KevinMD.com

September 27, 2013Sep 27, 20138

Recently, another report was released by the Centers For Disease Control saying that antibiotic overuse is creating "so-called superbugs." In this USA Today article, it states that superbugs "cause at least 2 million infections and 23,000 deaths each year." You…

Recently, another report was released by the Centers For Disease Control saying that antibiotic overuse is creating “so-called superbugs.” In this USA Today article, it states that superbugs “cause at least 2 million infections and 23,000 deaths each year.”

You know who is causing the problem, right? It’s doctors like me. Depending on the report you read, I am the one who is giving antibiotics out like candy. Now, if you …

Patient voices

I’ve unintentionally made most of my doctors uncomfortable

Jessica Rice

September 27, 2013Sep 27, 20136

Since becoming ill, I’ve learned that I have the innate ability to make doctors very uncomfortable -- squirmy, even. It’s surprising because I had assumed medical professionals with decades of experience have fielded every possible question a patient might ask.…

Since becoming ill, I’ve learned that I have the innate ability to make doctors very uncomfortable — squirmy, even. It’s surprising because I had assumed medical professionals with decades of experience have fielded every possible question a patient might ask.

But I suppose I’m not a typical patient. In November 2011, I was diagnosed with stage IV lung cancer (bronchioloalveolar carcinoma, a subset of adenocarcinoma) with extensive spread to the mediastinal and …

Physician voices

The latest salvo in the federal government’s war on physicians

Karen S. Sibert, MD

September 27, 2013Sep 27, 201327

The latest salvo in the federal government’s war on physicians comes to us courtesy of the Veterans Health Administration (VHA), which is proposing drastic policy changes to expand nursing scope of practice in all veterans’ hospitals. A new draft VHA…

A new draft VHA Nursing Handbook would eradicate all existing VHA policies concerning physician supervision, and would designate all advanced practice registered nurses (APRNs), including nurse anesthetists, as licensed independent practitioners (LIPs). This means that …

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Health technology

Creating a truly meaningful and useful patient medical record

Rob Lamberts, MD

September 26, 2013Sep 26, 20136

I have a vague recollection, a memory shrouded in mist, where I pondered what seemed like a radical question: What would a health record look like if my only concern was patient care? This was a radical question because in my previous life I was an electronic health record aficionado. I was good at EMR, which meant that I was really good at finding work-arounds:

How can I work around the requirements for

…

Physician voices

Defining the 3 goals of palliative care

James Marroquin, MD

September 26, 2013Sep 26, 20134

After finishing medical school and my residency in internal medicine, I undertook an additional year of training in a field called palliative care. Patients who notice my background sometimes ask me what exactly palliative care means. It’s really a simple concept. Palliative care is helping people with a serious illness have the best possible quality of life. It’s enabling sick patients to make the most of the time they have left …

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Defining the 3 goals of palliative care

Medical education

Learn to do other things besides medicine that will engage your brain

Wes Fisher, MD

September 26, 2013Sep 26, 20132

Three years ago, in the midst of all that was happening with health care reform, I thought about if I'd ever recommend medicine to my daughter. I thought and thought about that issue and looked deep inside myself for reasons…

Three years ago, in the midst of all that was happening with health care reform, I thought about if I’d ever recommend medicine to my daughter. I thought and thought about that issue and looked deep inside myself for reasons one might still choose this profession, then penned “The Top Ten Reasons to Be a Doctor.” It is, by far, the most popular post on my blog, having been …

Conditions and diseases

Concern about autism on the part of a parent is an emergency

Lisa Shulman, MD

September 26, 2013Sep 26, 20133

I recently returned from a 10-day vacation from my position as a developmental pediatrician. I specialize in the early identification and management of autism at Einstein’s Children’s Evaluation and Rehabilitation Center. The night before returning to work, I decided to…

Since my last vacation, a new office voicemail system had been installed. It seems that I now have an unlimited amount of …

Patient voices

A 77 percent success rate is good enough for a guy without insurance

Andrew T. Gray, PA-C

September 26, 2013Sep 26, 201320

The doctor was adamant. "This is America, not Sweden," he told me. "We operate." How did this happen to me? I wondered, looking at him across the ER exam room. How could I, a healthcare provider, not have insurance? I…

The doctor was adamant. “This is America, not Sweden,” he told me. “We operate.”

How did this happen to me? I wondered, looking at him across the ER exam room. How could I, a healthcare provider, not have insurance?

I had woken up that morning with a mildly upset stomach. Nonetheless, I’d gone to my job (begun only six weeks earlier) as a physician assistant at a Beverly Hills HIV clinic. I’d seen patients …

Physician voices

Going all the way should mean more than completing high school

Greg Smith, MD

September 26, 2013Sep 26, 20139

So what is the one thing that I see over and over and over again in the management of emergency room psychiatric patients that makes me fear for our survival as a country and even as a species? Is it…

So what is the one thing that I see over and over and over again in the management of emergency room psychiatric patients that makes me fear for our survival as a country and even as a species?

Is it the severity of psychotic illness? The rampant drug and alcohol use that starts now when kids are pre-adolescent? Is it the broken families that are producing another generation of children who …

Physician voices

Unregulated gun access and its drain on medical resources

Julia Frank, MD

September 25, 2013Sep 25, 201333

On September 17, 2013, I joined the growing ranks of physicians who have gotten a message they hoped never to receive: “There has been a mass shooting in the area. Prepare to receive casualties.” That morning, a gunman was indiscriminately…

On September 17, 2013, I joined the growing ranks of physicians who have gotten a message they hoped never to receive: “There has been a mass shooting in the area. Prepare to receive casualties.”

