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Will health reform survive the Supreme Court?

Health Policy

June 21, 2012

The Supreme Court’s imminent decision on the Affordable Care Act will trigger a political firestorm whether they accept the legislation in its entirety, throw out every page of the 906-page bill or do something in between, which is the most likely outcome.

If the high court follows the polls, it probably will rule the requirement that individuals purchase insurance – the mandate – is unconstitutional but leave the rest of “Obamacare” …

Is rationing necessary to reduce health care costs?

Stephen C. Schimpff, MD

Health Policy

June 21, 2012

Healthcare costs keep rising. Your insurance premiums go up, your deductible and co-pays go up, pharmacy benefits go down. Despite the high cost you get little time with your physician, insurance statements are complex beyond belief and “customer service” seems to be a foreign concept. To combat high costs we are often told that rationing will be necessary. Is that true?

Why are costs so high in this very dysfunctional healthcare …

How families cope with the surgical waiting room

Kevin R. Campbell, MD

Physician

June 20, 2012

All of us hate waiting in lines. Our society breeds a “me-first” attitude. Often the lines in which we wait are slow to move and, we become irritable and angry. Somehow there is always someone who is able to outsmart the system and get served ahead of their place in the queue. In the typical queue at the grocery store, (or at the apple store genius bar) we become impatient because …

Why are female physicians paid less?

Peter Ubel, MD

Physician

June 20, 2012

In a new study published in JAMA, my colleagues and I found that even after accounting for productivity, women working as physician researchers at American Medical Schools are paid $13,000 less per year than their male colleagues, a difference that amounts to hundreds of thousands of dollars over the course of their careers.

But does this difference stand as evidence of discrimination?

Many claims of gender inequity in pay have suffered …

Read more…

Why are female physicians paid less?

Become not just a physician, but a great physician

Michael Mank

Medical Education

June 20, 2012

As the nation, physicians, hospitals, and political pundits await the Supreme Court’s decision on the Affordable Care Act, I find myself waiting for something else: to begin medical school. I will be hitting the books, studying vigorously, and desperately trying to remember the myriad of information being thrown at me well after the justices decide the fate of President Obama’s landmark legislation. So what does this mean for me, or …

What does patient centered care say about psychiatry as a science?

Steve Balt, MD

Physician

June 20, 2012

When asked what makes for good patient care in medicine, a typical answer is that it should be “patient-centered.” Sure, “evidence-based medicine” and expert clinical guidelines are helpful, but they only serve as the scientific foundation upon which we base our individualized treatment decisions. What’s more important is how a disorder manifests in the patient and the treatments he or she is most likely to respond to (based on genetics, …

Why doctors should attend residency graduations

Wes Fisher, MD

Physician

June 19, 2012

June in the United States heralds the month when residencies end and new ones begin. While much will be written soon about the dangers of entering hospitals this time of year (this story never seems to tire with mainstream media), I would like to step back and reflect on why doctors should consider attending residency graduations. I had the pleasure of doing so recently.

Excitement. With all of the dreary news of …

Should medical students consider a combined psychiatry residency?

Julia Frank, MD

Medical Education

June 19, 2012

“What about combined psychiatry-family medicine-neurology-internal medicine programs? Should I try to do a triple board program in psychiatry-child psychiatry and pediatrics?”

Every April, I field such questions from a slew of rising fourth year students who have become, to their surprise (and sometimes dismay), passionately interested in psychiatry. Psychiatry is a shortage specialty and psychiatric issues rank high among the challenges facing medical care systems here and around the world. For …

Most medical students don’t have what it takes for primary care

Lucy Hornstein, MD

Physician

June 19, 2012

I figured it out! I realized what the basic, underlying, fundamental problem is with medical care in this country.

The problem is that it’s too expensive and often isn’t very good, but that’s clear.

The reason medical care in this country is fragmented and overly expensive is that there is a perverse inversion of the correct ratio between primary care and specialty physicians (should be significantly greater than one, instead of significantly …

11 tips I’ve learned from 11 years sick

Toni Bernhard, JD

Patient

June 19, 2012

A year ago, KevinMD.com was kind enough to post my piece, 10 Tips from 10 Years Sick. Well, a year has gone by and I’m still sick. So, I’ve re-visited that post, changing several of the tips and adding to others. And, of course, there are now 11 tips, not 10! At the end of the piece, I hope you’ll share your own experiences.

