KevinMD.com

July 26, 2013Jul 26, 201314

It’s happened at last: the epitome of ridiculousness in the already pretty ridiculous world of drug prior authorizations. I wish I could say that I made this up. I got a fax from a pharmacy requesting a prior authorization for…

It’s happened at last: the epitome of ridiculousness in the already pretty ridiculous world of drug prior authorizations. I wish I could say that I made this up.

I got a fax from a pharmacy requesting a prior authorization for a brand name drug called Protonix, one of a family of medications used to treat ulcers, acid reflux, and other forms of tummy ache. This happens. Because there are five different …

Physician voices

Why Congress should be responsible to fix mental health

Allen Frances, MD

July 25, 2013Jul 25, 20135

The past months have been disastrous for mental health. One embarrassment has followed another -- leading to a crisis of confidence that is potentially dangerous for those who rely on psychiatric care. Most damaging were the negative reviews of DSM-5,…

The past months have been disastrous for mental health. One embarrassment has followed another — leading to a crisis of confidence that is potentially dangerous for those who rely on psychiatric care.

Most damaging were the negative reviews of DSM-5, the new diagnostic manual. It was justly panned for introducing many unsafe and scientifically unsound diagnoses that will worsen the already existing over-treatment of the worried well and the shameful neglect …

Physician voices

Cockpit culture and using the two challenge rule in the OR

Marjorie Stiegler, MD

July 25, 2013Jul 25, 20132

With the crash of the Asiana 777, we're hearing a lot about cockpit culture and how communication across a hierarchy sometimes fails, even when the very lives of the folks communicating (or failing to do so) are on the line.…

With the crash of the Asiana 777, we’re hearing a lot about cockpit culture and how communication across a hierarchy sometimes fails, even when the very lives of the folks communicating (or failing to do so) are on the line. This isn’t a new concept, and isn’t unique to aviation. Many parallels have been drawn between aviation communication and healthcare team communications, …

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Conditions and diseases

Injections for back pain: The evidence is weak

John Mandrola, MD

July 25, 2013Jul 25, 201310

It’s been a while since I did a cycling topic. As I was skimming thorough the Journal of the American Medical Association recently, I came across this review article on spinal injection therapy for low back pain. It was a…

It’s been a while since I did a cycling topic.

As I was skimming thorough the Journal of the American Medical Association recently, I came across this review article on spinal injection therapy for low back pain. It was a shocker.

Two factors brought my attention to the article. First, almost all the cyclists or runners I know have been beset with either back pain or sciatica (referred pain or weakness down the leg). In …

Physician voices

Doctor bashing has become a national sport: How to stop it

Carla J. Rotering, MD

July 25, 2013Jul 25, 2013121

Doctors used to be among the most admired and respected persons in the community; now just a mention of this formerly revered title in a social setting will generate a totally different response. Patients far too often will pour out…

Doctors used to be among the most admired and respected persons in the community; now just a mention of this formerly revered title in a social setting will generate a totally different response.

Patients far too often will pour out stories of traumatic healthcare experiences, insults suffered, acts of disrespect or poor bedside manners, and disappointments in a system and in doctors who let them down. Doctor bashing has become a …

Conditions and diseases

Is obesity really a disease?

Suzanne Koven, MD

July 25, 2013Jul 25, 201312

A few years ago, while I was teaching in the hospital, a medical student presented the case of a man with coronary artery disease, diabetes, hypertension, and hyperlipidemia. When we entered the man's room I was surprised that the student…

No one argues that diabetes and blocked coronary arteries are diseases. And nobody argues that obesity, …

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Is obesity really a disease?

Conditions and diseases

The stigma experienced by patients with psychiatric disorders

Julia Frank, MD

July 24, 2013Jul 24, 201317

“It don’t matter how many men you shot in Memphis,” the saying goes, “if your name is Sierra or Sequoia, you can’t sing the blues”. In a sense, this adage reworks an older, more bitter joke from the civil rights era, the one that begins “some of my best friends are …” and ends with “but you wouldn’t want your sister to marry one.” Both statements embody stigma, the social effects …

Health technology

Weighing the cost of technology advances in medical devices

Wes Fisher, MD

July 24, 2013Jul 24, 2013

A New York Times op-ed entitled "In Cancer Care, Cost Matters," described what may be one of the earliest accounts where doctors at Sloan-Kettering decided not to use a new cancer drug because of its extra cost when they were…

A New York Times op-ed entitled “In Cancer Care, Cost Matters,” described what may be one of the earliest accounts where doctors at Sloan-Kettering decided not to use a new cancer drug because of its extra cost when they were already using equally-effective drugs for their cancer treatments. The article piqued my interest. These days for any doctor who uses expensive technologies, it is easy to see where this evaluation …

Medical education

Discovering medicine’s unrehearsed harmony

Ron Li

July 24, 2013Jul 24, 2013

There is something deeply satisfying about hitting the right note on the violin. On the rare occasion when my left hand is perfectly positioned and my bow arm is applying the perfect amount of pressure on the violin string, the resulting note that resonates from the wooden belly of the instrument is, for lack of a better word, perfect.

My favorite piece that …

Health policy

Reform creates new incentives in health care

Kohar Jones, MD

July 24, 2013Jul 24, 201316

I advocated for the Affordable Care Act, and celebrated when it was passed. It’s good to have everyone covered, I thought. Insurance for everyone is the first step to health care for all. Alas, access to health insurance isn’t the…

I advocated for the Affordable Care Act, and celebrated when it was passed.

