KevinMD.com

July 1, 2013Jul 1, 20136

One of the benefits of being an oncologist is that, as a rule, people appreciate our work. That does not mean they want to hear about our day, and the response when someone learns my vocation is rarely, “Hey, that’s…

Nonetheless, at least there is a modicum of respect. However, I found a group of people with major questions about the work of cancer docs or at least …

Conditions and diseases

When is genetic testing appropriate for children?

Courtney Schmidt, PharmD

July 1, 2013Jul 1, 2013

Angelina Jolie shared publicly her decision to have a preventive double mastectomy after genetic testing revealed that, due to a mutation in the BRCA1 gene, she carried an 87% risk of developing breast cancer and a 50% risk of developing ovarian cancer. Jolie identifies her mother’s decade-long struggle with ovarian cancer and death from that disease six years ago as one of the primary influences behind her decision.

Angelina Jolie’s …

Health policy

Addressing racial disparities in health care

Ashish Jha, MD, MPH

July 1, 2013Jul 1, 201315

Racial disparities in health and healthcare are a persistent and troubling problem for the U.S. Despite substantial policy efforts to the contrary, racial and ethnic minorities, especially African-Americans, often receive a lower quality of care and have worse outcomes. The…

Over the past decade, two primary theories have emerged to explain disparities and propose …

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Social media in medicine

What does managing a loved one’s digital legacy really look like?

Naomi Cahn & Rev. Amy Ziettlow

July 1, 2013Jul 1, 20132

With the recent Pew Report announcing that “caregivers are wired for support” and digital estate planning resources entering our mainstream consciousness, many of us have been inspired to think about the end of life and our online selves. And we should. Hundreds of thousands of Facebook users die each year, the average American believes that she has almost $55,000 worth of digital assets, though most of us – …

Medical education

A powerful address to graduating medical students

Wes Fisher, MD

July 1, 2013Jul 1, 201312

Dear Graduating Class of 2013, I appreciate the opportunity to address such an impressive pool of medical school attendees. From the first day of medical school when you were introduced to your cadaver, you have endured countless lectures and lab…

Dear Graduating Class of 2013,

I appreciate the opportunity to address such an impressive pool of medical school attendees. From the first day of medical school when you were introduced to your cadaver, you have endured countless lectures and lab hours, physical examination and sensitivity training sessions, and ward rotations under the watchful eye of senior residents and attendings. Today, you will hold something that few people are privileged to …

Patient voices

How to create clear patient education materials

Erin Marcus, MD

June 30, 2013Jun 30, 2013

Clear communication from doctors, nurses, hospitals and clinics is essential for patients to manage their health care effectively. But creating easily understood materials isn't simple. Many health workers don't realize when they're using technical terms, and many non-medical people have…

Clear communication from doctors, nurses, hospitals and clinics is essential for patients to manage their health care effectively. But creating easily understood materials isn’t simple. Many health workers don’t realize when they’re using technical terms, and many non-medical people have problems reading and understanding scientific and mathematical concepts.

Fortunately, several web sites offer helpful advice about how to create patient-friendly educational print materials. Two of the most useful are the National …

Physician voices

Confronting the reality of uncertainty in medicine

Allen Frances, MD

June 30, 2013Jun 30, 20132

Medical care in the U.S. over-promises and under delivers. It costs about twice as much as in most other developed countries, but compared to them manages to produce only mediocre health outcomes. The profit motive has resulted in badly misallocated…

The impact of advances in medical science on the delivery of …

Patient voices

The patient is the center of the medical home

Amberly Killmer, RN

June 30, 2013Jun 30, 20139

My patient and I had spent most of the 45-minute appointment discussing the challenges of living with diabetes and some ways that he could begin changing his eating and exercise habits. I started to wrap up the visit and asked…

He looked at me incredulously and said, “You are supposed to tell me what to do: I’m …

Physician voices

4 complaints of physician employees and 1 solution to fix them

Dike Drummond, MD

June 30, 2013Jun 30, 20134

Medscape published an article titled, 4 Top Complaints of Employed Doctors, and it was a very interesting read. Turns out the things employed physicians complain about are basically that they are employees. Let me lay out these employed physicians gripes…

Let me lay out these employed physicians gripes for you with a little detail so you will see what I mean. I will finish this article with a solid way to address all of them. These …

Physician voices

Nelson Mandela: Recognize the end of life equation

Monica Williams-Murphy, MD

June 30, 2013Jun 30, 2013

By typical end-of-life definitions, Nelson Mandela is dying (he is in critical condition after a lengthy hospital stay, and has had multiple recent admissions). Those of us in the healthcare professions see this end-of-life equation all of the time: increasing severity of illness and frequency of hospitalizations plus advanced age almost always equals dying. Now, everyone likes to believe this equation may be altered by hopes, prayers, and modern medicine. …

Physician voices

The power of culture in health care

David L. Katz, MD

June 30, 2013Jun 30, 20132

Our culture -- at least the movie-going part of it -- seems to have embraced the adage: With great power comes great responsibility. Somehow, at the same time, it seems to have ignored the inevitable, underlying principle: Power and responsibility…

Our culture — at least the movie-going part of it — seems to have embraced the adage: With great power comes great responsibility. Somehow, at the same time, it seems to have ignored the inevitable, underlying principle: Power and responsibility are conjoined. This, in turn, implies a corollary our culture also neglects routinely, if not universally: Before anyone can reasonably be expected to take responsibility, they must be suitably empowered.

