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Embrace the gift that our patients are giving us

Leana Wen, MD

Physician

March 19, 2013

Everyone knows that life in the ER is fast-faced, extremely busy, and ever-challenging. When things get crazy, it becomes habit for busy physicians to see patients as “the chest pain in room 6” or “the broken wrist in the hallway.” We turn people with their amazing lives and fascinating stories into a nameless number and a “chief complaint”.

It’s a practice that’s easy to justify—after all, taking a long …

Comprehensive annual physical exams have no scientific value

Davis Liu, MD

Physician

March 18, 2013

Is the Ontario Annual Physical Exam going the way of the dinosaur? That appears to be the case for healthy individuals between the ages of 18 to 64 in the Canadian province of Ontario. Effective in 2013, these patients no longer would have available an annual physical examination, but instead a “personalized health review.”

The new personalized health review would only be available to those who were healthy and did not …

Empower whistleblowers to improve the health of all Americans

Kenneth Lin, MD

Physician

March 18, 2013

The first instinct of a bureaucracy is self-preservation, and health care bureaucracies are no exception. This rule applies not only to government agencies, but to academic and industry settings as well. This was the conclusion I came to after listening to a panel of scientist and physician “whistleblowers” at the Selling Sickness 2013 conference in Washington, DC.

One by one, they described their painful discoveries that widely prescribed …

An OB/GYN perspective on Choosing Wisely

Margaret Polaneczky, MD

Conditions and Diseases

March 18, 2013

From ACOG comes five new cautions, part of the American Board of Internal Medicine Foundation’s Choosing Wisely campaign, to eliminate wasteful and unnecessary medical interventions that can actually cause harm. All the recommendations are evidence-based and have broad consensus.

1. Don’t schedule elective, non-medically indicated inductions of labor or cesarean deliveries before 39 weeks 0 days gestational age. Delivery prior to 39 weeks 0 days has been shown to be associated with an increased risk …

Questions to ask before your CT scan

Toni Brayer, MD

Physician

March 18, 2013

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The United States is higher in its use of computed tomography (CT) scans than any other industrialized country. There were about 3 million scans done in the U.S. in 1980. By 2007 that number had risen to 70 million. A number of articles published in medical journals over the past few years have reported that excess radiation delivered by these scans will …

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Questions to ask before your CT scan

Visiting the ER on a day when others needed a heartfelt hug

StorytellERdoc, MD

Physician

March 18, 2013

Sometimes as human beings, despite all the layers we consciously build upon the shell of our souls to shelter us, define us, and project an image to others of what we hope we are, our basic inherent quality of goodness emerges on its own free will. A kind word, a gentle touch, a hint of a smile, an understanding patience–these are all things that escape uncontrollably in moments where our …

Violence and severe mental illness: 6 questions to ask

Annette Hanson, MD

Physician

March 17, 2013

Recently one of our readers posted this comment:

“If any Shrink Rapper ever has the time and inclination it would be interesting to read about what you would do to fix the mental health system, particularly the issue of involuntary hospitalization, if you had unlimited funds and political resources. You’ve been in the trenches, it would be great to hear your thoughts.”

Over on Peter Earley’s blog I see …

I am a doctor, but not like the kind on TV

Paul H. Ting, MD

Physician

March 17, 2013

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

Hospital dramas are not very short on excitement, but for some reason, anesthesiologists never seem to get the glamour treatment. Maybe that’s because our job is so difficult to transition onto the silver screen. After all, it would be pretty boring to see only one …

After my daughter’s death, I work to prevent future deaths

Martha Deed, PhD

Patient

March 17, 2013

Another disturbed and disturbing night. It doesn’t happen often three years later. Now – when it does happen – I generally know why.

I am preparing to make a presentation of a sentinel event from my daughter’s final illness to a group of medical professionals and patient advocates. Last night, I was working on key points. What issues seem most important for hospital staffs to address after these years of reflection?

I …

The role of medical research in developing countries

Wilson Castillo Tandazo

Medical Education

March 17, 2013

As a medical student, I am in direct contact with the past, present and future of science. Sometimes, for instance, I read books concerning the history of medicine that bring me back to how diseases were diagnosed and treated a hundred years ago. Bloodlettings, leeches, herbs, and venoms.

