KevinMD.com

If I did everything right, I would be having some pretty sweet dreams

Greg Smith, MD

Conditions and Diseases

November 13, 2012

It was a simple enough store front. Unassuming, paint chipping a little but a clean parking lot outside the low one story building. I went in and walked down the rickety ramp, then sat down on a hard-backed wooden chair next to a tired, worn couch with a hideous print and stuffing peeking out of the ripped seams at the front end of both arms. She was in the office …

Does Medicare provide too many choices for seniors?

Trudy Lieberman

Health Policy

November 13, 2012

Seniors need more Medicare choices, or do they? The answer depends, of course, on who’s doing the asking.

Republicans and others advocating a voucher plan for Medicare invoke the choice argument as the rationale for transforming Medicare from social insurance provided by the government to privatized arrangements between individuals and the marketplace. Under a voucher system, the government would give seniors and people who are disabled a fixed amount of money …

The fine line between gaming the system and maximizing documentation

John Schumann, MD

Health Technology

November 12, 2012

Does your doctor use a computer instead of a paper chart?

Chances are that she does. The rate of adoption of electronic medical records (EMRs) over the last three years has been very steep.

The main driver of this is a government subsidy from a part of the 2009 Stimulus Act (called the HITECH Act) that incentivizes doctors and hospitals to make the conversion to electronic record-keeping.

The push has …

In the battle of life, a joy that only the ferocious can comprehend

Edwin Leap, MD

Physician

November 12, 2012

I recently treated two young men, both injured in the same football game. On the way out, one passed the other in the hall, injuries treated and dressed. “See you next game!” they said. They laughed and looked forward to the struggle.

My wife and I have tried to raise our kids that way. To enjoy life, to move through difficulty and injury. They suffer from having a physician father, so …

The EMR is trying to serve too many masters

Christopher Johnson, MD

Health Technology

November 12, 2012

The electronic medical record (EMR) is here to stay. Its adoption was initially slow, but over the past decade those hospitals that do not already have it are making plans for implementing it. On the whole this is a good thing because the EMR has the ability greatly to improve patient care. Physicians, as well as all other caregivers, no longer have to puzzle over too often barely legible handwritten …

Why it’s important to place limits on liability by association

Chris Rangel, MD

Physician

November 12, 2012

In June of 2006 Mary Ann Ambrogio went to see her gastroenterologist Dr. Frank Troncale in Connecticut for a follow up of her history of liver cirrhosis and associated hepatic encephalopathy.

Reportedly following this visit Mrs. Ambrogio was driving home when she passed out and hit a pedestrian John Jarmie causing “severe and permanent” injuries. The injured pedestrian sued Dr. Troncale claiming malpractice under Connecticut law in that the doctor did …

What Instagram and Kodak have to do with health reform

Rob Lamberts, MD

Health Policy

November 12, 2012

I grew up in Rochester, NY. Statistically, this means that I probably had a family member who worked at Eastman Kodak, as the company employed over 62,000 people in Rochester at its peak. I did, in fact, have two: my father and my brother-in-law. My brother and I both worked there during two fun and profitable summers of our college years in the delightful “roll coating” division. It actually paid …

An end of life discussion is one of the most important to do right

Janice Boughton, MD

Physician

November 11, 2012

During an internal medicine residency, newly hatched doctors are responsible for some of the sickest patients in their teaching hospitals. This is because those patients often don’t have private doctors to attend them and are poor and sometimes self abusive, with the complex problems that go with smoking, drug and alcohol abuse and lack of regular medical care. These patients often present with their diseases late in game, when much …

It’s not fair to anyone for me to be working in this condition

Fizzy, MD

Physician

November 11, 2012

I wake up at 4am feeling nauseous.

I’m not that surprised. My girls have been vomiting all weekend. Not just vomiting, epic vomits. Like the kind where they vomit a lot and you think, “Wow.” Then they vomit again. And then a third time. And now it’s on the couch, the carpet, the TV, basically everywhere in a 50 foot radius. And then just when you think this may never end, …

Patient education is often an afterthought

Heidi Roman, MD

Physician

November 11, 2012

I recently took call on the pediatric ward. Our team was caring for a young patient facing a new diagnosis of a chronic illness. In addition to stabilizing her symptoms, coordinating care with her new specialist, and managing her medications, I also see it as our job to make sure she and her family start to understand what is going on and what this diagnosis means for her.

