KevinMD.com

February 18, 2013Feb 18, 20134

Groundhog Day was on Saturday this year, and unlike the furry little beast, what I have to say each year around this time is just as good today as him looking for his shadow on Saturday. What is all this…

Groundhog Day was on Saturday this year, and unlike the furry little beast, what I have to say each year around this time is just as good today as him looking for his shadow on Saturday.

What is all this about, you are probably asking yourself?

It is about an annual update that …

Physician voices

My first year as a locum tenens physician

Janice Boughton, MD

February 18, 2013Feb 18, 201319

Locum tenens (literally "place holder") is professional work done to fill in where help is needed. It is what I have primarily been doing for the last year, and has been an interesting ride. When I decided to leave my…

Locum tenens (literally “place holder”) is professional work done to fill in where help is needed. It is what I have primarily been doing for the last year, and has been an interesting ride.

When I decided to leave my practice related to losing a couple of partners and wanting to update my knowledge base and re-evaluate my career, I decided to do locum tenens work. I had always thought that …

Physician voices

Stopping prescription drug abuse starts with primary care

Julie Craig, MD

February 18, 2013Feb 18, 20134

As with any disease, prevalence of this narcotics abuse is region-specific; an hour north of the office where I practice, Rio Arriba County in New Mexico is home to one of the highest opioid overdose rates in America – up to five times higher than the national average. Our patients routinely lose family to addictions; our clinic has been home to a …

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Physician voices

Is the history and physical examination worth performing anymore?

Gregory W. Rutecki, MD

February 17, 2013Feb 17, 20137

Would it be silly to ask, “Is the history and physical examination worth performing anymore?” especially in this era of high-technology medicine? Does it matter if the diagnosis is made by the bedside in contrast to CT or echocardiography? Someone…

Four hundred and forty-two consecutive patients were admitted from the emergency department to an …

Physician voices

Healthcare businesses need better managers

Donald Tex Bryant

February 17, 2013Feb 17, 20132

Do you read the comic strip “Dilbert” by Scott Adams? I read it most every day. It tells the story of an engineer named Dilbert and the people with whom he works, including notables such as Wally, Alice and the pointy-haired boss. Mr. Adams daily relates amusing situations of the dysfunctional relations at Dilbert’s work site. While the situations are hilarious at times, they reflect the actual work processes at …

Physician voices

Doctors: Keep your medical practice about medicine

Adam Banks

February 17, 2013Feb 17, 20135

There’s certainly a lot of buzz surrounding the word “holistic” in the field of medicine lately. For the purposes of what I am talking about in this article, I assume that all, or at least most, doctors take a holistic approach to medicine. Meaning that they can think across many of the body’s systems, understanding how one condition or component affects the others, and considering each aspect of a patient’s …

Conditions and diseases

MKSAP: 76-year-old woman with dizziness, shortness of breath, and palpitations

mksap

February 17, 2013Feb 17, 2013

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 76-year-old woman is evaluated in the emergency department for dizziness, shortness of breath, and palpitations that began acutely 1 hour ago. She has…

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

A 76-year-old woman is evaluated in the emergency department for dizziness, shortness of breath, and palpitations that began acutely 1 hour ago. She has a history of hypertension and heart failure with preserved ejection fraction. Medications are hydrochlorothiazide, lisinopril, and aspirin.

On physical examination, she is afebrile, blood pressure is 80/60 mm Hg, pulse rate …

Medical education

The deaf medical student: Why technical standards need updating

Josh Butler

February 16, 2013Feb 16, 20134

A technical standard is a formal document establishing requirements in several aspects of medical care which all physicians-in-training candidates must possess. Most medical schools require that all candidates meet these requirements in order to receive their doctor of medicine (MD) degree. Some schools require students to sign that document when applying to a program or as a condition to matriculate into medical school.

I took a closer look at different technical …

Patient voices

Survivors of medical error need crisis intervention

Martha Deed, PhD

February 16, 2013Feb 16, 20139

When health journalist Cheryl Clark wrote about the need for crisis intervention for "second victims" of medical error, defining "second victims" as medical caretakers, she struck a nerve. Recommending crisis intervention for staff, highlights the absence of meaningful help for…

When health journalist Cheryl Clark wrote about the need for crisis intervention for “second victims” of medical error, defining “second victims” as medical caretakers, she struck a nerve. Recommending crisis intervention for staff, highlights the absence of meaningful help for injured patients and their families.