It’s good to have everyone covered, I thought.

Insurance for everyone is the first step to health care for all.

Alas, access to health insurance isn’t the same as access to health care.

First there is the niggling detail of providers. We already have a primary care provider shortage. Internists, pediatricians, family physicians are already working at full capacity in caring for …

Physician voices

Separating work from home life makes for happier doctors

Arsheeya Mashaw, MD

July 24, 2013Jul 24, 201316

One tired early morning, during my residency, I had been up all night in the ICU with a sick patient. Exhausted I sat in the cafeteria for a quick breakfast before rounds with my attending physician. I was explaining to her how I couldn’t leave my patients side I was so worried. She looked at me like Obi-Wan Kenobi: “The sign of a good doctor is when you can’t go to sleep at night worrying about …

Health technology

5 reasons why music would be great for digital health

David Lee Scher, MD

July 24, 2013Jul 24, 20135

Music as a healing mechanism has been accepted for over 50 years. Music is a source of primal memory similar to that of smell. It has been used in brain injury patient management, as well as to promote wellness, manage stress alleviate pain, promote physical rehabilitation, and enhance memory in Alzheimer’s Disease patients. I have appreciated the power of music my whole life and as a physician and …

Health policy

Are Cadillac plans responsible for rising health costs?

Chris Rangel, MD

July 23, 2013Jul 23, 201318

If there’s anything that liberals hate it’s inequality – unless it’s the Federal tax code – and health care is a prime offender. The liberal mantra is that everyone should have the same access to basic health care. But this doesn’t just involve improving health care access and affordability for millions of uninsured Americans. It also involves limiting or impairing (through taxes) those health care plans liberals have decided are …

Physician voices

Behind the scenes of a total colectomy

Sid Schwab, MD

July 23, 2013Jul 23, 2013

Next in a continuing series. Would you know what I mean if I describe whistling without whistling? Barely pursing the lips, making little quasi-audible windy sounds while inhaling and exhaling, in tune yet nearly silent? Unless there's music playing, that's…

Next in a continuing series.

Would you know what I mean if I describe whistling without whistling? Barely pursing the lips, making little quasi-audible windy sounds while inhaling and exhaling, in tune yet nearly silent? Unless there’s music playing, that’s what I do when I operate. And for reasons about which I have absolutely no clue, I nearly always “whistle” The Caisson Song. I’ve always wondered if anyone …

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Behind the scenes of a total colectomy

Health policy

Navigating the shopping troubles with insurance exchanges

Trudy Lieberman

July 23, 2013Jul 23, 20132

One could easily make a case that health care is today’s biggest consumer problem—not unlike those that sparked the consumer movement of the 1960s and 70s. Back then, consumer issues centered on problems with using credit, buying cars and home improvement services, and obtaining the best price for food, appliances, and just about every other new-fangled and expensive product that sprang from the post-war economy.

Like many old consumer problems, health …

Medical education

Physician education: The downside of taking a business approach

Leslie Kernisan, MD, MPH

July 23, 2013Jul 23, 2013

Recently I came across yet another media article with suggestions as to how digital health products can gain more widespread adoption. The writer notes that “we can learn a lot from the pharma and healthcare industries,” and goes on to…

This article, like many I read, doesn’t acknowledge the downsides of using pharma’s tactics.

I have to assume that this is because from a business …

Health policy

Why Obamacare is a marketing fail

Toni Brayer, MD

July 22, 2013Jul 22, 20136

The massive confusion about Obamacare (the Affordable Care Act) is much worse than I thought. The Kaiser Family Foundation came out with a poll that shows 42% of Americans don't even know that Obamacare is the law. Seven percent of…

The massive confusion about Obamacare (the Affordable Care Act) is much worse than I thought. The Kaiser Family Foundation came out with a poll that shows 42% of Americans don’t even know that Obamacare is the law. Seven percent of people think the Supreme Court struck it down and 12% think Congress repealed it.

I understand that there is confusion about the way it will work and who will be affected. …

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Why Obamacare is a marketing fail

Medical education

Medicine is on the clock: An unfortunate reality

Kevin R. Campbell, MD

July 22, 2013Jul 22, 20133

It is unfortunate, but now medicine is on the clock. We now must not only battle disease, but we must also battle time. Physicians are asked to do more in less time. Innovations such as EMR (which in theory are…

Additionally, ongoing debate exists as to how best train medical residents and prepare them for the practice of medicine. …

Physician voices

A guide to giving bad news to patients

James C. Salwitz, MD

July 22, 2013Jul 22, 20136

The massive magnets of the MRI radiate fields through her brain, scanning veins, arteries and every millimeter of cortex. Grey and white matter, containing all she is and all she ever will be, identified, cataloged, mapped. Two centimeters under the front of her skull, just to the left of center, there is an abnormality; a one centimeter mass surrounded by swelling. The lung cancer has spread, metastasized. Really bad news.

A …

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A guide to giving bad news to patients

Conditions and diseases

Beware of that new car smell when shopping for a new car

Dr. Charles

July 22, 2013Jul 22, 20135

As I shopped for a new car last year, I realized that my priorities were considered odd by most car salesmen. The three most important characteristics I desired in a new car were good gas mileage, good crash safety, and relatively low concentrations of “new car smells.” The often celebrated (but particularly noxious) new car smell is actually a synthetic blend of respiratory irritants and potential carcinogens off-gassing from the …

Real physician voices, twice a week

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