KevinMD.com

December 30, 2012Dec 30, 201215

I only met her once; she was young—in her mid-thirties—and she had been diagnosed with ovarian cancer during her pregnancy. Following chemotherapy and the delivery of a healthy baby, she underwent a hysterectomy and staging. She was ultimately diagnosed with…

Unfortunately, it was short lived, …

Physician voices

Common criticisms of concierge medicine that deserve to be answered

Albert Fuchs, MD

December 30, 2012Dec 30, 201225

The idea that patients are better off paying their doctor directly and using their insurance only for unaffordable catastrophes is gaining some traction. With implementation of the Affordable Care Act looming in 2014 many patients are looking at their doctor’s already crowded waiting room and wondering how their care will be impacted when their doctor is responsible for even more patients. And doctors who even now are swamped and frustrated …

Physician voices

Behind the complex decision to opt out of Medicare

Rob Lamberts, MD

December 30, 2012Dec 30, 201212

It seems both ironic and inevitable: I won’t be getting any more “meaningful use” checks. It’s not that I didn’t qualify for the money; I saw plenty of patients on Medicare and met all of the requirements. I was paid for my first year money without much hassle. The problem I am facing is this: I am probably going to be “opting out” of Medicare, and once I do that …

Real physician voices, twice a week

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Physician voices

A doctor for the elderly: What to look for

Steven Reznick, MD

December 30, 2012Dec 30, 20127

My elderly and infirm parents live 15 minutes south of my home in an assisted living facility. They moved there after it became apparent that they could not manage their affairs in their own home, have some degree of independence and socialization with friends and receive the care and supervision they needed to stay out of the hospital. Their cognitive impairment …

Physician voices

A poorly managed end of life experience can transform families

James C. Salwitz, MD

December 30, 2012Dec 30, 20126

A grandfather-father-husband-salesman-cook-gardener-hiker-gentleman, adored by many, is struck down by cancer. His disease is particularly horrible, spreading quickly though his body causing damage not only to bone and organ, but to sinew and nerve. He suffers terrible pain for weeks, relieved poorly with inadequate doses of inferior medications, thrashing in misery witnessed by his kin, always at the bedside, ages seven to seventy. Finally, uncomfortable and agitated until the end, he …

Physician voices

The age differential in medical care

Ishani Ganguli, MD

December 30, 2012Dec 30, 2012

We know that physicians (and their pens/keyboards) are some of the main drivers in health care spending. But which ones are the biggest offenders? A recent study from the nonprofit RAND Corporation asked this question and found that newer doctors…

We know that physicians (and their pens/keyboards) are some of the main drivers in health care spending. But which ones are the biggest offenders?

A recent study from the nonprofit RAND Corporation asked this question and found that newer doctors tend to run up higher health care bills for their patients than their more seasoned colleagues. The study, published in Health Affairs earlier this month, looked at insurance …

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The age differential in medical care

Health policy

Medicare made the rules and now punishes doctors for following them

Shadowfax, MD

December 29, 2012Dec 29, 201258

I wanted to expand on something I wrote recently, which relates to my other sort-of-recent post on upcoding. I wrote, about scribes and compliance: Knowing that the scribe cannot document a complete ROS unless I actually did that ROS, I…

I wanted to expand on something I wrote recently, which relates to my other sort-of-recent post on upcoding. I wrote, about scribes and compliance:

Knowing that the scribe cannot document a complete ROS unless I actually did that ROS, I am more compulsive about making sure I hit all ten systems. (Even when it’s not clinically relevant. Such is the Kafkaesque world we live in.) And I make sure to do

…

Physician voices

Ask your toddler to do the chores

Natasha Burgert, MD

December 29, 2012Dec 29, 20125

If you ask for a spoon in my house, you may expect to be directed towards a drawer of neatly nestled stacks of stainless. Instead, you will likely find this a tangled mess of silver and plastic in no apparent…

If you ask for a spoon in my house, you may expect to be directed towards a drawer of neatly nestled stacks of stainless.

Instead, you will likely find this a tangled mess of silver and plastic in no apparent order.

I used to be bothered by a such a disorganized silverware drawer, but that was years ago. I have let go of …

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Ask your toddler to do the chores

Conditions and diseases

MKSAP: 50-year-old man with Parkinson disease

mksap

December 29, 2012Dec 29, 2012

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 50-year-old man is seen for a new-patient evaluation. He reports a recent diagnosis of Parkinson disease made after a 2-year history of stiffness…

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

A 50-year-old man is seen for a new-patient evaluation. He reports a recent diagnosis of Parkinson disease made after a 2-year history of stiffness in his right arm, a tendency to posture when walking, an awkward and stiffly inverted step when using the right leg, but no tremor. During this period, his voice became …

Medical education

Medical schools don’t care about the primary care shortage

Reflex Hammer

December 28, 2012Dec 28, 201250

I attended a talk by the Dean of Admissions of one of the most competitive medical schools nationwide. The topic was primary care and community health. He talked at length about how not enough medical students were entering primary care. He put up some graphs showing that the most lucrative specialties tend to be the most competitive ones, with primary care among the lowest-paying and least-competitive. He said that medical …

Health technology

My smart phone helps me be a better doctor

Claire McCarthy, MD

December 28, 2012Dec 28, 20122

Your child has a rash and is acting a little sick. You reach for your phone--not to call the doctor, but to look up rashes on Google or your symptom checker app. This, according to the latest report from the…

Your child has a rash and is acting a little sick. You reach for your phone–not to call the doctor, but to look up rashes on Google or your symptom checker app.

