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Quality healthcare isn’t just about clicks and lists

Physician

April 10, 2013

My hospital has just weathered an impressive upswing in patient volume. The house was full for weeks. The experience highlights an important aspect about quality care–an obvious one that doesn’t always make headlines.

What I notice when the hospital gets full is that patients are sent to units that they don’t normally go to. For instance, at my hospital, like yours probably as well, there are numerous different types of heart …

When photographs transform relationships with patients

Suzanne Koven, MD

Physician

April 10, 2013

When I entered the exam room I found my patient, a woman in her 80s who’d come in for a routine visit, holding a photograph. “I need to show you something,” she said. Some patients bring me photos at every visit–usually their kids’ or grandkids’ annual school pictures, or smartphone shots of a wedding or christening–but she never had before. I wondered what it might be.

She laid the photo on …

There is no such thing as minor anesthesia

Karen S. Sibert, MD

Medications

April 10, 2013

It’s a nightmare that doesn’t end for the family of 24-year-old Marek Lapinski, who suffered cardiac arrest recently during the removal of two wisdom teeth in a southern California oral surgery clinic. The former college football player had no known health problems prior to the surgery, but died three days later in a hospital intensive care unit.

While the circumstances of Mr. Lapinski’s death are still being investigated, the case highlights …

The real reason to be cautious about Z-Paks and azithromycin

Albert Fuchs, MD

Medications

April 10, 2013

The FDA issued a warning about the antibiotic azithromycin (Zithromax). The media stories have some patients terrified and some of them are calling me convinced that azithromycin is poison, a reliable agent for suicide.

What’s the hubbub about?

Azithromycin is in a family of antibiotics called macrolides, which also includes erythromycin and clarithromycin (Biaxin). Erythromycin and clarithromycin have long been known to very rarely cause fatal abnormal heart rhythms. It …

Medical educators: Take charge and help deflate medical bills

Neel Shah, MD, Christopher Moriates, MD, and Vineet Arora, MD

Potpourri

April 10, 2013

At a time when one in three Americans report difficulty paying medical bills, up to $750 billion is being spent on care that does not help patients become healthier. Although physicians are routinely required to manage expensive resources, traditional medical training offers few opportunities to learn how to deliver the highest quality care at the lowest possible cost. While the gap is glaring the problem is not new.

In 1975, the …

What is each minute of my time is really worth?

Hans Duvefelt, MD

Physician

April 9, 2013

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Countless times during the course of my day, some person, entity or task vies for my time and attention.

“If I could just have a minute of your time” begins a request to also see the spouse of a scheduled patient, a sales pitch from a pharmaceutical “rep” or home oxygen vendor, a phone call from a visiting nurse, a message from a …

Digital advocacy for patients: The message must be accurate

Laurie Edwards

Patient

April 9, 2013

An excerpt from In the Kingdom of the Sick: A Social History of Chronic Illness in America.

For Jennifer Crystal, a thirty-three-year-old woman living with Lyme disease and two of its co-infections, life changed dramatically with one tiny tick bite in the summer of …

Celebrate what makes being a woman in medicine special

Katherine Chretien, MD

Physician

April 9, 2013

Recently, I went straight from the hospital to the Washington DC Convention Center for the AMSA National Convention. I was there to receive the 2013 Women Leaders in Medicine Award, along with 4 other women; part of the award reception was a panel discussion on the significance of women leaders in medicine. We had received some questions to ponder ahead of time that the moderator would ask us, and then …

The Wax Pencil Sign will soon be obsolete

Bruce Campbell, MD

Medical Education

April 9, 2013

Tell me to what you pay attention and I will tell you who you are.
-Jose Ortega y Gasset

The senior resident hauled our little band of medical students down to the radiology file room. As he dug through the heavy manila x-ray jacket searching for films, he told us the patient’s story. “This 63-year-old lady was really sick when she came in. Heart attack a couple of years ago. New trouble …

Health reform: China offers a cautionary tale

Leana Wen, MD

Health Policy

April 9, 2013

Wang Li is a 48-year old farmer from Dalian, China. After a two-day trip to the major provincial hospital, he’s heading home to his village to die. Wang has lung cancer, and even with insurance, his surgery will cost him 20,000RMB—$3,000, which is twice his annual salary. The surgery would be curative, but it doesn’t matter. “I cannot burden my family,” he said.

