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Break the cycle of intimate partner violence

Patient

September 29, 2012

I was curious why Lahey Clinic, a nonprofit group practice outside of Boston, started asking patients, “Are you safe at home?” during intake. Trying to find this out turned into an exploration of the inconsistent state of intimate partner violence screening in the US.

“Are you safe at home?”

The first time I was asked “Are you safe at home?” during patient intake at Lahey Clinic, I was surprised that such a …

I have seen the tragedy of prescription drug abuse

John F. Dombrowski, MD

Medications

September 29, 2012

A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com.

To say prescription drug abuse is one of the biggest drug problems in the United States today is clearly an understatement. The Partnership at Drug-Free America cites every day more than 2,000 kids use a prescription drug to get high for the …

Help your doctor better help you

Linda Brodsky, MD

Physician

September 29, 2012

In my office, every new patient encounter starts the same way. I walk in and say, “Hello.” Then I put down my computer (which I take from room to room), wash my hands (which I purposely point out that I do before I touch anyone or anything else), and then I turn to the family and greet the child first. Depending on the age, I might be squatting and gently …

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Help your doctor better help you

Why I quit internal medicine for physiatry

Fizzy, MD

Physician

September 29, 2012

Some of you may know that I started out in an internal medicine residency and quit for physical medicine and rehabilitation (PM&R). Switching residencies? Not recommended. But entirely doable.

I spent most of my first half of internship being really, really miserable. I remember sitting in the call room during my ICU month, talking to my mother about how badly I wanted to quit and what my options would be if …

Why is there a primary care shortage?

John Schumann, MD

Health Policy

September 28, 2012

Health care reform is a locomotive barreling down America’s tracks. In two years, the Affordable Care Act (ACA) will cover some 30 out of 50 million of us that currently lack health insurance, provided neither the Supreme Court nor a new president overturns the law. Political beliefs aside, it would seem that supplying insurance to protect the health of more people is a societal good. Though the costs of reform …

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Why is there a primary care shortage?

Are insurance companies responsible for increasing health costs?

Stephen C. Schimpff, MD

Health Policy

September 28, 2012

The insurance system for healthcare is perverse. The individual is not the customer of the healthcare company; in most cases it is the employer or the government (i.e., Medicare, Medicaid). They physician works for the insurer who determines for what and for how much the doctor is paid. But are the insurance companies the blame that is often placed on them for our current state of affairs?

This system abrogates the …

Medical residents need to be accountable for their own well-being

Brian J. Secemsky, MD

Medical Education

September 28, 2012

I am three months into my medical residency, and I am getting fat. Not the noticeable change-in-pant-size fat, not yet. But I am most certain that what was once muscle is now just “padding,” and I can no longer solely attribute the words “muffin top” to the anatomy of the snacks that I scrounge to stay alive during the long hours in the hospital.

I am three months into my medical …

Can the AMA be fixed?

George Lundberg, MD

Physician

September 27, 2012

There is nothing more powerful than an idea whose time has come. There is nothing less powerful than an idea whose time has come and gone.

In 1846, and for more than 100 years after that, the American Medical Association as a nationwide organization for all physicians was a powerful idea whose time had come. It worked well for many things and OK for many more.

Then, in the 1970s, 80s, 90s, …

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Can the AMA be fixed?

Health IT: We can fix health care, and we know exactly how to do it

Margalit Gur-Arie

Health Technology

September 27, 2012

High tech people are very enthusiastic people. We are optimistic, confident and creative and if I may be allowed to say so, really, really smart. We start out by saying “Hello World!” not “Hi, I’m Jack or Jane”. We hail the entire Universe and assume it knows who we are, or that it will soon find out, because the sky is not the limit and we are going to change …

Generic drug denied, try a brand name first

Rob Lamberts, MD

Medications

September 27, 2012

I got an unusual request last week. I written a prescription of a generic medication (which has been generic for a couple of years) and the prescription was denied by the insurance carrier. The reason for denial: I had to try a brand-name medication first.

