KevinMD.com

February 22, 2013Feb 22, 20139

I’ve always had nagging doubts about filling out death certificates. An excellent article in American Medical News explores the “inexactitude” of the custom. Doctors are never taught how to fill out the documents. The article quotes Randy Hanzlick, MD, chief…

I’ve always had nagging doubts about filling out death certificates.

An excellent article in American Medical News explores the “inexactitude” of the custom.

Doctors are never taught how to fill out the documents. The article quotes Randy Hanzlick, MD, chief medical examiner for Fulton County, GA:

Training is a big problem. There are very few medical schools that teach it,” he said. “For many physicians, the first time they see it is when

…

Physician voices

Why physicians tend to decline CPR and other heroic measures

Maria Yang, MD

February 22, 2013Feb 22, 20136

Radiolab recently aired a show called “The Bitter End” that discusses the end-of-life care preferences of physicians and non-physicians. Physicians are much more likely to decline “heroic” measures, such as CPR, mechanical ventilation, feeding tubes, etc. This comes as a surprise to the hosts and, presumably, to other non-physicians. It’s a good show. I recommend it. (Full disclosure: I like Radiolab.)

In the show, Ken Murray argues that …

Physician voices

Why don’t doctors talk about death with their patients?

James C. Salwitz, MD

February 21, 2013Feb 21, 201312

The failure of doctors to talk to their patients about end of life decisions perplexes me. This gap in vital communication results in poor care, uncontrolled pain, futile treatment and death in hospital or nursing home, where no patient wants to be. Certainly, for oncologists, every patient they see is concerned about dying and by not opening the topic it leaves each isolated.

I have generally taught my students that this …

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Medical education

Medical education: Reform the investment of tuition and time

Kevin R. Campbell, MD

February 21, 2013Feb 21, 20132

When I was in medical school in the 1990s, students were given a bleak picture of the life of a subspecialist. We were told that there would be few job opportunities and that the only way to ensure a job was to pursue a career in primary care. Many of my classmates did go into primary care but the majority of us accepted residency positions in surgery, neurosurgery and other …

Social media in medicine

4 reasons parents should enforce the age restriction on social media

Natasha Burgert, MD

February 21, 2013Feb 21, 20135

During a routine office visit, I was discussing activities and extracurriculars with a bright 10-year old girl. She loved talking about her dance team, gymnastics, and her new hobby of horseback riding. Towards the end of our conversation, however, she…

Towards the end of our conversation, however, she said something that surprised me: “And, I am addicted to Pinterest.”

I turned to her mother, who was also in the exam room, and asked, “Did you know she is on Pinterest? …

Patient voices

Can you really choose a hospital based on the best price?

Trudy Lieberman

February 21, 2013Feb 21, 201321

Consumerism in health care is coming to mean patients must shop around for the best price — for a doctor’s visit, Cipro, health insurance and maybe even your next operation. The marketplace gurus are telling us we can buy health…

But can you really choose a place for surgery based on the …

Health policy

The path to data driven public policy: Ask the right questions first

David L. Katz, MD

February 21, 2013Feb 21, 20133

Should marijuana be legal, for either medical or recreational use? I think the best initial answer to this is: It's a crummy question! We are good at those. It's a crummy question, because it calls for answers based on unsubstantiated…

Should marijuana be legal, for either medical or recreational use? I think the best initial answer to this is: It’s a crummy question! We are good at those.

It’s a crummy question, because it calls for answers based on unsubstantiated opinion. Answering it does not invoke or even encourage any relevant evidence, or precedent. So what would a better question be? How about: On what basis should any particular substance be …

Physician voices

Stop blaming patients for not doing enough to stay healthy

Bob Doherty

February 20, 2013Feb 20, 201374

"Discrimination against heavy people, by the general public and medical professionals, might be a greater health and social problem than any extra pounds they may be carrying" argues UCLA Professor Abigal Saguy, PhD, in a provocative essay in the Washington…

“Discrimination against heavy people, by the general public and medical professionals, might be a greater health and social problem than any extra pounds they may be carrying” argues UCLA Professor Abigal Saguy, PhD, in a provocative essay in the Washington Post.

“Despite the fact that body weight is largely determined by an individual’s biology, genetics and social environment, medical providers often blame patients for their weight and blame their …

Physician voices

Downton Abbey: Medicine then and now

Suzanne Koven, MD

February 20, 2013Feb 20, 20138

If you have not yet seen the fourth episode of the third season of Downton Abbey and wish to be surprised by it, read no further. And if you aren't watching PBS's addictive costume drama currently set in 1920--and, seriously,…

If you have not yet seen the fourth episode of the third season of Downton Abbey and wish to be surprised by it, read no further. And if you aren’t watching PBS’s addictive costume drama currently set in 1920–and, seriously, why aren’t you?–read on anyway.

This is about medicine, then vs. now.

First, to recap the medically relevant aspects of the story: Lady …

Read more…

Downton Abbey: Medicine then and now

Physician voices

Make patients more accountable for their own health

Shirie Leng, MD

February 20, 2013Feb 20, 201367

Let’s talk a little about health accountability. Two news items have provoked the following rant: why is it always someone else’s responsibility? The first item was on NPR. The FDA, reacting to the epidemic of prescription drug abuse in this…

Let’s talk a little about health accountability. Two news items have provoked the following rant: why is it always someone else’s responsibility?

