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Patients and doctors remain connected, even though distance

Physician

July 3, 2012

“Everything must change, nothing stays the same. Everyone will change, no one stays the same.”

Technology is amazing. I love to download random songs on my iPhone and listen to the songs that populate. On one bright early morning, Oleta Adams came on. The song was “Everything must change.” It’s a beautiful and haunting, somewhat sad but at the same time hopeful, song. It stirred up memories, and I found myself …

Customer service has limits in the exam room

Julie Craig, MD

Physician

July 3, 2012

Health reform includes measures to link hospital reimbursement to patient satisfaction measures. Through both public and private insurers, this trend is likely to spill over into the outpatient setting in the very near future.

Aside from creating redundancy in the market (with some very rural exceptions, patients can act as agents of their own satisfaction by voting with their feet), there are serious limits to physicians as agents of pure …

Doctors see little of the money patients pay towards health insurance

Juliet K. Mavromatis, MD

Physician

July 3, 2012

I was recently struck by two conversations that I had with acquaintances about recent experiences that they had had with their primary care physicians. The first occurred at my local pool. A fellow swimmer asked me if I took new Medicare patients. She bemoaned that she was abandoned — her beloved physician of over 20 years had sent out a letter announcing that she would no longer accept Medicare patients. My …

You have to get comfortable with being uncomfortable to disrupt health

Chris Gibbons, MD, MPH

Health Technology

July 2, 2012

Fitness maven Jeanette Jenkins recently tweeted that “to see big results you have to get comfortable with being uncomfortable.”

In other words, making change happen, inevitably leads to emotional or physical discomfort. If you are serious about change you must be willing to endure a lot of discomfort. While this is no doubt true, I would take things one or maybe two steps further and say, “Disruptive change will only happen …

The moments that define the job of a physician

Allison Overmon

Medical Education

July 2, 2012

One of the most intense moments of my third-year of medical school was during my internal medicine clerkship when a code blue was called.

It was our responsibility as medical students on the inpatient service to report to every code blue while we were on our calls every 4th night. This time was no different, and my call partner and I ran to the code. When we arrived, I recognized the …

How copy and paste in electronic medical records affects patient care

Elizabeth Hipp

Health Technology

July 1, 2012

With many hospitals and medical providers still in the early adoption stages of EHR, objections or problems with the various systems are still just coming to light. However, one particularly growing concern is providers using the copy-paste or copy-forward function in patient records. This is a shortcut that many physicians have found to be handy after the implementation of the new system, however using it actually can violate patient confidentiality …

5 questions to change your end-of-life path

Monica Williams-Murphy, MD

Physician

July 1, 2012

I had just put him on a ventilator. Mr. Barnes (not his real name) had come in by ambulance sweating, barely responsive, gasping for air. The paramedics said he was from the local rehabilitation hospital and had just been sent there 2 weeks ago after a protracted hospitalization for a stroke which had left him partially paralyzed. Then they showed me medical orders indicating that he was “full code,” medical …

Why reducing readmission rates is so difficult

Winslow W. Murdoch, MD

Physician

June 30, 2012

Local hospital readmission data mirror national data in that twenty percent of hospitalized patients are readmitted within 12 days of discharge, and 30% within 30 days. Hospital reimbursement has changed to global, not fee for service payment. Hospitals and physicians need to create effective ways to prevent readmission. Readmissions also portend poorer outcomes. Therefore, it is our task as the physician community, to work collaboratively in this process.

Currently, most patients …

Obstetric anesthesiologists not only relieve pain, they save lives

Craig M. Palmer, MD

Physician

June 30, 2012

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

As an obstetric anesthesiologist, it is my responsibility to make sure expectant mothers are comfortable during labor and delivery. It is important women understand their pain management options during childbirth by having discussions with their anesthesiologist and obstetrician. However, as an obstetric anesthesiologist, my role often extends …

The decision to prescribe testosterone replacement therapy or not

Edward Pullen, MD

Medications

June 29, 2012

It seems like every day in the office I see at least one man concerned about testosterone deficiency. If you look at the symptoms of testosterone deficiency most of us have one or more of these symptoms at least some of the time. Fatigue, depression, weight gain, lack of energy, reduced sex drive, loss of physical strength, and moodiness are all described as symptoms typical of testosterone deficiency. Making the …

Sometimes both physicians and patients learn the hard way

Emily Gibson, MD

Physician

June 29, 2012

“There are three kinds of men. The ones that learn by reading. The few who learn by observation. The rest of them have to pee on the electric fence for themselves.”
– Will Rogers

Learning is a universal human experience from the moment we take our first breath. It is never finished until the last breath is given up. With a lifetime of learning, eventually we should get it right.

