KevinMD.com

May 25, 2013May 25, 201313

These days, there is a lot of talk about expanding scopes of practice for the group of folks who used to be called physician extenders and then midlevel providers and more recently non-physician providers, many of whom are now getting…

While it seems to vary, these folks may include nurses, physician assistants (one day to be called physician associates perhaps), pharmacists, and more. Lots …

Conditions and diseases

Creating value for others boost to our happiness

Alex Lickerman, MD

May 25, 2013May 25, 2013

The set-point theory of happiness suggests that our level of subjective well-being is determined primarily by heredity and by personality traits ingrained in us early in life and as a result remains relatively constant throughout our lives. Our level of happiness may change transiently in response to life events, but then almost always returns to its baseline level as we habituate to those events and their consequences over time. Habituation, …

Physician voices

Professionalism is not a stable trait

Patti M. Thorn, PhD

May 25, 2013May 25, 201320

In my work as an academic medicine education specialist, and, perhaps more importantly, in my experience as a patient, I have observed time and time again a common scenario. I call it the grumpy physician trickle down scenario. Here is…

Here is how it plays out. A physician, likely good-hearted, well-intentioned, competent, and compassionate, develops frustration with system operations (scheduling, inefficiencies, miscommunication, the list goes on). The physician internalizes the frustration, perhaps believing …

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Professionalism is not a stable trait

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Medical education

Address the disease of residency work hours

Joyce Ho, MD

May 25, 2013May 25, 201324

I knew from the beginning that residency would be one of the biggest challenges in a career in medicine and reading Dr. Pauline Chen’s article, "The Impossible Workload for Doctors in Training," put into mathematical terms what I had been…

I knew from the beginning that residency would be one of the biggest challenges in a career in medicine and reading Dr. Pauline Chen’s article, “The Impossible Workload for Doctors in Training,” put into mathematical terms what I had been sensing all along.

In what other profession do you go through four years of undergrad and four years of $60k/year medical school, only to end up working 100 hour weeks for …

Physician voices

The dark side of social marketing to physicians

Hans Duvefelt, MD

May 24, 2013May 24, 2013

As a Swede, I know all about socialized medicine. I grew up with it and I learned my trade in it. I worked under budget constraints, treatment protocols and formularies in the late 70′s and early 80′s while American doctors…

I remember one of my surprises when I arrived in this country: I had learned in medical school that trimethoprim-sulfa was the drug …

Physician voices

Think of a soda ban like seatbelts

Claire McCarthy, MD

May 24, 2013May 24, 2013141

I’m sad that a New York judge struck down the 16-ounce size limit for sodas and some other sweet drinks. I think Mayor Bloomberg had the right idea. I get that whole personal freedom argument (although the court just said…

I’m sad that a New York judge struck down the 16-ounce size limit for sodas and some other sweet drinks. I think Mayor Bloomberg had the right idea.

I get that whole personal freedom argument (although the court just said that it was arbitrary and out of Bloomberg’s purview), that this was a “nanny state” idea. But honestly, when it comes to obesity, …

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Think of a soda ban like seatbelts

Conditions and diseases

What is the excuse for not taking action on Alzheimer’s?

Alexander Halperin, DDS

May 24, 2013May 24, 20136

Having early-stage Alzheimer's, I get extraordinarily sentimental when I hear the words of songs when I go for early morning walks with my headphones on. Yesterday morning, I heard the song, "Memories," and some of the lyrics hit my heart,…

Having early-stage Alzheimer’s, I get extraordinarily sentimental when I hear the words of songs when I go for early morning walks with my headphones on.

Yesterday morning, I heard the song, “Memories,” and some of the lyrics hit my heart, soul and mind. I looked up the lyrics on the Web: “Daylight (and the sun was about to rise soon after at that time), I must wait for the sunrise, I …

Conditions and diseases

A proton therapy center opens: A radiation oncologist reflects

Miranda Fielding, MD

May 24, 2013May 24, 20132

When I was a radiation oncology resident in Boston in the early 80’s, a few brilliant minds in physics and medicine came up with the notion that it would be a good idea to treat certain cancers with a beam of protons. Protons are the positively charged particles which are created with a hydrogen atom is split into its component parts, a proton and an electron. When accelerated towards a …

Health technology

English is the second language of medical documentation

American College of Physicians & Yul Ejnes, MD

May 24, 2013May 24, 20135

A guest column by the American College of Physicians, exclusive to KevinMD.com. English is the international language of medicine, according to many. Regardless of whether that is true, what is becoming increasingly clear is that English is the second language…

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

English is the international language of medicine, according to many. Regardless of whether that is true, what is becoming increasingly clear is that English is the second language of medical documentation. For those of you who blame EHRs for this, the replacement of English by something else started in the pre-EHR era, but EHRs certainly accelerated it. …

Patient voices

Don’t call me a health care consumer

Jessie Gruman, PhD

May 24, 2013May 24, 20138

The highly charged political debates about reforming American health care have provided tempting opportunities to rename the people who receive health services. But because the impetus for this change has been prompted by cost and quality concerns of health care payers, researchers and policy experts rather than emanating from us out of our own needs, some odd words have been called into service. Two phrases commonly used to describe us …