It’s amazing to see how medical science has progressed since then. It’s only been a hundred years. We have gone from the discovery …

I wish my hospital was a Dreamliner

Richard Corder

Health Policy

March 17, 2013

The stories have now been relegated to the back pages: “Smoldering batteries forced safety regulators to ground Boeing’s new 787 Dreamliner jets.” This is a glimpse into the challenges that this aircraft and company seem to have been besieged by. The recent grounding of the fleet comes on the heels of other safety related incidents that while “typical” with a new plane …

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I wish my hospital was a Dreamliner

The evolution of writing during a cancer journey

Andrew Griffith

Patient

March 16, 2013

As we embark on our cancer journey, writing can be a way to help us understand, work out issues, and help us accept and come to terms with our fate. The wide variety of blogs and discussion fora, whether religious or secular in outlook, optimistic or pessimistic in tone, medical or emotional in emphasis, all reflect the richness of our individual lives, circumstances and perspectives.

My cancer journey was no different. …

Explaining the rise in legal narcotic misuse and addiction

Donald Tex Bryant

Medications

March 16, 2013

Quick! Can you name the leading cause of accidental death in the United States now? It is prescription drug overdose. Since 2009 death from legally prescribed narcotics has led auto accident deaths as the number one cause of accidental death in the United States. More than 15000 die now annually.

On October 5, 2012 the Wall Street Journal on its front page published …

Medicare Advantage works well when you are healthy

Brad Wright, PhD

Health Policy

March 16, 2013

We all know about Medicare, the federal government health insurance program for Americans who are over the age of 65 and/or disabled. We know that as we have begun to live longer, the Medicare population has ballooned and the costs of the program are, by most estimates, “unsustainable.”

We also know that Medicare, despite being a government program, is beloved by America’s seniors. If it was an unpopular program, Congress would …

Can group visits be an ideal way to practice primary care?

Joshua St. Louis

Medical Education

March 16, 2013

After a long day on the internal medicine ward at St. Elizabeth’s Medical Center, I rushed across town to lead that evening’s two-hour group diabetes visit at Union Square Family Health Center in Somerville, MA. So when my preceptor asked me if I’d lead the group on a field trip after the two-hour visit, it was the last thing I wanted to do.

Although we had discussed taking our Brazilian patients …

MKSAP: 65-year-old man with daytime somnolence

mksap

Conditions and Diseases

March 16, 2013

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

A 65-year-old man is evaluated for a 2-year history of daytime somnolence, snoring, and apneic episodes during the night as witnessed by his wife. He does not have blurred vision, tinnitus, or headache. He has no cardiopulmonary symptoms and does not smoke cigarettes. The patient has hypertension for which he takes lisinopril and atenolol.

On …

In one of the darkest days of my life, you cared for my mom

Kristi Bruno

Patient

March 15, 2013

When you are sorrowful look again in your heart, and you shall see that in truth you are weeping for that which has been your delight.
-Kahlil Gibran

Dear Debbie,

You cared for my mom briefly in the ICU. You might not remember me, but I remember you. My mother, a healthy 54-year-old woman came down with the flu on Christmas. Within a …

Scripting with patients is a silly game

Edwin Leap, MD

Physician

March 15, 2013

Our nurses will soon have “scripting” guidelines for their interactions with patients. This is apparently widespread in many industries. The idea being, patients will be more satisfied with their care if certain key phrases are repeated to them; phrases which might, possibly, just maybe find their way onto satisfaction surveys. Wink, wink!

Whether I will have to engage in this tawdry bit of theater remains to be seen. But bless the …

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Scripting with patients is a silly game

The fine balance between hope and cope in cancer patients

James C. Salwitz, MD

Physician

March 15, 2013

At tumor board recently, we discussed what we tell our patients about prognosis. Some oncologists give detailed information, including specific survival times. Others never discuss the future, and let the events of the illness teach patient and family. All try to adjust what they say by what the patient needs, because each physician expressed one core goal; “Whatever I say I don’t want the patient to lose hope.” I thought …

How to avoid becoming a gunner in medical school

Wayfaring MD

Medical Education

March 15, 2013

gunner: a pre-med or medical student who is ambitious to a fault. They often throw other students under the bus, put their accomplishments and grades on display, and generally make life miserable for any student who they perceive to be a threat to their own success. In short, they are what Hermione would be if she was a Slytherin.

On my blog, I am fairly vocal about my disdain for gunners. They …