We live in a strange world. What would happen if tomorrow a common sedative was found to cause 21,000 cancer deaths every year? What if it resulted in breast cancer, mouth cancer, hepatoma and esophageal malignancies, and if the average patient lost 19 years of life? What if the drug also killed by cirrhosis, massive upper GI bleeding, accelerated dementia, and for …
There is no completely safe dose or form of alcohol
Much has already been written about the Oregon Medicaid study that came out in the New England Journal of Medicine. Unfortunately, the vast majority is reflex, rather than reflection. The study seems to serve as a Rorschach test of sorts, confirming people’s biases about whether Medicaid is “good” or “bad”. The proponents of Medicaid point to all the ways in which Medicaid seems to help those who were …
Why the Oregon Medicaid study is misunderstood
Too often patients feel like they’re in the passenger seat when entering the hospital. Even in the best of circumstances — such as planned admissions — patients often don’t feel in control of their own care.
One of the most unnecessary issues facing patients when they enter the hospital is untreated (or undertreated) pain. Often the focus of the medical team is to treat a condition, and controlling a patient’s pain …
How to have a hospital stay without pain
I empathize with people who don’t take an active role in their health care decisions. There are real barriers to any of us really getting engaged: limited information about price and quality, a perpetuated culture of “doctor knows best,” and a daunting and confusing set of rules about coverage. Who wants to think about it?
There are only so many minutes in the day or neurons in the brain. So, we …
Patients: Play the role of a consumer who has choices
Not old enough to remember any sort of “glory day” in medicine, I still enjoy hearing from older colleagues who recount days when they were respected, paid fairly, and able to practice medicine autonomously at the highest and most uncompromising level. What was that like, I wonder?
For five years, I’ve been a busy practicing anesthesiologist. And for five years, I’ve listened …
America is at war with its doctors, and patients are the losers
After six weeks in the accelerated bachelor of science in nursing program at the University of Rochester, I was already on clinical rotations in the hospital. I was learning clinical functions that my second-year medical school friends had no idea how to perform: catheterizations, wound dressing changes, how to calculate and administer medications. There’s just not enough time in the first two years.
On the other hand, in the nursing program, …
I am wrong to think of myself as just a nurse
Psychotic and manic depressive disorders can not only disrupt the life of the person suffering with one of these illnesses, but the lives of family and friends as well.
You should seek professional advice if you suspect that you, a friend or a relative or even a spouse may be experiencing a psychotic or bipolar disorder. It’s important not to attempt a diagnosis yourself. There are many external factors that can …
Understanding psychotic and bipolar disorders
What is the measure of successful technology adoption? Is it never having to hunt for a missing chart? Is it a reduction in specific operating cost line items? Is it about access to clinical information when you need it and where you need it?
Technology implementation has a significant effect on profitability. The Medical Group Management Association Cost Survey Report beginning with 2010 data shows that total medical revenue after operating …
10 mistakes practices make in implementing information technology
I recently took part in a “civil discourse,” an unusual occurrence in this era of media pundit-orchestrated shouting matches.
Unlike a debate with winners and losers, a civil discourse begins with the premise that, when there are different points of view on a topic, it is better to understand those with whom we disagree than to turn off the sound.
By listening and asking probing questions, we come to understand how such …
Health reform needs a healthy respect for civil discourse
Medical and surgical errors are very common in the hospital setting. They increase malpractice lawsuits, the cost of medical care, patients’ hospital stays, and morbidity and mortality. As an infectious diseases specialist for over forty years, I was not aware how common these errors are until I became a patient myself after being diagnosed with hypopharyngeal carcinoma. My initial cancer was successfully removed, but a local recurrence occurred twenty months …
Medical mistakes occurred at all levels of my care
I have witnessed a lot of obesity bias in my career, and I have railed against it on more than one occasion. But it’s not the focus of my career, as it is for some of my colleagues. I have long thought those colleagues who do devote themselves to the topic may tend to overlook a very fundamental question, namely: Why would obesity bias even exist? What rational basis is …
Choosing a new doctor is never easy. You need to know about convenience factors, such as office location, available appointment times, and accepted insurance plans. You will probably also consider background information, such as education, board certifications, and licenses. But the most important question you likely have involves results: Is this doctor any good?
Unfortunately, there just isn’t a single, perfect way to measure the quality of individual …
A hidden way to measure quality when finding a doctor
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 45-year-old man is admitted to the hospital for a 2-day history of fever and abdominal pain. His medical history is notable for cirrhosis due to chronic hepatitis C, esophageal varices, ascites, and minimal hepatic encephalopathy. His medications are furosemide, spironolactone, nadolol, lactulose, zinc, vitamin A, and vitamin D.
On physical examination, temperature is 36.5 …
MKSAP: 45-year-old man with fever and abdominal pain
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For the past fifteen years, I have had an incurable form of leukemia.
Such diseases used to be called terminal illnesses, but we don’t hear that term as much anymore. With all the new drugs and treatments available, doctors have become more reluctant to refer to diseases they can’t cure yet as “terminal.”
In the years just after my diagnosis, when friends and family would ask what could be done for it, …
Living with an illness for which there is no cure
I am a physician, an anesthesiologist. I care for the sickest of the sick every day – struggling NICU babies born only hours earlier, victims of major traumatic accidents, and critically ill patients with life threatening illness. In this job, I must both connect with the patient, but also maintain a distance from them at the same time. Dealing with life threatening …
Being a caregiver has made me a better doctor
Don’t get me wrong, it’s huge to see patient safety evolving to be a front-burner issue. After beating the drum for years, the National Patient Safety Foundation and other groups are seeing progress, with meaningful use, electronic health records, pay for performance, and the patient-centered medical home.
Medicare innovation grants and the Partnership for Patients are chipping away at medical harm and 30 day readmissions. Empowered patients are test-driving their choices …
Measuring patient engagement: What would Ken Schwartz think?
If you’ve read my reviews of the new medical TV show Monday Mornings, you’ll know I’ve been critical of many things about it. I was particularly disappointed with the way the show handled one of its central themes: the morbidity and mortality (M&M) conference.
I thought it might be useful to tell you how most real M&M conferences are run. M&M conferences generally take place at hospitals with residency training …
What really happens in a morbidity and mortality conference
Could a greater miracle take place than for us to look through each other’s eyes for an instant?
-Henry David Thoreau
It is almost 7:00am I carry my briefcase and lunch bag from the car to my office. I nod to some of the night shift employees heading home. Another day has begun.
I type my password and check the computer, reminding myself of the twenty patients I am scheduled to see today …
Stories surround every physician
In many of our local supermarkets, there is a section of organic produce in addition to produce that is traditionally farmed. For those of us selecting and preparing food for our families, we often wonder what items, if any, we should purchase with the organic label.
When I shop, I typically choose traditionally farmed foods for my family’s meals. There are certain items …
There is little nutritional advantage to organic food
A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com.
Recently, discussion about health care has reached a fever pitch, between changes in policy, adjustments to scope of practice and a multitude of other medical issues. As health care providers, it is our duty to provide the highest level of medical care to all patients to …
ASA: Doctors and nurses are simply not one and the same
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