KevinMD.com

January 29, 2013Jan 29, 20133

Those who forget history are doomed to repeat it. Most of us have not had personal experience with illnesses like measles, mumps, German measles, or polio. Thank goodness for that. It is because a generation ago individuals, families, and doctors choose a different path. They witnessed loved ones stricken with these diseases. When the opportunity arose to protect themselves from these …

Drugs and prescribing

Who really won when Accutane was pulled off the market?

Michael Kirsch, MD

January 28, 2013Jan 28, 20133

I was engaged in one of my pleasures, sitting in a coffee shop leafing through medical journals. Usually, I am perusing newspapers. I spend many hours each week combing through various newspapers and routinely forward items of interest to folks of interest. No newspapers today. I have a few gastroenterology journals to look through. My professional reading habits have evolved over my career. I am more interested in reading about …

Physician voices

Taking care of other physicians and their families

James C. Salwitz, MD

January 28, 2013Jan 28, 201310

Terry is a particularly difficult patient. She is not hard because of her cancer, which is in remission, nor is there a problem with pain, of which she has little, and Terry is not particularly demanding for the nursing staff. No there real problem, the challenge, the thing that makes her so difficult is that Terry is married. Terry is married to Dr. P and he is a particularly difficult …

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Conditions and diseases

Why I’m saying goodbye to football

Jeffrey Parks, MD

January 28, 2013Jan 28, 20138

Junior Seau had CTE, chronic traumatic encephalopathy, the degenerative brain disease known to afflict individuals who have sustained repeated head injuries over time. Junior Seau played football his whole life and was never officially diagnosed with a concussion. Last May…

Junior Seau had CTE, chronic traumatic encephalopathy, the degenerative brain disease known to afflict individuals who have sustained repeated head injuries over time.

Junior Seau played football his whole life and was never officially diagnosed with a concussion. Last May he sat down one day and shot himself in the heart. Dave Duerson, the former Bears safety, did this too, as a way to …

Read more…

Why I’m saying goodbye to football

Physician voices

A hospice visit: We will sing together again some day

Rick Boulay, MD

January 28, 2013Jan 28, 20135

I mustered up the courage to visit Mary today. Pulling into her driveway, I was greeted with the majesty of autumnal brilliance—golds, rusts, and crimsons set against a brilliant azure sky. A bold display of nature’s defiance against the upcoming…

I mustered up the courage to visit Mary today.

Pulling into her driveway, I was greeted with the majesty of autumnal brilliance—golds, rusts, and crimsons set against a brilliant azure sky. A bold display of nature’s defiance against the upcoming long winter’s sleep. Not to be ignored, those leaves that had flamed out early chattered against my every step as I slowly ambled toward the doorway.

I took a deep breath and …

Physician voices

The only way to accomplish big things is to do the little things

Rob Lamberts, MD

January 27, 2013Jan 27, 20132

Sorry for not posting for a while. It’s not that things have been quiet; they definitely haven’t been. Here’s the update: The construction has been delayed, so the office will open on the 28th of this month at the earliest.…

Sorry for not posting for a while. It’s not that things have been quiet; they definitely haven’t been.

Here’s the update:

The construction has been delayed, so the office will open on the 28th of this month at the earliest. Inspectors are a pain in the buttocks.
This delay has kept me from hiring staff, as I need to have a solid start date for them.
The extra time has allowed me to do

…

Physician voices

One day of a psychiatrist at a geriatric adult home

Maria Yang, MD

January 27, 2013Jan 27, 201321

A sample agenda as the consulting psychiatrist at a geriatric adult home: 8:20am. Arrive at the concrete building. Wave through the locked glass door at the woman sitting behind the desk. She pushes a button and the door buzzes. Pull…

A sample agenda as the consulting psychiatrist at a geriatric adult home:

8:20am. Arrive at the concrete building. Wave through the locked glass door at the woman sitting behind the desk. She pushes a button and the door buzzes. Pull the door open. Say good morning. She never sounds cheerful when she replies, “Good morning.”

Because there is no open stair access, take the elevator up one floor. It travels slowly. The …

Physician voices

Why should I try to find compassion for Adam Lanza?

Alex Lickerman, MD

January 27, 2013Jan 27, 20135

Like most Americans, when I learned that twenty children and six adults had been massacred in Newtown, Connecticut, I recoiled. Like most parents, my next thought was for my own son, the image I retain of his happy, smiling self for one moment replaced by an image of his tiny body lying twisted on the ground. Even as I write these words, an emotion I rarely feel—one I often can’t …

Drugs and prescribing

MKSAP: 71-year-old man with new dyspnea on exertion

mksap

January 27, 2013Jan 27, 2013

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 71-year-old man is evaluated in the emergency department for new dyspnea on exertion. He has a 15-year history of type 2 diabetes mellitus…

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

A 71-year-old man is evaluated in the emergency department for new dyspnea on exertion. He has a 15-year history of type 2 diabetes mellitus and has had a number of changes in his medications over the past 12 weeks to improve glycemic control. His dosage of metformin has been increased to 1000 mg/d, glyburide …

Physician voices

The closing of a mental health facility in Newtown

Deep Ramachandran, MD

January 26, 2013Jan 26, 20137

I wrote in a previous post about what life was like growing up in Newtown, Connecticut. It truly is a picturesque New England town. But what might be surprising is that within that town sat a gem. A hundred acres of wooded rolling hills within which sat an inner campus of professionally landscaped and meticulously manicured grounds crowned with stately and handsome brick buildings in a colonial architectural style. These …

Physician voices

Patients need to be involved in quality metrics

Kyle Bradford Jones, MD

January 26, 2013Jan 26, 201313

I recently heard from an aging and respected physician the old adage that “what is good for the doctor is good for the patient.” The room full of physicians of all ages and specialties nodded their heads in agreement. This saddened me, as it represents a physician-centric system that oftentimes leaves the patient’s needs and desires completely out of the equation.

