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How should physicians give bad news to patients?

Physician

July 25, 2012

When I see patients in the office, I try to guess their occupations from their demeanor and mannerisms. Salesmen are the easiest to ID. In general, they are gregarious males with manly handshakes. They laugh loudly and like to tell jokes. Teachers are more reserved and often give their narrative in a logical and chronological order, as would be expected. Another clue that the patient is an educator is that …

Why I would never go to a non-board certified physician

Jennifer Gunter, MD

Physician

July 25, 2012

Full disclosure. I have 4 board certifications and dutifully do all of the required reading, continuing medical education (CME) and recertification exams to maintain my status (I am board certified in OB/GYN in both the US and Canada as well as board certified in pain medicine by both the American Board of Pain Medicine, ABPM, and the American Board of Physical Medicine and Rehabilitation).

I would never go to a non-board …

I love my new EMR, but my staff hates it

Lucy Hornstein, MD

Health Technology

July 24, 2012

I love my new EMR, which I’ve been using for about 18 months now. I love having all my patients’ information at my fingertips in and out of the office. I don’t miss the piles of paper charts all over the place at all! In short, there’s really nothing about it I don’t like.

My staff, on the other hand, hates it.

Now that they’re not jumping up and down all the …

Eliminate the guilt in parenting

Claudia M. Gold, MD

Conditions and Diseases

July 24, 2012

In my behavioral pediatrics practice, it is not uncommon for parents to go to great lengths to put up a good front. They feel terrible shame about moments of out-of-control behavior, and also fear that I will blame them for their child’s troubles. They focus primarily on “what to do” about their child’s difficult behavior. However with time, and the realization that I am interested in understanding, not shaming or …

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Eliminate the guilt in parenting

Reaching the end of PSA screening

Kenneth Lin, MD

Conditions and Diseases

July 24, 2012

In the summer of 2007, then-U.S. Preventive Services Task Force member Russ Harris, MD, MPH approached me about taking on what he suggested would be a fairly quick and straightforward project: summarizing the small amount of medical literature on the benefits and harms of the prostate-specific antigen (PSA) test that is commonly used to screen asymptomatic men for prostate cancer.

Little did I know that this research and its implications would …

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Reaching the end of PSA screening

Sick days: When our children show us the way

Wendy Sue Swanson, MD

Physician

July 24, 2012

I had an unexpected gift this week: a not-so-sick sick day with my 5 year-old. And it really couldn’t have come at a better time.

We’ve never had a sick day like this before and he’s off to Kindergarten in September so the days were running out for preschool stolen-away sick leave.

In the past when he’s been ill he’s been well enough for me to head off to clinic or work …

Workers’ comp: The dark corner of medicine

John Schumann, MD

Physician

July 23, 2012

An article in the New York Times sheds a little light in a dark corner of medicine, the world of workers’ compensation. In particular, it highlights a world of doctors that dispense drugs in their offices, which improves both patient satisfaction and profits.

Though fraudulent insurance claims are always easy headline-grabbers, the real world of workers’ comp is complex and not always so tailor-made for sound bites.

Add to this …

What could bring psychiatry to its knees, or save it

Steve Balt, MD

Physician

July 23, 2012

The practice of medicine has changed enormously in just the last few years. While the upcoming implementation of the Affordable Care Act promises even further—and more dramatic—change, one topic which has received little popular attention is the question of exactly who provides medical services. Throughout medicine, physicians (i.e., those with MD or DO degrees) are being replaced by others, whenever possible, in an attempt to cut costs and improve access …

Let’s not get rid of the annual physical

Juliet K. Mavromatis, MD

Physician

July 23, 2012

Recently a physician reporter for the New York Times, Elisabeth Rosenthal, argued in the cover article of the Sunday Review that routine physicals are in many ways pointless, and perhaps even dangerous.

In the article, entitled “Let’s Not Get Physicals,” Dr. Rosenthal goes on to point out that many routine tests performed during physicals — EKG’s, pap smears and blood work, are unnecessary. In my opinion, Dr. Rosenthal’s front page …

Doctors experience trauma to their hearts and stress to their souls

Edwin Leap, MD

Physician

July 23, 2012

shutterstock_222923164

I was talking to some new friends over lunch recently, at the nationally renowned Hominy Cafe, in Charleston, SC. Any place with a fried green tomato BLT, and shrimp and grits for breakfast, has my vote!

