KevinMD.com

July 29, 2013Jul 29, 20133

Recently, I have spent a lot of time talking to patients, trying to explain why I've had to cancel their upcoming fecal transplant. The FDA has ruled that stool is an investigational new drug (IND), which now imposes a huge…

Recently, I have spent a lot of time talking to patients, trying to explain why I’ve had to cancel their upcoming fecal transplant. The FDA has ruled that stool is an investigational new drug (IND), which now imposes a huge bureaucratic hurdle to getting a much needed therapy for patients with recurrent or intractable C. difficile infection.

Even before the FDA did this, there were already hurdles for patients who are really suffering …

Medical education

Medical students: How to survive the 21st century medical school

Maureen Miller, MD, MPH

July 29, 2013Jul 29, 20137

Congratulations on your admission to medical school! Your white coat ceremony is coming, and it'll be grand. Your orientation leaders will suggest study skills, where to find scrubs and the best cheap supplements. Maybe more enlightened members of the faculty…

Congratulations on your admission to medical school! Your white coat ceremony is coming, and it’ll be grand. Your orientation leaders will suggest study skills, where to find scrubs and the best cheap supplements. Maybe more enlightened members of the faculty will remind you that medicine is really about the patients. If your parents are physicians, as so many medical students’ parents are—mine are not—they will reminisce about their own days …

Physician voices

Treating the psychiatric patient in the ED: 3 changes I’d like to see

Greg Smith, MD

July 29, 2013Jul 29, 201312

"Most EDs do not have separate secure areas in which psychiatric patients can be held. They typically don’t have a psychiatrist immediately available to evaluate the patient and provide guidance on management, and they do not have extra nursing staff…

“Most EDs do not have separate secure areas in which psychiatric patients can be held. They typically don’t have a psychiatrist immediately available to evaluate the patient and provide guidance on management, and they do not have extra nursing staff to monitor often unpredictable patients.”

This was a comment on one of my blog posts.

Well, we have been talking about the way psychiatric patients get to the ED …

Real physician voices, twice a week

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Health policy

Break the cycle of event centered care

Fred N. Pelzman, MD

July 28, 2013Jul 28, 20136

Creating a patient-centered medical home within our existing system seems, at times, like a Herculean task. Getting all the pieces in place so that we can make the needed changes sometimes seems too vast to get it all right. We…

We find ourselves asking: Why bother? Is our healthcare system that broken? Is the way we take care of patients now failing, satisfactory, or outstanding? If we just continue on the path …

Read more…

Break the cycle of event centered care

Medical education

The benefit of a public health degree in medical education

Joshua St. Louis

July 28, 2013Jul 28, 20137

On a rotation in internal medicine last year during my third year of medical school, I spent several days watching the residents work to optimize a homeless patient’s insulin regimen. They were understandably concerned with his diabetes medications because he had been admitted in a diabetic coma, but the real reason for the coma, as far as I could see, had nothing to do with his medication regimen and everything …

Physician voices

Reflecting on DNR/DNI after being a code team leader

Robert Glass, MD

July 28, 2013Jul 28, 20134

“Got a new admission for you. 93-year-old male with end stage kidney disease on dialysis, coronary artery disease, hypertension, diabetes, peripheral vascular disease here after being found unresponsive. Oh by the way, I think he’s DNR/DNI.” It’s like music to…

It’s like music to the ears of any medicine resident. I’m still not entirely sure why this phrase brings such relief, but I’m in my last year of residency and still exhale a little bit …

Health policy

Turning health care into a giant used car lot

Naomi Freundlich

July 28, 2013Jul 28, 201313

I’m not a big fan of bargaining and my half-hearted attempts to get a better price for a used car, garage sale find or contractor’s service have been mostly unsuccessful. There’s always that nagging feeling that the seller is laughing…

And so it has come as somewhat of a shock to me that medical care has become …

Patient voices

Why more medical information does not lead to better health

Beth Waldron

July 28, 2013Jul 28, 20136

As the director of a health education program at a public university, my work is predicated upon the belief that greater knowledge is the key to improving health outcomes. If patients and healthcare professionals simply had better access to the latest information on a particular medical topic—if they simply knew more about a diagnosis, treatment, or prevention strategy—then we’d surely see improved health outcomes.

I have come to realize this assumption is wrong. …

Physician voices

Suicide in female physicians: Recognize, respond, reconsider

Linda Brodsky, MD

July 28, 2013Jul 28, 201349

More people are dying because they commit suicide than in motor vehicle accidents this year. The number of suicides is rapidly approaching the number of deaths from breast cancer. The trend upward has been noted for the past decade. Physicians…

Physicians are the professional group with the highest rate of suicide. And studies have estimated that women physicians have as much as an eight fold rate of suicide compared to their male colleagues. Is …

Health policy

How to aggressively pursue population health

David B. Nash, MD, MBA

July 27, 2013Jul 27, 20139

A good recipe is one that combines high-quality ingredients in appropriate quantities to produce a savory main course or a decadent dessert. It strikes me that, in order to answer the Affordable Care Act's call for us to aggressively pursue…

A good recipe is one that combines high-quality ingredients in appropriate quantities to produce a savory main course or a decadent dessert.

It strikes me that, in order to answer the Affordable Care Act’s call for us to aggressively pursue population health, we must first understand what the recipe calls for.