After …

Read more…

The power of culture in health care

Physician voices

Colonoscopies don’t need anesthesiologists

Shirie Leng, MD

June 29, 2013Jun 29, 201317

Where do I start with this: The $2.7 Trillion Medical Bill. I’m going to let Ms. Rosenthal tell you about how many unnecessary colonoscopies we do. I’ll let her tell you how much more it costs here than anywhere else.…

Where do I start with this: The $2.7 Trillion Medical Bill.

I’m going to let Ms. Rosenthal tell you about how many unnecessary colonoscopies we do. I’ll let her tell you how much more it costs here than anywhere else. I will address the anesthesia bit.

Let me tell you a little story. When I was a baby anesthesiologist my hospital sent anesthesiologists downstairs to do anesthesia for GI procedures …

Social media in medicine

If your teens are on social media, you need to be there too

Melissa Arca, MD

June 29, 2013Jun 29, 20133

Teens, smartphones, Facebook, Instagram, and a myriad of other social apps. What do they have in common? Well they simply go together these days. Just look around and if you spot a teen, he/she is likely virtually connected, phone firmly…

The social landscape has certainly changed since our own teen years and it’s up to us as parents to catch up.

There …

Physician voices

A doctor guilty of fraud has great patient satisfaction scores

Skeptical Scalpel, MD

June 29, 2013Jun 29, 201331

A paper in JAMA Surgery noted that patient satisfaction ratings have very little to do with the quality of care provided by a hospital. The study analyzed data from 31 hospitals that participated in patient satisfaction surveys, the CMS Surgical…

A paper in JAMA Surgery noted that patient satisfaction ratings have very little to do with the quality of care provided by a hospital. The study analyzed data from 31 hospitals that participated in patient satisfaction surveys, the CMS Surgical Care Improvement Project (SCIP), and employee safety attitudes questionnaires. They found that patient satisfaction did not correlate at all with the rates of hospital compliance with SCIP process measures nor …

Conditions and diseases

A surgeon deconstructs bowel surgery

Sid Schwab, MD

June 29, 2013Jun 29, 2013

Next in a continuing series. Let's make it easy on ourselves. I haven't yet established why -- other than liking the particular operation -- we're removing this nice person's colon. So since our patient has agreed to remain exposed and…

Next in a continuing series.

Let’s make it easy on ourselves. I haven’t yet established why — other than liking the particular operation — we’re removing this nice person’s colon. So since our patient has agreed to remain exposed and to do so for all to see, I declare s/he has diverticulitis. (Were it cancer, the operation would be largely the same, taking a bit more out.) Most likely …

Read more…

A surgeon deconstructs bowel surgery

Conditions and diseases

MKSAP: 78-year-old man with worsening heart failure

mksap

June 29, 2013Jun 29, 2013

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 78-year-old man was admitted to the hospital 5 days ago for worsening heart failure. On physical examination at admission, temperature was normal, blood…

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

A 78-year-old man was admitted to the hospital 5 days ago for worsening heart failure.

On physical examination at admission, temperature was normal, blood pressure was 150/88 mm Hg, pulse rate was 108/min, and respiration rate was 22/min. There were bibasilar crackles and dullness to percussion at both posterior lung bases. Jugular venous distention, an …

Conditions and diseases

MKSAP: 52-year-old man with fatigue and fever

mksap

June 29, 2013Jun 29, 2013

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 52-year-old man is admitted to the hospital with fatigue and fever of 3 days' duration. He is a health care worker and has…

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

A 52-year-old man is admitted to the hospital with fatigue and fever of 3 days’ duration. He is a health care worker and has a bicuspid aortic valve. He takes no medications.

Blood cultures are obtained at the time of admission, and he is started on empiric vancomycin for possible endocarditis.

On hospital day 2, …

Health policy

Some patients are receiving too little care

Trudy Lieberman

June 28, 2013Jun 28, 2013

Twelve years ago, in its landmark study Crossing the Quality Chasm, the Institute of Medicine (IOM) found that “the health care industry is plagued with overutilization of services, underutilization of services, and errors in health care practice.” In simple English,…

Twelve years ago, in its landmark study Crossing the Quality Chasm, the Institute of Medicine (IOM) found that “the health care industry is plagued with overutilization of services, underutilization of services, and errors in health care practice.” In simple English, the IOM reported that health care was riddled with overuse, underuse and misuse of medical services.

The IOM also defined quality health care as “the degree to which health services for …

Physician voices

For some, a loss of independence is a worse fate than falling

Suzanne Koven, MD

June 28, 2013Jun 28, 20136

A moving van pulled up to my house the other day. It contained the last of my mother’s belongings, a few pieces of furniture that neither my brothers nor I nor our children had wanted. It’s been over four years since Mom died and we finally gave up trying to sell the things down in Florida, where they’d been sitting in storage.

Among the items was a china cabinet fashioned from …

Medical education

How should we be training the next generation of doctors?

Janice Boughton, MD

June 28, 2013Jun 28, 20137

I have been spending time at an academic medical center lately and I'm noticing some obvious flaws in our method of shaping the doctors of the future. When I went to medical school I was trained by physicians who were…

I have been spending time at an academic medical center lately and I’m noticing some obvious flaws in our method of shaping the doctors of the future.

When I went to medical school I was trained by physicians who were eminent in their areas of specialty and also did some research. They taught in classrooms and as attending physicians when we were working on the wards as doctors in training. I …

Real physician voices, twice a week

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