KevinMD.com

June 1, 2013Jun 1, 201348

Recently the wires have been active with suggestions that people with obesity pay more for airline travel. This discussion was prompted by a Samoan airline announcing that they would begin charging passengers by the pound. It was also stimulated by Bharat Bhatta, an economist from Norway suggesting that heavier passengers pay a surcharge while lighter passengers are offered discounts.

The logical argument …

Conditions and diseases

MKSAP: 78-year-old woman is evaluated for incontinence

mksap

June 1, 2013Jun 1, 2013

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 78-year-old woman living in a nursing home is evaluated for incontinence. Over the past year, she has had progressive decline in her cognitive…

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

A 78-year-old woman living in a nursing home is evaluated for incontinence. Over the past year, she has had progressive decline in her cognitive status and now spends most of the day in bed. She requires coaxing to join the other residents in their communal meals and requires assistance for eating and bathing. When …

Conditions and diseases

Wary about the Angelina Jolie effect on breast cancer screening

Kenneth Lin, MD

May 31, 2013May 31, 20134

There is nothing like a celebrity to call attention to a preventable disease, especially if that disease is cancer. In March 2000, then-Today Show host Katie Couric, whose husband Jay Monahan died of colorectal cancer in 1998, underwent a live colonoscopy to promote uptake of colorectal cancer screening. Over the next 9 months, national colonoscopy utilization rates rose by 20 percent, a phenomenon that researchers dubbed ” …

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Social media in medicine

Why you shouldn’t give medical advice on Twitter

Iltifat Husain, MD

May 31, 2013May 31, 20139

A few weeks ago I was following an online discussion conducted by a widely followed health site. During the discussion, they had a physician who was giving out wellness advice to users via Twitter. That physician had one tweet in…

A few weeks ago I was following an online discussion conducted by a widely followed health site.

During the discussion, they had a physician who was giving out wellness advice to users via Twitter.

That physician had one tweet in particular that terrified me.

Medical-twitter14-338x600

Medical-twitter23

As the above screenshot shows, one tweet mentioned that when in doubt regarding …

Medical education

Medical nomenclature is needlessly complex

Reflex Hammer

May 31, 2013May 31, 20137

Try your hand at a question from one of our anatomy exams. What nerve supplies the obturator internus muscle (a muscle in the pelvis)? The correct answer is the "nerve to obturator internus." It's like answering who is buried in…

Try your hand at a question from one of our anatomy exams.

What nerve supplies the obturator internus muscle (a muscle in the pelvis)?

The correct answer is the “nerve to obturator internus.” It’s like answering who is buried in Grant’s Tomb.

As a time-strapped medical student, it feels like a godsend when a medical term is named in an obvious way. Even a lay person can intuit the meaning of medical terms …

Health policy

How physician-owned hospitals are making teaching hospitals pay

Joanne Conroy, MD

May 31, 2013May 31, 201313

I always believed that, if we could harness the entrepreneurial spirit of the American physician, we could be capable of great things. Physician decisions drive much of what is good and bad about our health care system. Their pens are the biggest driver of cost and their vigilance is the most significant driver of quality. It is a shame that physician-owned hospitals are accelerating the creation of a two-tier system …

Health policy

Risk stratify patients to best use non-physician providers

Doug Olson, MD

May 31, 2013May 31, 201335

“There are two diagnoses you will never make: those you didn’t think about, and those you have never heard of.” This quote, ascribed to many an attending physician over the years, underlies what has become on some levels a vitriolic…

“There are two diagnoses you will never make: those you didn’t think about, and those you have never heard of.”

This quote, ascribed to many an attending physician over the years, underlies what has become on some levels a vitriolic discussion of primary care delivery in the United States today. It was recently highlighted by a study published in the New England Journal of Medicine.

This article showed a real …

Conditions and diseases

What parents can do to support teen drivers

Wendy Sue Swanson, MD

May 31, 2013May 31, 20134

I’m going to sound very middle-aged in this post. Whenever I talk about texting and driving I tend to show my age. I don’t know how it happened or when it was that I truly became a grown-up, but when…

Unfortunately, teens are particularly vulnerable in the car. Motor vehicle accidents are the number one killer of teens …

Drugs and prescribing

The only thing a cleanse truly cleans is your wallet

Jennifer Gunter, MD

May 30, 2013May 30, 20134

From time to time I get asked about cleanses. What is typically meant by a “cleanse” is only drinking a juice concoction for several days. Some cleanses add things like cider vinegar, cayenne pepper, or other supposedly “healthy” substances. The…

The most common reasons to “cleanse” that I hear from people who drink these things include:

Lose weight
Feel better
Remove “toxins”

Let’s start with weight loss. Cleanses are very low calorie and don’t contain protein …

Conditions and diseases

Lessons from a diagnosis of skin cancer

J. Leonard Lichtenfeld, MD

May 30, 2013May 30, 20136

I have been diagnosed with skin cancer. There really isn't much special about that, since it is a distinction I share with over 2 million Americans who have a skin cancer removed every year. Fortunately, for most, it is a…

I have been diagnosed with skin cancer.

