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 …
Explaining the rise in legal narcotic misuse and addiction
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 …
Medicare Advantage works well when you are healthy
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 …
Can group visits be an ideal way to practice primary care?
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 …
MKSAP: 65-year-old man with daytime somnolence
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 …
In one of the darkest days of my life, you cared for my mom
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 …
Scripting with patients is a silly game
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 …
The fine balance between hope and cope in cancer patients
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 …
How to avoid becoming a gunner in medical school
To cut costs in our health system, reformers target the massive of waste. One way to reduce waste is to change the way doctors are paid. The fee for service payment system, they say, encourages doctors to prescribe more expensive care, which lines their pockets and drive up the cost of care.
To combat this trend, reformers often have providers in their crosshairs, …
Health reformers fail to hold patients accountable for health costs
Next in a continuing series.
The preliminaries are over. Sponges, needles, and instruments have been counted and checked, their number recorded on a whiteboard on the wall, as well as a clipboard. The checkoff is a comforting hum of words; the tuned machinery of the workplace. As the bottle of local is opened and poured into a sterile bowl on …
The act of incising human flesh is never routine
In these early days of pay for performance (P4P) reimbursement, as the size of your paycheck begins to reflect your patient satisfaction scores, let’s have a frank discussion about three important topics all healthcare providers and organizations must understand going forward.
The key for patient satisfaction is physician satisfaction
The Saturday after Sandy hit, I was the medical student in a Cambridge, Massachusetts emergency room. Around the time my shift started, Andrew, a man about my age, couldn’t bear the pain in his nose any longer. The ED nurse still talks about the “huge booger” bulging from his nose. A few days before coming to the ED, he’d left behind his flooded, powerless Brooklyn apartment seeking refuge in his …
When doctors don’t know the cost of medical care
A few months ago I wrote a post about the 159 page digital fax that I received, containing records for a patient’s recent lengthy hospitalization.
I’ve now discovered something even more time-consuming and annoying: a 202 page paper record mailed to me by a major medical system. (I won’t name names right now; suffice to say this system uses Read more…
My workflow for going through old paper charts
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An email was waiting for me one morning from my wonderful nurse, Laura. “Very sad day,” it said in the subject line. I opened the email quickly upon receiving it and read that one of my patients had died. This age-old dilemma again made me wonder what I should do: Should I call the family? Send an email or a card …
The importance of saying goodbye at the end of life
Are there really too few primary care physicians? And if so, what can we do to solve the PCP shortage? The standard answer to the first question is “yes, we have too few PCPs.” And the standard solution is to train more such docs, or allow more foreign-trained primary care docs into the country or, better yet, simply pay PCPs more money, so that graduating medical students will be more …
Why the primary care physician shortage is overblown
Today I’m doing anesthesia for colonoscopies and upper GI scopes. Nowadays we have three board-certified anesthesiologists doing anesthesia for GI procedures every single day at my institution. I’ll probably do 8 cases today. I will sign into a computer or electronically sign something 32 times. I have to type my user name and password into 3 different systems 24 times.
I’m doing essentially …
10 ways to make EMRs more doctor-friendly
An elderly doctor passes away, and he find himself standing before the Pearly Gates. The Almighty greets him and says, “In recognition of your stellar life of service to your patients, family and community, I welcome you to paradise. And because I know that doctors have a great sense of curiosity about all things, you can now ask me any question—any—and I will answer it.” The doctor ponders for a …
Is this the year Congress repeals the SGR?
I have it on good authority that it’s not easy being green. But I’m willing to wager that it’s a whole lot easier when you have a lovable name like “Kermit.” Imagine being green (or brown) with a name like “Ramachandran”? Growing up with a name like mine certainly had its disadvantages. While most neighborhoods have a local bully who kicks ass and takes names, in my case, he would …
Doctors: Pronounce the names of your patients correctly
If you haven’t seen the movie, “Amour”, but are planning to, you might want to skip this commentary – but by all means do go!
It starts and ends with love, but not in Hollywood’s usual youthful romantic fashion. It also starts and ends with death after much caring, love and suffering. The agonizing toll on the patient and caregiver are equally …
Death by voluntary cessation of fluids and nutrition needs discussion
A guest column by the American College of Physicians, exclusive to KevinMD.com.
Whether we call them “unnecessary,” “not indicated,” “inappropriate,” or “overused,” certain tests and procedures add little or no clinical benefit to patients and in some cases they cause harm. They also contribute to the cost of care without improving care. At a time when payers are challenging payment …
ACP: 5 excuses physicians and patients should question
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