KevinMD.com

November 20, 2012Nov 20, 201219

“This note was produced using medical dictation software. While every effort has been made to insure accuracy, errors may still exist.” Really? What kind of doctor would admit in a medical chart to being too lazy or incompetent to produce…

“This note was produced using [mega-brand] medical dictation software. While every effort has been made to insure accuracy, errors may still exist.”

Really? What kind of doctor would admit in a medical chart to being too lazy or incompetent to produce an accurate record?

A lot of them. Dictations are easy to read if you are willing to confound legibility and accuracy. Dictation software is relatively cheap, and with the continued profusion …

Physician voices

Why there’s still value in the routine physical

John Mandrola, MD

November 20, 2012Nov 20, 20123

Millions of Americans believe in the practice. Government reformers believe in it. Doctors too. Heck, even I, an accused therapeutic nihilist, tracked down a poor soul who agreed to be my primary care doctor. Call it old-fashioned, but I wanted…

Millions of Americans believe in the practice.

Government reformers believe in it.

Doctors too.

Heck, even I, an accused therapeutic nihilist, tracked down a poor soul who agreed to be my primary care doctor. Call it old-fashioned, but I wanted my own doc, and I wanted yearly “checkups.”

No procedure—not even AF ablation–is as good as prevention. Taking your body in for routine checks and scheduled maintenance makes perfect sense. Call such a notion–obvious.

But …

Physician voices

Why are we still failing patients despite open communication?

Linda Brodsky, MD

November 20, 2012Nov 20, 20122

Did you know that urine pregnancy tests are routinely performed on all females before every surgery? No exceptions. The Children’s Hospital in Buffalo tests 9 years and above. Don’t know if a parent or a patient has a right to refuse the test, but I do know that the anesthesiologist will refuse to give anesthesia, except for a life-threatening emergency.

I have never paid much attention to these tests. The nurses …

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Physician voices

The new standard of an exceptional physician

Wes Fisher, MD

November 20, 2012Nov 20, 20122

There are so many changes in medicine these days, but it takes a bit of time away from the keyboard to appreciate them. So glued have I become to looking at computer screens, it's been hard to pull my head…

There are so many changes in medicine these days, but it takes a bit of time away from the keyboard to appreciate them.

So glued have I become to looking at computer screens, it’s been hard to pull my head from them any more. Doctors lives are spent staring at these damn screens now. I wonder how many of my youngest colleagues know how to start an IV, a foley, place a central …

Health policy

Penalizing hospitals for never event infections is ineffective

Skeptical Scalpel, MD

November 20, 2012Nov 20, 20123

I told you so. Three months ago, I blogged about the Medicare (CMS) “never events” list, diagnoses that Medicare will no longer reimburse hospitals for. In Medicare’s eyes, these diagnoses are totally preventable, should never happen and will not be…

I told you so.

Three months ago, I blogged about the Medicare (CMS) “never events” list, diagnoses that Medicare will no longer reimburse hospitals for. In Medicare’s eyes, these diagnoses are totally preventable, should never happen and will not be reimbursed. I pointed out that several were in fact not 100% preventable despite any institution’s best efforts, and the rates of many of these occurrences would not fall to zero.

Now …

Health policy

The futile attempt to provide cheaper care to poor people

Margalit Gur-Arie

November 20, 2012Nov 20, 20124

Wherever health care reformation and transformation is discussed, sooner or later the imperative of patient engagement is sure to materialize. Patients, it seems, are no longer content to be passive spectators while care is administered to them, and instead are demanding to be active participants in their own health care decisions. Gone are the paternalistic days of doctor knows best, replaced by informed and educated patients on an equal footing …

Physician voices

Cancer survivors are truly remarkable people

J. Leonard Lichtenfeld, MD

November 19, 2012Nov 19, 20122

David Sampson, who is a colleague of mine here at the American Cancer Society, recently sent me a blog written by a woman well known in the breast cancer community who days previously had been diagnosed with recurrence of her breast cancer. The blog has captivated me, perhaps more so now that I have been facing some of my own …

Physician voices

Why I hate the SOAP note

Suzanne Koven, MD

November 19, 2012Nov 19, 20125

Medicine, like law, the military, and many other professions, has its own language--a kind of verbal secret handshake by which its members recognize one another and close ranks against outsiders. Sometimes, the use of technical terms, abbreviations, and other forms…

Medicine, like law, the military, and many other professions, has its own language–a kind of verbal secret handshake by which its members recognize one another and close ranks against outsiders.

Sometimes, the use of technical terms, abbreviations, and other forms of jargon can impair patients’ understanding of their medical care. This article discusses the extent to which clinicians overestimate patients’ “health literacy“–with potentially dangerous results.

But sometimes, medical lingo has …

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Why I hate the SOAP note

Conditions and diseases

Where are the tonsils and why would we take them out?

Christopher Johnson, MD

November 19, 2012Nov 19, 2012

There are some important new recommendations both about strep throats in general and about tonsillectomy – taking out the tonsils — as a treatment for recurrent strep throats. Some of us can recall a time when getting your tonsils out…

There are some important new recommendations both about strep throats in general and about tonsillectomy – taking out the tonsils — as a treatment for recurrent strep throats.

Some of us can recall a time when getting your tonsils out was one of the rites of passage of childhood. Usually a related procedure is added — an adenoidectomy, removing the adenoids as well. It’s called a T&A …

Physician voices

In defense of the terrible twos

Heidi Roman, MD

November 19, 2012Nov 19, 2012

People often ask how old my son is when we are out and about. When he proudly says, “Two!”, the most common response is a smile to him ... and a knowing glance to me. This is often accompanied by,…

People often ask how old my son is when we are out and about. When he proudly says, “Two!”, the most common response is a smile to him … and a knowing glance to me. This is often accompanied by, “Oooh, the terrible twos!”