1. The onset of chronic illness …

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11 tips I’ve learned from 11 years sick

The frustrating gap of physician leadership skills

Dike Drummond, MD

Physician

June 18, 2012

One of the big practice challenges most physicians face is a frustrating gap in our leadership skills. We step out of residency and are instantly installed as the leader of a multidisciplinary team charged with delivering the highest quality care to our patients.

This new leadership role can be daunting. We are prepared to diagnose and treat, but what about all the other questions that come our way? At times It …

Don’t give up on the family dinner

Claire McCarthy, MD

Physician

June 18, 2012

For years, I have been telling families in my practice, especially those with teens, to eat dinner together. Family dinners make a difference, I tell them. Studies show that they not only help prevent obesity, they help kids do better in school and help keep them out of trouble.

Now a study says that’s a bunch of hogwash.

Well, not exactly hogwash. The researchers from Cornell who wrote “Assessing Causality and …

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Don’t give up on the family dinner

Start the difficult conversation with ICD patients

John Mandrola, MD

Conditions and Diseases

June 18, 2012

There was a very important article written in the New York Times recently. It highlighted a common medical scenario in my world—the defibrillator (ICD) world.

I am going to talk about ICDs here, but the big picture inherent in this story illustrates the important issue of how best to apply invasive therapy to elderly and sicker patients.

The Times piece delved into medical decision-making when patients present with battery depletion of their …

James Reason and the foundation of patient safety

Robert Wachter, MD

Physician

June 18, 2012

Professor James Reason is the intellectual father of the patient safety field. I remember reading his book Managing the Risks of Organizational Accidents in 1999 and having the same feeling that I had when I first donned eyeglasses: I saw my world anew, in sharper focus.

Reason’s “Swiss cheese” model, in particular – which holds that most errors in complex organizations are caused not so much by …

Should hydrocodone be changed to a schedule 2 drug?

Edward Pullen, MD

Medications

June 17, 2012

Hydrocodone as it is currently prescribed in the U.S. is a schedule 3 drug. The FDA puts rules and regulations on the prescribing of medications that have a significant potential for abuse, diversion or addiction, and the lower the schedule number, the more the restrictions.

Schedule 1 drugs are illegal in the U. S. They are deemed to have no legitimate medical purpose. Examples are heroin, LDS, methamphetamine, marijuana (strange but …

Parents need to ask: Is this CT scan necessary?

Catherine Musemeche, MD

Conditions and Diseases

June 17, 2012

I know a surgeon who, when consulted about a child with appendicitis, will insist that a CT scan of the abdomen be performed before he will see the patient. It doesn’t matter that the history and physical exam fit the diagnosis perfectly. It doesn’t matter that the child has already undergone an ultrasound of the appendix that shows it is dilated and inflamed. It doesn’t matter that the radiologist has …

The tragic outcome of a decision to minimize costs

Alexis Ball

Patient

June 17, 2012

My mom passed away last December to Stage V breast cancer metastasized to her liver. During this battle she developed ascites (an accumulation of fluid in the peritoneal cavity) as her liver failure progressed. This accumulation of fluid was not only extremely uncomfortable but painful as well. In an attempt to find symptomatic relief for the last months of my mom’s life, the oncologist presented us two options: we could …

Robots for surgery aren’t ready for widespread use in hospitals

Kevin Pho, MD

KevinMD

June 17, 2012

The following column was published on June 5th, 2012 in USA Today.

I recently had the opportunity to try out a surgical robot, a medical device that has excited doctors, patients and hospital marketing departments. During the demonstration, I was able to precisely manipulate the robotic arms using joysticks. The experience felt right out of a Hollywood movie, as I was able …

Marcus Welby, MD is still relevant today

Hans Duvefelt, MD

Physician

June 17, 2012

The year is 2012. A 58-year-old veteran Family Physician who has just finished a day with more human heartaches than clinical triumphs settles down among the pillows with his wife in front of his MacBook to watch a movie, delivered wirelessly over the Internet:

“The year is 1969. A 62-year-old veteran general practitioner who has just seen his health threaten to fail him, speaks passionately to a group of doctors about …

Does it matter if your doctor is board certified or board eligible?

Christopher Johnson, MD

Physician

June 16, 2012

Does your doctor have something on the wall that starts with “American Board of … “?

The terms “board certified” and “board eligible” are confusing to people not in the medical profession. It doesn’t help that more than a few doctors blur the distinctions to their own benefit. This post gives you a brief rundown of the distinctions at stake.

The first thing to understand is that anybody who has graduated from …