But we don’t. …

Is not seeing patients the answer for many doctors?

Karen S. Sibert, MD

Physician

June 29, 2012

We’ve come to a sorry pass in American medicine when physicians are willing to spend a lot of money to attend conferences—not to learn how to become better physicians, but to find a way out of the pit of clinical practice.

Few of us have the charisma (or chutzpah) to make a living in medical show business, like Sanjay Gupta or Mehmet Oz. But apparently any physician today can be clever …

How to intelligently prevent opioid abuse

George Lundberg, MD and Maria A. Sullivan, MD, PhD

Medications

June 29, 2012

Acute and chronic pain is bad. Proper pain management is essential and has been strongly emphasized by the American medical establishment for the past nearly two decades.

Simultaneously, during these years, both the quantity of opioids prescribed by physicians and dentists has increased dramatically and prescription opioid abuse has escalated at an alarming rate among chronic pain patients and the general population. Opioid analgesics now result in Read more…

How to intelligently prevent opioid abuse

The problem of expert witnesses in medical malpractice trials

Jim deMaine, MD

Physician

June 28, 2012

I went to court recently sitting quietly in the gallery listening to the testimony of two designated experts who criticized the care of a cardiologist (admired in local medical circles for his brilliance and excellent care of patients). The case on first glance didn’t look very good for this defendant. The patient had presented to the ER with atypical chest pain, was admitted and evaluated with an exercise test and …

Doctors and patients are both losing in our health system

W. Ryan Neuhofel, DO, MPH

Health Policy

June 28, 2012

Early in my medical training I envisioned myself as an old-fashioned family doctor. Marcus Welby, MD was well before my time, but he seemed like a good fictional role model for a naive student-doctor. (Especially considering Dr. Cox of Scrubs was my alternate choice.) After finishing my primary classroom studies, I was eager to leave the stacks of paper behind and to learn from real clinicians caring for real people. After donning my short white coat …

The Supreme Court on health reform: Everybody wins!

Kevin Pho, MD

KevinMD

June 28, 2012

The Supreme Court upheld the Affordable Care Act.

I’ll leave the detailed legal analysis to other commentators that you’ll no doubt find elsewhere.

Although some may not feel this way, this is an outcome everybody should be happy with.

Most important, patients should be happy. As I wrote in the New York Times Room for Debate recently, the ACA has already …

Don’t accept the face value price of a drug

Marni Nicholas, MD

Medications

June 28, 2012

Everybody knows that some medications can cost a lot of money. I always try to take the cost to my patients into account when prescribing a medication- after all, if someone can’t afford it, they are not going to take it. When it’s appropriate (and 9 times out of 10 it is), I try to prescribe a generic medication. They are much cheaper and work just as well as the …

A Supreme Court split decision will cause health confusion

Emily P. Walker

News

June 27, 2012

Utter confusion could result if the Supreme Court invalidates the Affordable Care Act’s (ACA) individual mandate while upholding other parts of the law, a physician expert predicted ahead of Thursday’s expected decision.

And a split decision is, indeed, likely, said Randy Wexler MD, MPH, of Ohio State University in Columbus.

That will create chaos, he said, which is something other …

Why I am a surgeon

David Gelber, MD

Physician

June 27, 2012

An excerpt from Behind the Mask.

Why do you do it?

Do what? Get up in the middle of the night? Rush in to the hospital to patch mangled bodies, sew holes closed, stick my finger in a dike spewing blood and, hopefully, repair what’s broken and allow some unfortunate soul to live and love another day? A good question. I could have been a pediatrician, almost became one as a matter of …

Read more…

Why I am a surgeon

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