Stop. Read that again. They wouldn’t allow me to give a prescription for the (cheaper) generic drug because I had to try the brand-name medication first. This …

Morning rounds in the SICU

Amanda Xi, MD

Medical Education

September 27, 2012

I open the heavy, wooden door to the unit. On my left are the patient rooms, equipped with minimal privacy; to my right are members of the healthcare team shuffling around. I continue toward my destination, a small room containing a couple desks and computers dedicated to mid-level providers, but cannot help but notice how eerie the unit is. Although there are at least fifty individuals within this space, it …

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Morning rounds in the SICU

Death came in whatever he might be wearing at the time

Greg Smith, MD

Physician

September 26, 2012

He was just a kid.

Fifteen I think, something like that, too young to have experienced too much in life at that point, but old enough to die by his own hand.

His father, only a year and change older than me, had already dealt with some issues of his own. Diabetes, a member of his family on both sides for generations, had already taken its toll on him by the time …

5 things that I want my patients to know

Leana Wen, MD

Physician

September 26, 2012

Today’s healthcare consumer is constantly barraged with conflicting information. Does wine prevent or predispose to cancer? Should I eat certain foods or avoid them? Is this new medication going to hurt me or help me? Many issues are still controversial, but there are some things that have a large amount of evidence behind them.

1. Antibiotics will not help the common cold. Colds are caused by viruses, and antibiotics kill bacteria, which …

Policy experts need to lead by storytelling

Kenneth Lin, MD

Physician

September 26, 2012

Public health leaders must often tell people things that they don’t really want to hear. “Stop smoking.” “Eat a healthier diet.” “Exercise for at least 30 minutes each day.” To motivate people to heed these messages, leaders construct simple narratives to communicate the potential harms of undesired health behaviors and the benefits of desired ones. Who wants to spend their golden years tethered to an oxygen tank for every moment …

Doctors should care about global climate change

George Lundberg, MD

Physician

September 26, 2012

Most humans, even those who are educated, can read and write, and have studied some science, seem to have a hard time comprehending unpleasant future realities, absent personal experience.

Some say that people learn most from their own mistakes. If true, that makes widespread prevention of anticipated calamities very difficult.

And I am not only talking about people who are deeply into religion and superstition, and those who send politicians who proudly …

4 reasons why doctors need to drive health care technology

David Lee Scher, MD

Health Technology

September 25, 2012

The physician’s role is drastically changing. More and more physicians are becoming institutional employees. More patient encounters are performed via non-physician providers. The increasing regulatory demands on physicians are consuming an inordinate amount of their time. Stress and burnout are universal to some degree. Both the financial and emotional rewards of practicing medicine have greatly diminished. They are becoming more quality control officers than healthcare providers. However, physicians will never …

Preserving the doctor-patient encounter in the face of technology

David Mokotoff, MD

Physician

September 25, 2012

I recently was on vacation in Rocky Mountain National Park. Suspended on an overlook of astonishing beauty at 11,000 feet above sea level, I stared out at the tundra and bits of August snow that still clung to the highest peaks. Suddenly my attention was snapped from the massive boulders and landscapes to the ringing of my cell phone. It was a referring doctor asking me about a mutual patient …

How my military experience helped me become a better doctor

Jared Solomon, MD

Physician

September 25, 2012

Not long ago, I read an article titled, “What health care can learn from the military.” As a former member of the US Army, I was intrigued. I learned many things in the military that I use everyday in the clinic. Before that, I employed things I learned to help me get through medical school. My military experience gave me some fantastic skills. None were brought up in …

Why punishing medical mistakes won’t make patients safer

Edmund Kwok, MD

Physician

September 25, 2012

An interesting story came across my desk recently. Apparently, some states in the U.S. have moved towards a punitive model in trying deal with medical errors and adverse outcomes – this particular story describes how Utah will no longer fund healthcare providers and hospitals for dealing with illnesses that resulted from avoidable errors and infections.

On the surface, it kind of makes sense – one should be punished for making a …