In Clark’s article, a hospital patient safety officer notes that medical error trauma is worse when hospital staff …

Physician voices

The less effectively we communicate, the more likely we are to be sued

Carla J. Rotering, MD

February 16, 2013Feb 16, 20138

As a physician, do you care enough about your patients? It is my belief – and my experience – that physicians care deeply in ways that we demonstrate through our hard work, our commitment, and our willingness to go beyond the ordinary almost every day of our professional lives. What often gets “lost in the soup” of busyness is the communication of that caring in a mindful, purposeful and comfortable …

Medical education

Part of medical education is to learn limitations

Neil Baum, MD

February 16, 2013Feb 16, 2013

There is a strong relationship comparing sports to the military, business, and also to medicine. Young athletes, in their late teens and early 20s, are mostly brawn and use their strength and speed to achieve success early in their professional careers. As the athlete matures in their late 20s and early 30s, the physiologic processes slowly decrease and efficiency and maturity and other cerebral skills emerge.

There are 2 rainbow arcs …

Conditions and diseases

MKSAP: 20-year-old man with a 6-month history of low back pain

mksap

February 16, 2013Feb 16, 2013

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 20-year-old man is evaluated for a 6-month history of low back pain accompanied by prolonged morning stiffness. His symptoms improve over the course…

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

A 20-year-old man is evaluated for a 6-month history of low back pain accompanied by prolonged morning stiffness. His symptoms improve over the course of the day, but he is now unable to play recreational soccer. Rest, physical therapy, and acupuncture have not improved his symptoms. Use of ibuprofen or diclofenac provides only partial …

Health technology

The EMR template: I want to believe

Betsy Nicoletti, MS

February 15, 2013Feb 15, 201319

The X-Files fans will remember the poster that Agent Mulder had on his bulletin board with a picture of a flying saucer and the words, “I want to believe.” That’s how I feel reading EMR notes sometimes. I want to…

I know how this happens. The EMR vendor, the practice implementation team and the doctor have a meeting to develop the “normal” template for a hospital admission …

Read more…

The EMR template: I want to believe

Health technology

How the physician replaced the medical secretary

David Mokotoff, MD

February 15, 2013Feb 15, 201316

I recently sat in a small room, in the bowels of a local hospital, training for the impending implementation of CPOE. For those not familiar with current health care acronyms, this stand for Computerized Physician Order Entry. Nearing the end…

Nearing the end of my medical career, I could not help but admire the timing of this phenomenon. “They’ve finally done it,” I mused silently. They …

Physician voices

Leukemia crept into my home and attacked my wife’s body

Rick Boulay, MD

February 15, 2013Feb 15, 20134

“Look at all those beautiful little white flowers,” I said to my wife. “I don’t remember seeing them there before.” In the neglected ten-by-thirty foot corner of our garden, a crop of white flowers began to emerge toward the end…

“Look at all those beautiful little white flowers,” I said to my wife. “I don’t remember seeing them there before.”

In the neglected ten-by-thirty foot corner of our garden, a crop of white flowers began to emerge toward the end of the summer.

“You never saw them because they are weeds,” my wife said.

“What do you mean … weeds?” I asked. “They are beautiful!”

“Weeds …

Medical education

Questions to ask when selecting medical interns

Brian J. Secemsky, MD

February 15, 2013Feb 15, 2013

Spring season is still many months away, but residency programs are in early heat as selection committees across the country buckle down to nominate the next batch of interns for the upcoming academic year. Spread across these institutions' tables one…

Spread across these institutions’ tables one may find headshots, board scores, recommendations and interviewer comments of top candidates interested in training at their respective programs. Often, faculty members of esteemed medical centers will have only a few …

Physician voices

5 ways to adapt to an evolving healthcare workforce

Linda Brodsky, MD

February 15, 2013Feb 15, 20132

Once upon a time a doctor first attended 3 or 4 years of college, then finished 3 or 4 years of medical school, trudged through 1 to 8 years of residency training to hang out “a shingle,” and finally begin to practice medicine, usually in solo practice. Those days are long gone. Time has expanded—schooling and training are longer.

Breaks are taken between and during this once but no longer traditional …

Physician voices

When doing nothing makes the most sense and is the least risky option

Emily Gibson, MD

February 14, 2013Feb 14, 20138

Even doctors must become patients eventually, and often challenging patients at that. We know enough to be dangerous but not enough to be in charge. We want to question everything but try not to. We can tend to be catastrophic thinkers because that is how we are trained to be, but fear being alarmists. We want our care providers to actually like us, when we know they inwardly cringe knowing …

Health policy

The RUC survives and now our health system is worse off

Brian Klepper, PhD

February 14, 2013Feb 14, 201328

On January 7, 2013, a federal appeals court rejected six Georgia primary care physicians’ (PCPs) challenge to the Centers for Medicare and Medicaid Services’ (CMS) 20-year, sole-source relationship with the secretive, specialist-dominated federal advisory committee that determines the relative value of medical services. The American Medical Association’s (AMA) Relative Value Scale Update Committee (RUC) is, in the court’s view, not subject to …

Real physician voices, twice a week

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