KevinMD.com

September 6, 2013Sep 6, 2013116

10 years ago today my first son was born and 10 years ago today he died. Born at 22 1/2 weeks he lived for three minutes, at least that’s what was written on the certificate that they gave me at…

10 years ago today my first son was born and 10 years ago today he died.

Born at 22 1/2 weeks he lived for three minutes, at least that’s what was written on the certificate that they gave me at the hospital. It seemed like both hours and seconds.

It was very anticlimactic in a way. I don’t say this to be trite, but it was as if his motor just stopped …

Physician voices

Is there an acceptable way to end friendships?

Alex Lickerman, MD

September 6, 2013Sep 6, 20134

When I was in first grade, my teacher once called the class together and said, “Glen is feeling bad because no one will play with him. Will anyone here play with Glen?” Glen was new (I think he moved to the area mid-year) and awkward-looking, and I remember how bad I felt for him when she said that. So I raised my hand. “I’ll play with Glen,” I said. To …

Conditions and diseases

Does the process of diseasification hold any promise in obesity?

Paul Marantz, MD, MPH

September 5, 2013Sep 5, 201318

In a thoughtful, measured and well-reasoned blog post, Dr. Keith Ayoob recently discussed the AMA’s decision to classify obesity as a disease. As he concluded his post, Dr. Ayoob wrote: “I don’t care how obesity is categorized. I care about what’s being done about it … We need to stop talking about whether obesity is or is not a disease and start talking about preventing it altogether.” This got me thinking: …

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Physician voices

Billing for end of life conversations needs to be an honest discussion

Shirie Leng, MD

September 5, 2013Sep 5, 201315

Good old Earl Blumenauer. A bespectacled and bowtied Congressman from Oregon. He of the “death panel” proposal. Thank God he’s still here. Presuming that the crazy talk over the provision in the Affordable Care Act that would have paid doctors to discuss end-of-life issues with patients is over, he has introduced a separate bill with this provision and hopes to get it passed in the next couple of …

Health policy

The primary care crisis has been legislated

Jordan Grumet, MD

September 5, 2013Sep 5, 201314

It was the same years ago in residency. There was both a categorical and primary care residency track. Each had their own distinctive curriculum and rotation schedule. The outpatient track did more time in the clinic, the categorical more on the hospital wards. We trained side by side. We attended many of the same lectures. And our fellowship choices matched identically. In fact, most of my colleagues from the primary …

Physician voices

The difficult transition between the hospital and nursing home

Ken Covinsky, MD

September 5, 2013Sep 5, 20139

Huge numbers of older persons transition from hospitals to the nursing home. Often, an older hospitalized patient needs skilled nursing care before they are ready to return home. In other cases, a nursing home patient who needed hospitalization is returning to the nursing home. Older patients and their families certainly hope that great communication between the hospital and nursing home would assure …

Health policy

What health care in the United States can learn from Nepal

Brad Wright, PhD

September 5, 2013Sep 5, 201310

In the US, many health care woes are blamed on the federal or state government. Whether there is too little oversight and lack of transparency or too much interference and regulation, it seems that policy and politics often end up getting blamed for health care system troubles. But what happens when one lives in a country with no functioning …

Physician voices

Treating cancer patients puts everything else into perspective

Miranda Fielding, MD

September 5, 2013Sep 5, 20133

When I was about ten years old, swimming on a Texas swim team, I remember hearing that the child of one of the local coaches had been diagnosed with leukemia. The idea of a kid dying of an untreatable disease was so foreign to me that I am sure that I have blocked out most of the details. I do know that the child died, and it didn’t take very …

Physician voices

10 questions to ask before anesthesia

American Society of Anesthesiologists & Karen S. Sibert, MD

September 4, 2013Sep 4, 2013

A guest column by the American Society of Anesthesiologists. Not so many years ago, surgeons wouldn't operate on patients they considered too old to tolerate the stress of anesthesia and surgery. Today, however, patients of every age — from Baby…

A guest column by the American Society of Anesthesiologists.

Not so many years ago, surgeons wouldn’t operate on patients they considered too old to tolerate the stress of anesthesia and surgery. Today, however, patients of every age — from Baby Boomers to the Greatest Generation — undergo anesthesia safely for surgery and diagnostic procedures.

Realistically, even if you believe that 60 is the new 40, concerns about having anesthesia are different …

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10 questions to ask before anesthesia

Drugs and prescribing

Are ADHD drugs responsible for mental illness in college?

Claudia M. Gold, MD

September 4, 2013Sep 4, 20136

Recently, I "launched" my oldest off to college. As anticipated, it was an intense emotional experience full of joy, sadness, and many things in between. (I have to tip my hat to Beverly Beckham for her piece I was the…

Recently, I “launched” my oldest off to college. As anticipated, it was an intense emotional experience full of joy, sadness, and many things in between. (I have to tip my hat to Beverly Beckham for her piece I was the sun, the kids were my planets that was very helpful. However, I might have written that my child was the sun, a burst of light in our household, and the experience …

Conditions and diseases

Should school buses have seat belts?

Natasha Burgert, MD

September 4, 2013Sep 4, 20134

Recently, parents all over the Kansas City area waited patiently for the news that the 6th graders were okay. Many were holding their breath. And those of us whose children ever step foot onto a school bus, thoughts came to…

Recently, parents all over the Kansas City area waited patiently for the news that the 6th graders were okay. Many were holding their breath.

