KevinMD.com

January 3, 2013Jan 3, 2013

Prior to heading out West for my postgraduate medical training, I spent four amazing years in Chicago absorbing everything I could about becoming a doctor. Throughout this time in medical school, I was taught everything from the smallest components of atoms to the largest organs of the human body. Academic physicians spent countless hours teaching me the art of bedside patient care and the scientific evidence behind clinical decision-making.

Despite this …

Physician voices

The role of faith in a patient beating long odds

Sid Schwab, MD

January 2, 2013Jan 2, 2013

I first met her when I consulted on her hospitalized son, who'd been in and out several times with transient abdominal pain. He'd already been through various tests and consultations, each time improving before a diagnosis was established. When I…

I first met her when I consulted on her hospitalized son, who’d been in and out several times with transient abdominal pain. He’d already been through various tests and consultations, each time improving before a diagnosis was established. When I was asked to see him he was once again on the mend, but I concluded that he likely had the uncommon …

Physician voices

Are you a thrifty patient? How to get the care you need and save money

Davis Liu, MD

January 2, 2013Jan 2, 20135

It is increasingly becoming the year of the Thrifty Patient. People are paying for more medical care and are more responsible for the costs of getting that care via higher deductibles and co-pays. Patients don’t have a choice but to be involved in their care. Though the recent 2008 recession saw a decrease in overall medical and health care utilization as …

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Physician voices

How to deliver bad news to patients: 9 tips to do it better

Alex Lickerman, MD

January 2, 2013Jan 2, 201311

My heart began pounding as I listened to the sound of the dial tone in my ear. After three rings a woman answered groggily and uncertainly, “H-hello?” “Mrs. Peterson?” I asked. My voice trembled slightly. It was 2 a.m., and…

My heart began pounding as I listened to the sound of the dial tone in my ear. After three rings a woman answered groggily and uncertainly, “H-hello?”

“Mrs. Peterson?” I asked. My voice trembled slightly. It was 2 a.m., and I’d awakened her from what I imagined had been a troubled sleep.

“Yes?”

“This is Dr. Lickerman. I’m calling from the hospital.” I paused. “I’m calling about your husband.”

There was silence. Then a breathless, “Yes?”

“Mrs. Peterson, …

Physician voices

Offer hospice patients a smile

Deep Ramachandran, MD

January 2, 2013Jan 2, 20132

Hospitals are busy places to work. The work is fast paced, and never seems to stop. For most physicians, the work ends when the work is done, or until you fall over, whichever comes first. So as a consultant, when I am seeing a patient wherein there is no longer anything that I am contributing to a patient’s care it’s routine that a physician would “sign off” the case, meaning …

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Offer hospice patients a smile

Patient voices

What patients can learn from public hospital ratings

Trudy Lieberman

January 2, 2013Jan 2, 20133

Recently, I spent some time answering the questions on one of those CAHPS surveys for doctors. CAHPS stands for Consumer Assessment of Healthcare Providers and Systems, and these days hospitals ask patients to use them to review not only their…

Many public hospital ratings use data collected from CAHPS hospital experience surveys, but patients rarely have much access to …

Health policy

What Lincoln can teach us about health reform

Bob Doherty

January 2, 2013Jan 2, 20132

“Passed by corruption, aided and abetted by the purest man in America” is how anti-slavery Congressman Thaddeus Stevens described President Lincoln’s successful effort to enact the 13th amendment, banning slavery. This historically accurate quote, which runs counter to the public image of “Honest Abe” Lincoln, is among the many fascinating stories recounted in the Steven Spielberg’s masterpiece “Lincoln” playing …

Physician voices

Patients have trouble giving true informed consent

Harriet A. Hall, MD

January 1, 2013Jan 1, 20132

Most of us would agree that doctors should not treat patients without their consent, except in special cases like emergency care for an unconscious patient. It’s not enough for doctors to ask “Is it OK with you if I do this?” They should get informed consent from patients who understand the facts, the odds of success, and the risk/benefit ratio of treatments. The ethical principle of autonomy requires that they …

Physician voices

How often should I screen for disease?

Lucy Hornstein, MD

January 1, 2013Jan 1, 20132

Surprise! It turns out that if every woman in the US got a mammogram every year, almost exactly the same number of them would still die of breast cancer. Why? Watch this video. Read this by TBTAM. Bottom line: mammograms don’t find aggressive cancers soon enough (by definition, you can’t), while too many of the cancers they do find were never going to be fatal anyway. This is what “over-diagnosis” …

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How often should I screen for disease?

Physician voices

Don’t devalue physicians to mere employees

Jeffrey Parks, MD

January 1, 2013Jan 1, 20134

A buddy of mine sent along an interesting link by a physician named Ben Brown that makes an argument that doctors actually aren't all that well off. Salaries are down. Education costs can exceed $300,000 over the course of college,…

A buddy of mine sent along an interesting link by a physician named Ben Brown that makes an argument that doctors actually aren’t all that well off. Salaries are down. Education costs can exceed $300,000 over the course of college, medical school, and residency. By the time you take that first job, you’re on the wrong side of 30 and Wells Fargo is demanding $1800 a month for all your student loans. It’s a topic …

Physician voices

P4P: Should physicians be treated as purely economic animals?