That morning, a gunman was indiscriminately mowing down people at the US Navy Yard. Within an hour my hospital had geared up to provide both medical and supportive care, answer calls from those seeking to know the …

Medical education

Does the amount of interns’ time spent in direct patient care matter?

Paul Bergl, MD

September 25, 2013Sep 25, 20134

Recently in NEJM Journal Watch General Medicine, Abigail Zuger reviewed an article from the Journal of General Internal Medicine in which researchers examined how medical interns spend their time. The results from this time motion study might be concerning but…

Recently in NEJM Journal Watch General Medicine, Abigail Zuger reviewed an article from the Journal of General Internal Medicine in which researchers examined how medical interns spend their time. The results from this time motion study might be concerning but are not unexpected. The investigators found that interns on inpatient rotations spend only 12% of their time in direct patient care and spend only 8 minutes daily with each patient on their inpatient services. Dr. Zuger notes this …

Conditions and diseases

The time to get flu shots is now

Wendy Sue Swanson, MD

September 25, 2013Sep 25, 20138

Please don’t tune me out on this one. Don’t let this post resemble Gary Larson’s The Far Side cartoon where you only hear, “Blah, blah, blah, Flu shot, blah, blah, blah, Flu shot, blah, blah, blah” I write about flu…

I write about flu every year because it’s one infectious disease that is not only more aggressive and dangerous for babies and young children, it’s vaccine preventable. The flu causes high fever, terrible cough, body aches, and significant discomfort. …

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The time to get flu shots is now

Conditions and diseases

Childhood obesity: A problem of will and money

David L. Katz, MD

September 25, 2013Sep 25, 20133

The American Heart Association recently published a sobering "scientific statement" on severe obesity among children and adolescents in the U.S. in their flagship journal, Circulation. The report, predictably spawning widespread attention in the popular press, suggests that by reasonable criteria,…

The American Heart Association recently published a sobering “scientific statement” on severe obesity among children and adolescents in the U.S. in their flagship journal, Circulation. The report, predictably spawning widespread attention in the popular press, suggests that by reasonable criteria, between 4 percent and 6 percent of our kids between the ages of 2 and 19 have severe obesity.

Those percentages probably don’t fully convey how common that makes this ominous condition. …

Conditions and diseases

A symptom that will hasten Medicare’s eventual insolvency

Henry Kimmel, PsyD

September 25, 2013Sep 25, 201311

Days from her 80th birthday, “Nancy” (not her real name) is doing well. She’s active, exercises, drives, travels, and lives alone in a multi-story apartment building without an elevator. Her busy schedule of weekly activities includes several appointments with physicians.…

Nancy’s been in psychotherapy for a half-century. She’s seen me, her psychotherapist, for the past three years. Nancy reports difficulty developing meaningful

…

Conditions and diseases

The catch behind free prostate cancer screening

Janice Boughton, MD

September 25, 2013Sep 25, 2013

I just got an email from a hospital where I sometimes practice with a picture of two aging but clearly active and vital men standing on a beach with the words "free prostate cancer screening" printed below in an attractive…

I just got an email from a hospital where I sometimes practice with a picture of two aging but clearly active and vital men standing on a beach with the words “free prostate cancer screening” printed below in an attractive font. The hospital is sponsoring the screening, along with the urology clinic affiliated with the hospital. The advertisement gives guidelines for who should avail themselves of this service, including men …

Patient voices

The side effects of cancer treatment can become permanent glitches

Jessie Gruman, PhD

September 24, 2013Sep 24, 20137

Sara was treated for multiple myeloma in the mid-90s and had a stem cell transplant seven years ago. When I asked her husband how she was doing, he said, “Pretty well … just the gift of a little edema in…

On one hand you think, “Hey! That’s great! Those little gifts — those side effects — are a small price to pay.”

On the …

Physician voices

Why aren’t hospitals more attentive to the needs of patients?

Leslie Kernisan, MD, MPH

September 24, 2013Sep 24, 201336

In a recent post, Dr. Ashish Jha raises this issue as he relates his own story of coming to an ED with a very painful dislocated shoulder. Unsurprisingly, prompt treatment of his pain was deferred while staff diligently completed registration,…

On the bike path where Jha took his initial tumble, people went out of their way to …

Conditions and diseases

Can sexualized images from pop music be a teachable moment?

Heidi Roman, MD

September 24, 2013Sep 24, 2013

I have a confession. I like pop music. During my commute each day I admit I often make the mind-bending switch between NPR and the top 40 station. Even if you trend toward a more high-brow music collection, perhaps you’ll allow me that these tunes are catchy and they’ve got a beat. But lately I’m feeling fairly conflicted about it.

I didn’t watch the VMAs. …

Health policy

The relative value of how physicians are paid needs to change

Toni Brayer, MD

September 24, 2013Sep 24, 201335

The Centers for Medicare and Medicaid (CMS) sets the rates all physicians get paid and insurance companies base their rates on the same formula. So who creates the formula? Well, it’s the doctors, silly! Or at least some of the…

A 31-member committee formed by the American Medical Association is made up of representatives from the various specialty societies. This Relative Value Update Committee (RUC) meets …

Health technology

Addressing the disparities in those using patient portals

Zackary Berger, MD, PhD

September 24, 2013Sep 24, 201351

My institution recently switched from its home-grown electronic medical record (EMR) to EPIC, a system for which many great things have been promised. Indeed, it is a considerable improvement over the past one. A number of hopes have been pinned on the latest-generation EMRs, not the least of which is the idea that finally, with this newest generation of tools, a nexus can be created and sustained among comparative effectiveness …

Real physician voices, twice a week

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