To the point: my question to these esteemed emergency medicine educators was this: “Do you ever have irrational fears about the people you love, because of …

Discrimination against providers and students with hepatitis B

Francis Deng

Conditions and Diseases

July 22, 2012

A silent pattern of discrimination persists today in healthcare institutions in the United States, according to a number of hepatitis B experts and advocates. A number of doctors have been recently dismissed or threatened with dismissal when they were discovered to carry the hepatitis B virus (HBV). Infected medical and dental students have had their acceptances deferred or rescinded altogether. These are nefarious instances of defensive medicine, based on an …

A review of NY Med, and fixing health care’s public image

Roheet Kakaday

Physician

July 22, 2012

The ACA passed and is already in trouble. The Republicans are up in arms, calling the ACA an overreach of a totalitarian governmental regime. The Democrats are defending it, promoting its cost-saving measures as a progressive step forward for America.

To say the rhetoric has heated would be an understatement.

I’m not here to debate politics though. In the run up to the Supreme Court’s ruling on the ACA and the recent aftermath, …

Medical device connectivity in hospitals: One size does not fit all

Michelle Grate, RN, CPHIMS

Health Technology

July 22, 2012

As a project manager working with hospitals on a daily basis, it can sometimes feel like I’m on an episode of “MythBusters.” Consistently, I work with hospital executives, nurses, clinicians and IT staff that have been told “one-size-fits-all” when it comes to various technology implementations. And, in my experience, it typically doesn’t take long before the truth is exposed.

For hospitals entertaining a technology implementation like medical device connectivity, there is …

The role of IVs and central lines in critical care

Mark E. Nunnally

Conditions and Diseases

July 22, 2012

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

As a critical care anesthesiologist, I care for patients when they are most vulnerable. Critical care patients require intravenous (I.V.) fluids and medications, frequently through central venous access. These are catheters inserted into larger veins with a special procedure. I believe managing I.V. lines requires procedural skills, …

How hot-spotting stops bedbugs and other social ills

Mark Wallace, MD, MPH

Physician

July 21, 2012

Too often, bedbugs prevent cost-effective and quality health care – both literally and figuratively.

In the literal sense, consider the case of an elderly woman we’ll call Mary. A frequent visitor to emergency rooms in Northern Colorado, Mary has a long list of medical and behavioral health problems.

Recently, a pilot project implemented by the North Colorado Health Alliance brings together a team of providers representing different walks of the health care …

Pharmacies can charge different prices for their prescription drugs

Arvin Akhavan

Medications

July 21, 2012

Most of the American public doesn’t know that different pharmacies can and do charge drastically different prices for their prescription drugs. Does that surprise you? It sure surprised me when I found this out a few months ago in my medical school class.

I consider myself well educated. I’m a college graduate and in the throes of professional school — in healthcare nonetheless. I have an open mind and I read quite …

How can primary care be a policy leader?

Brian Klepper, PhD

Health Policy

July 21, 2012

The dream of reason did not take power into account – modern medicine is one of those extraordinary works of reason – but medicine is also a world of power.
-Paul Starr, The Social Transformation of American Medicine, 1984

How can primary care’s position be reasserted as a policy leader rather than follower? Even though it is a linchpin discipline within America’s health system and its larger economy – …

MKSAP: 79-year-old man with vertigo

mksap

Conditions and Diseases

July 21, 2012

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

A 79-year-old man is evaluated in the emergency department for vertigo that began suddenly about 1 hour ago, associated with severe nausea and vomiting. He noticed that he could not seem to sit up straight and could not walk without assistance. The patient denies confusion, motor weakness, hearing loss, dysarthria, diplopia, fever, or paresthesias. …

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MKSAP: 79-year-old man with vertigo

Will recommendations from Choosing Wisely ever be followed?

William Sullivan, DO, JD

Physician

July 20, 2012

Choosing Wisely is the new campaign advocated by the ABIM Foundation to help physicians “be better stewards of finite health care resources.” The recommendations in the campaign have been published in Consumer Reports and has been distributed to AARP members.

At first glance, the campaign seems to make sense. Limit unnecessary testing and decrease costs. However, I predict that the Choosing Wisely campaign will also have many less desirable effects. I picked out …

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