How does this …

MKSAP: 78-year-old man with poor glycemic control

mksap

Conditions and Diseases

November 11, 2012

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

A 78-year-old man is evaluated in the hospital for poor glycemic control before undergoing femoral-popliteal bypass surgery. He has been on the vascular surgery ward for 3 weeks with a nonhealing foot ulcer.

The patient has an extensive history of arteriosclerotic cardiovascular disease, including peripheral vascular disease, and a 20-year history of type 2 diabetes …

Take advantage of the vision of primary care physicians

William Rawlings, MD

Health Policy

November 10, 2012

In the ancient and oft-told story of the blind men and the elephant, several sightless men seek to learn the nature of the great beast, none of them familiar with it prior to the encounter. One, who feels the trunk, describes the elephant as powerful and snake-like. Another who examines one of the mighty legs, opines that the animal is like a great tree. Still another, having first touched a …

2 C-words that explain the rising cost of health

Timothy Johnson, MD, MPH

Health Policy

November 10, 2012

Having established that the U.S. spends twice as much per person on healthcare as the average per person cost in all other developed countries – but with no better overall results – it is time to ask how this happens.

Obviously, there are many factors contributing to this dangerous cost escalation, but in my mind two stand out.

The first is our unrealistic expectations as American healthcare consumers. Here are a bunch …

Make IT vendors your partner for a smooth EMR transition

Rosemarie Nelson

Health Technology

November 10, 2012

Vendors talk about partnering with medical practices all the time – especially in the information technology (IT) world of electronic health records (EHRs) and practice management systems. But, ask any physician about their IT solution and most will express dissatisfaction, unhappiness, or harsh complaints.

The reason? For the most part, medical groups are not trained effectively for integrating IT into their work flow.

Ask EHR vendors about their approach to training and …

MKSAP: 70-year-old malnourished man with dementia

mksap

Conditions and Diseases

November 10, 2012

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

A 70-year-old malnourished man with a 4-year history of Alzheimer dementia is admitted to the intensive care unit from the emergency department for treatment of community-acquired pneumonia and impending respiratory failure. He is inattentive and confused and has a weak productive cough. His only medications are donepezil and memantine.

Temperature was 38.3 °C (101.0 °F), …

Doctors can play a major role to reduce waste

Manoj Jain, MD, MPH

Health Policy

November 9, 2012

Thirty percent of health care spending — amounting to $750 billion a year — is wasted, according to a recent report by the Institute of Medicine.

I know. As a doctor, I am party to this waste, and I think doctors can play a major role in recovering it.

In a private conversation, a cardiologist tells me about his partners — “loose guns” he calls them. “At the hint of chest pain …

Not all cancer survivors have cancer

Don S. Dizon, MD

Physician

November 9, 2012

“You look amazing!” It was the first thing out of my mouth upon seeing Sharon.^* She is a woman in her mid-seventies, and she has recurrent ovarian cancer.

We had met after she was diagnosed with recurrence, only five months after the end of her “curative” treatment. At the time, we talked about her life—how she had been a nurse before …

Read more…

Not all cancer survivors have cancer

I am so glad that you have chosen me to be your guide

Amy Tuteur, MD

Physician

November 9, 2012

Hi! My name is Ima Frawde and I am so glad that you have chosen me to be your guide during your climb of Everest.

The fact that you have chosen me indicates that you are well on your way to mastering the most important skill in climbing the mountain: Trust Everest.

And why shouldn’t you trust Everest? The mountain is totally natural; climbing is totally natural; reduced oxygen concentration at higher …

Selling a cure based on imaginary evidence is immoral

PalMD

Medications

November 9, 2012

In the ongoing battle to gain from our society’s scientific illiteracy, Dr. Oz has nocked another arrow. This time, he as the cure for all fatigue. I hope he’s got this right because this is one of the most common and most difficult problems to treat.

Fatigue is a tough one. Everyone has experienced fatigue at some point, and as a physician, part of my job is to figure …