KevinMD.com

July 16, 2013Jul 16, 20133

I recently attended the University of Miami Miller School of Medicine graduation for the class of 2013. It had special meaning for me since this was the last group of students at the University of Miami Miller School of Medicine-Charles M. Schmidt Florida Atlantic University (FAU) joint venture to pass through my tutelage prior to the Boca Raton program becoming solely an FAU program.

One of the graduates visited my office …

Physician voices

Sedasys for anesthesia: Can a machine guide sedation?

Karen S. Sibert, MD

July 16, 2013Jul 16, 20132

Movie buffs and science fiction fans certainly remember HAL, the computer in 1968’s hit movie “2001: A Space Odyssey”. Considered one of the greatest villains in film history, HAL was capable of reasoning and language processing to assist the astronauts on their space mission. Ultimately, however, HAL decided that its best course of action was to kill all the astronauts. “I am …

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Health policy

Do corporate wellness programs work?

Trudy Lieberman

July 15, 2013Jul 15, 2013

On a recent trip to Lincoln, NE, I visited Lincoln Industries, a company that makes chrome trims for Harley-Davidson motorcycles. I was curious about the firm’s award-winning wellness program, especially since more employers are penalizing workers by making them pay…

At the heart of Lincoln Industries’ wellness program is its Platinum Scorecard, which awards points to workers who …

Read more…

Do corporate wellness programs work?

Physician voices

Radiation exposure is related to the rise of a lawsuit culture

Dr. Charles

July 15, 2013Jul 15, 20135

A study published in the British Medical Journal highlights the importance of carefully choosing which children should receive diagnostic CT scans. As a diagnostic test, CT scans utilize ionizing radiation that can cause cellular DNA damage, increasing the risk of…

A study published in the British Medical Journal highlights the importance of carefully choosing which children should receive diagnostic CT scans. As a diagnostic test, CT scans utilize ionizing radiation that can cause cellular DNA damage, increasing the risk of cancer. Children who received a CT scan were 25% more likely to develop a cancer in 10 years after radiation exposure, according to a study of 11 …

Physician voices

Judiciously order CT scans to protect our children

Wendy Sue Swanson, MD

July 15, 2013Jul 15, 2013

A JAMA Pediatrics article found that the use of pediatric CT scans rose in the late 1990′s and early 2000′s. Further, research shows that these CT scans can increase risk for future cancer diagnoses. Authors calculated the risk: they estimate…

A JAMA Pediatrics article found that the use of pediatric CT scans rose in the late 1990′s and early 2000′s. Further, research shows that these CT scans can increase risk for future cancer diagnoses. Authors calculated the risk: they estimate that for every 4 million pediatric CT scans preformed annually, some 4800 children will go on to develop cancer as a result. Like many studies published this decade, the …

Physician voices

Are physicians still responsible for mistakes in health care?

James C. Salwitz, MD

July 14, 2013Jul 14, 20134

Who is responsible for mistakes in health care? Who should take credit for success or blame for failure? Most families, patients and obviously the courts, hold the doctor responsible. It seems to me this is reasonable; it is the obligation physicians assume and which society returns with empowerment and respect. However, is this changing because of the Internet and big data?

In 2013, most patients have spent hours on the Internet …

Drugs and prescribing

How to know whether alternative medicine is safe

Juliet K. Mavromatis, MD

July 14, 2013Jul 14, 201333

Recently a patient of mine brought in a bottle given to her by her acupuncturist. She had turned to acupuncture with my encouragement after traditional medicine fell short at addressing her chronic pain. Indeed, there is data to support the efficacy of acupuncture in the management of chronic pain. I was encouraged to hear that this treatment, often labeled as “alternative,” seemed to be helping her substantially.

However, my patient’s questions …

Patient voices

Caught in the sandwich generation: An excerpt from Mother Daughter Me

Katie Hafner

July 14, 2013Jul 14, 2013

In 2009, at age 51, journalist Katie Hafner invited her elderly mother to move from San Diego to San Francisco and live with her and her 16-year-old daughter. Brilliant and funny, Hafner’s mother had also been a divorced alcoholic who lost custody of Hafner and her older sister when they were young girls. As Hafner reveals in the pages of Mother Daughter Me, her sixth book …

Physician voices

One source of information that never feels overwhelming

Suzanne Koven, MD

July 14, 2013Jul 14, 20135

A fascinating op-ed piece by Brigham and Women's physician and Harvard Medical School professor Jerry Avorn appeared on June 11th in the New York Times. It's called "Healing the Overwhelmed Physician." What the 'overwhelmed physician" about whom Dr. Avorn writes…

A fascinating op-ed piece by Brigham and Women’s physician and Harvard Medical School professor Jerry Avorn appeared on June 11th in the New York Times. It’s called “Healing the Overwhelmed Physician.” What the ‘overwhelmed physician” about whom Dr. Avorn writes is overwhelmed by may surprise you.

