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Minimize reactance in your health organization

Patient

May 7, 2012

Can you say “reactance”? Don’t feel bad, I wasn’t familiar with the term either until recently. But as you will see, anyone that has ever been a patient will catch on pretty quickly as to what reactance is and how it works.

Reactance is how we respond to something that threatens to limit or eliminate our behavioral freedom. I recently experienced reactance in the course of “prepping” for a colonoscopy. The …

No one told me that getting on with life after cancer would be so hard

Merry Jennifer Markham, MD

Physician

May 7, 2012

I met with a young patient recently, a woman who has been done with chemotherapy for lymphoma for close to a year. She was feeling well, and she had no symptoms of cancer, nothing that made her suspicious of a recurrence. After I examined her and reviewed her most recent CT scan and labs, I agreed. No recurrence. I wrote in my note, “NED,” the acronym for no evidence of …

Shift the cultural obsession away from skinny

Solmaz Amirnazmi, MD

Physician

May 6, 2012

If you Google “skinny definition” what will pop up is the following:

Adjective: (of a person or part of their body) Unattractively thin.

The word skinny according to Webster’s is defined as the following:

1. resembling skin: membranous
2a. lacking sufficient flesh: very thin: emaciated
2b. lacking usual or desirable bulk, quantity, qualities or significance.

So how did our culture take this word and use it to represent a goal, or rather set “skinny” as a …

How an EMR makes connecting with the patient more difficult

Shabbir Hossain, MD

Health Technology

May 6, 2012

I have the great privilege of being a medical educator. Everyday, I have an incredible time working with internal medicine residents at their continuity clinic, teaching the art of ambulatory medicine. Our working environment here is academically rich and fulfilling. The name of the legendary Dr. Martin Leibowitz (an iconic figure in ambulatory medicine here) stands outside our conference room as a constant reminder of how medicine is practiced and …

To test or not to test? Include the patient first

Peter Goldbach, MD

Conditions and Diseases

May 6, 2012

Shannon Brownlee’s recent post, “Don’t discard shared decision making on the basis of PSA testing,” couldn’t ring more true. The crux of shared decision making is that the patient must decide, with his or her physician, which tests or procedures make sense, given the various risks, tradeoffs and outcomes. Discarding the construct on the basis of one test (PSA testing) is not only poor form in that it is a …

Why this pediatrician makes the MMR vaccine mandatory in his practice

Nelson Branco, MD

Conditions and Diseases

May 6, 2012

Vaccines have been a hot topic among parents, pediatrician and in the media for many years. Recently, there have been many news stories about pediatricians who will not care for families who either choose not to vaccinate their children or who do not follow the recommended schedule. These policies are based on knowledge about the safety of vaccines, the effectiveness of the recommended schedule and concern about the spread of …

ASA: Need anesthesiology providers? Consider anesthesiologist assistants

James R. Mesrobian, MD

Potpourri

May 6, 2012

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

On March 28, 2012, Governor Scott Walker signed into law SB383, a bill to license Anesthesiologist Assistants (AA) in Wisconsin. The Wisconsin Academy of Anesthesiologist Assistants (WAAA), the Wisconsin Society of Anesthesiologists (WSA), the Wisconsin Medical Society, numerous other medical specialty societies, the Medical Examining Board, and six major hospital systems supported the bill. Since 2001, seven states …

Injectable epinephrine often isn’t used quickly enough

Paul M. Ehrlich, MD

Conditions and Diseases

May 5, 2012

Mark Twain once said, “The difference between the right word and the wrong word is the difference between lightning and lightning bug.” He was referring to the power of language. With an allergist, the consequences of the right and wrong words have measurable consequences, ranging from comfort to chronic misery, to medical payments spent wisely or wasted, and sometimes life or death.

For example, people with lactose intolerance will mistakenly believe …

Poor transitions in care result in unsafe patient care

Maria Maldonado, MD

Physician

May 5, 2012

I have participated in two transitions in care with my mother. The first was when she was released from the hospital after undergoing neurosurgery for a malignant brain tumor. Immediately after surgery of her brain tumor, she went through two weeks of intensive physical, occupational, and speech therapy. At the end of this period, the recommendation was clear. She required around the clock supervision. The plan was to send her …

How to save a trillion dollars in health care

George Lundberg, MD

Health Policy

May 5, 2012

It is both conventional wisdom and factual truth that, unimpeded, American healthcare cost inflation will bankrupt the United States economically, educationally, socially, and politically in the not too distant future.

