KevinMD.com

March 14, 2013Mar 14, 201344

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 …

Health technology

10 ways to make EMRs more doctor-friendly

Shirie Leng, MD

March 13, 2013Mar 13, 201314

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 …

Health policy

Is this the year Congress repeals the SGR?

Bob Doherty

March 13, 2013Mar 13, 20135

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 …

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Physician voices

Doctors: Pronounce the names of your patients correctly

Deep Ramachandran, MD

March 13, 2013Mar 13, 201311

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 …

Physician voices

Death by voluntary cessation of fluids and nutrition needs discussion

Jim deMaine, MD

March 13, 2013Mar 13, 201342

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…

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 …

Physician voices

ACP: 5 excuses physicians and patients should question

American College of Physicians & Yul Ejnes, MD

March 13, 2013Mar 13, 20137

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…

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 for legitimate services that patients need, the medical profession …

Physician voices

Home genetic testing raises more questions than answers

Lucy Hornstein, MD

March 12, 2013Mar 12, 20135

A reader recently wrote: My and I are 63 and childless. We are thinking of spending $99 to get genetic screening on the theory that it could help us plan a little better for our old age. Just as a…

A reader recently wrote:

My [spouse] and I are 63 and childless. We are thinking of spending $99 to get genetic screening on the theory that it could help us plan a little better for our old age. Just as a random example, if I knew my chances for getting Alzheimer’s disease were high, I might want to move into assisted living sooner rather than later. We have many questions. Is

…

Physician voices

Why malpractice reform will happen, whether lawyers like it or not

Wes Fisher, MD

March 12, 2013Mar 12, 20134

A collision is coming. Scratch that. The collision is here. I'm not quite sure how to describe this, but I'll try. Every day, I look at a computer screen for health care delivery with an increasing number of menu options.…

A collision is coming.

Scratch that.

The collision is here.

I’m not quite sure how to describe this, but I’ll try.

Every day, I look at a computer screen for health care delivery with an increasing number of menu options. I tried counting these menu options once and after scrolling through them, I never reached all of them after counting up to 275 items.

Yes, there are …

Physician voices

Working in an urgent care center: An assault on the soul

Richard Young, MD

March 12, 2013Mar 12, 201343

I recently received this email message from one of my residents who has moonlighted in a local commercial urgent care center. This message is reprinted with his permission just as I received it, except I removed the brand name. Hey…

Hey Dr. Young, I’m looking for some basic mentoring advice. I’ve been moonlighting at ZZZ Urgent Care for about a year. Not my favorite work, but oh well. I don’t routinely prescribe antibiotics

…

Health policy

Is a winning health reform strategy best for patients?

Joe Flower

March 12, 2013Mar 12, 2013

Rapid change is engulfing health care across the United States, but the strategic responses of organizations to these changes are sharply divided. In the shift that has been broadly shorthanded “from volume to value,” many organizations across the country are deeply engaged in moving toward “value” by building new partnerships, affiliations, capacities and economic structures, striving to bring better health and health care to more people for less money.

At the …

Physician voices

Lessons from starting a new practice from scratch

Rob Lamberts, MD

March 12, 2013Mar 12, 20136

Since I started my new practice, it’s been an über hectic and very draining time, but I am happy to report that the end of the week was significantly better than the beginning. Here are some things I am learning.…

Since I started my new practice, it’s been an über hectic and very draining time, but I am happy to report that the end of the week was significantly better than the beginning.

Here are some things I am learning.

1. Starting a business is really, really hard. I did my best to make my business as simple as possible, mainly because I understand my own deficiencies when it comes to business-related activities. …

Physician voices

Physician burnout is an obstacle to patient safety

Robert Wachter, MD

March 11, 2013Mar 11, 201317

These should be the best of times for the patient safety movement. After all, it was concerns over medical mistakes that launched the transformation of our delivery and payment models, from one focused on volume to one that rewards performance. The new system (currently a work-in-progress) promises to put skin in the patient safety game as never before.

