KevinMD.com

September 20, 2013Sep 20, 201314

Though I have been accused by various commenters as protecting my own specialty when I point out excesses, flaws and conflicts of interest in the medical profession, this accusation would be handily dismantled after a fair reading of prior posts. Indeed, my own specialty of gastroenterology and my own medical practice has felt the effects of the honed Whistleblower scalpel. If an individual or an institution will not willingly engage …

Physician voices

This is the grim reality of starting a private primary care practice

Davis Liu, MD

September 20, 2013Sep 20, 201313

She was the first Michigan Wolverine I met who taught me their college fight song “Hail to the Victors,”and demonstrated their rabid pride anytime football or basketball season rolled around. (If you know people from the University of Michigan, you know what I mean). She was also one of the smartest and hardest working doctors in our family medicine residency program and one of our two chief residents.

So …

Conditions and diseases

What to say to anyone who has a baby in the NICU

Jennifer Gunter, MD

September 20, 2013Sep 20, 20139

A friend delivered twins early. One is in the NICU, one died. What can I say or do? This question was sent to me via Twitter. The person who added my name to the tweet knew that I might have…

A friend delivered twins early. One is in the NICU, one died. What can I say or do?

This question was sent to me via Twitter. The person who added my name to the tweet knew that I might have something to offer because 10 years ago I was that friend. I entered the hospital with ruptured membranes at 22 1/2 weeks, pregnant with triplets. My son Aidan died at birth …

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Physician voices

Intelligent information synthesis is the basis of error prevention

Val Jones, MD

September 20, 2013Sep 20, 20132

As I travel around the country, working in the trenches of various hospitals, I’ve been struck by the number of errors made by physicians and nurses whose administrative burden distracts them from patient care. The clinicians who make the errors…

However, the volume of tasks required of them in a day (many of which are designed to fulfill …

Conditions and diseases

Why is cancer care failing?

Shirie Leng, MD

September 19, 2013Sep 19, 201316

The Institute of Medicine (IOM) recently released a report on the state of cancer care in the United States. The IOM generally knows what it’s talking about. It’s a non-profit, non-governmental advisory group essentially. To get on one of their advisory boards you have to be a national, if not international, expert in whatever field is being studied. According to the cancer advisory board, the state of cancer care in …

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Why is cancer care failing?

Conditions and diseases

Estrogen in men: Masculinity isn’t a molecule

Albert Fuchs, MD

September 19, 2013Sep 19, 20132

Testosterone is one of the most over-prescribed and poorly understood medications. It is prescribed to millions of men for myriad indications, many of them unproven. Athletes believe it will improve their muscle mass and strength. Older men look to it as an anti-aging remedy. Men with flagging libido hope it will restore their sex drive. Testosterone has developed a mythology of masculinity. This is very similar to the notions we …

Health policy

Defeating overtesting: Right sometimes does bring might

Allen Frances, MD

September 19, 2013Sep 19, 201310

Medical science is making such remarkable progress that soon none of us will be well. -Aldous Huxley The recently completed conference, "Preventing Over Diagnosis," was easily the most important meeting I ever attended. Sponsored by the British Medical Journal, Consumer's…

Medical science is making such remarkable progress that soon none of us will be well.
-Aldous Huxley

The recently completed conference, “Preventing Over Diagnosis,” was easily the most important meeting I ever attended. Sponsored by the British Medical Journal, Consumer’s Reports, and Dartmouth and Bond Universities, the goal was to identify the excesses in medical care and to figure out how to correct them.

The evidence is compelling that we in the developed countries …

Health policy

Corporate wellness programs fail both companies and patients

Kevin Pho, MD

September 19, 2013Sep 19, 201314

This column was published in USA Today on September 9, 2013. More patients are coming to my primary care clinic with forms from their employer, asking me to measure their blood pressure, or check their sugar and cholesterol levels. Companies…

This column was published in USA Today on September 9, 2013.

More patients are coming to my primary care clinic with forms from their employer, asking me to measure their blood pressure, or check their sugar and cholesterol levels. Companies requesting medical data drive employee wellness programs, a booming $6 billion business, with approximately half of large employers offering such plans.

Coaching and financial incentives are often offered to help employees meet certain health metrics, …

Physician voices

Delivering bad news: A vast divide between doctor and patient

James Marroquin, MD

September 18, 2013Sep 18, 20133

My wife recently read me her journal entry from the day our younger son turned two years old. She had written quizzically that he had still not spoken any words despite a good deal of speech therapy. For months previous to that birthday, he had also been engaging in repetitive, obsessive behaviors. He walked circuits around the couch with total concentration, oblivious to the rest of his surroundings. If you …

Physician voices

When a physician resorts to jargon, educating patients can fail

Peter Ubel, MD

September 18, 2013Sep 18, 201328

The urologist broke the news: "Out of 12 cores, three were positive for cancer, so you have a small amount of cancer." He would soon explain the treatment choices -- surgery, radiation, or active surveillance (watching the cancer closely with…

The urologist broke the news: “Out of 12 cores, three were positive for cancer, so you have a small amount of cancer.”

He would soon explain the treatment choices — surgery, radiation, or active surveillance (watching the cancer closely with blood tests and biopsies). He described each option in elaborate detail, because he knew that the “right choice” would depend on what his 70-year-old patient thought about the pros and cons …

Health policy

How physicians can fight obstructivism over Obamacare

Bob Doherty

September 18, 2013Sep 18, 201323

Soon, millions of uninsured Americans will be able to enroll in qualified private health insurance plans offered through their state marketplaces, with federal dollars to help them afford it. The state marketplaces, created by the Affordable Care Act (Obamacare) will begin enrolling eligible people on October 1, and eligible persons will have until March 31 to sign up. The coverage and subsidies for those who sign up will start on …

Health technology

Does electronic communication actually improve care?

