KevinMD.com

September 19, 2012Sep 19, 201213

We’re a disgruntled bunch these days. We think there must be a better way to experience health care. Doctors say they’re pressed for time, don’t make enough money, have to hassle with insurance companies and typically feel generally burned out…

We’re a disgruntled bunch these days. We think there must be a better way to experience health care.

Doctors say they’re pressed for time, don’t make enough money, have to hassle with insurance companies and typically feel generally burned out about medicine.

Patients feel they wait too long in the waiting room, don’t get much time in the examining room to ask questions or share concerns, want to be more involved in …

Conditions and diseases

The decision to have a child circumcised

Natasha Burgert, MD

September 19, 2012Sep 19, 201222

Soon-to-be parents come to “interview” me almost every day. Typically, they come prepared with a long list of questions for a pediatrician. I answer them as best as I am able. For parents soon-to-be-expecting sons, I am frequently asked about…

Soon-to-be parents come to “interview” me almost every day. Typically, they come prepared with a long list of questions for a pediatrician. I answer them as best as I am able.

For parents soon-to-be-expecting sons, I am frequently asked about circumcision.

Most parents are just curious about how the procedure is technically done, when their baby can get the procedure, and …

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Physician voices

Despite the best evidence, oncologists cannot dictate treatment

Don S. Dizon, MD

September 19, 2012Sep 19, 201210

During Multidisciplinary Gynecologic Oncology Tumor Board at Massachusetts General Hospital, a case was presented of an older woman with stage IV ovarian cancer who was deemed inoperable. Following review, we recommended a course of chemotherapy. I asked our fellow what…

I asked our fellow what treatment she would administer, and this sparked a discussion on how patients and providers create a treatment plan. We discussed options, …

Health policy

Both sides are spewing nonsense when they talk Medicare

Bob Doherty

September 19, 2012Sep 19, 20122

Medicare has suddenly become a centerpiece issue in the 2012 election—but not in a good way. Instead of an informed debate about Medicare’s present and future place in our health care system, the politicians have subjected us to a daily…

Let’s start with the nonsense accusation by Governor Romney that “There’s only one president that I know of in history that robbed Medicare, $716 billion to …

Drugs and prescribing

Should doctors stop prescribing inhalers for smokers?

Deep Ramachandran, MD

September 18, 2012Sep 18, 20128

I’ve always had a tough relationship with cigarettes and the people who love them. As a lung doctor I hate cigarettes, and I hate that patients I see everyday continue to use them. But I also understand that vilifying smokers seems to be in vogue right now. I figure that if someone does something that is not considered socially palatable, and that does them harm, even as they strive to …

Health policy

Physicians need to embrace change to fix health care

Eugene Spiritus, MD

September 18, 2012Sep 18, 201212

Several interesting facts crossed my computer screen recently. The first was a Tweet by American Medical News that the first CT scan was performed on August 25th 1973. The second focused on the large number of practicing physicians who suffer…

Several interesting facts crossed my computer screen recently. The first was a Tweet by American Medical News that the first CT scan was performed on August 25th 1973. The second focused on the large number of practicing physicians who suffer from burnout, and the third was an article, which cited a talk given by Vinod Khosia in which he is quoted as saying “80 percent of doctors could …

Conditions and diseases

I hope my son never asks me if he can play tackle football

Manoj Jain, MD, MPH

September 18, 2012Sep 18, 20128

Last fall, I went with my 12-year-old son to his middle school's opening home football game. The bleachers were lined with parents, the smell of hot dogs and nachos wafted over the field, the announcer's voice blared, and the cheerleaders…

Last fall, I went with my 12-year-old son to his middle school’s opening home football game. The bleachers were lined with parents, the smell of hot dogs and nachos wafted over the field, the announcer’s voice blared, and the cheerleaders jumped out of sync.

The boys were dressed in shoulder, chest, thigh and kneepads covered with clean white numbered uniforms. They each wore a helmet that seemed to weigh more than …

Health policy

What can we learn about health care from Europe?

John Mandrola, MD

September 18, 2012Sep 18, 20126

May I tiptoe onto a ledge for a moment? Some (just-back-from-Europe) thoughts on health care policy, perhaps? One of the many differences between the European Society of Cardiology (ESC) Congress and a typical American cardiology meeting was the scarcity of…

May I tiptoe onto a ledge for a moment?

Some (just-back-from-Europe) thoughts on health care policy, perhaps?

One of the many differences between the European Society of Cardiology (ESC) Congress and a typical American cardiology meeting was the scarcity of healthcare policy sessions at the ESC. That’s hard to explain; perhaps European countries are settled on their own systems and do not wish to — or can’t — influence their neighbors.

It goes …

Health technology

How can technology entrepreneurs disrupt health care?

Davis Liu, MD

September 17, 2012Sep 17, 201210

I recently viewed health care through the lenses of a technology entrepreneur by attending the Health Innovation Summit hosted by Rock Health in San Francisco. As a practicing primary care doctor, I was inspired to hear from Andy Grove, former CEO of Intel, listen to Thomas Goetz, executive editor of Wired magazine, and Dr. Tom Lee, founder of One Medical Group as well as ePocrates.