Robert Wachter, MD

January 1, 2013Jan 1, 20136

The debate over pay for performance in healthcare gets progressively more interesting, and confusing. And, with Medicare’s recent launch of its value-based purchasing and readmission penalty programs, the debate is no longer theoretical. Just in the past several months, we’ve…

Just in the past several months, we’ve seen studies showing that pay for performance works, and others showing that …

Health technology

Information overload for doctors increases malpractice risk

Wes Fisher, MD

January 1, 2013Jan 1, 20133

I have used the electronic medical record (specifically EPIC) since 2004. I have grown accustomed to its nuances, benefits and quirks. There are parts about it I really like. There are parts of it I’d like to do without but accept that they are necessary evils in our current health care climate. I know that there will always be parts of any modified …

Physician voices

ACS: Finding the truth about mammogram screenings

J. Leonard Lichtenfeld, MD

January 1, 2013Jan 1, 2013

We are on a search for truth, but will we ever find it? That summarizes how I feel after reading an article in the New England Journal of Medicine, which once again raises the question of how much screening mammography…

We are on a search for truth, but will we ever find it? That summarizes how I feel after reading an article in the New England Journal of Medicine, which once again raises the question of how much screening mammography contributes to the progress we have made in reducing deaths from breast cancer in …

KevinMD: The most popular posts of 2012

Admin

December 31, 2012Dec 31, 2012

Want to know the most viewed posts on KevinMD in 2012? Here they are, in order of pageviews. Happy New Year, and thank you all for your engaged readership and discussion during these turbulent health care times. 1. Why one-third…

Want to know the most viewed posts on KevinMD in 2012? Here they are, in order of pageviews.

Happy New Year, and thank you all for your engaged readership and discussion during these turbulent health care times.

1. Why one-third of hospitals will close by 2020. A third of hospitals now in existence in the United States will not cross the 2020 …

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KevinMD: The most popular posts of 2012

Drugs and prescribing

It’s time to rethink the role of antivirals in flu treatment

Kenneth Lin, MD

December 31, 2012Dec 31, 20122

Flu season has begun in the U.S., and in addition to familiarizing themselves with the Advisory Committee on Immunization Practice's vaccination guidelines for the 2012-13 season (offer influenza vaccine to everyone 6 months of age or older), physicians should consider…

Flu season has begun in the U.S., and in addition to familiarizing themselves with the Advisory Committee on Immunization Practice’s vaccination guidelines for the 2012-13 season (offer influenza vaccine to everyone 6 months of age or older), physicians should consider how they plan to diagnose patients with suspected influenza. Despite the availability of multiple antiviral medications for influenza, whom to treat remains a …

Drugs and prescribing

How drugs are promoted isn’t a freedom of speech issue

PalMD

December 31, 2012Dec 31, 201220

I learned of a disturbing decision from the Court of Appeals for the Second Circuit. In an insane ruling, two of judges determined that a drug rep promoting “off-label” uses for a drug was exercising his freedom of speech. Let’s…

Of all the ways pharmaceutical companies …

Physician voices

How to foster generosity at an early age

Wendy Sue Swanson, MD

December 31, 2012Dec 31, 2012

Our 5 year-old keeps forgetting to draw arms on his people at school. The lack of arms has evolved since school started in September and even came up in his parent-teacher conference recently. I found it odd– he always seems to remember that humans have arms when he draws at home. We didn’t mention it to him. And when his brother …

Physician voices

Physicians can be better doctors by being patients

Kevin R. Campbell, MD

December 31, 2012Dec 31, 20125

Physicians are terrible patients. That fact is one of the few absolutes in medicine. I can remember developing an acute appendicitis as a medical student. I remember the fear, the uncertainty and the discomfort. I can remember wanting someone who was in charge to spend a little time in my room explaining things to me. I can remember the embarrassment I felt when a group of 6 student nurses paraded …

Physician voices

I remember you: Rest in peace, my friend

Dr. Hilton Koppe

December 31, 2012Dec 31, 20125

I remember you the day we met. It was five years ago. I was terrified. You seemed relaxed and at peace. I'd been invited to join the Lennox Head Club, in the town where I live and work; this over-thirty-five…

I remember you the day we met. It was five years ago. I was terrified. You seemed relaxed and at peace. I’d been invited to join the Lennox Head Club, in the town where I live and work; this over-thirty-five match was the first game of soccer I’d played in twenty-five years. I was the oldest on the team. You were the youngest. For you it was just the start …

Physician voices

Physician credentialing needs better standardization

Christopher Johnson, MD

December 31, 2012Dec 31, 2012

There is one aspect of our relentlessly rising healthcare costs that seems particularly out of control — administrative costs. An interesting recent editorial in the New England Journal of Medicine provides some sobering details. Every physician confronts daily the burden…

There is one aspect of our relentlessly rising healthcare costs that seems particularly out of control — administrative costs. An interesting recent editorial in the New England Journal of Medicine provides some sobering details.

Every physician confronts daily the burden of dealing with healthcare bureaucrats of various sorts. The average doctor personally spends 43 minutes each day at it, and behind every physician there is an army of coders. …

Real physician voices, twice a week

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