KevinMD.com

February 10, 2013Feb 10, 20132

Throughout the course of my career I have probably been with hundreds of people as they transitioned into and out of death. Although I am familiar with what this journey looks like, I have not yet been privy to the journey myself. Rarely though, I have had the pleasure of listening to someone who has journeyed back from death and arrived with a story to tell. Regardless of your position …

Health technology

A virtual office visit for your cold is not a good idea

Kevin Pho, MD

February 10, 2013Feb 10, 20132

USA Today. Like many other primary care doctors across the country, I’m seeing my fair share of patients with runny noses during this winter season. I recently saw a patient for a sinus infection whom asked, “Why did I have…

A version of this column was published on January 13, 2013 in USA Today.

Like many other primary care doctors across the country, I’m seeing my fair share of patients with runny noses during this winter season.

I recently saw a patient for a sinus infection whom asked, “Why did I have to come in to see you? Couldn’t you have given me an …

Conditions and diseases

Evidence based medicine: Go beyond the headlines and dig into the data

Marc Cohen, MD

February 10, 2013Feb 10, 20135

Labor Day weekend, a young man in his early 50s came into our hospital. He had multi-vessel coronary artery disease. I sent him in for surgery. Every one of his vessels was blocked. The surgeon came to me and said…

Labor Day weekend, a young man in his early 50s came into our hospital.

He had multi-vessel coronary artery disease. I sent him in for surgery. Every one of his vessels was blocked. The surgeon came to me and said he couldn’t find enough veins to bypass all the occlusions.

There was an artery in the back of the heart, and he didn’t have any veins left to work with. Let’s sit …

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Conditions and diseases

Idiopathic neuropathy: 2 steps providers can take

Shanna K. Patterson, MD

February 10, 2013Feb 10, 20139

It is estimated that over 20 million Americans have neuropathy. Many people don’t know that prior to the advent of the obesity pandemic and the associated rising rates of diabetes, leprosy was the most common cause of neuropathy worldwide. Although it is now widely recognized that diabetes is the most common cause of neuropathy, for up to 30% of patients the cause of their neuropathy remains unknown. These cases are …

Health policy

Should we expect patients to think about costs?

Skeptical Scalpel, MD

February 9, 2013Feb 9, 201317

Not long ago, I blogged about a plastic surgeon who aggressively pursues patients who refuse to pay her bills. The state is suing her to make her stop and also considering lifting her medical license. The central theme is that she makes patients who she sees in the ED to sign a form stating that they will pay her. It is unlikely that the patients are aware of …

Health policy

How pushing the Triple Aim ignores doctors and their patients

Margalit Gur-Arie

February 9, 2013Feb 9, 20137

Better Care for Individuals, Better Health for Populations, and Lower Per Capita Costs -ihi.org If you stop to think about the holy grail of health care reform, also known as the Triple Aim, it sounds like a grand challenge involving…

Better Care for Individuals, Better Health for Populations, and Lower Per Capita Costs
–ihi.org

If you stop to think about the holy grail of health care reform, also known as the Triple Aim, it sounds like a grand challenge involving wizardry or wishful thinking or worse, propaganda for the masses, particularly the last part. It’s like attempting to build a better driving machine, with better fuel efficiency at lower cost. …

Health technology

Doctors lack an analytic engine: Why we need EMR 3.0

David B. Nash, MD, MBA

February 9, 2013Feb 9, 20138

Health information technology (HIT) has had a tremendous – and mostly positive -- impact on our systems for recording, delivering, monitoring, and reporting the healthcare and services we deliver. Like most of my colleagues, I can tick off at least…

Health information technology (HIT) has had a tremendous – and mostly positive — impact on our systems for recording, delivering, monitoring, and reporting the healthcare and services we deliver.

Like most of my colleagues, I can tick off at least five or six large “pioneer” corporations – companies like Epic, Cerner, Allscripts, Siemens – in the forefront of the technology explosion that yielded …

Drugs and prescribing

Why I hold off on antibiotics for my cough

Edward Pullen, MD

February 9, 2013Feb 9, 20135

For as long as I can remember I have tended to develop a bad cough nearly every time I get sick in the cold and flu season. I’m not sure if I have a minor tendency to bronchospasm or if…

For as long as I can remember I have tended to develop a bad cough nearly every time I get sick in the cold and flu season. I’m not sure if I have a minor tendency to bronchospasm or if my years of passive smoke exposure as a child somehow damaged my lungs. Who knows, but I seem to have the tendency for every URI become a lingering bronchitic cough.

In …

Physician voices

I didn’t become a doctor to bankrupt my patients

Jordan Grumet, MD

February 8, 2013Feb 8, 201316

I have come to terms with making difficult decisions. I accept the possibility of committing a mistake that will cost a life. But I never signed on to bankrupting my patients. Never! I had been up all night tossing and…

I have come to terms with making difficult decisions. I accept the possibility of committing a mistake that will cost a life. But I never signed on to bankrupting my patients. Never!

I had been up all night tossing and turning. The stat CT scan was deemed unnecessary by the insurance company. My patient called crying saying he couldn’t afford the thousands of dollars in charges. Never …

Physician voices

When should a physician obtain a palliative care consult?

James C. Salwitz, MD

February 8, 2013Feb 8, 20133

I had a most surprising visit with a patient last week; she came to say goodbye, because she was dying. The surprise was that while she does have a terminal illness, she is not actively dying; I would put her prognosis at four to eight months. She was bidding me adieu, because I had referred her to hospice.

