KevinMD.com

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 …

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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

Physician voices

Can telepsychiatry really work?

Greg Smith, MD

September 2, 2013Sep 2, 20138

I have been asked one question about my work in telepsychiatry more that any other, hands down. “Can you really help a mental health patient like that, through a television screen?” The quick and dirty answer? Yes, absolutely. The extended…

I have been asked one question about my work in telepsychiatry more that any other, hands down.

“Can you really help a mental health patient like that, through a television screen?”

The quick and dirty answer? Yes, absolutely.

The extended answer? Read on.

Psychiatry is an intensely personal specialty. It requires knowing yourself as a doctor, as a therapist, as a consultant, and as a person more than any other kind of medical practice I …

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Can telepsychiatry really work?

Health technology

Your EMR is watching you

Skeptical Scalpel, MD

September 2, 2013Sep 2, 201315

A recent article on American Medical News titled "Medical charting errors can drive patient liability suits" led with a case involving a bad outcome after coronary artery bypass surgery. The plaintiff's attorney alleged that the doctors did not review the…

A recent article on American Medical News titled “Medical charting errors can drive patient liability suits” led with a case involving a bad outcome after coronary artery bypass surgery. The plaintiff’s attorney alleged that the doctors did not review the patient’s lab results or x-rays because they did not specific say so in the medical record.

The article quoted a defense attorney who said, “By the time [the doctors] are deposed, …

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Your EMR is watching you

Physician voices

Why hospice is special to me

Kristina Newport, MD

September 2, 2013Sep 2, 20132

When socializing with fellow young physicians, most of whom are not in palliative medicine, I am reminded that I have the unique opportunity to share time and attention with my patients. We reflect on “the old days” of medicine, where physicians had long standing relationships with their patients which allowed them to more easily direct medical decision making which was appropriate for the individual patient. I often tell others I …

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Why hospice is special to me

Physician voices

Is the end near for small community hospitals?

Mike Sevilla, MD

September 2, 2013Sep 2, 201314

Are the days numbered for Salem Community Hospital and other community hospitals around the country? Recently, a local story happened that made me think of this. The announcement was made that the Akron General Health System was being purchased by…

Are the days numbered for Salem Community Hospital and other community hospitals around the country? Recently, a local story happened that made me think of this.

The announcement was made that the Akron General Health System was being purchased by a joint venture of Cleveland Clinic and Community Health Systems (CHS). CHS is a Tennessee-based hospital operator who also owns three other hospitals in the Northeastern Ohio area where I live.

Six months …

Physician voices

When I see young pregnant patients, I see potential and opportunity

Jeff Livingston, MD

September 2, 2013Sep 2, 201318

When I look in the eyes of a pregnant teenage patient, I see my wife. My wife was a teen mother. She was a teen mother who beat the odds. She is not a statistic. She is an example of…

When I look in the eyes of a pregnant teenage patient, I see my wife. My wife was a teen mother. She was a teen mother who beat the odds. She is not a statistic. She is an example of the tremendous potential that lies before each and every teen facing the challenges of teen pregnancy. Pregnancy did not stop her from succeeding. My wife tells the story of riding …

Patient voices

How design can empower patients

Pat Mastors

September 2, 2013Sep 2, 20139

To designer and architect Michael Graves, paralyzed from a rare virus and in a wheelchair since 2003, the ultimate indignity came one day while he was a patient in a top-ranked hospital: “I was in a Hoyer Lift.” (a body sling mounted to a metal structure, used to help lift and move a patient). “The nurse was moving me from the bed …

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How design can empower patients

Health policy

To the legislators blocking Medicaid expansion

Chris Lillis, MD

September 1, 2013Sep 1, 2013115

As a primary care doctor I typically see 20-25 patients a day in my private practice. My community is gearing up for changes and is planning measures to integrate the many private practices locally. I was asked to serve on a committee evaluating software solutions to connect the disparate electronic medical records in the community, and had several hours of meetings at the hospital at the beginning of the week. …

Physician voices

Financial advice for brand new doctors

Davis Liu, MD

September 1, 2013Sep 1, 20136

This past July, the newest doctors, interns, have continued their journey in becoming experienced doctors. These newly minted and graduated doctors have excitement, anxiety, and anticipation not unlike the first day of medical school, college, or high school. But as…

But as new doctors begin their next step, we rarely talk about those who also graduated. Specifically, doctors who have completed their residency and in some cases their advanced fellowship training. What about …

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Financial advice for brand new doctors

Patient voices

Health insurance is wasted on the young

Kelly Wooten

September 1, 2013Sep 1, 201360

There has never been a time in my life when I’ve owed a lot of money. That certainly has changed this past two years as my husband and myself find ourselves with medical debt that we may never pay off. As you can guess, we have no health insurance — we can’t afford it and even if we did have an extra $650 a month we couldn’t obtain it due …

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Health insurance is wasted on the young

Medical education

Redesigning residency training: The evidence is lacking

Justin List, MD

September 1, 2013Sep 1, 201339

Three-year program residents graduating in June 2013 like me represented a unique cohort in medicine. As interns we experienced the 2003 ACGME duty-hour restrictions and the 2011 ACGME changes as residents. For example, I took thirty-hour call with a resident my intern year and ended residency with a dizzying iteration of a mixed call/shift system composed of multiple handoffs, residents, and interns. But this story is a call to more …

Medical education

For medical students, learning to keep their emotions aside

Holly Yong

September 1, 2013Sep 1, 201314

Flowers and bees. By no means is that very telling of my current life. On the contrary, I get glimpses of different times of the day when I go into patients' rooms and look out the window or if by…

Flowers and bees.

By no means is that very telling of my current life. On the contrary, I get glimpses of different times of the day when I go into patients’ rooms and look out the window or if by chance the anesthesiologist decides to open the curtains in the OR (yes, this hospital has windows in its ORs!).

So this topic of flowers and bees is very random. But it just …

Physician voices

Can technology help individualized medical decision making?

Leslie Kernisan, MD, MPH

September 1, 2013Sep 1, 2013

Shouldn't everyone get an individualized assessment of likely benefits, burdens, and risks before making a big medical decision? I was asked this question recently, during an interview for an Internet radio show on aging. Per my host's request, I'd been…

Shouldn’t everyone get an individualized assessment of likely benefits, burdens, and risks before making a big medical decision?

I was asked this question recently, during an interview for an Internet radio show on aging.

Per my host’s request, I’d been explaining the practice of geriatrics, and talking about the geriatric approach to addressing the medical needs of older adults. Since I’d mentioned that aging often brings on greater risk of side-effects or …

Physician voices

14 ways to drive your doctor crazy during a physical exam

WhiteCoat, MD

August 31, 2013Aug 31, 201312

1. When your doctor looks into your eyes with a flashlight, shut your eyes tightly so he can’t see your pupils. Later, when your doctors asks you to shut your eyes tightly to test your eyelid strength, look at him like he’s speaking in tongues and keep your eyes open. If he whips out his flashlight to look at your pupils …

Medical education

Women physicians in academia: The academic versus the biological clock

Linda Brodsky, MD

August 31, 2013Aug 31, 20136

Undoubtedly, those pursuing a career in academic medicine have a tough time line. In most medical schools, somewhere between the 7th and 10th year, depending on whether the academic clock was stopped for pregnancy, the fate of the academic physician is decided. During these years when women have the biologic clock ticking, they also have the “up or out” academic clock ticking.

This rush to create academic contributors is pure insanity, …

Real physician voices, twice a week

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