KevinMD.com

June 18, 2013Jun 18, 2013

This, apparently, is a map of my mind. It’s a little shocking to find out that my mind looks like a sea creature, a bug, or perhaps a vegetable. Actually, “Rob’s mind” and “vegetable” are often used in the same…

Someone suggested to me that I may benefit from mind mapping. I don’t know how to describe it, but I think spatially; …

Conditions and diseases

The link between ADHD and obesity

Wendy Sue Swanson, MD

June 17, 2013Jun 17, 20133

Last week I served lunch at my son’s school. It was a hoot, really, serving an entire K-8 school lunch. Dishing out lasagna, broccoli, pizza, and grilled cheese provided all sorts of insight into what lunch is like in 2013. My son didn’t choose exactly as I’d predict (see below). When a 33-year prospective study published recently which connects childhood ADHD with adult obesity, …

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The link between ADHD and obesity

Patient voices

Dying a hero’s death

Peg Ackerman, APRN

June 17, 2013Jun 17, 20136

Blanched by anemia, Mary rested quietly in the hospital bed. Her pallor made her barely visible amid the bleached bed linens--she seemed a mere shock of white hair against the pillowcase. Age ninety-three, she'd visited the hospital a half-dozen times…

Blanched by anemia, Mary rested quietly in the hospital bed. Her pallor made her barely visible amid the bleached bed linens–she seemed a mere shock of white hair against the pillowcase.

Age ninety-three, she’d visited the hospital a half-dozen times in as many months, shuttling between nursing home and hospital as many elders unwittingly do in their last year of life. She may have preferred to stay put, but no one …

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Dying a hero’s death

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Physician voices

Thanks for the compliment, but I’m not a nurse

Megan S. Lemay, MD

June 17, 2013Jun 17, 2013312

Let’s get one thing clear from the start: I love nurses. My grandmother was a nurse’s aide. My aunt is a nurse. My mother is a nurse. Nurses have been by my side for the most frightening and important experiences in my life (in the hospital and out). However, I’m not a nurse. I’m a doctor. And when someone calls me …

Health technology

EHRs need to talk to each other, but make sure they work first

Deep Ramachandran, MD

June 17, 2013Jun 17, 20138

I’ve written several times before about my love/hate status with my EMR. While I enjoy using mine, I long for it’s usefulness to get to the next level. While the EMR is useful at tracking data, it’s greatest handicap right now, is that it can’t talk to other systems. Data is still locked in individual systems and can’t be shared across platforms. This lack of interoperability has thus far been …

Physician voices

ACP: Physicians around the world face similar non-clinical issues

American College of Physicians & Yul Ejnes, MD

June 17, 2013Jun 17, 20135

A guest column by the American College of Physicians, exclusive to KevinMD.com. Over the past several years, I have had the honor of representing the American College of Physicians at scientific conferences and professional society meetings. In addition to hearing…

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

Over the past several years, I have had the honor of representing the American College of Physicians at scientific conferences and professional society meetings. In addition to hearing about the latest advances in internal medicine at these events, I learn what is on the minds of physicians in the various regions to which I travel.

Three “hot topics” …

Physician voices

Palliative care has become the last bastion of health care sanity

Jordan Grumet, MD

June 17, 2013Jun 17, 20138

I couldn't really blame the social worker. He was just doing his job. The skilled nursing facility (SNF) connected to the hospital was full of flailing patients. So he thought he would ask for a palliative care consult (after getting…

I couldn’t really blame the social worker. He was just doing his job. The skilled nursing facility (SNF) connected to the hospital was full of flailing patients. So he thought he would ask for a palliative care consult (after getting an okay from the primary team). It was his third request of the day. He spoke slowly as he tried to untangle the twisted path the patient had taken.

“Dr. X …

Medical education

AMA: A significant redesign of undergraduate medical education

American Medical Association & Jeremy Lazarus, MD

June 17, 2013Jun 17, 201311

A guest column by the American Medical Association, exclusive to KevinMD.com. To close the gaps between how medical students are educated and how health care is delivered now and in the future, the American Medical Association (AMA) has awarded $11…

A guest column by the American Medical Association, exclusive to KevinMD.com.

To close the gaps between how medical students are educated and how health care is delivered now and in the future, the American Medical Association (AMA) has awarded $11 million to 11 U.S. medical schools to fund their bold proposals that support a significant redesign of undergraduate medical education. This is just one part of the ambitious three-part strategy the …

Physician voices

Numbers fail to answer that one vital question

James C. Salwitz, MD

June 16, 2013Jun 16, 20135

When I visited Allan in the hospital yesterday, I told him to get up and stroll the hall. However, when I checked in on him this afternoon, the nurses informed me that he refused to get up, even to the chair. When I asked why, Allan told me he could not walk. I was concerned, but when I examined him, I found his vital signs were fine, he had no …

Medical education

Should medical resident training be limited to 40 hours per week?

Skeptical Scalpel, MD

June 16, 2013Jun 16, 201316

Dr. Sam Ko says resident work hours should be limited to 40 per week. Via Twitter, I warned him that I would rebut his assertion. Without any data or references except a tangential one, he bases his opinion on four…

Dr. Sam Ko says resident work hours should be limited to 40 per week. Via Twitter, I warned him that I would rebut his assertion.

Without any data or references except a tangential one, he bases his opinion on four premises.

1. Residents will be happier and nicer to patients because they will be less stressed. There is no proof that this is so. In fact, a recent …

Physician voices

Use batch processing and stop working like a dog

Dike Drummond, MD

June 16, 2013Jun 16, 201312

Do you find yourself spending too much time on things that have nothing to do with seeing patients, and then getting home later than you would like? Do you notice that for every 15 minutes you spend with a patient…

Do you find yourself spending too much time on things that have nothing to do with seeing patients, and then getting home later than you would like?