There is confusion about the role of the primary doctor, when a patient …

Physician voices

When patients feel trapped by doctors and the medical system

Leana Wen, MD

February 8, 2013Feb 8, 201311

An excerpt from When Doctors Don't Listen: How to Avoid Misdiagnoses and Unnecessary Tests. Danielle is a 20-year old college student at the New England Conservatory. She came to the ER because of a headache. When she woke up this…

An excerpt from When Doctors Don’t Listen: How to Avoid Misdiagnoses and Unnecessary Tests.

Danielle is a 20-year old college student at the New England Conservatory. She came to the ER because of a headache. When she woke up this morning, her head hurt badly. Her mouth was dry, and when she tried to get up to go to the bathroom, she felt like she was getting faint.

She attributed all …

Medical education

Why we should nurture creativity in medical residents

Vineet Arora, MD

February 8, 2013Feb 8, 2013

I recently had the opportunity to read Daniel Pink’s Drive. I read it partly to understand why pay-for-performance often fails to accomplish its goals for complex tasks, such as patient care. However, the thing I found most interesting about this…

I recently had the opportunity to read Daniel Pink’s Drive. I read it partly to understand why pay-for-performance often fails to accomplish its goals for complex tasks, such as patient care. However, the thing I found most interesting about this book was the way in which creativity is deliberately inspired and cultivated by industry.

I could not help but think about why we don’t deliberately nurture creativity in medical trainees. Why …

Physician voices

Let doctors know if you’re using alternative medicine

Claire McCarthy, MD

February 8, 2013Feb 8, 201326

Lots of people are using complementary and alternative medicine (CAM) these days—things like vitamins, homeopathic or herbal medicine, chiropractors, acupuncture or massage therapy. But they don’t always tell their doctors about it. In a study in the journal Pediatrics, researchers…

In a study in the journal Pediatrics, researchers in Canada found that among kids with chronic health problems, 64.5 percent of them were using some form of CAM—but more than a third didn’t tell their …

Health technology

Dr. Google: Tips for patients who diagnose online

Wendy Sue Swanson, MD

February 7, 2013Feb 7, 201311

For practicing physicians, there’s a tricky balance in believing that the Internet can help save lives. I’m a doctor who encourages families to look up health info online and one who believes technology will afford improved partnerships. Yet, when we’re…

For practicing physicians, there’s a tricky balance in believing that the Internet can help save lives.

I’m a doctor who encourages families to look up health info online and one who believes technology will afford improved partnerships. Yet, when we’re in the old-fashioned exam room, there isn’t always a place for the Internet. Many clinics block video-streaming sites and don’t allow for traditional email …

Physician voices

Will Mayor Bloomberg win the war on prescription drug abuse?

Shadowfax, MD

February 7, 2013Feb 7, 20132

Recently, there was a bit of hue and cry regarding Mayor Bloomberg's report on the matter of prescription drug abuse and restrictions on new prescriptions for painkillers through the emergency department. Initially, I was concerned. I completely agree with the…

Recently, there was a bit of hue and cry regarding Mayor Bloomberg’s report on the matter of prescription drug abuse and restrictions on new prescriptions for painkillers through the emergency department.

Initially, I was concerned. I completely agree with the comment from the linked article: “Here is my problem with legislative medicine,” said Dr. Alex Rosenau, president-elect of the American College of Emergency Physicians … “It prevents me …

Health policy

The nursing shortage: Why it isn’t a good time to become a nurse

David Williams

February 7, 2013Feb 7, 201338

For years we’ve read that the US faces a looming shortage of nurses. Shortfalls in the hundreds of thousands of nurses are routinely predicted. These predictions have been good for nursing schools, which have used the promise of ample employment…

Yet somehow 43 percent of newly-licensed RNs can’t find jobs within …

Conditions and diseases

How to know whether your cough is serious

Suzanne Koven, MD

February 7, 2013Feb 7, 2013

I saw 17 patients in my primary care practice yesterday. Six of them were coughing. One of the most basic parts of my job is sorting out who's a little sick from who's very sick, or in danger of getting…

I saw 17 patients in my primary care practice yesterday. Six of them were coughing.

One of the most basic parts of my job is sorting out who’s a little sick from who’s very sick, or in danger of getting very sick. How do I do that when so many people have the same symptom? And, as a patient, how do you …

Physician voices

I wonder what Lance Armstrong tells his kids

Jennifer Gunter, MD

February 7, 2013Feb 7, 2013

My membranes ruptured at 22 weeks during my pregnancy. It was the evening of July 5th, 2003. Two days later my first son was born and died. The task before me was bed rest and squeeze as many more days (hopefully weeks) out of the pregnancy as possible to save my other two sons. It was, to put it mildly, a very low time.

To pass the hours I read, slept, …

Physician voices

The days of the primary care gatekeeper are coming to an end

Jeffrey Parks, MD

February 6, 2013Feb 6, 201359

The American Journal of Surgery had a nice little (38 patient cohort) study from the VA database that tried to determine the process by which patients make informed decisions on elective surgery. The results were rather surprising, at first glance.…

The American Journal of Surgery had a nice little (38 patient cohort) study from the VA database that tried to determine the process by which patients make informed decisions on elective surgery. The results were rather surprising, at first glance.

Sixty-nine percent of patients decided to have surgery before meeting their surgeon, and 47% stated that the surgeon did not influence their decision. Although the surgeon was an important source of

…

Drugs and prescribing

Answers to common vaccine questions from patients

Davis Liu, MD

February 6, 2013Feb 6, 20132

One of the true joys of being a primary care doctor is partnering and educating patients to make the best decision for themselves and their families. Though they may not always agree with what I have to say, at least I know I’ve done my best to give them the information they need to be informed. What follows are common conversations I …

Real physician voices, twice a week

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