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MKSAP: 38-year-old man is evaluated during a routine health examination

mksap

Conditions and Diseases

November 17, 2012

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

A 38-year-old man is evaluated during a routine health examination. He exercises two or three days each week by jogging for 30 minutes without shortness of breath or chest discomfort. During stressful emotional situations, he occasionally feels “skipped heart beats” but has not had prolonged palpitations, presyncope, or syncope. He generally feels in good …

The long years between the last words and the final breath

Rev. Kathy Speas

Patient

November 16, 2012

Visiting the dementia unit of a nursing home is never easy.

First off, you have to find your patient amid the assemblage of people–mostly women–seated in wheelchairs, recliners, wingbacks, sofas and assorted walkers, or wandering around.

Then, you must make yourself known to the person you’ve found. Here’s where the harder questions arise: How can I introduce myself and convey my role–a hospice chaplain–to someone who has outlasted language? Is my state …

The obstacles patients face in making the right decisions

Davis Liu, MD

Health Policy

November 16, 2012

New York Times columnist Nicholas D. Kristof wrote a heartfelt piece “A Possibly Fatal Mistake” about his college roommate Scott Androes, who recently was diagnosed with metastatic prostate cancer. His story illustrates the problem with the current health care system. It isn’t about the lack of health insurance. It’s about the obstacles all patients face in making the right decisions and the right treatment.

Something that will increasingly be …

Know the risk factors for teen motor vehicle crashes

Claire McCarthy, MD

Physician

November 16, 2012

There was some good news recently about teens and driving: according to the Centers for Disease Control (CDC), the number of teens who report drinking and driving has come down by half in the past decade from two in ten to one in ten.

While that really is good–great–news, it doesn’t change the fact that motor vehicle crashes are the leading cause of death for US teens. In 2010, every day …

On the inpatient psychiatry ward, a new code governs

Shara Yurkiewicz

Medical Education

November 16, 2012

“By the way,” my chief resident told me on the first day of my inpatient psychiatry rotation, “don’t lick your lips in front of him.”

“Wait, what happens if–”

I fell silent as the patient walked into the interview room. The resident wanted to discuss his paranoid delusions; the patient wanted to discuss his discharge.

The patient wasn’t ready to leave because the medications that made the demons stay away were also making his …

Do patients bond best with doctors who misinform them with optimism?

Albert Fuchs, MD

Physician

November 16, 2012

Metastatic (stage IV) colon cancer and lung cancer are fatal incurable illnesses. That doesn’t just mean they are life-threatening. A fatal incurable illness is one which has zero survivors. You don’t know anyone who had metastatic colon or lung cancer who survived and is no longer ill.

Chemotherapy is still occasionally used in such cases and sometimes can prolong life by a few months. Chemotherapy might also help temporarily alleviate some …

Physicians need to be more cost aware

Lauren Demosthenes, MD

Physician

November 15, 2012

I had lunch with my old college roommate last week. She’s a new grandmother and was telling me about her daughter who lives in another state. Her daughter is self pay because she and her husband own a restaurant and have opted out of insurance due to the cost. She received her hospital bill in the mail and she was surprised at the cost of some of the items. As …

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Physicians need to be more cost aware

Apple has introduced me to the uncertainty of being doctored

Rena Xu

Physician

November 15, 2012

On a recent Saturday morning, I took my problems to a bar. The bar was on Boston’s Boylston Street at the end of a row of pubs. Years ago, during orientation week of medical school, my classmates and I had worked our way methodically down that row.

The bar I headed to on this particular day was the Apple Store Genius Bar. The “bouncer,” a man with skinny arms and a …

A new organizational structure is coming in health care

Brian Klepper, PhD

Health Policy

November 15, 2012

At our first meeting years ago, Tom Emerick, Walmart’s then VP of Global Benefits, told me, “No industry can grow continuously at a multiple of general inflation. It will eventually become so expensive that purchasers will simply abandon it.”

He said it casually, as though it was obvious and indisputable.

Health care is playing out this way. From 1999 to 2011, health care premium inflation grew steadily at 4 times the general inflation rate. During …

Improve patient service: Keep your phones open during lunch hour

Neil Baum, MD

Physician

November 15, 2012

I have watched more offices over the past few years close their phones and front desk during the lunch hour. If you close your office for an hour at lunchtime, what message are you sending your patients? You are declaring that serving your patients takes a back seat to serving yourself and your employees. Closing your phone lines at lunchtime means that you are creating missed opportunities for a vital …

Inappropriate care requests: The role of health care professionals

Yul Ejnes, MD

Physician

November 15, 2012

A guest column by the American College of Physicians, exclusive to KevinMD.com.

