KevinMD.com

March 29, 2013Mar 29, 2013172

My office consultation for the 50 year-old woman was her complaint of chest pain. I could not help but glance at her insurance and it was for Medicare. I have always been fascinated with what types of disability people have which qualifies them for Medicare and SSD, (Social Security Disability), before the usual age of 65. To say that I have observed bizarre and inequitable awards would be a gross …

Physician voices

A frequent witness to the power of faith

Rick Boulay, MD

March 29, 2013Mar 29, 20134

I believe the role that God plays in our lives is often magnified during times of great suffering. How we perceive that role is a question of faith, often strong and steadfast in some, especially my patients, but sometimes unreliable…

During the terminal stages of my grandmother’s colon cancer, I recall her saying, “Je pense que le Bon …

Physician voices

Solving the issue of tired doctors: My radical idea

Kevin Pho, MD

March 29, 2013Mar 29, 201329

The problem of medical resident work-hours has vexed medical educators for decades. The traditional model of sleep-deprived residents led to highly publicized medical mistakes, most famously the Libby Zion case in 1984. Nobody wants tired doctors caring for them. In…

Nobody wants tired doctors caring for them.

In response, various restrictions have been placed on how many hours medical residents are allowed to work. Since 2011, for instance, medical residents were …

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Physician voices

Where can doctors publish literary writing?

Louise Aronson, MD

March 29, 2013Mar 29, 2013

There are many ways to write about health, medicine, and health care. And there are many people – patients, caregivers, policymakers, pundits, thought leaders, and health professionals – in a position to do so. Fortunately, the world also offers a…

Fortunately, the world also offers a similar and growing diversity of places in which to publish this sort of work.

My focus today is more, well, literary.

I know the word “literary” often …

Physician voices

How diminishing returns may render the surgical timeout ineffective

Jeffrey Parks, MD

March 28, 2013Mar 28, 201315

Wrong site surgery is never acceptable. A surgeon ought never to find himself in a situation where he has to inform the family that he just operated on the wrong body part. It is embarrassing, unprofessional, and an egregious violation…

That being said, we have allowed this issue to be defined entirely in terms of “systems management”. And hence the …

Conditions and diseases

3 scientific breakthroughs plagued by uncoolness

Janice Boughton, MD

March 28, 2013Mar 28, 20137

During the last year I have been paying particular attention to lesser known and under appreciated miracles in medicine. It is a mystery why miracles of any sort would be under appreciated, but it is so very human to ignore things in plain sight which disrupt our deeply held belief systems or even are simply not what we are looking for.

For those readers who don’t believe that they could actually ignore something …

Medical education

Do board exams teach doctors to overtest?

Ishani Ganguli, MD

March 28, 2013Mar 28, 20138

I just took step three of the national board exams - the final in a series that all U.S. physicians must pass to practice medicine unsupervised. The two day exam, composed of multiple choice questions and simulated patient cases requiring…

I just took step three of the national board exams – the final in a series that all U.S. physicians must pass to practice medicine unsupervised. The two day exam, composed of multiple choice questions and simulated patient cases requiring free-text answers, brought up subjects that we haven’t thought about since medical school (Sick children? Terrifying.) The test also shed some light into how doctors think under pressure and why reigning …

Medical education

Should medical schools find a way to fail gunners?

Kevin R. Campbell, MD

March 28, 2013Mar 28, 201319

In the satirical novel The House of God, author Samuel Shem writes about experiences as a medical student at Harvard. In the novel, many famous quotations are used that have been passed on from generation after generation of medical students…

In the satirical novel The House of God, author Samuel Shem writes about experiences as a medical student at Harvard. In the novel, many famous quotations are used that have been passed on from generation after generation of medical students and residents. Some slang terminology is also referenced and characters are created to illustrate the qualities of certain types of students.

One particular student that is found in every medical school …

Patient voices

The first meeting with a group of Amish patients

Pamela Wible, MD

March 27, 2013Mar 27, 20134

An excerpt from Pet Goats and Pap Smears. Phoning isn’t an option. Nor is e-mail. So I write a letter to the head elder, asking that the Amish community meet with me. He agrees. Today is the day. I accompany…

An excerpt from Pet Goats and Pap Smears.

Phoning isn’t an option. Nor is e-mail. So I write a letter to the head elder, asking that the Amish community meet with me. He agrees.

Today is the day. I accompany Steve, the hospital CEO, to an Upper Midwest town so tiny that the post office is inside the grocery store. On the third floor of a local bank, we …

Physician voices

Why more physicians should write

Michael Kirsch, MD

March 27, 2013Mar 27, 20135

I am a physician who writes and I think that more of my colleagues should do so. Not because, we are such skilled wordsmiths or understand plot and characterization. We don’t. But, we confront the human condition every day. We…

Beyond my own profession, I think everyone should write, because everyone has something important to say and to …

Read more…

Why more physicians should write

Conditions and diseases

Should Medicare cover PET scans for the diagnosis of dementia?

Leslie Kernisan, MD, MPH

March 27, 2013Mar 27, 20133

Do they need a PET scan to confirm the presence or absence of amyloid plaque? More importantly, would doing such PET scans make meaningful impacts on patients’ health? Those are the questions that a Medicare expert panel recently considered, and…

Do they need a PET scan to confirm the presence or absence of amyloid plaque?

More importantly, would doing such PET scans make meaningful impacts on patients’ health?

