KevinMD.com

May 12, 2013May 12, 20133

The real problem is not whether machines think, but whether men do. - B. F. Skinner When I was a relatively junior member of the surgical faculty, an even more junior member came to my office and announced that a…

The real problem is not whether machines think, but whether men do.
– B. F. Skinner

When I was a relatively junior member of the surgical faculty, an even more junior member came to my office and announced that a general surgeon and gynecologist in Georgia had performed gallbladder surgery with a laparoscope.

“Stupid stunt,” I snorted, or something equally derisive and all-knowing.

Some weeks or months later he returned to the topic, telling …

Conditions and diseases

How one urologist approaches PSA testing

Neil Baum, MD

May 12, 2013May 12, 2013

Prostate cancer is the most commonly diagnosed non–skin cancer among U.S. men. It can be life-threatening, and many men have cancer without knowing it. For those reasons, doctors sometimes look for prostate cancer in healthy men (screen for cancer) by measuring blood levels of prostate-specific antigen (PSA), a protein secreted by the prostate gland. High PSA levels can be caused by cancer and may lead a doctor to take a …

Physician voices

Is this Fisher Price sleeper safe for infants?

Roy Benaroch, MD

May 12, 2013May 12, 20135

You might think a thing sold by a huge manufacturer of children’s toys and furniture as a “sleeper” would a safe, appropriate place for a baby to sleep. It is, after all, called a “sleeper.” But it is not a…

The Fisher Price Newborn Rock ‘n Play Sleeper is a sling-shaped baby holder sort of gizmo, …

Real physician voices, twice a week

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Medical education

Why the conversations that start in TEDMED need to continue

Chris Gibson

May 11, 2013May 11, 201311

A few weeks ago I had the distinct privilege to attend TEDMED as a Front Line Scholar. TEDMED isn’t your usual medical conference; artists share the stage with scientists and your notions of what healthcare could be are shifted. While…

While the talks I attended were often inspiring and eye-opening, the interaction with fellow attendees was by far the most enriching aspect of the …

Drugs and prescribing

Prescribing antibiotics: It’s time to draw a hard line

Wesley Nickens, MD

May 11, 2013May 11, 20139

This is a call to arms to my fellow providers to protect our patients from themselves and our willingness to comply with their requests. We live and practice in a society filled with fear of medications and their side effects. People will not take blood pressure, cholesterol, or diabetic medication because of the side effects they have heard or read about.

However, these same patients will take antibiotics every day of …

Conditions and diseases

How to know if your toddler has autism

Julie Kardos, MD & Naline Lai, MD

May 11, 2013May 11, 2013

About half of all children in the United States with an autistic spectrum disorder are diagnosed at age five or older, according to a May 2012 NCHS (National Center for Health Statistics) data brief. However, many parents are suspicious much sooner. As part of autism awareness month, we bring you clues into toddler development that can alert you to a potential issue.

Pediatricians often use a questionnaire called the M-CHAT (Modified …

Read more…

How to know if your toddler has autism

Physician voices

3 ways for doctors to reclaim their value

Natasha Deonarain, MD, MBA

May 11, 2013May 11, 2013107

A few years ago, I sat in a coding lecture for urgent care providers given by a very entrepreneurial physician assistant. An emergency room doctor, who had recently established his own private clinic, put up his hand to ask a…

“I can see your point about coding at a higher level for a sore throat when I was younger,” he said. “I used to take longer to …

Conditions and diseases

MKSAP: 27-year-old pregnant woman with hypothyroidism

mksap

May 11, 2013May 11, 2013

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 27-year-old woman is evaluated during the fourth week of an uneventful pregnancy. She has a 3-year history of primary hypothyroidism due to Hashimoto…

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

A 27-year-old woman is evaluated during the fourth week of an uneventful pregnancy. She has a 3-year history of primary hypothyroidism due to Hashimoto thyroiditis that is treated with levothyroxine, 125 µg/d. She also takes prenatal vitamins and iron sulfate.

On physical examination, temperature is 37.1 °C (98.8 °F), blood pressure is 128/80 mm Hg, …

Physician voices

Medical problems can be uncovered by a history and physical exam

Jim deMaine, MD

May 10, 2013May 10, 20139

Bobby was admitted to the hospital once again with overwhelming fatigue and shortness of breath. Yet this 37 year old farmer looked the picture of health. He grew up on a farm rising before dawn, milking cows and working long days in the fields with hay or corn. He was never seriously ill as a child and was a good football halfback in high school.

But this was his third admission …

Health technology

Why it’s risky to pay for a proprietary health IT system

Edmund Billings, MD

May 10, 2013May 10, 20137

“No aspect of health IT entails as much uncertainty as the magnitude of its potential benefits.” A few years into the Meaningful Use program, it seems this quote from a 2008 Congressional Budget Office report entitled "Evidence on the Costs…

“No aspect of health IT entails as much uncertainty as the magnitude of its potential benefits.”

