KevinMD.com

July 12, 2013Jul 12, 2013

Historians are left forever chasing shadows, painfully aware of their inability to ever reconstruct a dead world in its completeness. -Simon Schama “Tell me about your prior cancer treatment,” I say. “When did you have the surgery and radiation?” “It…

Historians are left forever chasing shadows, painfully aware of their inability to ever reconstruct a dead world in its completeness.
-Simon Schama

“Tell me about your prior cancer treatment,” I say. “When did you have the surgery and radiation?”

“It wasn’t a surgery,” He tells me emphatically. “It was a biopsy.”

“But the doctor SAID it was a surgery!” chimes in his wife.

“Yes, Dad. You have a long scar on your neck,” adds his …

Physician voices

How can we fix the doctor-patient relationship?

Rob Lamberts, MD

July 12, 2013Jul 12, 20136

A post I wrote nearly three years ago has recently gone viral, bringing tens of thousands of readers and a huge number of comments. It’s a letter I wrote to my patients who do something that all but guarantees a…

There are basically two responses I get to this post: either readers are grateful to have a doctor admit …

Health policy

Is your hospital leader committed to patient-centered care?

Robbin Dick, MD

July 11, 2013Jul 11, 20133

Nearly every hospital leader in America will tell you their hospital is all about patient-centered care. Of course, we know this isn’t true in many cases, especially when it comes to hospital capacity management. Though many institutions will deny to…

They usually go like this: first priority is high margin surgical cases; second priority is …

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Physician voices

Primary care doctors need 35 hour work weeks

Leslie Kernisan, MD, MPH

July 11, 2013Jul 11, 201332

Jeff Goldsmith recently opined on why practice redesign isn’t going to solve the primary care shortage. In the post, Goldsmith explains why a proposed model of high-volume primary care practice — having docs see even more patients per day, and grouping them in pods — is unlikely to be accepted by either tomorrow’s doctors or tomorrow’s boomer patients. He points out that we are replacing a generation of workaholic boomer …

Physician voices

Medical writing: Tips to avoid burnout when starting out

Brian J. Secemsky, MD

July 11, 2013Jul 11, 20132

Last month marked the first anniversary of two very important milestones in my career in medicine: I began training as a physician and started writing about medicine. Although perhaps not equally as demanding, both of these new activities in my…

Writing medical humanities pieces for different media outlets has been and continues to be a source of personal …

Physician voices

True pain and suffering: There is no place for manipulation

Greg Smith, MD

July 11, 2013Jul 11, 201329

“Well then, if you won’t prescribe the Xanax for me, I guess I’ll just have to get it off the street.” “If you send me home, I promise you’ll be reading about me in the obituaries tomorrow.” “I’m in terrible…

“Well then, if you won’t prescribe the Xanax for me, I guess I’ll just have to get it off the street.”

“If you send me home, I promise you’ll be reading about me in the obituaries tomorrow.”

“I’m in terrible pain. You have to treat me. You have to give me narcotics. If you don’t, I’ll call the state medical board and report you.”

I hate to be manipulated.

Hate. It.

There is a certain …

Patient voices

3 secrets my doctor doesn’t know

Danea Horn

July 11, 2013Jul 11, 20133

Dear Doctor, I am a good patient. I’m organized, I know my health history and I’m particularly polite. I’ll thank you just for giving me bad news. I look up to you. I do see myself as a partner in…

Dear Doctor,

I am a good patient. I’m organized, I know my health history and I’m particularly polite. I’ll thank you just for giving me bad news.

I look up to you. I do see myself as a partner in my care, but I depend on your expertise. I appreciate the years of schooling and sleepless residency nights that have trained you to know what might be causing my pain and how …

Read more…

3 secrets my doctor doesn’t know

Health policy

American’s health cost problem has no easy fixes

Kevin R. Campbell, MD

July 11, 2013Jul 11, 20139

It is clear that healthcare in the US is more costly than in any other place in the world. We spend 18% of the gross domestic product on healthcare and our outcomes are no different than those of other industrialized nations who spend less than half that amount. How did we get here and what are we to do about it?

Recently, an article appeared in the …

Health policy

Physicians need to speak with a unified voice

Jordan Grumet, MD

July 10, 2013Jul 10, 20137

Many ask of our profession, "Are you knight or knave?" The supposition, that there exists a dichotomy of options for the current physician, is a false one. Likely we are a little bit of both, and many shades in between.…

Many ask of our profession, “Are you knight or knave?”

The supposition, that there exists a dichotomy of options for the current physician, is a false one. Likely we are a little bit of both, and many shades in between. The maddening belief that the future of our healthcare system depends on this delineation is preposterous. I would more aptly characterize us as pawns.

The time for change has come.

After patiently listening to my …

Patient voices

Firing your doctor carries emotional weight

Jessie Gruman, PhD

July 10, 2013Jul 10, 201344

Last week, a friend told me that her mother had been fired as a patient by her primary care physician in a letter she received in the mail. “Our philosophies of care are too different,” was the explanation. Last week,…

Last week, I fired my oncologist by email. “I have transferred my care to ___ ___.” I gave no explanation, although the note was polite and appreciative.

My friend and I spent some time …

Physician voices

How should the workplace accommodate women physicians?