The inexorable upward trend line is unsustainable.

In 2009, I described six ways to save nearly $1,000,000,000,000 per year without serious harm, and with positive benefit to the public health.

They were:

Use intensive medical therapy instead of coronary artery bypass grafts and invasive …
Read more…

How to save a trillion dollars in health care

MKSAP: 65-year-old woman with E. coli in a urine culture

mksap

Conditions and Diseases

May 5, 2012

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

A 65-year-old woman is evaluated because a screening urine culture for an insurance policy grows greater than 10⁵ colony-forming units/mL of Escherichia coli. She does not have fever, dysuria, urinary frequency, or other symptoms. Medical history is unremarkable. She has no allergies and takes no medications. …

Is managed care worth the price of a life?

Kristy Jensch

Patient

May 4, 2012

The first time I met Tom his head was on the table at the Christmas banquet held by the mental health support program where I worked. He was sitting next to his wife, who worked on the staff.

Tom’s alcoholism soon brought him into the program, fractured his marriage, and I became his first case manager. The alcoholism had roots in childhood abuse. Years of drinking followed, with hospitalizations, chaos and …

Should electronic medical records be considered medical devices?

Wes Fisher, MD

Health Technology

May 4, 2012

In our rush to establish a national electronic medical record (EMR) system as part of the American Recovery and Reinvestment Act of 2009, powerful silos of independent EMR systems have sprung up nationwide. While most systems are being developed responsibly, like the Wild, Wild West, many have been developed without an objective eye toward quality and the potential harm they may be causing our patients.

As most readers of this blog are aware, …

How the Affordable Care Act combats preventable hospital infections

Christian John Lillis

Health Policy

May 4, 2012

As the Supreme Court deliberates the Affordable Care Act, Americans should take a closer look at the commonsense reforms embedded in the law, including those that strengthen public health. Fixation on the law’s individual mandate has overlooked the law’s very important benefits for public health.

Lost amid the rhetoric about individual liberty is the public interest and common good of protecting all Americans from the costly and deadly menace of preventable …

Will a shift to longitudinal experiences improve medical education?

James Haddad

Medical Education

May 3, 2012

As a medical student who just completed this third year of training, I took special interest in Dr. Pauline Chen’s recent article about Harvard Medical School’s “Integrated Clerkship” – a program that eliminates traditional block-style clerkships and asks students to follow a panel of “up to 100 patients” longitudinally over the course of a year in order to emphasize continuity of care and the humanistic aspects …

A trauma surgeon on the pointlessness of gang violence

Bryan Hubbard, MD

Physician

May 3, 2012

Another call night in downtown L.A. It had not been a particularly eventful day: the usual offering of people hit by cars, falling off of things, and victims of man-made violence. Some injuries happen as a result of an accident, some as a result of carelessness, and of course many happen because of an intentional act. At about 1am the trauma pager went off; the text announced a “Level 1 …

Being insured does not equate to being covered

Richard Just, MD

Health Policy

May 3, 2012

A few weeks ago, my wife and I attended “A Conversation With David ‘Sonny’ Lacks” at the California Center for the Arts, Escondido. The event was a sellout with 900 attendees. As it turns out, most of the colleges and universities in San Diego County designated “The Immortal Life of Henrietta Lacks” as the book discussed by students and …

How single payer can improve the access to cancer care

Aldebra Schroll, MD

Physician

May 3, 2012

The call came in the middle of a busy office day; the radiologist had found a suspicious area on the mammogram. I had received similar calls many times in my primary care practice. This time was different; the patient was me.

My first thought “thank God I’m insured.” My second thought was for all those who are not. It was hard enough waiting the week, until further testing could be performed; …

A doctor has difficulty making sense of medical bills

Manoj Jain, MD, MPH

Physician

May 2, 2012

Rarely do people think about medical costs when there is a medical emergency or an urgent need for a test. Recently, I was in such a situation.

A few days after a 22-hour international flight, the calf muscle in my right leg began to ache. If it were not for the recent flight, or if I were not a doctor, I would have just let it pass.

But long periods of sedentary …

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