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Don’t call me a health care consumer

Health policy

Transitional care programs are ripe for innovation

Michael Cetta, MD

May 23, 2013May 23, 2013

Right now hospitals around the country are being asked to reckon with some stark realities regarding readmissions. $17 billion a year is spent on readmissions for Medicare patients alone, and 75% of those readmissions are considered to be preventable. Of all Medicare patients who are admitted to a hospital, 18 percent will be readmitted in 30 days and of those, 50 percent will not have seen a primary care physician …

Medical education

Family medicine residents need to learn reproductive healthcare

Alison Block, MD

May 23, 2013May 23, 201311

Jennifer was one of my first patients as a new doctor, and she came to see me about an unintended pregnancy. A single mom to a rambunctious 5-year-old girl, Jennifer was struggling economically and battling depression. We talked about the options available to her: continuing the pregnancy and preparing to parent another child, offering the baby for adoption or having an abortion. She chose to continue with the pregnancy, and …

Physician voices

It’s time to treat mental illness in the ER with dignity

Greg Smith, MD

May 23, 2013May 23, 201355

We doctors who specialize in psychiatry have a sacred trust. We are given the opportunity to talk to people who are hurting every day, people who trust that we will listen to them, try to understand them, not laugh at them, and not think that they are stupid, crazy, or horrible. A tall order, granted, given that we hear stories that sometimes border on the unimaginable, bizarre and otherworldly. This …

Health technology

The impact of outdated communications technologies in healthcare

Sean Kelly, MD

May 23, 2013May 23, 2013

As a physician, I experience first-hand the impact that internal communication at a hospital—both good and bad—has on patient care. If I am able to quickly access clinical systems, analyze patient information and collaborate with colleagues, I can diagnose and…

As a physician, I experience first-hand the impact that internal communication at a hospital—both good and bad—has on patient care.

If I am able to quickly access clinical systems, analyze patient information and collaborate with colleagues, I can diagnose and interact with the patient much more efficiently and effectively. Conversely, breakdowns and inefficiencies in the communications process can inhibit the delivery of quality patient care by bogging down workflows, creating delays …

Physician voices

Practice hassles are threatening our profession

Robert Centor, MD

May 23, 2013May 23, 201318

Do you know anyone who has tried to find an internist recently? Good luck. Internists are either overflowing with patients, switching to retainer medicine, switching to hospital medicine or quitting. Internists are frustrated, burned out, and unhappy with the external…

We spend 20 years in school, and then 3 years of residency training. We learned to think and apply our cognitive expertise to the diagnosis and …

Conditions and diseases

Is drug resistant bacteria a major public health issue?

Colin Son, MD

May 23, 2013May 23, 20133

Infectious disease is the most hyperbolic of all medical fields, at least when the media gets ahold of such. Right now we are to fear a new avian influenza virus. Previously there was another avian influenza strain whose outbreak threatened…

Infectious disease is the most hyperbolic of all medical fields, at least when the media gets ahold of such.

Right now we are to fear a new avian influenza virus. Previously there was another avian influenza strain whose outbreak threatened the world and of course SARS and, more distantly, the ebola virus and the threat of bioterrorism. And on the …

Drugs and prescribing

When patients rely on financial assistance programs for drugs

Nancy Meredith

May 22, 2013May 22, 201319

I had been laid off a few months when my ulcerative colitis kicked in, and my doctor and I struggled to get it under control. After trying a variety of medicines, my health continued to deteriorate and I agreed to…

Remicade is a potent drug, administered through an IV infusion at the oncology center that comes with a whole host of potential side effects. The dosage requires an initial …

Physician voices

Why banning curbside consults may not be the answer

Robert Wachter, MD

May 22, 2013May 22, 20139

Everybody hates curbside consults – the informal, “Hey, Joe, how would you treat asymptomatic pyuria in my 80-year-old nursing home patient?”-type questions that dominate those Doctor’s Lounge conversations that aren’t about sports, Wall Street, or ObamaCare. Consultants hate being asked…

Consultants hate being asked clinical questions out of context; they know that they may give incorrect advice if the underlying facts and assumptions aren’t right (the old garbage in, …

Health policy

Why pay for performance saves lives in the UK but not in the US

Jason H. Wasfy, MD & Jesse Pines, MD

May 22, 2013May 22, 20132

This past November, the New England Journal of Medicine published results from the “Advancing Quality” program in the United Kingdom: hospitals in the northwest of England were paid up to 4% more based on quality scores for treating several common…

This past November, the New England Journal of Medicine published results from the “Advancing Quality” program in the United Kingdom: hospitals in the northwest of England were paid up to 4% more based on quality scores for treating several common medical conditions. Patient outcomes were compared to other National Health Service hospitals not eligible for the bonuses, and several other conditions that were not explicitly measured in the same …

Real physician voices, twice a week

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