KevinMD.com

March 9, 2013Mar 9, 20138

Somewhere between the 20th century bank ATM and the 25th century Tricorder, lays the EMR that we should have today. Somewhere between the government-designed meaningful use EMR and the holographic doctor in Star Trek, there should be a long stretch of disposable trial-and-error cycles of technology, changing and morphing from good to better to magical. For this to happen, we must release the EMR from its balls and chains.

We must …

Physician voices

The hospital has a circadian rhythm of its own

Laura Webb, RN

March 9, 2013Mar 9, 20137

It wasn’t until I became a nurse that I realized how long a hospital hall could be! And, whether we are walking, rolling, or running down those halls, our steps can seem endless. Oh sure. Current hospital halls may be…

It wasn’t until I became a nurse that I realized how long a hospital hall could be! And, whether we are walking, rolling, or running down those halls, our steps can seem endless.

Oh sure. Current hospital halls may be relatively short, compared to the immense and cavernous wards of days gone by. But hospital halls have an open and hollow resonance of …

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Health policy

Reducing medical errors: What we can learn from the Dreamliner

David B. Nash, MD, MBA

March 9, 2013Mar 9, 201316

If you think that medical errors are a thing of the past, you are mistaken. It has been 14 years since the Institute of Medicine's report "To Err Is Human" shattered the myth that most, if not all, physicians are…

If you think that medical errors are a thing of the past, you are mistaken.

It has been 14 years since the Institute of Medicine’s report “To Err Is Human” shattered the myth that most, if not all, physicians are all-knowing practitioners with flawless skills and infallible judgment.

The story of what happened in the report’s wake was predictable:

Where the healthcare industry failed to

…

Conditions and diseases

MKSAP: 54-year-old woman is evaluated during a routine examination

mksap

March 9, 2013Mar 9, 20132

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 54-year-old woman is evaluated during a routine examination. She is very concerned by her lack of interest in sexual intercourse. The patient feels…

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

A 54-year-old woman is evaluated during a routine examination. She is very concerned by her lack of interest in sexual intercourse. The patient feels like she “just doesn’t want to be touched.” She used to enjoy intercourse and does not know why she feels this way now, but she acknowledges that it is causing …

Medical education

When it comes to medical residents, patients have a choice

Shirie Leng, MD

March 8, 2013Mar 8, 20136

A resident is a person who has an MD, meaning they have completed 4 years of school, but they are not yet qualified to actually do anything. An MD is just a piece of paper saying you did your time…

A resident is a person who has an MD, meaning they have completed 4 years of school, but they are not yet qualified to actually do anything. An MD is just a piece of paper saying you did your time in the lecture hall/lab. Residency is where you learn how to be a doctor. The term “resident” originates from the old days in which newly-minted doctors were actually living at …

Physician voices

When end of life approaches: 2 pathways of care

Jordan Grumet, MD

March 8, 2013Mar 8, 20132

It was the best of times, it was the worst of times, it was the age of wisdom, it was the age of foolishness, it was the epoch of belief, it was the epoch of incredulity. The woman lying on…

It was the best of times, it was the worst of times, it was the age of wisdom, it was the age of foolishness, it was the epoch of belief, it was the epoch of incredulity.

The woman lying on the gurney was motionless. Her chest moved up and down with a timid but halting regularity. The calmness of her face was in sharp contrast to the panicked despair of the …

Drugs and prescribing

Oprah should devote a show to vaccine safety

Jennifer Gunter, MD

March 8, 2013Mar 8, 201361

I am sure Oprah had spectacular ratings for her Lance Armstrong interview and so, in the spirit of truth-telling, I have another mea culpa show for Ms. Winfrey to consider: vaccine safety. Until Jenny McCarthy got major air time the…

I am sure Oprah had spectacular ratings for her Lance Armstrong interview and so, in the spirit of truth-telling, I have another mea culpa show for Ms. Winfrey to consider: vaccine safety.

Until Jenny McCarthy got major air time the link between vaccines and autism was relatively fringe. But with Oprah in September of 2007 McCarthy, and by extension Andrew Wakefield, the erroneous link …

Physician voices

One day of a psychiatrist with a homeless outreach team

Maria Yang, MD

March 8, 2013Mar 8, 20132

A sample agenda as the consulting psychiatrist with a homeless outreach team: 8:17am. Arrive at the office, which is in a tall building that is a short walk from the New York Stock Exchange. Speak with the case managers and…

A sample agenda as the consulting psychiatrist with a homeless outreach team:

8:17am. Arrive at the office, which is in a tall building that is a short walk from the New York Stock Exchange. Speak with the case managers and social workers about who should be seen that day.

8:55am. Walk with a case manager to the ferry terminal meet Paul (note: all patients described here are composites of people I have …

Patient voices

A prayer for the patient

Stephen W. Leslie

March 8, 2013Mar 8, 20136

I was startled awake at 3:40 am by a loudspeaker blaring "Code Blue ... Code Blue." As the hospital's newly hired chaplain intern, I'd been sleeping in the overnight room. Stumbling out of bed and groggily changing out of my…

I was startled awake at 3:40 am by a loudspeaker blaring “Code Blue … Code Blue.”

As the hospital’s newly hired chaplain intern, I’d been sleeping in the overnight room. Stumbling out of bed and groggily changing out of my pajamas, I made sure to put on my hospital badge.