I am a Chinese-born, American …

Doctors and nurse practitioners: We’re failing the reality test

Yul Ejnes, MD

Physician

April 9, 2013

A guest column by the American College of Physicians, exclusive to KevinMD.com.

Over the past several months, I have covered some controversial topics, such as electronic health records and the overuse of diagnostic testing. For this month’s column, I will address a less provocative topic: the role of non-physician …

Reviewing my cataract surgery: A casual disregard for patients

Trudy Lieberman

Patient

April 9, 2013

At last it was time for my cataract surgery. Having had one eye surgery done by a different physician in another New York eye and ear specialty hospital a few months earlier, I knew what to look for and could make comparisons from a patient perspective. As I noted months ago on this blog, I really had no choice of hospitals. If I wanted my trusted doctor to …

Probiotics promise better health, but that’s hard to prove

Michael Kirsch, MD

Medications

April 8, 2013

My kids know that I enjoy a spirited argument. During the days when the dinner table was our public forum, I tried hard to offer a responsible voice of dissent on the issues before us. I admit now that the view I espoused was not always my own, but one that I felt merited inclusion in the discussion. I still do this with them and to others in my life …

Awareness about intraoperative awareness

Nina Singh-Radcliff, MD

Conditions and Diseases

April 8, 2013

A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com.

During the Civil War, anesthesia was provided by dipping cloth in chloroform or ether and holding it over a patient’s nose and mouth. Today, anesthetic medications are delivered in a controlled (and more civil) manner through specialized devices to provide unconsciousness for surgery.

Over the last several …

Should OpenNotes become the standard of care?

Leslie Kernisan, MD, MPH

Physician

April 8, 2013

Iinspired by the VA’s big bold step of going OpenNotes, I wrote a blog post titled OpenNotes in geriatrics: 6 awkward concerns.

It was written in the spirit of just about everything I write: to share the nitty-gritty complexities of what I find myself navigating in geriatrics, to bring attention to medical issues that older adults and PCPs struggle with, and to try to bridge …

How can doctors avoid killing or hurting people in their care?

Janice Boughton, MD

Physician

April 8, 2013

Hospitals are very focused on avoiding harming patients lately. They have been moving in that direction for a long time, but with health care reform legislation, payments are on the line, which makes something that was a very good idea into an imperative.

In the year 2000, the Institute of Medicine, a non-profit organization that monitors various aspects of medical care, reported that 44,000-98,000 people died each year due to medical …

The best doctors teach their patients

James C. Salwitz, MD

Physician

April 8, 2013

The Oxford English Dictionary (OED) identifies the first use of the term “doctour”, as the year 1303 AD, shortened to “doctor” in the 1557 addition of the Geneva Bible. The OED first defines doctor not as a caregiver or healer, not as a science researcher or expert and not even as one with an advanced educational degree. The OED, the world’s foremost English language dictionary, defines “doctor,” 700 years ago …

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The best doctors teach their patients

The KevinMD toolkit: Speaking

Kevin Pho, MD

KevinMD

April 8, 2013

Part of the KevinMD toolkit series.

A lot of people ask me, “What tools do you use for blogging, speaking, when you’re on the road, seeing patients etc. …” So I decided to start a series that describe what tools I use, and why.

First in this series are tools I use for my social media keynote presentations. My …

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The KevinMD toolkit: Speaking

Robotic prostatectomy: A debate with a urologist

Skeptical Scalpel, MD

Conditions and Diseases

April 8, 2013

I’m involved in a protracted and good-natured (I hope) debate about the merits of robotic surgery with a University of Pittsburgh urologist named Ben Davies. Today he tweeted the following (with translation for the Twitter averse):

“I would love for a $ISRG [stock symbol for Intuitive, makers of the robot] MD hater (like @Skepticscalpel) to actually watch 10 open RRPs [radical retropubic prostatectomies] …

Medical apps: We are approaching the tipping point

Joe Flower

Health Technology

April 7, 2013

The progeny of the iPhone and the iPad will change the shape of your institution — and your balance sheet.

One of the more striking images, to me, out of the online spew in the last few months was from the inauguration. It was a wide view of an inaugural ball. There was the president waltzing with the first lady, and a crowd of several hundred watching them. What was striking …

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