This, according to the latest report from the Pew Internet and American Life Project, is the direction we are moving. As a doctor, I think it’s great.

In May of 2011, …

Physician voices

Doctors should return phone calls because it is the right thing to do

Miranda Fielding, MD

December 27, 2012Dec 27, 2012134

My veterinarian answers my phone calls. The other day I called her office to ask for a renewal of the pain medication for my little dog Jack. He has been blind and deaf for over a year, but now his rear end is going and he is falling a lot and having a hard time getting up. When I asked for …

Medical education

4 bad reasons why medical students choose a specialty

Jessica Freedman, MD

December 27, 2012Dec 27, 20124

“I love the hours.” “I want to be just like Dr. Smith. He has a sweet practice.”“I want to make a ton of money.” “I want to make a ton of money.” These are some bad reasons why medical students…

“I love the hours.”

“I want to be just like Dr. Smith. He has a sweet practice.”“I want to make a ton of money.”

“I want to make a ton of money.”

These are some bad reasons why medical students choose a specialty. Most medical students decide what specialty to pursue when they are in their mid to late 20s. While we all think …

Health policy

Does health reform require doctors to stray from their ethical code?

Robert Sewell, MD

December 27, 2012Dec 27, 20126

The difference between a job and a profession is a matter of ownership. Anyone who is applying for employment understands that the job they seek actually belongs to someone else. It is typically offered by an individual or a corporation who defines the job and determines who is qualified to perform it. If the job holder is unable or unwilling to do the work, the owner takes the job back …

Physician voices

A war in the House of Medicine: Can women physicians help?

Linda Brodsky, MD

December 26, 2012Dec 26, 201211

A war is brewing in the House of Medicine. It's a war of philosophy based on how we physicians approach our patients--the people who come to us to be cared for and to be cared about. The people who come…

A war is brewing in the House of Medicine. It’s a war of philosophy based on how we physicians approach our patients–the people who come to us to be cared for and to be cared about. The people who come as patients to the physician as healer, a healer who also has a wealth of scientific knowledge which can be used to stamp out disease and bring long, healthy lives …

Health policy

Fix our health system: Be like Switzerland

Cedric Dark, MD, MPH

December 26, 2012Dec 26, 201242

I was working in the ER this weekend when one of my nurses asked me a simple question: “How would you fix the health care system?” Obviously, this is a complex problem requiring complex solutions, but in an environment where at any minute a heart attack or a stroke could disrupt a conversation I prepared a sound bite for an answer.

“Do …

Physician voices

My advice to a new generation of doctors

Natasha Deonarain, MD, MBA

December 26, 2012Dec 26, 201219

-Nelson Mandela Amidst the chaos of our noisy world, it’s hard to know where to begin a new career as a healthcare professional who’s about to inherit an American disaster called healthcare. And it’s likely that in a few years,…

“There’s no passion to be found playing small, in settling for a life that is less than the one you are capable of living.”
-Nelson Mandela

Amidst the chaos of our noisy world, it’s hard to know where to begin a new career as a healthcare professional who’s about to inherit an American disaster called healthcare. And it’s likely that in a few …

Health policy

Most ACOs are accountable in name only

Brian Klepper, PhD

December 25, 2012Dec 25, 20122

Veteran analyst Vince Kuraitis recently reviewed a report from the consulting firm Oliver Wyman (OW), arguing that the trend toward reconfiguring health systems to deliver more accountable care is more widespread than any of us suspect: The healthcare world has…

The healthcare world has only gotten serious about accountable care organizations in the past two years, but it is already clear that they are well positioned to provide a serious competitive threat to traditional fee-for-service medicine. In

…

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Most ACOs are accountable in name only

Health policy

We have inherited a health system that is broken beyond repair

Zachary Leonard, PA-C

December 25, 2012Dec 25, 201218

I can truly say logging on to the National Commission on Certification of Physician Assistants website and seeing I’ve passed the boards was one of the happiest moments of my life. All of the hours invested learning to take great care of patients was worth that feeling. Like an entire generation of young new MD/DO/PA/NP graduates looking to make a positive …

Patient voices

When patients are socialized into the sick role

Steve Wilkins, MPH

December 25, 2012Dec 25, 20125

Each of us wears many different “hats” throughout the course of the day. We are an employee, a wife, a father, a club member, a consumer and so on. It comes as no surprise that our thinking, what we say, and how we say it at any particular time coincides with the hat we are wearing at that moment. The thing about these “hats” or roles is that they come …

Real physician voices, twice a week

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