Linda Brodsky, MD

July 10, 2013Jul 10, 20138

A dichotomy has emerged as we consider the best way for women physicians to realize both their potential and their dreams in the service of patients and society. One position states that women have to internalize behaviors that are known to result in success and are based on a long history of professionalism, albeit developed for and by men physicians over the last 100 years. This is more along the …

Physician voices

How teamwork can help improve primary care access

David Margolius, MD

July 10, 2013Jul 10, 20137

In the Department of Public Health (DPH) clinics in San Francisco, CA, demand for doctor's appointments far outweighs supply. This has been especially dramatic in clinics that have switched to “open access” scheduling, an innovation that allows patients to schedule…

In the Department of Public Health (DPH) clinics in San Francisco, CA, demand for doctor’s appointments far outweighs supply. This has been especially dramatic in clinics that have switched to “open access” scheduling, an innovation that allows patients to schedule same-day or next-day appointments. Open access is meant to eliminate long waits for appointments, but the reality is that often dozens of patients call for a limited number of appointments. …

Medical education

As residency begins, always remember there is hope in medicine

Kyle Bradford Jones, MD

July 10, 2013Jul 10, 2013

Nearly twelve years ago, Major League Baseball’s Cleveland Indians were losing to the Seattle Mariners 14-2 in the 6th inning. Cleveland, who were fighting off the resurgent Minnesota Twins and the pesky Chicago White Sox in a tight division race, were playing against a Mariners team that would finish the season tied for the most wins ever in a single season. Despite the seemingly insurmountable lead, Cleveland came back to win …

Conditions and diseases

Ultrasounds don’t cause autism

Roy Benaroch, MD

July 10, 2013Jul 10, 20137

Emily wrote in about an article about prenatal ultrasounds and autism: “I saw this on The Daily Beast today. Is the media trying to freak us expecting couples out or what? How big of a question is this in scientific…

Emily wrote in about an article about prenatal ultrasounds and autism: “I saw this on The Daily Beast today. Is the media trying to freak us expecting couples out or what? How big of a question is this in scientific circles or is this just sensational stuff? Sometimes I think there should be studies about how the internet causes anxiety disorders!”

A good question, and another post that I’m going to put …

Read more…

Ultrasounds don’t cause autism

Conditions and diseases

Youth sports should never knowingly risk brain damage

Claire McCarthy, MD

July 9, 2013Jul 9, 2013

Repeated bumps to the head are bad for children. This sounds incredibly obvious, yet as a society, we don't particularly act like we get it at all. When the Bruins made it into the Stanley Cup finals, I thought about…

Repeated bumps to the head are bad for children. This sounds incredibly obvious, yet as a society, we don’t particularly act like we get it at all.

When the Bruins made it into the Stanley Cup finals, I thought about all the young hockey players who would be inspired to practice harder and play harder in the hope of one day doing the same. And I wondered: if they bumped their …

Physician voices

A ruptured eardrum turns out to be something much more

BirdStrike, MD

July 9, 2013Jul 9, 20136

My shift is over, and I’m ready to head out the emergency department door. When I walked in 12 hours ago, the department had 20 waiting patients. I look up at the monitor and after 12 hours of trying to wrestle the department under control, not only is it not under control, now we’re 25 patients deep in the weeds. My partner Dr. Jim looks at me and says, “Get …

Conditions and diseases

A low salt diet for high blood pressure: Where’s the evidence?

Albert Fuchs, MD

July 9, 2013Jul 9, 201313

We know that people with high cholesterol have a higher risk for strokes and heart attacks than people with low cholesterol. So if a medicine lowers cholesterol it should also lower the frequency of strokes and heart attacks too. Right?…

Estrogen lowers cholesterol and doesn’t lower stroke or heart attack risk. We also know that people with high blood pressure have …

Health policy

Does HIPAA really protect our privacy?

Wes Fisher, MD

July 9, 2013Jul 9, 20136

As my head reels at the implications of the IRS scandal mushrooming in Washington, the IRS's recently disclosed ability to access emails without warrant, the intricacy of the NSA PRISM wiretap techniques that includes their ability to acquire tech firms'…

As my head reels at the implications of the IRS scandal mushrooming in Washington, the IRS’s recently disclosed ability to access emails without warrant, the intricacy of the NSA PRISM wiretap techniques that includes their ability to acquire tech firms’ digital data, and even the Justice Department’s ability to secretly acquire telephone toll records from the Associated Press, I wonder (as a doctor) what all this means for the privacy protections afforded …

Read more…

Does HIPAA really protect our privacy?

Physician voices

Choosing a hospital: What is most important to you?

Leana Wen, MD

July 9, 2013Jul 9, 20136

Here’s a thought experiment presented a recent conference on healthcare consumer advocacy. Let’s say that you’re told you need surgery of your knee. It’s an elective surgery to repair a torn knee ligament, the ACL. Your insurance covers part, but…

At the moment, there is very little information for you to make such a decision. Many people will choose …

Health policy

Quality is a word that lacks universal meaning

Hans Duvefelt, MD

July 9, 2013Jul 9, 20135

In 2009 I wrote a post titled “Quality or Conformity," where I pointed out that many of the quality measures in primary care have more to do with whether doctors follow guidelines than if they deliver care that helps patients…

In 2009 I wrote a post titled “Quality or Conformity,” where I pointed out that many of the quality measures in primary care have more to do with whether doctors follow guidelines than if they deliver care that helps patients live long and well. There is a tendency to focus quality efforts on measuring what is easy to measure, rather than what matters the most.

That phenomenon is called …

Real physician voices, twice a week

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