December 14, 2013

“What is the one best test?”

A test-taker’s frustration boils over as they read this prompt and think, “in real life we would do all of the above.” And for the most part, they are correct. In the United States, medical trainees are taught for exam purposes to answer the one best test for diagnosis or the one best procedure for management.

However, in practice the same trainees watch our role-models take …

Will fee for service ever go away?

Brian Klepper, PhD

Health Policy

December 14, 2013

The catchy title of a recent Harvard Business Review Blog post, The Big Barrier To High Value Health Care: Destructive Self-Interest, suggested that the Institute for Healthcare Improvement (IHI) is forging arrangements that can overcome fee-for-service reimbursement’s propensity to drive excess. As the honest broker, IHI could advocate for arrangements of mutual self-interest based on the right care, better outcomes and less money. Employers and unions would get lower costs, with …

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Will fee for service ever go away?

Cholesterol management with patients requires shared decisions

Michael J. Barry, MD and John B. Wong, MD

Medications

December 14, 2013

New guidelines from the American College of Cardiology and the American Heart Association on the assessment of cardiovascular risk and the manipulation of cholesterol levels to mitigate that risk have certainly been in the news. The guidelines appropriately use high quality evidence to abandon old untested or unproven paradigms such as treatment to LDL targets and manipulation of non-HDL cholesterol as a secondary goal. In many ways, the new guidelines …

It’s scary when our loved ones have surgery

Starla Fitch, MD

Physician

December 14, 2013

Recently, after a fairly long day of surgery where everything was going well, I was finishing my fourth case. It was about 2pm on a Friday, and we were running on schedule, which made me happy.

As I walked out to the waiting area in search of the family of the elderly woman on whom I had performed an elective procedure, I noticed her husband sitting in the corner. He stood …

How can a physician retire gracefully?

David Mokotoff, MD

Physician

December 14, 2013

Retirement is an intensely personal decision. I have done virtually nothing but medicine for the last 35 years. Oh sure, I have made some money from writing, or giving lectures and expert case reviews, but most of these are tied to medicine as well. Having just turned 65, my financial advisor says from his analysis, I can retire any time now. I have a contract with my cardiology group, which …

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How can a physician retire gracefully?

It’s time to support performance measurement in health care

Richard Patterson, MD

Health Policy

December 14, 2013

I practiced surgery for many years in a very large hospital. In the 1980s, the marketing department launched a campaign with the tagline, “A Leader in World Medicine.” About the same time, two of my colleagues created the Hernia Institute, sensing gold in them groins. They placed ads in the sports pages of our local newspaper, right next to those of the topless clubs.

These initiatives had two things in common:

they …
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It’s time to support performance measurement in health care

The difference between playing doctor and being a doctor

James C. Salwitz, MD

Physician

December 13, 2013

I have outstanding, compassionate and dedicated partners; rarely goes by a day that they fail to teach me by their intelligence and example. Nonetheless, yesterday, in the middle of 30+ patient office hours, one of them said, “You know there are times when I just can’t stand to listen to another complaint.” He took a deep breath, straightened his coat, and opened the exam room door and, smiling, greeted the …

Why Regina Benjamin was an ineffective Surgeon General

Mike Sevilla, MD

Physician

December 13, 2013

Recently, way beneath all the press about Obamacare, there have been articles panning the president’s pick as the next Surgeon General of the United States. Wait a minute. What happened to the last Surgeon General?

Six months ago, family physician Dr. Regina Benjamin stepped down as the first Surgeon General under President Obama. Quick! Name one accomplishment under Dr. Benjamin. I can’t either. What happened?

Dr. Benjamin was a rising star in the …

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