An area of emerging importance in medicine, whose impact should …

Health technology

When should physicians hire an IT consultant?

Rosemarie Nelson

January 26, 2013Jan 26, 20132

Should physicians use a consultant to help choose a practice management system or EHR for their practice? According to recent Medical Group Management Association surveys more than 50% of physicians used the services of a healthcare consultant or firm at…

But did they have to? Was it a smart move?

The answer: It depends

Not every practice needs a consultant’s assistance when replacing and choosing …

Conditions and diseases

MKSAP: 38-year-old man with ulcerative colitis

mksap

January 26, 2013Jan 26, 2013

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 examination. He was diagnosed with ulcerative colitis 10 years ago and is currently asymptomatic. His last…

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 examination. He was diagnosed with ulcerative colitis 10 years ago and is currently asymptomatic. His last colonoscopy, performed at the time of diagnosis, showed mildly active extensive colitis extending to the hepatic flexure. There is no family history of colon cancer or colon polyps. His only …

Drugs and prescribing

Why I’m not sure that psychiatric medications work

Steve Balt, MD

January 25, 2013Jan 25, 201333

I have a confession to make. I don’t think what I do each day makes any sense. Perhaps I should explain myself. Six months ago, I started my own private psychiatry practice. I made this decision after working for several…

I have a confession to make. I don’t think what I do each day makes any sense.

Perhaps I should explain myself. Six months ago, I started my own private psychiatry practice. I made this decision after working for several years in various community clinics, county mental health systems, and three academic institutions. I figured that an independent practice would permit me …

Physician voices

The culture of ruling out leads to misdiagnosis

Leana Wen, MD

January 25, 2013Jan 25, 201316

May is a recent divorcee in her early sixties. She was working out at the gym when she began to feel queasy and lightheaded. She awoke in the back of an ambulance, and soon, she was in an ER getting…

As the day went on, May underwent test after test to “rule …

Health policy

How will pay for performance ultimately impact the quality of care?

Thomas Santo, MD

January 25, 2013Jan 25, 20137

“Pay for performance” made headlines again this week, when Health and Hospitals Corporation (HHC), the multi-billion dollar corporation which operates New York City’s public hospitals, announced that they will be linking physician reimbursement to pre-determined “quality” metrics and patient satisfaction…

This announcement comes quickly on the heels of details recently released by the Centers for Medicare and Medicaid Services (CMS) regarding its first Medicare payment adjustment to hospitals under the …

Physician voices

Just: A word that I’ve resented since leaving clinical medicine

Lumi St. Claire, MD

January 25, 2013Jan 25, 201313

Over the past few years, I have realized that I have come to resent the word "just." Certainly not in the civil sense of the word: social justice is the driving force behind virtually all the work I do these…

Over the past few years, I have realized that I have come to resent the word “just.” Certainly not in the civil sense of the word: social justice is the driving force behind virtually all the work I do these days. I am talking about using “just” as a qualifier. As in, “Oh, I’m just the medical student,” or, “He’s just a nurse.” We use it blatantly as an offense …

Medical education

Building residency training from scratch: What would you do?

angienadia, MD

January 25, 2013Jan 25, 201312

Back in the day, legend has it that when space programs were just developed, NASA soon discovered that ball-point pens will not write in zero-gravity. Unfazed, NASA spent a large amount of money developing pens that will work in space,…

It turns out that this legend is only half true, but the lesson remains – sometimes, we get bogged down trying to solve …

Physician voices

Big Joe: Living proof of our fallibility

Sid Schwab, MD

January 24, 2013Jan 24, 20134

When I think of Big Joe, I see his overalls, and how he filled them. And how a couple of months after I operated on him, there was room for both of us in there. Big Joe: farmer, salt of…

When I think of Big Joe, I see his overalls, and how he filled them. And how a couple of months after I operated on him, there was room for both of us in there. Big Joe: farmer, salt of the earth, tough, stoic. On the day I met him, if it’d been Halloween, I might have tried to stick a candle in him. That’s how orange he was. My …

Conditions and diseases

Overdiagnosis: An epidemic or minor concern?

Kenneth Lin, MD

January 24, 2013Jan 24, 201335

An editorial by two oncologists in the New Year's issue of Annals of Internal Medicine discusses overdiagnosis, a controversial health problem that some have called "a modern epidemic" but others, including the editorialists, feel is a minor concern. Although many…

An editorial by two oncologists in the New Year’s issue of Annals of Internal Medicine discusses overdiagnosis, a controversial health problem that some have called “a modern epidemic” but others, including the editorialists, feel is a minor concern. Although many chronic conditions are overdiagnosed, cancer is the most thoroughly studied, as well as the most emotionally charged.

I am a generally healthy man with …

Real physician voices, twice a week

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