I’m here today to stand in the defense of two-year-olds. Sure, they have their share of tantrums and the transition from infant to preschooler is sometimes a …

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In defense of the terrible twos

Physician voices

Good decision making often depends on good communication

Peter Ubel, MD

November 19, 2012Nov 19, 20122

We live in an age of patient empowerment. Medical students are now routinely taught that the “right choice” often depends on patient preferences—on how an individual patient weighs the pros and cons of her treatment alternatives. That means medical decisions depend, more than ever, on good communication. Physicians need to help patients understand their choices so that they can partner with their patients in discovering the best alternatives, ones personalized …

Health technology

What are the biggest issues with EMR today?

Kevin R. Campbell, MD

November 19, 2012Nov 19, 201212

As medicine moves forward in its most technologically advanced era yet, we continue to struggle with basic concepts such as record keeping. The medical record is vital to the care of the patient. It tells the story of each patient’s journey through the medical system. The idea of centralizing all pertinent medical information is, in theory, a step in the right direction. In utopia, there would be one medical record …

Physician voices

5 steps to establish a partnership for shared diagnosis

Leana Wen, MD

November 18, 2012Nov 18, 2012

In a recent post, you met Catherine, a young woman who came down with a stomach bug but was ushered through numerous blood tests and a CT scan, only to be even more confused than ever. You saw how shared decision-making needs to begin with the process of establishing a partnership for shared diagnosis, because diagnosis is the first and most critical step to your medical care.

Here …

Physician voices

Love: A word that medicine fears

Kirsten Meisinger, MD

November 18, 2012Nov 18, 20127

Mom, what is the one thing you can’t live without?” My six-year-old son asked me out of nowhere one day. Air? Water? It was a more interesting riddle than usual. “Love.” He said proudly, not waiting for me to answer.…

Mom, what is the one thing you can’t live without?” My six-year-old son asked me out of nowhere one day.

Air? Water? It was a more interesting riddle than usual.

“Love.” He said proudly, not waiting for me to answer.

Wow. He’s right. Love. But if it is the one thing you can’t live without, why are we so afraid of it in medicine – a field that sustains life?

Doctors seldom use the word …

Read more…

Love: A word that medicine fears

Physician voices

Care on the continuum far surpasses the episodic approach

Rob Lamberts, MD

November 18, 2012Nov 18, 20122

My change from a traditional practice to direct-care has caused me to challenge some of the basic assumptions of the care I’ve given up to this point. Certainly, the nature of my documentation will radically change with my freedom from…

Perhaps the biggest change in my care comes courtesy of the way I get paid. The traditional way to be paid is for service rendered (either at …

Conditions and diseases

MKSAP: 24-year-old man with aplastic anemia

mksap

November 18, 2012Nov 18, 2012

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 24-year-old man undergoes follow-up evaluation for treatment of aplastic anemia. Two of his siblings are HLA-identical matches. Laboratory studies: Review of the bone…

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

A 24-year-old man undergoes follow-up evaluation for treatment of aplastic anemia. Two of his siblings are HLA-identical matches.

Laboratory studies:

Hemoglobin	8.3 g/dL (83 g/L) (following transfusion of 1 unit of irradiated packed erythrocytes last week)
Leukocyte count	500/µL (0.5 × 10⁹/L) with 23% neutrophils, 3% band forms, and 71% lymphocytes
Platelet count	26,000/µL (26 × 10⁹/L)
Reticulocyte count	0.2%

Review of the bone …

Conditions and diseases

Enjoying ourselves is far harder than it sounds

Alex Lickerman, MD

November 17, 2012Nov 17, 2012

According to Nichiren Buddhism, the reason we’re all here is to enjoy ourselves, to be “happy and at ease.” Though this may sound like a license for lasciviousness and hedonism, in reality it’s far from it: enjoying ourselves, as most of us know from experience, is far harder than it sounds. To develop lives in which we can freely enjoy each moment requires far more work—far more self-development—than many would …

Conditions and diseases

The difference between complications and negligence

Michael Kirsch, MD

November 17, 2012Nov 17, 2012

A patient who was minutes away from his colonoscopy, asked me how many colonoscopies I had performed. Before I could answer, he quickly followed-up asking if any of my patients developed perforation of the colon after the procedure. I satisfied…

I satisfied his initial inquiry when I informed him that I have intruded into at least 20,000 colons in the past 2 decades. With regard to his second and more ‘penetrating’ question, I …

Conditions and diseases

Is it possible to ignore prostate cancer?

James C. Salwitz, MD

November 17, 2012Nov 17, 20123

Is it possible to ignore a cancer? Prostate cancer infests almost 250,000 men in this country each year and will kill 28,000 men in the United States in 2012, over 200,000 around the world. Many lose their lives “too soon”, dying in their 60s or even their 50s. Nonetheless, authorities do not recommend the PSA blood test for routine screening of this disease. How can this make sense? Partly this …

Conditions and diseases

MKSAP: 38-year-old man is evaluated during a routine health examination

mksap

November 17, 2012Nov 17, 2012

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 health examination. He exercises two or three days each week by jogging for 30 minutes without…

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 health examination. He exercises two or three days each week by jogging for 30 minutes without shortness of breath or chest discomfort. During stressful emotional situations, he occasionally feels “skipped heart beats” but has not had prolonged palpitations, presyncope, or syncope. He generally feels in good …

Real physician voices, twice a week

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