KevinMD.com

May 22, 2013May 22, 20136

Like it or not, measuring physician performance is now a key part of the conventional wisdom on improving our health care system. Borrowing from management guru Peter Drucker’s mantra “You can’t manage what you can’t measure” health care policy makers have embraced performance measurement as being central to managing our heretofore unmanageable health care system. But there is a small but seemingly growing group of Don Quixote-like dissenters who are …

Medical education

One morning I woke up and I wasn’t an intern anymore

Arjune Rama, MD

May 22, 2013May 22, 20132

One Saturday morning at the Salt Lake City Veterans Affairs Medical Center, I got out of a call room bed and realized I had done it. The year everyone dreads, the year everyone says, “you just need to get through” was finally over. I had completed my write-ups on all the patients I admitted overnight. My emergency room consultation requests had been seen. I checked my pager for missed pages: …

Physician voices

A surgeon interviews a medical malpractice attorney: Read and decide

Jeffrey Parks, MD

May 22, 2013May 22, 201316

My interview series continues, this time with local litigation attorney Andrew Thompson, Esq. The topic this time is medical malpractice. I asked him a bunch of questions. He answered. See what you think. 1. In your opinion, is there a…

1. In your opinion, is there a medical malpractice crisis in this country?

No. This is not even a close issue. The concept of a “crisis” or dramatic increase in the number of medical malpractice cases is a fabrication …

Real physician voices, twice a week

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Physician voices

How can patients voice discomfort with excess services?

Ishani Ganguli, MD

May 21, 2013May 21, 20138

The cabdriver pulled up to take me to the community hospital where I work several weeks each year. Settling into the back seat, I made my request before he reached the intersection: “Could you please take 93 South?” He was quick to ask me why, and I hesitated. I had taken this route dozens of times and had usually found it to be faster than the alternative, I said, but …

Physician voices

Will high tech innovations actually improve health outcomes?

Kenneth Lin, MD

May 21, 2013May 21, 20132

One of my students told me about his experience at TEDMED, the future-oriented medical conference that bills itself as "a celebration of human achievement and the power of connecting the unconnected in creative ways to change our world in health…

One of my students told me about his experience at TEDMED, the future-oriented medical conference that bills itself as “a celebration of human achievement and the power of connecting the unconnected in creative ways to change our world in health and medicine.”

He recounted how one speaker showed off the Remote Presence Virtual + Independent Telemedicine Assistant, which news outlets quickly dubbed the “Robo-Doc.” This high-priced gadget is designed …

Physician voices

Why physicians need to write

Louise Aronson, MD

May 21, 2013May 21, 20133

Should doctors be able to write? At first glance, this might seem like a question with an easy answer. Yes, you might say, doctors receive a doctorate and are trusted with communicating to and about people at critical moments in…

Should doctors be able to write?

At first glance, this might seem like a question with an easy answer.

Yes, you might say, doctors receive a doctorate and are trusted with communicating to and about people at critical moments in their lives. Or you could reply, No, they are scientists and so need to be functional communicators able to write basic notes and prescriptions, and …

Read more…

Why physicians need to write

Physician voices

Science alone can’t make tough decisions for us

Peter Ubel, MD

May 21, 2013May 21, 2013

On April 14, The United States Preventive Services Task Force concluded that women with an elevated risk of breast cancer – who have never been diagnosed with breast cancer but whose family history and other medical factors increase their odds of developing the disease–should consider taking one of two pills that cut that risk in half. The Task Force is an independent panel of medical experts who …

Conditions and diseases

Why we should be thankful to Angelina Jolie and Betty Ford

Suzanne Koven, MD

May 21, 2013May 21, 201312

When Angelina Jolie announced that she'd undergone a bilateral mastectomy to prevent the breast cancer for which a genetic mutation puts her at high risk, I found myself, as a doctor and as a woman, full of admiration and gratitude…

When Angelina Jolie announced that she’d undergone a bilateral mastectomy to prevent the breast cancer for which a genetic mutation puts her at high risk, I found myself, as a doctor and as a woman, full of admiration and gratitude for her… and also, in retrospect, for Betty Ford.

In a single New York Times op-ed piece, Ms. Jolie used her celebrity …

Physician voices

Why we cannot keep the costs of end of life care in a reasonable range

Steven Reznick, MD

May 21, 2013May 21, 201316

“J.T.” is 92 and clearly a soul who lives to the beat of a different drummer. She has no children and her closest relative is a niece who she despises. Despite this the niece oversees her care, sending in a full time aide and her personnel assistant to run the household. J.T. will not come to the office for a visit. If I call and make an appointment to see …

Conditions and diseases

We continue to fall short in treating women with heart disease

Kevin R. Campbell, MD

May 20, 2013May 20, 20135

Women are undertreated and underserved when it comes to cardiovascular disease and stroke. Now, more than ever, this may even be more important due to several recent studies that have been published recently. Several investigations have demonstrated two troublesome facts.…

Several investigations have demonstrated two troublesome facts. In certain areas of the country, life expectancy for women is decreasing and women who smoke are much more likely to have lung cancer than men who smoke. These facts argue …

Physician voices

I believe we can find and promote joy in primary care

Christine A. Sinsky, MD

May 20, 2013May 20, 201323

A few years after I entered my practice as a newly certified internist, about two decades ago now, I started to burn out. I felt I was becoming a documentation drone and a guideline-following automaton. I was embarrassed for some of the care I gave–attempting to fit patients’ round needs into the square peg of the medical model. Patients who came to talk about depression were marched through a complete review …

Health technology

The legal risks of prescribing the AliveCor ECG

Wes Fisher, MD

May 20, 2013May 20, 201336

With the announcement that the FDA granted 510(k) approval for the AliveCor EKG case for the iPhone 4/4S, the device became available to "licensed U.S. medical professionals and prescribed patients to record, display, store, and transfer single-channel electrocardiogram (ECG) rhythms."…

With the announcement that the FDA granted 510(k) approval for the AliveCor EKG case for the iPhone 4/4S, the device became available to “licensed U.S. medical professionals and prescribed patients to record, display, store, and transfer single-channel electrocardiogram (ECG) rhythms.”