There really isn’t much special about that, since it is a distinction I share with over 2 million Americans who have a skin cancer removed every year. Fortunately, for most, it is a cancer that is not of particular concern since most can be removed. But even those “simple” surgeries–as I have learned …

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Lessons from a diagnosis of skin cancer

Health policy

A brave new world as more physicians become employed

Brian Klepper, PhD

May 30, 2013May 30, 201316

Several physicians have reached out recently to discuss attractive employment offers from health systems. They are invariably conflicted. They understand the trade-offs, that they’ll give up the autonomy they’ve become accustomed to in exchange for more money and fewer practice management headaches. On the down side, they’ll be accountable for generating significant revenues, sometimes independent of care appropriateness.

Most also are aware that the same care services they provide now will …

Physician voices

Fearing HIPAA: My patients are getting worse care

Rob Lamberts, MD

May 30, 2013May 30, 20137

Dear HIPAA: I’m sure you get a lot of hate mail, especially from folks in my profession, so when you got this letter from me you probably assumed it was more of the same. Let me reassure you: I am…

Dear HIPAA:

I’m sure you get a lot of hate mail, especially from folks in my profession, so when you got this letter from me you probably assumed it was more of the same. Let me reassure you: I am not one of those docs. I do think patient privacy is important, and actually found you quite useful when facing unwanted probing questions from family members. I believe the only way …

Patient voices

What chronic pain and illness make me miss the most

Toni Bernhard, JD

May 30, 2013May 30, 20136

When I began to gather my thoughts for this piece, I asked my husband what he thought. It was eye-opening. Even after twelve years of illness, I forget that his life has been impacted as much as mine by my health limitations. This is partly because he’s changed his major task in life to that of caregiver and partly because we can no longer do most of the things we …

Patient voices

It took cancer surgery to see a more profound dimension of life

Jeremiah Horrigan

May 30, 2013May 30, 20135

No one goes to a hospital to heal. They go because they must--as I did three years ago, when a one-hour colonoscopy turned into a four-day surgical sleepover. My grandfather had warned me long ago against hospitals. "You don't want…

No one goes to a hospital to heal. They go because they must–as I did three years ago, when a one-hour colonoscopy turned into a four-day surgical sleepover.

My grandfather had warned me long ago against hospitals. “You don’t want to go there,” he said. “That’s where the sick people are.” Pop died at the age of ninety-four, at home.

His warning came strongly to mind as I walked into the place …

Health technology

The burden of frequent technology transitions

Leslie Kernisan, MD, MPH

May 29, 2013May 29, 2013

I made a big decision recently: I decided to give up my Blackberry smartphone. Why? Like a good geriatrician, I considered the benefits and the burdens of sticking with the Blackberry. And since the burdens seem to outweigh the benefits,…

I made a big decision recently: I decided to give up my Blackberry smartphone.

Why? Like a good geriatrician, I considered the benefits and the burdens of sticking with the Blackberry. And since the burdens seem to outweigh the benefits, bye-bye Blackberry.

This was a difficult decision for me, however. To begin with, becoming comfortable with a new device for one’s daily work takes time. During the transition phase, one is slower …

Health policy

How the medical profession is being forced to game the system

Michael Kirsch, MD

May 29, 2013May 29, 201318

I attended a medical staff meeting recently. These are required meetings and attendance is taken, as was done when we were in kindergarten. While some folks are interested in these meetings’ content, many are not and simply sign the attendance sheet and then slither out in a stealth fashion. Sly doctors grab their pagers and then leave hurriedly pretending that they were summoned to an urgent medical situation, when they …

Physician voices

Please don’t call me a hospitalist

Suneel Dhand, MD

May 29, 2013May 29, 20138

I must confess that I love my job as a hospital medicine doctor. To me, very few specialties in medicine can be as rewarding as the one I’ve had the privilege of practicing for the last five years. We manage an array of medical illnesses, interact with staff from across the hospital in every different specialty, and follow our patients all the way through their—hopefully very short—hospitalization. We take ownership …

Read more…

Please don’t call me a hospitalist

Physician voices

Why I rely on non-physician providers

Don S. Dizon, MD

May 29, 2013May 29, 2013114

I still recall my first rotation as an inpatient attending at Memorial Sloan-Kettering Cancer Center (MSKCC). Perhaps it was the anxiety that I remembered most; that I was “in charge” of a service. Fortunately, having done fellowship at MSKCC, the…

Read more…

Why I rely on non-physician providers

Conditions and diseases

Visiting my family member: A tale of two facilities

Betsy Nicoletti, MS

May 29, 2013May 29, 2013109

Recently, a member of my family was involuntarily admitted to the psychiatric unit of a major teaching hospital in New York City and remained there for two and a half weeks. During that time, the unit kept him safe and provided medication for mood stabilization and thinking. After seeing my family member, my first priority was to talk with the attending physician and care team.

Evidently, the attending doesn’t like to …

Conditions and diseases

Migraine is very much a childhood disorder

Roy Benaroch, MD

May 29, 2013May 29, 201321

“My wife gets migraines—really bad ones—and now my daughter seems to be getting them too. She’s only 7! Is she just copying what her mom does? Can a child really start getting migraines?” Oh, yes they can. Migraine is very…

“My wife gets migraines—really bad ones—and now my daughter seems to be getting them too. She’s only 7! Is she just copying what her mom does? Can a child really start getting migraines?”

Oh, yes they can. Migraine is very much a childhood disorder. About 5% of adults have migraines, and half of them started having their migraines as kids.

As in adults, migraines in children can be severe and debilitating. However, …

Real physician voices, twice a week

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