How to reduce the cost of medical care while improving quality is the focus of several initiatives, including the American College of Physicians’ High Value Care initiative, the ABIM Foundation’s Choosing Wisely campaign, and Consumer Reports’ Consumer Health Choices.

The common message is that we …

Why I decided to opt out of Medicare as a provider

Natasha Deonarain, MD, MBA

Physician

November 15, 2012

There’s a lake in Northern Arizona where I jog. I call it “my” lake. It used to be filled to the brim, a playground for ducks, geese, Monarch butterflies, rabbits, and squirrels. Over the years when I’d jog in the cold mornings, my lake dried away from drought, measured by bathtub rings on the boulders that surrounded it. Today, rust-colored grass …

A Medicare payment system focused on quality

Jeremy Lazarus, MD

Health Policy

November 15, 2012

A guest column by the American Medical Association, exclusive to KevinMD.com.

Every physician caring for Medicare patients knows that the current payment system isn’t working. Most seniors know it too. For much of the last decade, patients and physicians have joined together to tell their elected officials that the system is broken. The response from members of Congress has been to …

Using the F-word when it comes to EHRs

Richard Patterson, MD

Health Technology

November 14, 2012

Not long ago, Secretary of Health and Human Services Sibelius and US Attorney General Holder issued a stern warning to healthcare providers who are using electronic health records (EHRs). The federal officers maintain there has been an alarming increase in the charges to Medicare in institutions where EHRs have been implemented, and they warn that those behaviors will be treated as “fraud,” an illegal gaming of the system to increase …

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Using the F-word when it comes to EHRs

Do annual physicals do more harm than good?

Naomi Freundlich

Health Policy

November 14, 2012

It sounds like heresy, but recent evidence challenges the long-held belief that the annual physical is beneficial for healthy adults. Researchers at the Nordic Cochrane Center in Copenhagen wrote that although a regular check-up with multiple screening tests might seem to offer the advantage of catching problems like heart disease and cancer early, their review of studies involving some 180,000 adults actually found no benefit. People who …

When a medical student sees you, consider it your lucky day

Melissa Arca, MD

Physician

November 14, 2012

Medical students rotate through the clinic I work at. I love it. It brings me back to those days. Sure, it reminds me how old I am, but also reminds me of the incredible impact patients have in directing the course of our career paths.

We all have those memories. Our first delivery. Our first code. The first time we had to …

Can women physicians truly be senior leaders in medicine?

Linda Brodsky, MD

Physician

November 14, 2012

It is nearly impossible to ignore the need for clear thinking, confident and “in control” leaders. And whether in Congress or in a physician’s office, medical school department or hospital administrative suite, women leaders are notably absent. And while recent research tells us that women aspire to be leaders, the barriers to achieving this nebulous goal are enormous.

So whose fault is it anyway? I say both the women and the …

Dad took me to work: The morgue was my favorite spot

Pamela Wible, MD

Physician

November 14, 2012

An excerpt from Pet Goats and Pap Smears.

Both my parents are physicians. They are never home much because they work all the time. With no reliable child care, Dad takes me to work. The morgue is my favorite spot. It’s like our secret clubhouse. Nobody ever bothers us there.

Entering the morgue, Dad opens the stainless-steel doors to the cooler and says, “Good morning! Is anyone home?” Then …

A high volume, efficiency-driven institution that delivers great care

Ashish Jha, MD, MPH

Physician

November 13, 2012

I visited Safdarjung Hospital in New Delhi recently – an institution with 1,531 beds and 145% occupancy rate. Yes, 145%. You do the math. A lot of bed sharing and asking families to bring in cots. It’s right across the street from the All India Institute of Medical Sciences (AIIMS), the premier public healthcare institution in India. While both AIIMS and Safdarjung are run by the federal government, …

What kind of basic healthcare coverage should we offer to prisoners?

Peter Ubel, MD

Physician

November 13, 2012

I expect most of us agree that an incarcerated felon experiencing a heart attack should receive medical treatment, even if that treatment comes at taxpayers’ expense. The same probably goes for more preventive measures—blood pressure pills, cancer screening tests and the like. While serving out the sentence for their crimes, prisoners should not be forced to suffer from treatable and preventable illnesses without receiving appropriate medical care. They can pay …

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