While this sounds nice, how, exactly, does one become a prescribed patient? Once a doctor prescribes such a device, what are his responsibilities? Does …

Physician voices

Bringing OpenNotes to Geisinger

Jon Darer, MD

May 20, 2013May 20, 201325

Recently, over 520 of our doctors began sharing their office visit notes with patients. All primary care doctors and general pediatricians, and selected physicians within pediatric subspecialties, dermatology, endocrinology, pulmonology, nephrology, rheumatology, cardiology, cardiothoracic surgery, vascular surgery, neurosurgery, and women’s…

Recently, over 520 of our doctors began sharing their office visit notes with patients.

All primary care doctors and general pediatricians, and selected physicians within pediatric subspecialties, dermatology, endocrinology, pulmonology, nephrology, rheumatology, cardiology, cardiothoracic surgery, vascular surgery, neurosurgery, and women’s health—including obstetrics and gynecology and gynecologic oncology—are participating in OpenNotes.

That means tens of thousands of our patients will have access to the notes doctors write about them. After each …

Read more…

Bringing OpenNotes to Geisinger

Conditions and diseases

Should you choose to have a robotic hysterectomy?

Jennifer Gunter, MD

May 20, 2013May 20, 201313

In a word, no (unless you have cancer). So, let’s take cancer out of the picture and discuss hysterectomy for non-cancerous (benign) reasons. First of all. A hysterectomy (removing the uterus) can be done via one of the 4 methods:…

In a word, no (unless you have cancer). So, let’s take cancer out of the picture and discuss hysterectomy for non-cancerous (benign) reasons.

First of all. A hysterectomy (removing the uterus) can be done via one of the 4 methods:

1. Vaginal, a small incision at the top of the vagina and the uterus is removed entirely through the vagina without any incision on the abdomen.

2. Laparoscopic surgery, where incisions are made …

Conditions and diseases

What are the health risks of eyelash extensions?

Orly Avitzur, MD

May 20, 2013May 20, 20132

“Something bad has happened. I’ve got eyelash extensions,” singer and actress Kristin Chenoweth confessed on the "Late Show with David Letterman" last year while wearing large dark sunglasses, and visibly drowsy on Benadryl. “Here’s the problem: The glue has formaldehyde…

“Something bad has happened. I’ve got eyelash extensions,” singer and actress Kristin Chenoweth confessed on the “Late Show with David Letterman” last year while wearing large dark sunglasses, and visibly drowsy on Benadryl. “Here’s the problem: The glue has formaldehyde in it, and I’m allergic,” Chenoweth said. “I swelled up and I’m sneezing. . . . It looks like I have lips on my eyelids.”

The Broadway star is far from …

Conditions and diseases

There is no completely safe dose or form of alcohol

James C. Salwitz, MD

May 20, 2013May 20, 201317

We live in a strange world. What would happen if tomorrow a common sedative was found to cause 21,000 cancer deaths every year? What if it resulted in breast cancer, mouth cancer, hepatoma and esophageal malignancies, and if the average patient lost 19 years of life? What if the drug also killed by cirrhosis, massive upper GI bleeding, accelerated dementia, and for …

Health policy

Why the Oregon Medicaid study is misunderstood

Ashish Jha, MD, MPH

May 19, 2013May 19, 201310

Much has already been written about the Oregon Medicaid study that came out in the New England Journal of Medicine. Unfortunately, the vast majority is reflex, rather than reflection. The study seems to serve as a Rorschach test of sorts,…

Much has already been written about the Oregon Medicaid study that came out in the New England Journal of Medicine. Unfortunately, the vast majority is reflex, rather than reflection. The study seems to serve as a Rorschach test of sorts, confirming people’s biases about whether Medicaid is “good” or “bad”. The proponents of Medicaid point to all the ways in which Medicaid seems to help those who were …

Conditions and diseases

How to have a hospital stay without pain

Anita Gupta, DO, PharmD

May 19, 2013May 19, 20135

Too often patients feel like they’re in the passenger seat when entering the hospital. Even in the best of circumstances — such as planned admissions — patients often don’t feel in control of their own care. One of the most…

One of the most unnecessary issues facing patients when they enter the hospital is untreated (or undertreated) pain. Often the focus of the medical team is to treat a condition, and controlling a patient’s pain …

Patient voices

Patients: Play the role of a consumer who has choices

Wendy Lynch, PhD

May 19, 2013May 19, 201315

I empathize with people who don’t take an active role in their health care decisions. There are real barriers to any of us really getting engaged: limited information about price and quality, a perpetuated culture of “doctor knows best,” and…

There are only so many minutes in the day or neurons in the brain. So, we …

Physician voices

America is at war with its doctors, and patients are the losers

Mona Kotecha, MD

May 19, 2013May 19, 201347

Not old enough to remember any sort of “glory day” in medicine, I still enjoy hearing from older colleagues who recount days when they were respected, paid fairly, and able to practice medicine autonomously at the highest and most uncompromising…

For five years, I’ve been a busy practicing anesthesiologist. And for five years, I’ve listened …

Real physician voices, twice a week

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