A few years into the Meaningful Use program, it seems this quote from a 2008 Congressional Budget Office report entitled “Evidence on the Costs and Benefits of Health Information Technology” may have been written with the assistance of a crystal ball.

Fast forward to 2013.

“Just from reading a week’s worth of news, …

Medical education

5 essential aspects of medical school that you wouldn’t expect

Survivor, DO

May 10, 2013May 10, 201313

Interview season is winding down and budding physicians everywhere are clutching tightly to their hard-fought medical school acceptance letters. I thought now would be an opportune time to reflect on what I wish I had known before starting medical school.…

Let’s boil it down to five essential aspects of medical school that you wouldn’t expect or are of such crucial importance you should be reminded of them.

1. You will have time …

Medical education

Giving feedback and asking for it is vital to progressing medicine

Helen M. Farrell, MD

May 10, 2013May 10, 2013

Giving and receiving feedback is really hard. When I left training and joined the faculty at a major medical school last year I found many things about my new position daunting. Fitting into a well established practice; learning a new system; being a teacher; juggling different services and roles; billing appropriately; and last but not least, giving feedback.

Psychological and logistical hurdles make it challenging to deliver feedback. Constructively criticizing the …

Conditions and diseases

Dealing with depression has made me a better doctor

Ronan Kavanagh, MD

May 10, 2013May 10, 20137

I was a junior doctor when I experienced my first episode. The strange thing is, that despite my medical training (I may have bunked off a few of the relevant lectures in medical school), I didn’t recognize the symptoms. I…

I had lost my appetite and had lost weight. I wasn’t sleeping and was irritable, angry and tired most of the time. Most disturbing to me was a feeling (despite being surrounded by work …

Medical education

We are training physicians to take care of the 1%

Andrew Morris-Singer, MD

May 10, 2013May 10, 20139

“That makes no sense!” a friend recently blurted out to me after I finished helping her understand how the vast majority of internal medicine residents are trained in this country. Her incredulousness was less about the "how," and more about…

No doubt. When you consider that the overwhelming majority of practitioners will ultimately be practicing almost exclusively in the outpatient environment, and that cost-conscious healthcare reform efforts are specifically …

Health technology

The advantages of having a connected EHR

Donald Tex Bryant

May 10, 2013May 10, 20136

Most clinical providers are aware of the more common capacities of EHRs. However, there are many capacities that are being underused that can be of great assistance in providing safe care that avoids waste and identifies best practices. Electronic communication with providers outside of one’s clinical setting, clinical decision support and improving the body of knowledge of best practices are three of …

Physician voices

4 tips to remember when end of life discussions go wrong

Monica Williams-Murphy, MD

May 9, 2013May 9, 2013

I write a lot about end of life conversations that go well or have unexpectedly positive outcomes. But to be fair and balanced, you should also hear about the ones that don't go so well, lest you be led to…

I write a lot about end of life conversations that go well or have unexpectedly positive outcomes. But to be fair and balanced, you should also hear about the ones that don’t go so well, lest you be led to believe that I have magical powers over my patients and their families.

Here are two of my attempted end of life map conversations that did not go over so well. In fact, …

Health policy

The path for physicians who want to remain in private practice

Brian Klepper, PhD

May 9, 2013May 9, 201310

What is the path forward for physicians who want to remain in private practice, outside the constraints of health system employment? How will the environment change and what new demands will that place on practices and physicians? What follows are the observations of one industry-watcher who has worked on all sides of health care, but who now spends most his time focused on the interests of those who pay for …

Physician voices

4 tips to better communicate with patients

Sharon Bahrych, PA-C, MPH

May 9, 2013May 9, 201319

I was listening to CBS This Morning recently as they were interviewing Alan Alda. He was discussing his acting career and being the host of Scientific American’s Frontiers (airs on PBS stations). Alan Alda relayed a personal story of his,…

I was listening to CBS This Morning recently as they were interviewing Alan Alda. He was discussing his acting career and being the host of Scientific American’s Frontiers (airs on PBS stations). Alan Alda relayed a personal story of his, having an intestinal blockage while he was filming an episode in Chile.

As he relayed this incident, he spoke of the physician who told him that he was going to remove the …

Health policy

Patient-centered care requires learning from the service industries

Amol S. Navathe, MD & Brian Powers & Sachin H. Jain, MD, MBA

May 9, 2013May 9, 20132

Over the past decade, patient-centered care has become a mantra for high-quality health care. Policymakers, researchers, physician-leaders, and patients have all cited the need for care to be tailored to patients’ unique needs and preferences. And there is solid evidence that patient-centered care can help improve care quality and reduce costs. However, in the rush to become more patient-centered, the health care system has misplaced its focus.

Current approaches to …

Real physician voices, twice a week

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