KevinMD.com

September 13, 2013Sep 13, 2013

If Hattie had but one flaw, it was that she held her doctors in too high esteem. It was not unusual for an eighty-year-old woman of her culture to want to please her cardiologist. So when her blood pressure came up a little high, she was too embarrassed to admit that she had forgotten to pick up the Toprol and hadn’t taken it in over a week.

The cardiologist hemmed and …

Drugs and prescribing

Is your physician immune to drug marketing?

Roy Benaroch, MD

September 13, 2013Sep 13, 201362

You’re at the doctor’s office, and you see strolling up to the window a good-looking, well-dressed professional. They’re usually pulling a little discreet cart, and after a few words with the receptionist they’re rushed right back. Sometimes they’ll bring a…

You think they had an appointment? No, but you can be they’re here to see the …

Medical education

What does a modern medicine intern do all day?

Edward Pullen, MD

September 13, 2013Sep 13, 201337

What does a modern internal medicine intern do all day (and night)? It turns out they spend 40% of their time at work using a computer, another 20% on other aspects of patient care that is not in the presence of the patient, 15% in educational activities, 5% on basic needs like walking around and eating, and only 12% in direct patient care. Direct patient care includes interviewing patients, examining …

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Physician voices

End of life care is a core part of medicine

James C. Salwitz, MD

September 13, 2013Sep 13, 20139

Recently, I continued my crusade to make end-of-life care a basic skill, as I gave the "Introduction to Dying" lecture to third year medical students, for the twentieth time. For me it is not just about pain control, family meetings…

Recently, I continued my crusade to make end-of-life care a basic skill, as I gave the “Introduction to Dying” lecture to third year medical students, for the twentieth time. For me it is not just about pain control, family meetings and hospice care, but rather convincing physicians that they must change the medicine practiced for the last 100 years. That medicine says that a doctor can fight all disease, give any treatment, …

Physician voices

What keeps some people from feeling that they really matter?

Greg Smith, MD

September 12, 2013Sep 12, 20137

“Yeah, Doc, I drink. I drink a lot. Some nights I drink a case of beer and a half pint. Can’t sleep if I don’t drink. Relaxes me. Pure and simple. Numbs me up like novocaine.” A toothless grin. “It’s…

“Yeah, Doc, I drink. I drink a lot. Some nights I drink a case of beer and a half pint. Can’t sleep if I don’t drink. Relaxes me. Pure and simple. Numbs me up like novocaine.”

A toothless grin.

“It’s the feeling of floating away. I don’t know, I just keep coming back to it. Stuff goes in, feel a little flushed, a little rush, then I go somewhere else, you know? …

Physician voices

Lawyers are a big impediment to disciplining bad doctors

Skeptical Scalpel, MD

September 12, 2013Sep 12, 2013198

If you are interested in patient safety and medical errors and haven't read the story in the Texas Observer about a spectacularly incompetent neurosurgeon, you should. It is long but worth it. It will make you cringe. The story includes…

If you are interested in patient safety and medical errors and haven’t read the story in the Texas Observer about a spectacularly incompetent neurosurgeon, you should. It is long but worth it. It will make you cringe.

The story includes many details about operations done poorly and patients suffering paralysis and death at the hands of Dr. Christopher D. Duntsch.

The Texas Medical Board is over-worked, slow to act and …

Drugs and prescribing

Are parents active parts of a national drug epidemic?

Claire McCarthy, MD

September 12, 2013Sep 12, 20138

When you reach for ibuprofen for your sore back or a pill to help you sleep, are you sending a bad message to your kid? Yes, says Bryant Gumbel in his video commentary about the drug charges against ball player…

When you reach for ibuprofen for your sore back or a pill to help you sleep, are you sending a bad message to your kid?

Yes, says Bryant Gumbel in his video commentary about the drug charges against ball player Alex Rodriguez. While he thinks that Rodriguez should be punished for being a liar and a cheat, he doesn’t think that people should be shocked by the fact that Rodriguez was …

Drugs and prescribing

Remember the side effects of needed drugs that go untaken

David L. Katz, MD

September 12, 2013Sep 12, 20136

You probably already know that what you do know about your medicine could kill you. You may not know that what you don't know could do so as well. Hold that somber thought -- we'll get back to it. You,…

You probably already know that what you do know about your medicine could kill you. You may not know that what you don’t know could do so as well. Hold that somber thought — we’ll get back to it.

You, and I, and everyone else has seen those direct-to-patient drug ads that Big Pharma runs on primetime television. Invariably, they feature a person skipping through butterflies and wildflowers, demonstrating …

Drugs and prescribing

Can e-cigarettes be a public health victory?

Justin Berk, MPH, MBA

September 12, 2013Sep 12, 20139

Annoying mall vendors have been pushing what may be one of public health’s greatest accomplishments—and few have taken notice. Behind pillow pet stations and the candle stand, mall shoppers can find electronic cigarettes, or “vapes.” Often targeted at smokers wanting…

Smokeless cigarettes have become a hot product, with an estimated $1.7 billion in sales …

Physician voices

Is there any single secret for aging well?

Suzanne Koven, MD

September 11, 2013Sep 11, 20136

The word "doctor" derives from the Latin verb docere: to teach and, as a doctor, I do often offer instruction. But when a woman in her eighties comes in for her annual physical and tells me she's still dancing, mowing…

The word “doctor” derives from the Latin verb docere: to teach and, as a doctor, I do often offer instruction. But when a woman in her eighties comes in for her annual physical and tells me she’s still dancing, mowing her own lawn, and helping out her older neighbors, I have no illusions about which of the two of us should be doing the teaching.

