KevinMD.com

January 24, 2013Jan 24, 201333

Dear hospitalists, This is just a note to say that we, in emergency medicine, appreciate you. Like all of us, you are stuck in an endless loop of unending residency. Don’t worry, it isn’t an episode of The Twilight Zone.…

Dear hospitalists,

This is just a note to say that we, in emergency medicine, appreciate you. Like all of us, you are stuck in an endless loop of unending residency. Don’t worry, it isn’t an episode of The Twilight Zone. It’s just your life. No, it’s our life!

As specialty after specialty withdraws from the practice of medicine, you, and all of us, …

Health policy

Let’s solve our most pressing healthcare problems first

PalMD

January 24, 2013Jan 24, 20134

“He’s dead, Jim.” So here’s my beef. At the recent Forbes Healthcare Summit there was a lot of focus on speakers and vendors offering very cool new tech, from future “Tricorders” that can diagnose multiple diseases, is non-invasive, and hand-held;…

“He’s dead, Jim.”

So here’s my beef. At the recent Forbes Healthcare Summit there was a lot of focus on speakers and vendors offering very cool new tech, from future “Tricorders” that can diagnose multiple diseases, is non-invasive, and hand-held; personal genomics, where data from your own genome is cheap and easy to get and can be integrated with clinical knowledge to produce better care; targeted therapies for various diseases, …

Physician voices

The best physicians learn from their patients

Peter Elias, MD

January 24, 2013Jan 24, 2013

The best clinicians I have worked typically speak enthusiastically of how much they learn from their patients. Perhaps because it is (happily) not a daily event, or perhaps because it is so much more personal, clinicians do not talk much about what they have learned from being a patient themselves. The other end of the stethoscope is a good place to learn about medical care.

During the diagnostic phase of my …

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Physician voices

Firearms violence is a public health safety issue

Manoj Jain, MD, MPH

January 23, 2013Jan 23, 20136

Two weeks before the Newtown, Conn, shooting I was at my doctor's office for an annual physical exam answering questions on an intake survey. Questions like "Do you smoke? How much?" and " Do you wear the seat beat?" And…

Two weeks before the Newtown, Conn, shooting I was at my doctor’s office for an annual physical exam answering questions on an intake survey. Questions like “Do you smoke? How much?” and ” Do you wear the seat beat?”

And then one question stuck out: “Do you have any firearms in the house? Are they stored in a locked area?” What business …

Health policy

Are hospitals learning from the lawyers?

Skeptical Scalpel, MD

January 23, 2013Jan 23, 20134

The September 2012 issue of the AARP Bulletin has a story about a woman who sued an elder-law attorney for legal malpractice. Bear with me. It’s an interesting tale. In 2004, a man consulted an elder-law attorney to set up…

The September 2012 issue of the AARP Bulletin has a story about a woman who sued an elder-law attorney for legal malpractice. Bear with me. It’s an interesting tale.

In 2004, a man consulted an elder-law attorney to set up a trust that would distribute his assets fairly. He had a daughter from his previous marriage and his wife had five children from her previous marriage. The story is …

Physician voices

The quandary of resident involvement in surgical procedures

Bruce Campbell, MD

January 23, 2013Jan 23, 20138

-Ralph Waldo Emerson We are in the last steps of getting surgery arranged; the counseling is complete and the consent is on the clipboard. Just as the patient is putting pen to paper, she asks, “When I’m asleep, you’re not…

Skill to do comes of doing.
-Ralph Waldo Emerson

We are in the last steps of getting surgery arranged; the counseling is complete and the consent is on the clipboard. Just as the patient is putting pen to paper, she asks, “When I’m asleep, you’re not going to let some trainee practice on me, are you? I mean, I wouldn’t let the brand …

Physician voices

A sexual predator at a daycare: Do your homework when choosing

Claire McCarthy, MD

January 23, 2013Jan 23, 20133

Here in the Boston area, we’ve all been shaken by the news that a known sexual offender raped and molested children for years at a daycare just north of the city—even babies. It’s beyond horrible. For those with a child in daycare, this story is especially terrifying. You can’t help thinking: could this happen to my child?

Ultimately, the sad truth is that we can’t always stop these …

Health technology

Using the iPad Mini in the hospital: One doctor’s experience

Vineet Arora, MD

January 22, 2013Jan 22, 201315

On my birthday several weeks ago, I was lucky to get an iPad Mini from my husband. I already have an iPad and have shared my experience. In fact, we gave all of our residents iPads (one of them contacted Steve Jobs and got a response), and documented an improvement in efficiency on the wards. So why the Mini? What is …

Physician voices

Why your nurse practitioner is your friend

Shirie Leng, MD

January 22, 2013Jan 22, 201352

A recent editorial in the New York Times about non-physician health care providers or NPPs, has drawn more than 260 comments. Who are these NPPs and why do so many people care about them? Historically, nurses have a long history…

A recent editorial in the New York Times about non-physician health care providers or NPPs, has drawn more than 260 comments. Who are these NPPs and why do so many people care about them?

Historically, nurses have a long history of stepping in when there are gaps. For example, in the early 1900s anesthesia was given by med students and interns, and …

Health technology

Do patient portals increase patient engagement?