And those of us whose children ever step foot onto a school bus, thoughts came to our brains that we don’t like to talk about.

The good news is that the kids were fine. Certainly shaken, but no critical injuries. The community is thankful …

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Should school buses have seat belts?

Conditions and diseases

Hospitalizing people against their will: 4 questions to ask

Maria Yang, MD

September 4, 2013Sep 4, 20137

Involuntary commitment refers to hospitalizing people against their will for psychiatric reasons. It is a controversial topic because this is where medicine and civil liberties intersect: Physicians have the ability to take away the rights of fellow citizens. (I suspect that few people who become psychiatrists realize that making recommendations about involuntary commitment is part of the job. I certainly did not know this. I also did not appreciate the …

Health technology

Health care through the lens of a technology entrepreneur

Davis Liu, MD

September 4, 2013Sep 4, 201324

If you want to see the future of health care, the can’t miss conference of the year is the Health Innovation Summit hosted by Rock Health in San Francisco. As a practicing primary care doctor, I had the opportunity to view health care through the lenses of technology entrepreneurs. I thought the conference was even better than the one I attended last year. Absent was the provocative rhetoric by 2012 …

Health policy

How customer service mechanisms don’t exist in health care

Paul Levy

September 4, 2013Sep 4, 201312

Now that I am a "civilian," I get to experience the health care system like most of you. I marvel at the degree to which customer service mechanisms used by service providers in other sectors do not exist in health…

Now that I am a “civilian,” I get to experience the health care system like most of you. I marvel at the degree to which customer service mechanisms used by service providers in other sectors do not exist in health care. Please understand that I am not talking about the quality of care, or empathy, or attentiveness offered by doctors, nurses, radiology techs, lab techs and the like. On that …

Conditions and diseases

Chronic Lyme symptoms after treatment deserve respect

David L. Katz, MD

September 3, 2013Sep 3, 201313

One of the more salient and concerning items of medical news reported this past week is an analysis by the CDC indicating that there is 10 times as much Lyme disease in the U.S. as formal reporting channels suggest. Rather than the 30,000 official cases each year, which would already make Lyme the most common tick-borne illness in the country — there are roughly 300,000 cases. An increase in Lyme prevalence by …

Conditions and diseases

The voices of schizophrenia: Treatment still has a long ways to go

Allen Frances, MD

September 3, 2013Sep 3, 20132

Read the original op-ed from the TED speaker who inspired this post: "Why I Thank the Voices in My Head." Eleanor Langdon is an extraordinary woman who has shown remarkable grit and creativity in transforming her disturbing symptoms into useful…

Read the original op-ed from the TED speaker who inspired this post: “Why I Thank the Voices in My Head.”

Eleanor Langdon is an extraordinary woman who has shown remarkable grit and creativity in transforming her disturbing symptoms into useful tools. Hats off to her for finding such a fruitful path to personal recovery and for sharing her techniques and inspiring story so that others may benefit from what she has learned.

There are …

Drugs and prescribing

Drugs that are not FDA approved: Is there a time to prescribe them?

Juliet K. Mavromatis, MD

September 3, 2013Sep 3, 201325

Here’s an interesting clinical dilemma brought to my attention by another physician. She was asked to refill a prescription for a drug called domperidone to help a patient with lactation. Domperidone is not FDA approved in the United States for…

Here’s an interesting clinical dilemma brought to my attention by another physician.

She was asked to refill a prescription for a drug called domperidone to help a patient with lactation. Domperidone is not FDA approved in the United States for any indication. However, in Europe and in Canada it is approved as a promotility agent for patients with a condition called gastroparesis, which causes the stomach to empty very slowly and results in …

Physician voices

The knowledge that one wasn’t alone in an uphill fight

StorytellERdoc, MD

September 3, 2013Sep 3, 2013

I smelled the patient, unfortunately, even before walking into his room to introduce myself. From the hallway, his odor of lingering stale smoke flared my nostrils, instigating childhood recollections of the wood-burning furnace at my grandmother’s home. From a distance, the scent of smoke was just that — charred-burnt air, its weight clinging to my nostrils. As I approached the patient, however, the scent of smoke smoldered my wishful memories …

Conditions and diseases

What conditions are more amenable to watchful waiting?

Edward Pullen, MD

September 3, 2013Sep 3, 20137

Watchful waiting has become a term often thought of as an alternative to surgery, radiation, or other interventions for early stage prostate cancer. Watchful waiting is actually a viable option for many other conditions too. Most Mom’s know that tincture…

Most Mom’s know that tincture of time with watchful waiting lets their children have the opportunity to recover without intervention for many minor injuries and illnesses without exposing them to the risks associated with antibiotics or …

Physician voices

The hubris of medicine has to end

John Mandrola, MD

September 3, 2013Sep 3, 201340

I used to think medicine would get easier over time. It makes sense, right? You see patterns, you learn how treatments work, and you just get to know stuff. Experience should make it easier to diagnose and treat. That’s not…

That’s not been the case for me. In fact, it’s closer to the opposite. In the exam room, as I look up to the patient from my stool, and before I stand at …

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The hubris of medicine has to end

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