Particularly since reading this lovely feature story about Ethel …

Health policy

The NP vs MD debate is missing the bigger picture

Brad Wright, PhD

September 11, 2013Sep 11, 201350

In coming years the US could see growing shortages in the availability of primary care physicians (PCPs). With the number of individuals seeking care increasing and the current medical system continuing to incentivize physicians to specialize, the number of available PCPs will decline proportional to the population. To fill that gap, Ezra Klein and others have asserted that expanded scope of practice will allow nurse practitioners (NPs) …

Physician voices

The role of physicians is set to evolve again

Hans Duvefelt, MD

September 11, 2013Sep 11, 20133

Talking with an insurance doctor, who denied a vertebroplasty for my patient with a spontaneous compression fracture, I started thinking about the dilemma of defining what a doctor-patient relationship is. A couple of years ago a local doctor with a…

A couple of years ago a local doctor with a dwindling private practice joined an Internet medical site that promoted drugs like Viagra and offered online consultations with physicians who prescribed the medications when they felt it was appropriate. The state …

Health technology

We need tools to meaningfully interpret health data

Peter Alperin, MD

September 11, 2013Sep 11, 2013

We generate it every minute of every day of every week of every month of every year. Data, in countless forms. Of recent and growing interest to a great many people is how this data can be use to improve…

Wear a FitBit or Jawbone? Amazing source of activity information. Check in on Foursquare? Insight into dietary habits. Post on Twitter? Sentiment analysis around …

Physician voices

What keeps this hospital CIO up at night

John Halamka, MD

September 11, 2013Sep 11, 20138

Now that Labor Day has come and gone, I’ve thought about the months ahead and the major challenges I’ll face. 1. Mergers and acquisitions. Health care in the US is not a system of care, it’s a disconnected collection of…

Now that Labor Day has come and gone, I’ve thought about the months ahead and the major challenges I’ll face.

1. Mergers and acquisitions. Health care in the US is not a system of care, it’s a disconnected collection of hospitals, clinics, pharmacies, labs, and imaging centers. As the Affordable Care Act rolls out, many accountable care organizations are realizing that the only way to survive is to create “systemness” through mergers, …

Physician voices

What Jay-Z can teach doctors about marketing their practice

Mary Pat Whaley

September 11, 2013Sep 11, 20137

Do you know who Jay-Z is? If not, chances are your kids do. Jay-Z is one of the most successful rap artists of all time, and has parlayed that success into a career in fashion, merchandising, his own line of…

Do you know who Jay-Z is?

If not, chances are your kids do. Jay-Z is one of the most successful rap artists of all time, and has parlayed that success into a career in fashion, merchandising, his own line of vodka, as well as an ownership stake in the NBA’s New Jersey Nets franchise that he recently sold to begin a new career …

Health policy

Can American doctors get off the hamster wheel?

John Mandrola, MD

September 10, 2013Sep 10, 201315

What follows are not complaints. These are just the facts. Here’s a recent exchange from an enlightened physician leader, one who has yet to give up: “My colleagues are discouraged and frustrated every day, leaving the office defeated and fatigued.…

What follows are not complaints. These are just the facts.

Here’s a recent exchange from an enlightened physician leader, one who has yet to give up: “My colleagues are discouraged and frustrated every day, leaving the office defeated and fatigued. There are other ways to practice.”

High health care costs get most of the attention, but there’s a more important crisis coming your way.

First a review, then to the looming crisis.

When Americans travel …

Conditions and diseases

People who participate in clinical trials are trailblazers

Don S. Dizon, MD

September 10, 2013Sep 10, 20134

Joan was 42, married, but appeared to be younger than that. Her husband was with her when we first met, as was her beautiful two-year-old son. “We couldn’t get a baby sitter, if you can believe that!” she said. Sarah…

Sarah was 38 and was also married. She and I were closer to the same age, which was not lost on either of …

Conditions and diseases

A medical student experiences sticker shock

David Marcovitz

September 10, 2013Sep 10, 201326

When I was a second year medical student, I gave blood at a Red Cross drive and noticed a week later that I had a hard and slightly tender blue spot on my left forearm arm where they had drawn…

When I was a second year medical student, I gave blood at a Red Cross drive and noticed a week later that I had a hard and slightly tender blue spot on my left forearm arm where they had drawn blood. I described it to my PCP through our online portal, and I mentioned that I’d had a similar occurrence a couple years prior after having an IV during an …

Patient voices

Survivorship care after cancer is a shared effort

Jessie Gruman, PhD

September 10, 2013Sep 10, 2013

I wish I had known earlier that survivorship care is neither a do-it-yourself project nor is it something that I can simply hand off to experts. There is no stable set of signs, signals and test protocols that, if followed assiduously — and that come up negative — means I am protected from a recurrence, new cancer or late effects of treatment. Observation, expertise and self-knowledge by both me and …

Physician voices

Bluffing wasn’t a skill I was expecting to master in pathology

Gizabeth Shyder, MD

September 10, 2013Sep 10, 201313

As a pathologist, I am one step removed from the patient. This is comforting for the most part. I render my diagnosis and another clinician communicates it to the patient. It is best this way — I have no treatment options in my own doctor toolbox to give meaning to the words I communicate. I learned this the hard way — in fellowship training.

Once I was doing a fine needle …

Real physician voices, twice a week

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