Not surprising, the most fascinating person, …

Physician voices

Remember the Professionalism APGAR during times of stress

Dawn Baker, MD

September 17, 2012Sep 17, 20123

What does it mean to be a professional? And how do we maintain our professionalism at a time when things such as stress, burnout, and caregiver fatigue threaten our motivation? As an anesthesiologist, the ability to remain professional in many scenarios is something I constantly strive for. Aside from how it affects my relationships with the interdisciplinary OR team, professionalism is an important attribute given that my job requires patients …

Physician voices

Doctors need to make room for disagreement with patients

Ishani Ganguli, MD

September 17, 2012Sep 17, 20125

While our dad was in the hospital last winter, my brother shared with me his strategy for talking to the doctors we encountered - an approach honed over ten years of marriage to an internist and dozens of pediatrician visits…

While our dad was in the hospital last winter, my brother shared with me his strategy for talking to the doctors we encountered – an approach honed over ten years of marriage to an internist and dozens of pediatrician visits for his two little boys. He asked smart questions that used medical terms to earn their respect, he told me. He was appropriately deferential, admitting his lack of clinical experience. …

Conditions and diseases

Restless legs syndrome in children: How the kids see it

Craig Canapari, MD

September 17, 2012Sep 17, 20122

When I was a kid, my parents used to avoid giving me Coca-Cola after lunch. Not because they were overly concerned about my health. (If they had been, my mom wouldn’t have given me milkshakes when I watched Kung Fu Theater every Sunday afternoon. But that is a different story). The reason was that I would have really severe problems falling asleep about a quarter of the time. I would …

Health policy

My wish list for a perfect ACO

Keegan Duchicela, MD

September 16, 2012Sep 16, 201210

If you believe what most people are saying about health care reform and future practice models, you or your physician, will soon be part of an accountable care organization (ACO). Health policy experts tell us that as physicians, we'll be…

If you believe what most people are saying about health care reform and future practice models, you or your physician, will soon be part of an accountable care organization (ACO).

Health policy experts tell us that as physicians, we’ll be embarking on a wonderful journey that bears no resemblance to the HMO/managed care heyday of the early 1990s. Of course, there’ll be similarities, like limited networks, top down implementation of health protocols, and …

Read more…

My wish list for a perfect ACO

Conditions and diseases

Can I still have a bladder infection with a negative urine culture?

Jennifer Gunter, MD

September 16, 2012Sep 16, 2012

In a word, yes. And this is a difficult concept for many doctors to get because we have long been taught that the gold standard is culture. Let’s back up a little. These are the symptoms of a bladder infection:…

In a word, yes.

And this is a difficult concept for many doctors to get because we have long been taught that the gold standard is culture.

Let’s back up a little. These are the symptoms of a bladder infection: needing to empty your bladder a lot (urinary frequency), when you gotta go, you gotta go (urgency), pain just over the pubic bone, blood in the urine, burning when you empty your …

Conditions and diseases

CT scans for lung cancer screening: Look closely at the statistics

Kenneth Lin, MD

September 16, 2012Sep 16, 20122

Enthusiasm for lung cancer screening has never been higher, following last year's report from the National Lung Screening Trial (NLST) that heavy smokers who underwent 3 rounds of low-dose computed tomography (CT) screening were 20 percent less likely to die…

Enthusiasm for lung cancer screening has never been higher, following last year’s report from the National Lung Screening Trial (NLST) that heavy smokers who underwent 3 rounds of low-dose computed tomography (CT) screening were 20 percent less likely to die from lung cancer compared to a similar group that was screened with chest x-rays (a “placebo” intervention that another study found to be ineffective). My own institution, Georgetown University Hospital, was one of the …

Conditions and diseases

Is there a role for the laxative free virtual colonoscopy?

Steven Reznick, MD

September 16, 2012Sep 16, 20125

Research radiologists at the Massachusetts General Hospital in Boston evaluated the accuracy and detail of imaging the colon (a virtual colonoscopy or colonography) with no laxatives as preparation and comparing it with traditional colonoscopy. There are clear evidence based guidelines suggesting that all low-risk men and women have a screening for colon cancer with a colonoscopy at age 50. If that study is normal they are directed to repeat it …

Conditions and diseases

Useful design flaws explain some hemoglobin disorders

Reflex Hammer

September 15, 2012Sep 15, 2012

Paradoxically, some parts of our body work best when they fail under stress. An illustrative story from my freshman year of college. I decided to buy a wheelie chair for my (miniscule) dorm room from a student who lived 1.5…

Paradoxically, some parts of our body work best when they fail under stress.

An illustrative story from my freshman year of college.

I decided to buy a wheelie chair for my (miniscule) dorm room from a student who lived 1.5 miles away. How could I transport the chair across campus when I didn’t have a car?

I didn’t feel like wasting an hour walking there and then walking the chair back. Instead, I …

Physician voices

Use the Janus principle in your medical practice

Neil Baum, MD

September 15, 2012Sep 15, 2012

Janus is the Roman god of doors and gateways but also the god of beginnings. Interestingly, good beginnings and required for good endings. The Temple of Janus had doors facing east and west, which allowed illumination of the temple at the beginning and the end of the day. Most statues of Janus show him with two faces facing opposite directions.

The Janus principle in your medical practice is the idea of …

Physician voices

These are the reasons why nurse practitioners are special

Kim Sakovich, WHNP

September 15, 2012Sep 15, 201213

By now most of us have heard of a nurse practitioner. But what exactly is a nurse practitioner? What can they do? How can they be incorporated into a medical practice? A nurse practitioner is a registered nurse who has…

By now most of us have heard of a nurse practitioner. But what exactly is a nurse practitioner? What can they do? How can they be incorporated into a medical practice?

A nurse practitioner is a registered nurse who has completed graduate-level education and advanced practice training. Nurse practitioners can see a wide range of patients, both well and sick, and perform many in-office procedures. Prescribing medications, ordering and interpreting tests, …

Real physician voices, twice a week

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