Those are the questions that a Medicare expert panel recently considered, and their impression, after carefully reviewing lots of high-quality research, is that we don’t yet have evidence supporting the benefit of using the PET scans. Unsurprisingly, some experts disagree, including a working group …

Physician voices

Why coroners should fill out death certificates

WhiteCoat, MD

March 27, 2013Mar 27, 2013

I happened to read an article in the Columbus (Ohio) Dispatch where Ohio coroners are complaining because some doctors, including emergency physicians, are refusing to sign death certificates listing a patient’s cause of death. The coroners are concerned because they…

I happened to read an article in the Columbus (Ohio) Dispatch where Ohio coroners are complaining because some doctors, including emergency physicians, are refusing to sign death certificates listing a patient’s cause of death. The coroners are concerned because they are being “burdened” with hundreds of extra cases every year that they must handle. And if other doctors don’t sign off on the cause of death, sometimes it takes two …

Health policy

How a smart process helped Kaiser Permanente save lives

Chip Heath & Dan Heath

March 27, 2013Mar 27, 20132

The following is an exclusive excerpt adapted from #1 New York Times best selling authors Chip and Dan Heath’s new book Decisive: How to Make Better Choices in Life and Work, which was released on March 26, 2013. Click here…

The following is an exclusive excerpt adapted from #1 New York Times best selling authors Chip and Dan Heath’s new book Decisive: How to Make Better Choices in Life and Work, which was released on March 26, 2013. Click here to order.

One of the most fundamental problems of decision-making, according to psychologists, is that people get stuck in a “narrow frame”—they view their decision in an unduly limited …

Physician voices

Our nation needs more love

John Mandrola, MD

March 27, 2013Mar 27, 20139

Every once in a while a news item becomes so big that a threshold is reached. Thinking people must weigh in. When the US Supreme Court hears two cases involving the rights and treatment of individuals who are lesbian, gay,…

Every once in a while a news item becomes so big that a threshold is reached. Thinking people must weigh in.

When the US Supreme Court hears two cases involving the rights and treatment of individuals who are lesbian, gay, bisexual or transgender, there is a lot at stake. Our country faces a really important test.

It’s not so much about the specific legal issues, though they are not insignificant. Much more …

Read more…

Our nation needs more love

Physician voices

We worship at the feet of pain and pills

Edwin Leap, MD

March 27, 2013Mar 27, 201357

I just finished reading Neil Gaiman’s fascinating novel, Gods of America. I first learned about his work by watching the movie Stardust, then reading the novel. One of the themes of Gods of America is that the deities of the…

I just finished reading Neil Gaiman’s fascinating novel, Gods of America. I first learned about his work by watching the movie Stardust, then reading the novel.

One of the themes of Gods of America is that the deities of the old world came to America in the hearts of their followers, but over time lose their followers and thus their power. A war is arranged between the …

Physician voices

Let us signal that we accept and support same-sex marriage

Stephanie D. Yoshimura

March 27, 2013Mar 27, 201314

I enthusiastically shared the news of the American Academy of Pediatrics (AAP)’s same-sex marriage endorsement with my medical school classmates yesterday. I even publicly posted the AAP’s article – the sole public posting on my private Facebook page – because to me, the strong endorsement of equal rights by an organization of 60,000 pediatricians seemed enormously important for my colleagues and for our world.

I was disheartened to read the viral …

Physician voices

Just sign here: That isn’t real informed consent

Peter Ubel, MD

March 26, 2013Mar 26, 201343

Before patients can become savvy consumers of healthcare, they need information about their healthcare choices. Too often, such information is nearly impossible to get, especially when it requires doctors to give patients useful statistics about things like treatment side effects.…

Since publishing Critical Decisions this fall, I have received a number of emails from readers who have recognized their own medical histories in the pages of my book. I received …

Medical education

The physician’s role in cost containment is absent during training

Brian Powers

March 26, 2013Mar 26, 201325

After graduating from college I had the opportunity to spend two years working at the Institute of Medicine on a variety of health care improvement topics. When it came time to apply to medical school I noticed an odd dissonance—the challenges I had been grappling with at the IOM were not manifest in most medical school curricula. I knew that multidisciplinary teams …

Patient voices

I suddenly know why I’m here

Priscilla Mainardi, RN

March 26, 2013Mar 26, 20132

Tuesday morning, eight o'clock, and I have seven things to do. Check vitals, change a dressing, get a patient out of bed, send another to the operating room. Review lab results, give medications, start a blood transfusion. I have six…

Tuesday morning, eight o’clock, and I have seven things to do. Check vitals, change a dressing, get a patient out of bed, send another to the operating room. Review lab results, give medications, start a blood transfusion.

I have six patients, and they have an average of five morning medications each. I make three trips to the med room for supplies, two trips to the pantry for fresh water.

Mrs. Napoli has …

Read more…

I suddenly know why I’m here

Health technology

Our most scarce health resources are asked to carry the largest load

Jordan Grumet, MD

March 26, 2013Mar 26, 20139

It happened, of all times, when I was in the car driving the kids to violin practice. My pager buzzed with a message from one of the medical floors. I waited till the car was parked, and dutifully pecked the…

Hello doctor, we have your patient, can you please put admitting orders into EPIC?

I, of course, like most doctors, wasn’t sitting by my phone waiting at a computer terminal. …

Real physician voices, twice a week

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