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Psychiatric patients don’t fit the usual medical mold in the ED

Greg Smith, MD

Physician

June 18, 2013

The ED is a hectic place.

Sore throats. Heart attacks. Dog bites. Broken bones. Strokes. Major trauma. If you work in an ED, you see it all. And then some.

Is it any wonder then, with the potential for literally thousands of medical and surgical problems to stumble through the doors of an ED, that hospitals and the bodies that accredit them demand strict, regimented, standard, reproducible emergency assessments …

Sexual health issues should be normalized in the exam room

Sharon Parish, MD

Physician

June 18, 2013

Sexual health, though fundamentally important to every human being, is rarely discussed between patients and their healthcare providers. It’s an important conversation and one that requires doctors and patients to venture into less-than-comfortable territory.

Who exactly should treat sexual health issues? Many assume that this should be the territory of a gynecologist for women or a urologist for men.

But because we see our patients more frequently than any other doctors, general …

A good business school student makes for a good medical student

Kevin R. Campbell, MD

Medical Education

June 18, 2013

Medical education today requires students to assimilate lots of facts and amass an incredible fund of knowledge quickly. As medical science advances, more material must be mastered. Medical students must be able to organize facts and apply them to patient care. Medical care today is becoming more of a team effort. Successful physicians must be adept at both leadership roles and in the role of a team member (worker bee). …

Consoling a family whom I’d never met

Jason McKeown, MD

Physician

June 18, 2013

It’s painful enough to lose a patient. But I found it even more painful to try to console a family whom I’d never met.

Depending on your point of view, the limited patient contact afforded the anesthesiologist is a disappointment or a perk of the specialty. Anesthesiologists are steadily branching out into other areas of perioperative care where lengthier patient/family contact is necessitated but the preop encounter with the anesthesiologist is …

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Consoling a family whom I’d never met

Pulling me away from the seductive simplicity of cookbook medicine

Rob Lamberts, MD

Physician

June 18, 2013

Mind-Map

This, apparently, is a map of my mind. It’s a little shocking to find out that my mind looks like a sea creature, a bug, or perhaps a vegetable. Actually, “Rob’s mind” and “vegetable” are often used in the same sentence.

Someone suggested to me that I may benefit from mind mapping. I don’t know how to describe it, but I think spatially; …

The link between ADHD and obesity

Wendy Sue Swanson, MD

Conditions and Diseases

June 17, 2013

Screen-Shot-2013-05-20-at-1.47.44-PM

Last week I served lunch at my son’s school. It was a hoot, really, serving an entire K-8 school lunch. Dishing out lasagna, broccoli, pizza, and grilled cheese provided all sorts of insight into what lunch is like in 2013. My son didn’t choose exactly as I’d predict (see below). When a 33-year prospective study published recently which connects childhood ADHD with adult obesity, …

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The link between ADHD and obesity

Dying a hero’s death

Peg Ackerman, APRN

Patient

June 17, 2013

Blanched by anemia, Mary rested quietly in the hospital bed. Her pallor made her barely visible amid the bleached bed linens–she seemed a mere shock of white hair against the pillowcase.

Age ninety-three, she’d visited the hospital a half-dozen times in as many months, shuttling between nursing home and hospital as many elders unwittingly do in their last year of life. She may have preferred to stay put, but no one …

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Dying a hero’s death

Thanks for the compliment, but I’m not a nurse

Megan S. Lemay, MD

Physician

June 17, 2013

Let’s get one thing clear from the start: I love nurses. My grandmother was a nurse’s aide. My aunt is a nurse. My mother is a nurse. Nurses have been by my side for the most frightening and important experiences in my life (in the hospital and out). However, I’m not a nurse. I’m a doctor. And when someone calls me …

EHRs need to talk to each other, but make sure they work first

Deep Ramachandran, MD

Health Technology

June 17, 2013

I’ve written several times before about my love/hate status with my EMR. While I enjoy using mine, I long for it’s usefulness to get to the next level. While the EMR is useful at tracking data, it’s greatest handicap right now, is that it can’t talk to other systems. Data is still locked in individual systems and can’t be shared across platforms. This lack of interoperability has thus far been …

ACP: Physicians around the world face similar non-clinical issues

Yul Ejnes, MD

Physician

June 17, 2013

A guest column by the American College of Physicians, exclusive to KevinMD.com.