Do you notice that for every 15 minutes you spend with a patient you spend way more than that messing around in the EMR and being distracted by things like prescription refills, test results and a hundred other forms of two bit clerical work …

Drugs and prescribing

The FDA is regulating the wrong things

Janice Boughton, MD

June 16, 2013Jun 16, 20139

The Food and Drug Administration was created in 1927 in order to carry out the mission of the Food and Drug Act put into effect by Theodore Roosevelt in 1906. In the early 1900's and before, medicines killed and maimed…

The Food and Drug Administration was created in 1927 in order to carry out the mission of the Food and Drug Act put into effect by Theodore Roosevelt in 1906. In the early 1900’s and before, medicines killed and maimed people in gruesome ways and adding chemical substances to foods to mask the fact that they were rotten or substandard was felt to need some sort of legal response. The …

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The FDA is regulating the wrong things

Health policy

Who’s truly responsible for the $2.7 trillion medical bill?

Kent Bottles, MD

June 16, 2013Jun 16, 201317

As someone who professionally closely tracks the debate over the transformation of the American health care clinical delivery system, I did not learn much new from the New York Times article: The $2.7 Trillion Medical Bill. I did find the…

As someone who professionally closely tracks the debate over the transformation of the American health care clinical delivery system, I did not learn much new from the New York Times article: The $2.7 Trillion Medical Bill. I did find the article’s approach useful in explaining how the wide variations in price for procedures contribute to the unnecessary high cost of American health care.

Although the article did document many procedures …

Health policy

Are hospitals really soaking the poor with high prices?

Chris Rangel, MD

June 16, 2013Jun 16, 20137

The Centers for Medicare and Medicaid recently released its compiled data on what over 3,000 hospitals across the country charge for 100 of the most common discharge diagnostic codes under the diagnosis related group (DRG) system, and boy did the DRG really hit the fan. Liberals, economists, and band wagoners got all upset about the enormous pricing differentials between hospitals for the same services.

For example, Twin Cities Community Hospital in …

Health policy

Are ER services really the cost villains?

Trudy Lieberman

June 15, 2013Jun 15, 20137

Maligned over the last decade as places to avoid because of the price of the care they delivered, a study by the RAND Corporation goes a long way toward improving the image of hospital emergency rooms (ERs). The ER price tag was too high for the insurance companies that paid the bills, so many of them tried to discourage ER use by designing policies with high coinsurance and copayments …

Physician voices

Childcare during medical training: Sometimes you just get lucky

Miranda Fielding, MD

June 15, 2013Jun 15, 2013

Sometimes you just get lucky. When I was pregnant with my first child, during my radiation oncology residency, we had a guy living in the apartment over our garage, which we liked to refer to as “the carriage house.” He was a dog trainer by trade, and in his spare time he played softball in a local adult league. When we told him he had to move out, because we …

Physician voices

Fear is a primal emotion in medicine

Danielle Ofri, MD, PhD

June 15, 2013Jun 15, 20133

An excerpt from What Doctors Feel: How Emotions Affect the Practice of Medicine. Excerpted with permission by Beacon Press. The stat cardiac-arrest page came through on my beeper at exactly the same moment as the hospital-wide PA system announced, “Code…

An excerpt from What Doctors Feel: How Emotions Affect the Practice of Medicine. Excerpted with permission by Beacon Press.

The stat cardiac-arrest page came through on my beeper at exactly the same moment as the hospital-wide PA system announced, “Code 411, cardiac arrest, MICU.” The operator chanted the mantra over and over with studied deliberativeness, as though there were even a snowball’s chance in hell that I hadn’t heard …

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Fear is a primal emotion in medicine

Health policy

What if doctors worked for free?

Hans Duvefelt, MD

June 15, 2013Jun 15, 201330

Today I am going to write about how the US could save up to 10% on its healthcare bill. The US spends more on health care than any other nation, $8,500 per person per year. Multiply that by 300 million…

Today I am going to write about how the US could save up to 10% on its healthcare bill.

The US spends more on health care than any other nation, $8,500 per person per year. Multiply that by 300 million people and try to grasp the vast sum of $2,5 trillion.

A lot of changes are taking place with the intent to save healthcare dollars. So far, many of those changes have …

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What if doctors worked for free?

Patient voices

A day in the life of a home care nurse practitioner

Laura Black, NP-C

June 15, 2013Jun 15, 20134

As a 24-hour-a-day, seven days a week, on-call nurse practitioner serving elderly and frail patients, my work day is anything but typical. I start my day not at a hospital or clinic, but at my dining room table. There, I document patient visits from the day before, write up my notes and place an average of 10 or more calls—ranging from setting up appointments to calling my patient’s family members …

Health policy

A more realistic approach to achieving accountable care

Sreedhar Potarazu, MD, MBA

June 15, 2013Jun 15, 20136

Hospitals that are already struggling financially to stay afloat face significant challenges in the coming months and years under some of the provisions of Obamacare. Under the Affordable Care Act's Hospital Readmissions Reduction Program, hospitals that readmit certain patients within…

Hospitals that are already struggling financially to stay afloat face significant challenges in the coming months and years under some of the provisions of Obamacare.

Under the Affordable Care Act’s Hospital Readmissions Reduction Program, hospitals that readmit certain patients within 30 days of discharge could face significant penalties.

The question is whether hospitals really have that much control over factors leading to readmission and whether they are really at fault.

Some readmissions are …

Real physician voices, twice a week

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