It surprised me.

Looking at the title of the piece, I thought it might be about the emotional toll of practicing medicine, which may contribute …

Physician voices

Allowing patients to define a medical adverse event

Doug Farrago, MD

July 13, 2013Jul 13, 201380

Patients do need the power to complain about bad doctors and, trust me, there are some bad doctors out there. That being said, the other way for patients to get some retribution is to stop seeing that doctor. Word of…

Right now, state boards allow patients to complain about anything and they have to investigate that complaint. …

Physician voices

An ovary removed instead of an inflamed appendix: What happened?

Skeptical Scalpel, MD

July 13, 2013Jul 13, 201319

On June 10, 2013 a 32-year-old pregnant woman was reported to have died after having an ovary removed instead of her inflamed appendix. As the infected appendix festered, she became septic and succumbed to multiple organ failure. This tragedy occurred…

How could this have happened?

Let me count the ways.

The surgery was performed by two trainee surgeons. Their …

Physician voices

What medicine has taught me about children

Edwin Leap, MD

July 13, 2013Jul 13, 20132

I’ve learned a few things about children over the years. While most have come from raising children, the rest have come from caring for them as patients. Knowing children, knowing their hearts and their ways, gives me great joy. I like to think that as I know them better, I become more like them, and while my time on earth may not be any longer for it, it may be …

Physician voices

Finding and keeping great front office staff

Rosemarie Nelson

July 13, 2013Jul 13, 20134

Your front office staff are the face of your practice -- an expression of your practice's philosophy, attitude, and values. So it should be a top priority to hire and retain top-quality people to fill such roles as receptionists, phone…

Your front office staff are the face of your practice — an expression of your practice’s philosophy, attitude, and values. So it should be a top priority to hire and retain top-quality people to fill such roles as receptionists, phone operators, medical secretaries, and transcriptionists.

But it can be a challenge to keep these people and keep their morale high because these positions often include high levels of stress for low …

Conditions and diseases

MKSAP: 38-year-old woman with fatigue and dyspnea on exertion

mksap

July 13, 2013Jul 13, 20135

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 38-year-old woman is evaluated for a 6-month history of progressive fatigue and dyspnea on exertion. Over the past 2 years she has noted…

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 38-year-old woman is evaluated for a 6-month history of progressive fatigue and dyspnea on exertion. Over the past 2 years she has noted episodes of hand swelling, joint pain, blue color change of her fingers with cold exposure, and difficulty swallowing. She takes no medications.

On physical examination, temperature is 36.9 °C (98.4 °F), …

Conditions and diseases

MKSAP: 26-year-old man with fever and lower abdominal pain

mksap

July 13, 2013Jul 13, 2013

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 26-year-old man is evaluated for a 3-day history of fever, lower abdominal pain, tenesmus, hematochezia, and watery diarrhea. Seven months ago, he underwent…

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 26-year-old man is evaluated for a 3-day history of fever, lower abdominal pain, tenesmus, hematochezia, and watery diarrhea. Seven months ago, he underwent a cadaveric kidney transplantation. At the time of transplantation, the transplant donor was seropositive for cytomegalovirus, and the patient was seronegative for this virus. Current medications are tacrolimus, mycophenolate …

Physician voices

Not everyone who has an opinion on nutrition is an expert

David L. Katz, MD

July 12, 2013Jul 12, 2013

Everyone has opinions. You probably know what they say about that. But leaving aside the olfactory qualities of all the opinions to which we are entitled, we at least tend to know when our opinions are just opinions. But not with nutrition, where not only does everyone have an opinion, but everyone seems to think theirs is an expert opinion. And our culture seems to be okay with that. I’m …

Conditions and diseases

Should drug testing be considered screening tests?

Chris Rangel, MD

July 12, 2013Jul 12, 20133

Tests like cholesterol levels are considered screening tests because they are cost effective, have high sensitivities (a low rate of false negatives), and have been proven to be beneficial in the identification of conditions that may require treatment before symptoms occur. The vast majority of medical tests are not considered to be “screening” because they violate one or more of these principles, …

Health policy

Health care price transparency should receive bipartisan support

Bob Doherty

July 12, 2013Jul 12, 20133

Most Republicans hate Obamacare for what they consider to be government over-reach, most Democrats support it because they believe only a strong policy of government intervention can extend coverage to the millions of uninsured—and there are no signs that their ideological battle will abate anytime soon. But there may be one sweet spot that both parties could agree on: providing consumers (or patients, if you prefer) information on the prices …

Real physician voices, twice a week

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