Over the past several years, I have had the honor of representing the American College of Physicians at scientific conferences and professional society meetings. In addition to hearing about the latest advances in internal medicine at these events, I learn what is on the minds of physicians in …

Palliative care has become the last bastion of health care sanity

Jordan Grumet, MD

Physician

June 17, 2013

I couldn’t really blame the social worker. He was just doing his job. The skilled nursing facility (SNF) connected to the hospital was full of flailing patients. So he thought he would ask for a palliative care consult (after getting an okay from the primary team). It was his third request of the day. He spoke slowly as he tried to untangle the twisted path the patient had taken.

“Dr. X …

AMA: A significant redesign of undergraduate medical education

Jeremy Lazarus, MD

Medical Education

June 17, 2013

A guest column by the American Medical Association, exclusive to KevinMD.com.

To close the gaps between how medical students are educated and how health care is delivered now and in the future, the American Medical Association (AMA) has awarded $11 million to 11 U.S. medical schools to fund their bold proposals that support a significant redesign of undergraduate medical education. This is just …

Numbers fail to answer that one vital question

James C. Salwitz, MD

Physician

June 16, 2013

When I visited Allan in the hospital yesterday, I told him to get up and stroll the hall. However, when I checked in on him this afternoon, the nurses informed me that he refused to get up, even to the chair. When I asked why, Allan told me he could not walk. I was concerned, but when I examined him, I found his vital signs were fine, he had no …

Should medical resident training be limited to 40 hours per week?

Skeptical Scalpel, MD

Medical Education

June 16, 2013

Dr. Sam Ko says resident work hours should be limited to 40 per week. Via Twitter, I warned him that I would rebut his assertion.

Without any data or references except a tangential one, he bases his opinion on four premises.

1. Residents will be happier and nicer to patients because they will be less stressed. There is no proof that this is so. In fact, a recent Read more…

Should medical resident training be limited to 40 hours per week?

Use batch processing and stop working like a dog

Dike Drummond, MD

Physician

June 16, 2013

Do you find yourself spending too much time on things that have nothing to do with seeing patients, and then getting home later than you would like?

Do you notice that for every 15 minutes you spend with a patient you spend way more than that messing around in the EMR and being distracted by things like prescription refills, test results and a hundred other forms of two bit clerical work …

The FDA is regulating the wrong things

Janice Boughton, MD

Medications

June 16, 2013

The Food and Drug Administration was created in 1927 in order to carry out the mission of the Food and Drug Act put into effect by Theodore Roosevelt in 1906. In the early 1900’s and before, medicines killed and maimed people in gruesome ways and adding chemical substances to foods to mask the fact that they were rotten or substandard was felt to need some sort of legal response. The …

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The FDA is regulating the wrong things

Who’s truly responsible for the $2.7 trillion medical bill?

Kent Bottles, MD

Health Policy

June 16, 2013

As someone who professionally closely tracks the debate over the transformation of the American health care clinical delivery system, I did not learn much new from the New York Times article: The $2.7 Trillion Medical Bill. I did find the article’s approach useful in explaining how the wide variations in price for procedures contribute to the unnecessary high cost of American health care.

Although the article did document many procedures …

Are hospitals really soaking the poor with high prices?

Chris Rangel, MD

Health Policy

June 16, 2013

The Centers for Medicare and Medicaid recently released its compiled data on what over 3,000 hospitals across the country charge for 100 of the most common discharge diagnostic codes under the diagnosis related group (DRG) system, and boy did the DRG really hit the fan. Liberals, economists, and band wagoners got all upset about the enormous pricing differentials between hospitals for the same services.

For example, Twin Cities Community Hospital in …

Are ER services really the cost villains?

Trudy Lieberman

Health Policy

June 15, 2013

Maligned over the last decade as places to avoid because of the price of the care they delivered, a study by the RAND Corporation goes a long way toward improving the image of hospital emergency rooms (ERs). The ER price tag was too high for the insurance companies that paid the bills, so many of them tried to discourage ER use by designing policies with high coinsurance and copayments …

Childcare during medical training: Sometimes you just get lucky

Miranda Fielding, MD

Physician

June 15, 2013

Sometimes you just get lucky. When I was pregnant with my first child, during my radiation oncology residency, we had a guy living in the apartment over our garage, which we liked to refer to as “the carriage house.” He was a dog trainer by trade, and in his spare time he played softball in a local adult league. When we told him he had to move out, because we …

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