Natalie Azar, MD

September 18, 2013Sep 18, 201310

The subject heading of a recent email correspondence read “beware, graphic picture ahead!” Obviously this piqued my curiosity, so, with one eye closed, I scrolled down on my iPhone to a picture of my patient’s tongue, which, truth be told,…

The tongue in question? Maybe some white spots, certainly nothing gruesome, and most assuredly nothing I hadn’t seen before in my 12+ …

Conditions and diseases

A case of paralysis, cured in the emergency department

BirdStrike, MD

September 18, 2013Sep 18, 20132

I open my car door to walk in to work. I’ve never heard crickets as loud as the ones this summer in Georgia. A wall of steam-heat blasts me simultaneously as a giant bzzz! bzzz! dive-bombs my ear. Man, it’s…

I open my car door to walk in to work. I’ve never heard crickets as loud as the ones this summer in Georgia. A wall of steam-heat blasts me simultaneously as a giant bzzz! bzzz! dive-bombs my ear. Man, it’s hot in Georgia. And the bugs! I think to myself. I walk slowly towards the ED doors, barely moving, but still breaking a sweat. I walk through the double doors now …

Physician voices

Doctors shouldn’t criticize other physicians in front of patients

Kevin R. Campbell, MD

September 18, 2013Sep 18, 201326

We all try to do our very best for our patients. Often the decisions we make have profound impacts on outcomes. Medicine is not always cut and dry, and many times gut instinct and judgement calls must play a role in choosing therapies for patients (especially when made in the setting of best available data). As it is in most professions, Monday morning quarterbacking frequently occurs in medicine as well. It is …

Health policy

Who gets left out of Obamacare?

Trudy Lieberman

September 17, 2013Sep 17, 201325

The main purpose of health reform, said the president at a recent press conference, was to provide health insurance to people at affordable rates. He meant the nub of Obamacare -- the state shopping exchanges with their smorgasbord of insurance…

The main purpose of health reform, said the president at a recent press conference, was to provide health insurance to people at affordable rates. He meant the nub of Obamacare — the state shopping exchanges with their smorgasbord of insurance policies — would give coverage to millions of Americans who did not have insurance.

Whether that coverage will be affordable or comprehensive for families remains to be seen. What is crystal …

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Who gets left out of Obamacare?

Drugs and prescribing

A gameplan against this year’s flu

Natasha Burgert, MD

September 17, 2013Sep 17, 20134

Did your team win this weekend? I hope so. It is so exciting when your team gets to throw up a “W” after their first contest. It gives all the fans hope for a successful and exciting season. Fall also…

Did your team win this weekend?

I hope so. It is so exciting when your team gets to throw up a “W” after their first contest. It gives all the fans hope for a successful and exciting season.

Fall also is a time to cheer for our annual opportunity to protect our families against a predictably unpredictable opponent: influenza.

That’s right. It’s time to defend against the flu by getting an annual flu vaccine.

This …

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A gameplan against this year’s flu

Conditions and diseases

Mammograms in younger women: Is the data there?

Margaret Polaneczky, MD

September 17, 2013Sep 17, 2013

A recent study has concluded that women with breast cancer who failed to get annual mammograms are more likely to die from their disease than those who had annual mammograms, and argues that more frequent mammograms are warranted in women under age 40. Unfortunately, despite all the media attention this study is getting, I don’t think the researcher’s conclusions are supported by the study results.

The researchers did a retrospective medical record …

Health policy

The Affordable Care Act ignores simple issues of human nature

Edwin Leap, MD

September 17, 2013Sep 17, 201358

The Affordable Care Act (ACA), aka Obamacare, is law. And its implementation is moving along slowly, but steadily. You have to give credit to the folks who believed in it, whether grass-roots supporters or highly placed politicians. They rammed it…

The Affordable Care Act (ACA), aka Obamacare, is law. And its implementation is moving along slowly, but steadily.

You have to give credit to the folks who believed in it, whether grass-roots supporters or highly placed politicians. They rammed it down the American gullet like a lead ball down the muzzle of a Hawken rifle. The problem is, once it goes off, the whole thing is going to explode.

The reasons are …

Physician voices

The Sunshine Act: A chilling effect on medical education?

John Mandrola, MD

September 17, 2013Sep 17, 20133

Recently, I awoke to a picture of myself in the Wall Street Journal. I was asked to comment on the effects of the coming Sunshine Act. Respected health care journalist Peter Loftus found me through social media channels. What follows…

Recently, I awoke to a picture of myself in the Wall Street Journal. I was asked to comment on the effects of the coming Sunshine Act. Respected health care journalist Peter Loftus found me through social media channels.

What follows are some thoughts about how the Sunshine Act might play out.

Every Thursday during my cardiac fellowship training, at noontime, the entire department gathered for an hour-long conference on echocardiography. Unknown …

Drugs and prescribing

Drug discount cards: Tips and tricks to watch out for

Richard J. Sagall, MD

September 17, 2013Sep 17, 2013

Everywhere I look today, I see ads claiming huge savings from drug discount cards. These cards promise huge savings to consumers, yet they are unable to deliver on these outrageous statements. Now, when I see these ads, I’m skeptical --…

The old saying, “If it seems too good to be true then it probably is” also applies to drug …

Real physician voices, twice a week

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