The first item was on NPR. The FDA, reacting to the epidemic of prescription drug abuse in this country, is offering incentives to the pharmaceutical company that can come up with a less addictive painkiller. Such a drug would be a gold-mine for that pharma company because it could …

Conditions and diseases

The myth about screening for heart disease

Davis Liu, MD

February 20, 2013Feb 20, 20137

An excerpt from The Thrifty Patient – Vital Insider Tips for Saving Money and Staying Healthy. In the spring of 2008, NBC’s Meet the Press moderator and Washington bureau chief, Tim Russert, died suddenly of a heart attack at the…

An excerpt from The Thrifty Patient – Vital Insider Tips for Saving Money and Staying Healthy.

In the spring of 2008, NBC’s Meet the Press moderator and Washington bureau chief, Tim Russert, died suddenly of a heart attack at the age of fifty-eight. Time magazine identified him as one of the one hundred most influential people in world in 2008. …

Conditions and diseases

The young and healthy can die from influenza complications

Emily Gibson, MD

February 20, 2013Feb 20, 20132

Nothing was helping. Everything had been tried for a week of the most intensive critical care possible. A twenty year old man, completely healthy only two weeks previously, was holding on to life by a mere thread and nothing and…

His battle had been lost against MRSA pneumonia precipitated by a brief influenza-like illness. Despite aggressive hemodynamic, …

Physician voices

Teaching children how to behave: 5 essential principles

Roy Benaroch, MD

February 19, 2013Feb 19, 20132

Young children are naturally petulant, noisy, and self-centered. We’re all born with ourselves in the center of the universe, an impression reinforced by parents who must cater constantly to their young babies. But babies become toddlers, and toddlers become children. Sometime during this transition, parents have to teach their children that they are part of a family. For a family to function …

Conditions and diseases

Anesthesiology and the heart: Working together for the best outcomes

American Society of Anesthesiologists & John R. Rotruck, MD

February 19, 2013Feb 19, 2013

A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com. February is a little more than candy hearts and heart-shaped arrows—February is prominent as American Heart Month, helping doctors and patients better understand cardiac health and how to…

A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com.

February is a little more than candy hearts and heart-shaped arrows—February is prominent as American Heart Month, helping doctors and patients better understand cardiac health and how to best care for one of the most important organs.

Each medical specialist takes great care to focus on heart health and ensure patients receive the highest quality care. Anesthesiologists, for …

Physician voices

What would you do if this was your parent? I honestly don’t know

Miranda Fielding, MD

February 19, 2013Feb 19, 201315

Yesterday I saw a 90-year old woman in consultation. She presented to the emergency room in September with abdominal pain, and in the process of working her up, a chest x-ray was taken which showed an infiltrate in her lingula,…

As it turned out, there was nothing wrong with her belly, but a follow up CT scan of her chest showed this …

Medical education

Academic promotion criteria should include social media

Wes Fisher, MD

February 19, 2013Feb 19, 2013

"Doctor, could we have a copy of your most recent CV." "Sure," I said, realizing it hadn't been updated recently. It is interesting how I approach my academic pursuits now. It used to be that it was "publish or perish"…

“Doctor, could we have a copy of your most recent CV.”

“Sure,” I said, realizing it hadn’t been updated recently.

It is interesting how I approach my academic pursuits now. It used to be that it was “publish or perish” in the world of academic medicine. Of course, even now the only “publishing” that counts to the academic world is that of conventional peer-reviewed journals with high impact factors (or grant applications that …

Health policy

Reform is suffocating private practice by design

Michael Kirsch, MD

February 19, 2013Feb 19, 201310

Cleveland and northeast Ohio are not hospitable to private practice medicine. I should know. I’m one of them. Private practice is fading as health care reform suffocates it by design. When this occurs, the public will have lost physicians who,…

Keep in mind that the first half of my professional career was spent as …

Physician voices

Advice for parents in medical school or residency

MomTFH, DO

February 19, 2013Feb 19, 20132

Being a single mother in medical school and residency isn't a piece of cake. But, being a single parent in this world isn't a piece of cake, either, and being a medical student and / or resident isn't a piece…

Being a single mother in medical school and residency isn’t a piece of cake. But, being a single parent in this world isn’t a piece of cake, either, and being a medical student and / or resident isn’t a piece of cake. Foregoing medical school isn’t necessarily the answer to any of that.

Here is some general advice I will share with parents, single or otherwise, who are facing decisions about …

Social media in medicine

The transformation of healthcare in the information age

Robert Wachter, MD

February 18, 2013Feb 18, 2013

Establishing, Managing, and Protecting Your Online Reputation: A Social Media Guide for Physicians and Medical Practices by Kevin Pho, MD, and Susan Gay (Greenbranch Publishing, 2013). Information technology is transforming the way we teach, learn, communicate, work, play, and think.…

This is the Foreword from Establishing, Managing, and Protecting Your Online Reputation: A Social Media Guide for Physicians and Medical Practices by Kevin Pho, MD, and Susan Gay (Greenbranch Publishing, 2013).

Information technology is transforming the way we teach, learn, communicate, work, play, and think. And there are few areas in which …

Physician voices

Physicians who hasten death should not be called doctors

Jeffrey Parks, MD

February 18, 2013Feb 18, 201339

From the Economist in October 2012 was an article on physician assisted suicide. In the United States, terminally ill patients can apply for permission to end their lives with the guidance of a doctor in Oregon and Washington state. Several…

From the Economist in October 2012 was an article on physician assisted suicide. In the United States, terminally ill patients can apply for permission to end their lives with the guidance of a doctor in Oregon and Washington state. Several safeguards are in place to prevent this from becoming the default death pathway (only 0.2% of total Oregonian deaths). Also, I had no idea that Holland, Switzerland, and Belgium allow assisted suicide …

Real physician voices, twice a week

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