David Lee Scher, MD

January 22, 2013Jan 22, 201312

Wikipedia defines patient portals as "... healthcare-related online applications that allow patients to interact and communicate with their healthcare providers. Some patient portal applications exist as stand-alone websites and sell their services to healthcare providers. Other portal applications are integrated…

Wikipedia defines patient portals as “… healthcare-related online applications that allow patients to interact and communicate with their healthcare providers. Some patient portal applications exist as stand-alone websites and sell their services to healthcare providers. Other portal applications are integrated into the existing web site of a healthcare provider. Still others are modules added onto an existing electronic medical record system. What all of these services …

Conditions and diseases

We cannot be complacent about drug resistant bacteria

Christopher Johnson, MD

January 22, 2013Jan 22, 20132

This little cartoon, courtesy of xkcd, highlights a problem we have had for some time, but which is getting worse–highly antibiotic-resistant bacteria. Soon after the first antibiotics appeared, especially penicillin, doctors noticed the phenomenon of developing bacterial resistance to them.…

Physician voices

When is making the decision to be DNR appropriate?

James C. Salwitz, MD

January 22, 2013Jan 22, 20134

Here is a little appreciated fact: Patients cannot order medical care; they can only accept or refuse it. Only a doctor can order medical treatment. In an extreme medical situation, the doctor can offer CPR, but it is the patient’s job to accept or reject. Any patient can refuse CPR. This refusal is known as Do Not Resuscitate or DNR, and for obvious reasons needs to be made ahead of …

Physician voices

Don’t make me leave primary care

Lydia Dugdale, MD

January 21, 2013Jan 21, 201321

You need a doctor, and I love what I do. But this work just isn't sustainable. In 2009, I finished medical training and joined a clinical academic practice. For those not in the know, doctors can -- very generally speaking…

You need a doctor, and I love what I do. But this work just isn’t sustainable.

In 2009, I finished medical training and joined a clinical academic practice. For those not in the know, doctors can — very generally speaking — work in one of two domains: in private practice, or on faculty at a medical school where they see patients, teach, and/or do research. Some docs manage to keep a …

Read more…

Don’t make me leave primary care

Physician voices

An excellent primary care doctor is your trusted health care advisor

Davis Liu, MD

January 21, 2013Jan 21, 20133

Assembling the right medical team is important to keeping you healthy and saving money. Besides you, one of the most important people on this team is your regular doctor. For many people, this is their primary care physician (PCP) or primary medical doctor (PMD). A highly trained and well-qualified primary care doctor can advise you on what preventive tests and treatments are truly necessary to stay healthy.

If you view your …

Physician voices

Dealing with psychological stress of being a doctor

Shadowfax, MD

January 21, 2013Jan 21, 20137

Chatting with some med students, a good question was raised: how do we, as doctors, deal with the emotional baggage we encounter in our profession? It's high stress, we see disturbing things, and sometimes we make mistakes that can result…

Chatting with some med students, a good question was raised: how do we, as doctors, deal with the emotional baggage we encounter in our profession? It’s high stress, we see disturbing things, and sometimes we make mistakes that can result in harm to patients. The pressure and responsibility can be very hard to handle.

These stresses, if unmanaged or poorly managed, can …

Physician voices

6 ways to close the gender pay gap in medicine

Linda Brodsky, MD

January 21, 2013Jan 21, 201320

Here are the sad the financial facts. You have heard them before: Women physicians earn $0.62 on the dollar as compared to men (US Census Bureau, 2010). Women physicians start out their careers with a $17,000 pay gap, after all…

Here are the sad the financial facts. You have heard them before:

Women physicians earn $0.62 on the dollar as compared to men (US Census Bureau, 2010).
Women physicians start out their careers with a $17,000 pay gap, after all other factors are accounted for (LoSasso, Health Affairs 2011).
Mid-career women physician researchers are paid $12,000 than their male counterparts (Jagsi, JAMA 2012).

Anyone who discounts that fact that we women physicians are discounted …

Medical education

The strong tradition of mentorship is unique to medicine

Reflex Hammer

January 21, 2013Jan 21, 20132

A friend was working an overnight shift in the ER for one of her mandatory rotations, so I popped in to observe. The ER was surprisingly quiet. A classmate was also observing that night, and like me, he was standing around, bored. We spotted an electrocardiogram (EKG) readout lying on a desk where a resident was working, and we asked him …

Health technology

2 ways technology will improve patient care

Mark Novotny, MD

January 20, 2013Jan 20, 2013

When I completed my internal medicine residency, my fellow trainees knew I was headed for a rural practice in Vermont. Much to my surprise, they gave me a traditional doctor’s black bag – a beautiful leather bag with pockets inside for instruments, tongue depressors, syringes, prescription pads, and all my tools. It was an extraordinarily meaningful gift that acknowledged a launch …

Health policy

Health plans need to take more responsibility for rising costs

Brian Klepper, PhD

January 20, 2013Jan 20, 20133

How many businesses do you know that want to cut their revenue in half? That’s why the healthcare system won’t change the healthcare system. -Rick Scott, Governor of Florida Former CEO, Hospital Corporation of America The Washington Post recently reported…

How many businesses do you know that want to cut their revenue in half? That’s why the healthcare system won’t change the healthcare system.
-Rick Scott, Governor of Florida
Former CEO, Hospital Corporation of America

The Washington Post recently reported that health plan lobbyists, charts at the ready, are working to convince legislators that unreasonable health care costs are everyone else’s fault. Karen Ignagni, the Executive Director of America’s Health Insurance Plans (AHIP) declared: “If you’re …

Physician voices

Hospitals must keep their doors open to all types of sick children

Jay Berry, MD, MPH

January 20, 2013Jan 20, 20133

My first encounter with a children’s hospital was as a first grader in 1980, when my 5-year-old cousin was diagnosed with cancer. Although her family was challenged to afford her cancer treatments, St. Jude Children’s Hospital in Memphis welcomed her and treated her cancer into remission. I remember my parents saying, “Everybody in that hospital loves children. No child is turned away.”

In 1997, walking into the Children’s Hospital of Alabama …

Real physician voices, twice a week

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