Yet I’ve never been more worried about the safety movement than I am …

Physician voices

Media and our kids: Are pediatricians out of touch?

Claire McCarthy, MD

March 11, 2013Mar 11, 2013

Recently I've been wondering if pediatricians are out of touch when it comes to media and kids. Our messaging is pretty straightforward: turn it off. The recommendation of the American Academy of Pediatrics is that children under the age of…

Recently I’ve been wondering if pediatricians are out of touch when it comes to media and kids.

Our messaging is pretty straightforward: turn it off. The recommendation of the American Academy of Pediatrics is that children under the age of 2 should not watch TV at all, and everyone else should watch no more than 2 hours a day. And when we talk …

Physician voices

The condolence letter: A dying tradition among doctors

Ishani Ganguli, MD

March 11, 2013Mar 11, 20138

When a patient dies in the hospital, we go through a checklist that has become eerily mundane. Examine the patient to confirm the death. Notify the family, the senior doctor, the local organ bank, the admitting office, and (in some cases) the medical examiner. Fill out the report of death. Write a death note. Brace yourself against the emotional weight of the event and get on with your work. Nowhere …

Health policy

Primary care trends in the health reform era

Matthew Mintz, MD

March 11, 2013Mar 11, 201325

As a physician who is involved in educating medical students, I am often asked for career advice. Medical students are by nature smart and ask very good questions. "Will I be able to pay of my student loans if I…

As a physician who is involved in educating medical students, I am often asked for career advice. Medical students are by nature smart and ask very good questions. “Will I be able to pay of my student loans if I choose primary care?” “Will I have a balanced lifestyle if I decide to go into primary care?”

I try to be both encouraging and realistic. However, far too often I have …

Health policy

How Obamacare penalizes safety net hospitals

Jeffrey Parks, MD

March 11, 2013Mar 11, 201311

The weakest aspect to Obamacare is in its cost control strategies, or lack thereof. The predicted savings from converting to electronic medical records (EMR) have failed to materialize. And the Rube Goldberg-esque plan to save money by penalizing hospitals and…

HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) is the Press-Ganey …

Physician voices

Let no broken hip go unfixed: When a surgeon fails to communicate

John Schumann, MD

March 10, 2013Mar 10, 201342

She was 94-years old with advanced Alzheimer's. She thought it was 1954 and asked if I wanted tea. Not a bad memory for someone in a hospital bed with a broken left hip. She'd fallen at her assisted living facility.…

She was 94-years old with advanced Alzheimer’s. She thought it was 1954 and asked if I wanted tea. Not a bad memory for someone in a hospital bed with a broken left hip.

She’d fallen at her assisted living facility. It was the second time in as many months. She’d broken her collarbone on the previous occasion.

Over the past year, she’d lost 30 pounds. This is natural in the progression of …

Conditions and diseases

Caring for the emotional needs of a cancer patient

Miranda Fielding, MD

March 10, 2013Mar 10, 20139

Multi-tasking has never been my forte and so I like to keep my schedule organized. Mondays, I see all of my on-treatment patients. Tuesdays and Thursdays I see new patients in consultation. Wednesdays are reserved for treatment planning and research projects. But Fridays—well, Fridays are usually the best day of the week. Not only is the weekend approaching, with time to spend on my menagerie and the ever present home …

Physician voices

Soft drinks and obesity: What do we want from Coca-Cola?

David L. Katz, MD

March 10, 2013Mar 10, 201316

Responding to our justifiably increasing preoccupation with widespread obesity, the Coca-Cola Company has released a masterful television ad on the subject. They characterize their own efforts, and invite us all to “come together” to combat this scourge. The whole “come together” concept receives great emphasis, with evocative images from the (presumably) good old days of: “I’d like to buy the world a …

Real physician voices, twice a week

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