Dichotomous as it may seem, the primary ingredient for population health is accurate, comprehensive data on the individuals who comprise the …

Patient voices

Patients and clinicians don’t have the same goals in mind

Jessie Gruman, PhD

July 27, 2013Jul 27, 2013

What we look for when we participate actively in our health care differs from what our clinicians, employers and health plans believe will result when we shift from being passive to active participants. We don't have the same goals in…

We don’t have the same goals in mind. Does this matter?

Ask patients who use the phrases “patient engagement,” “patient participation” or “patient empowerment” about their goals and we talk about having some measure of control over our health …

Physician voices

In medicine, trust needs to be built in a matter of minutes

Scott Finkelstein, MD

July 27, 2013Jul 27, 20136

I was a very shy child. I never felt comfortable speaking up, especially in groups or in new situations. When asked a question in class, my heart raced, my eyes teared up, and I felt sweaty. As I grew up, these physical reactions subsided as I learned to internalize and manage this fear. But at that time, I could not have imagined that my professional career would depend upon my …

Physician voices

The unwritten contract: Cancer cannot be beaten any other way

James C. Salwitz, MD

July 27, 2013Jul 27, 20135

I had a patient this week that really screwed up his medical care when he experienced a predicted side effect of curative chemotherapy. Despite clear instructions and access to every number my partners, my staff and I have, including office, triage, cell, and answering service, he did not reach out. Day-by-day he lay in bed, as he grew weaker and multiple systems failed. No one contacted me. Finally, he sent …

Conditions and diseases

Haunted by an autism diagnosis: A sense of closure after 20 years

Lisa Shulman, MD

July 27, 2013Jul 27, 2013

I believe most physicians have cases that haunt them, often patients whose treatment courses do not go ideally and who leave a mark on the physician, altering the way he or she practices ever after. When the physician is a surgeon, it might be a patient who died on the table. For a hematologist, it might be a patient with cancer who could not be cured. For a developmental pediatrician, …

Conditions and diseases

Why you should never order a herpes IgM blood test

Jennifer Gunter, MD

July 27, 2013Jul 27, 20134

Routine screening blood tests for herpes are not recommended by the Centers for Disease Control. When I say routine screening I mean a scenario such as, “I want to get checked for everything, ok?” Blood tests for herpes do have…

Blood tests for herpes do have a place in specific clinical situations, but that’s for another post.

But say you did get a herpes blood test (even though it’s not recommended many people seem to get it done) …

Physician voices

A watershed moment in my lifetime of treating cancer patients

Miranda Fielding, MD

July 26, 2013Jul 26, 2013

I have had patients and their families do strange things during a consultation. Patients taking notes and recording what the doctor says are pretty commonplace these days, as are answering a cell phone and arguing with a spouse over what…

Some patients go to great lengths to disconnect from the process, filing their nails, or flipping through a magazine. I’ve watched babies’ diapers being changed, …

Patient voices

The societal cost of low health literacy

Mary S. Kelly, PhD

July 26, 2013Jul 26, 20133

The mother, clearly agitated, came to my office holding a bottle of liquid antibiotic prescribed for her daughter’s ear infection. She asked, “How the hell am I supposed to get this into her ear?” She could not read the directions,…

She could not read the directions, which said to give the medication by mouth.

A survey conducted between 2008 and 2010 by the Adult Literacy Program at Einstein’s Fisher Landau Center for the Treatment of Learning Disabilities found …

Drugs and prescribing

The Supreme Court on Myriad: Will it stifle innovation?

Nicole D. Kling, PhD

July 26, 2013Jul 26, 2013

The recent ruling by the U.S. Supreme Court brought Association for Molecular Pathology v. Myriad Genetics back to the headlines, with interest being stoked by Angelina Jolie’s recent disclosure of her double mastectomy. The lawsuit revolved around patents owned by…

The recent ruling by the U.S. Supreme Court brought Association for Molecular Pathology v. Myriad Genetics back to the headlines, with interest being stoked by Angelina Jolie’s recent disclosure of her double mastectomy.

The lawsuit revolved around patents owned by Myriad related to its BRACAnalysis test, which assesses the likelihood that a person will develop certain cancers, including breast cancer, by searching the DNA for disease-causing …

Medical education

We are spending billions to train the wrong kind of doctors

Kenneth Lin, MD

July 26, 2013Jul 26, 201324

Earlier this year, the physicians at my academic family medicine practice met with two senior officials from our parent health care organization to be oriented to its new initiatives and projects. Their presentation documented the organization’s ongoing investments of many millions of dollars into renovating subspecialty care suites and purchasing new radiology equipment that was likely to be highly profitable, but provide dubious benefits to patients.

Two of my colleagues asked …

Drugs and prescribing

Move the placebo debate beyond the discussion of ethics

Ian Hsu

July 26, 2013Jul 26, 2013

"Promising new drug shown to be no better than placebo" – and so the careers of countless drugs in development have terminated, from pain medicines to chemotherapies to antidepressants. The success of investigational drugs depends on their capacity to outperform…

“Promising new drug shown to be no better than placebo” – and so the careers of countless drugs in development have terminated, from pain medicines to chemotherapies to antidepressants. The success of investigational drugs depends on their capacity to outperform the pesky placebo effect, so researchers are often trying to control or minimize the placebo effect so they can demonstrate more clearly …

Real physician voices, twice a week

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