I made my way to the hospital’s “Z” building, where the ICU was located, and took the elevator to the fourth floor. …

Read more…

A prayer for the patient

Physician voices

Cookbook medicine can make doctors clinically lazy

David Mokotoff, MD

March 7, 2013Mar 7, 20137

Juan Gonzales, (not his real name), is a somewhat demented elderly Hispanic male, who I met last week in an intensive care unit. He spoke little English, and I spoke limited Spanish. His devoted family was at the bedside, and fortunately his daughter was able to provide some history. He was admitted with palpitations and dizziness and atrial fibrillation with a rapid response.

His family had just moved him from Miami, …

Physician voices

The fine line between compassion and detachment

Christine A. Garcia, MD, MPH

March 7, 2013Mar 7, 201315

I'm told every doctor has their list of unsolved patient mysteries. Those patients where something terribly awful or something miraculous happens for which you lay awake at night trying to understand. The nature of doctors is to want solve problems…

I’m told every doctor has their list of unsolved patient mysteries. Those patients where something terribly awful or something miraculous happens for which you lay awake at night trying to understand. The nature of doctors is to want solve problems and figure out medical mysteries in sleuth-like Sherlock Holmes fashion. It’s these unsolved mysteries that you remember as they perplex you for days, weeks, possibly years after.

For me, it happened …

Physician voices

The cost of caring for undocumented immigrants is often ignored

Dhruv Khullar

March 7, 2013Mar 7, 201333

By the time I met her, Ms. Jacob had been in the hospital for 202 days, 15 hours, and 38 minutes. 39 minutes. 40 minutes. Starting work on a floor that prided itself on delivering comprehensive, efficient care, I studied…

By the time I met her, Ms. Jacob had been in the hospital for 202 days, 15 hours, and 38 minutes. 39 minutes. 40 minutes.

Starting work on a floor that prided itself on delivering comprehensive, efficient care, I studied the computer monitor describing patient lengths of stay, wondering why this woman had been here 25 times longer than the average patient – …

Physician voices

In defense of basic science: The need for translational research

Ron Cheung, MD, PhD

March 7, 2013Mar 7, 2013

When I first decided to pursue a career as a physician scientist by enrolling in the medical scientist training program, my goals seemed very clear; to bring what I learned at the bench to the bedside. Today, as a junior faculty member in a department of pediatrics who spends most of my time in the lab, this now clichéd phrase continues to echo in my mind. Yet, I am concerned …

Physician voices

You may be surprised at what family physicians do

Aaron George, DO & Dennis Gingrich, MD

March 7, 2013Mar 7, 201310

There are surprising misconceptions about what family physicians actually do in practice. Americans maintain a fond respect for the classic image of the family physician, making house calls with black handbag in tow. They admire the Marcus Welbys of the…

There are surprising misconceptions about what family physicians actually do in practice.

Americans maintain a fond respect for the classic image of the family physician, making house calls with black handbag in tow. They admire the Marcus Welbys of the world. While this classic image is endearing, it should not be confused with the 21st century family doctor. The modern family physician is trained to engage in the adaptable world of health …

Medical education

Is physician shadowing harmful for patients?

Elizabeth Kitsis, MD

March 6, 2013Mar 6, 201342

I was startled to learn, when interviewing medical school applicants, that tagging along with a physician, or “shadowing,” is a common practice among high school and college students these days. Yes, I did say students as young as high schoolers.…

Shadowing provides a way for students to observe at first hand what it is like to be a physician, and helps them decide whether the career will suit them. Medical school …

Health policy

Disclosure and offer: Who protects the patient’s interests?

Gabriel H. Teninbaum & Steve S. Kraman, MD

March 6, 2013Mar 6, 2013

When the Lexington, Kentucky VA Medical Center pioneered the “disclosure and offer” risk management strategy in 1987, it sought to make patients whole without the need to litigate. As part of this process, before meeting with injured patients, VA risk managers contacted the patient and recommended they seek their own legal counsel who they were welcome to bring to the meeting. The VA viewed this as a necessary step for …

Health policy

Medicare patients should care about the way we pay providers

Kavita Patel, MD

March 6, 2013Mar 6, 201315

It can be difficult to keep up with the jargon, countless proposals and complicated policies that surround the debate over Medicare reform. Whether you are discussing premium support, changing the eligibility age or Medicare for All, there is one relatively simple concept that patients should make a point to pay attention to – one that directly impacts them – and is …

Physician voices

Medical journals that accept stories and essays from physicians

Louise Aronson, MD

March 6, 2013Mar 6, 20136

Health and health care are hot topics lately, and not just for journalists and bloggers debating Obamacare. Suddenly – or so it seems; in fact the trend has been building for years – people from all walks of life want…

Within medicine, a majority of journals now have essay, viewpoint, or perspectives sections. Not only are such sections frequently …

Physician voices

When doctors dissociate themselves from the stories of their patients

Raminder Nirula, MD, MPH

March 6, 2013Mar 6, 20134

As trauma surgeons we often have to disassociate ourselves from the stories that surround our patients so that we can focus on their life-threatening injuries. It's also how I personally cope with the devastating injuries to the patient and the…

As trauma surgeons we often have to disassociate ourselves from the stories that surround our patients so that we can focus on their life-threatening injuries. It’s also how I personally cope with the devastating injuries to the patient and the aftermath left for the family. Sometimes, though, I am caught off guard and my defenses aren’t strong enough.

A middle-aged man was brought in one evening after being hit while riding …

Real physician voices, twice a week

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