KevinMD.com

August 30, 2012Aug 30, 201222

In "Big Med," his latest article on health care in The New Yorker, surgeon-writer Atul Gawande added the Cheesecake Factory to his running list of health care analogies (which have included, among others, farming, pit crews, and airline safety). Observing…

In “Big Med,” his latest article on health care in The New Yorker, surgeon-writer Atul Gawande added the Cheesecake Factory to his running list of health care analogies (which have included, among others, farming, pit crews, and airline safety). Observing that the Cheescake Factory and other upscale restaurant chains successfully lower costs and improve quality by “studying what the best people are doing, …

Physician voices

Does Anne-Marie Slaughter’s advice apply to female physicians?

Genmedmom, MD

August 30, 2012Aug 30, 20125

I just finished the just profoundly awesome article "Why Women Still Can't Have It All" by Anne-Marie Slaughter, in this the Atlantic. This is the article that has all the buzz going about professional women and work/life balance. It has…

I just finished the just profoundly awesome article “Why Women Still Can’t Have It All” by Anne-Marie Slaughter, in this the Atlantic. This is the article that has all the buzz going about professional women and work/life balance.

It has taken me a full week to finish this article, reading in bits and snatches before work, between patients and after work. I finally got through all 6 pages. Totally worth it. She says …

Physician voices

The unspoken sentiment towards patients with advanced cancer

Don S. Dizon, MD

August 30, 2012Aug 30, 201229

I have been thinking about the cancer experience—what it must be like to be on the receiving end of a cancer diagnosis, to live with cancer, and to experience the treatments; to receive the news that treatment worked or that it didn’t. I also have been thinking about what it must be like to “carry” a diagnosis of cancer around. …

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Health policy

An evidence based assessment of universal coverage

Bob Doherty

August 30, 2012Aug 30, 20123

A staple of conservative critiques of universal coverage is that having health insurance doesn’t equal access. The corollary is that the uninsured already have access to care—from doctors and hospitals willing to take care of them on a charitable basis…

This argument isn’t new, having been made years before the Affordable Care Act became law. In 2007, the Council for Affordable Health Insurance opined that universal coverage …

Conditions and diseases

Hospice care and palliative care: What’s the difference?

James Cooper, MD

August 29, 2012Aug 29, 20127

I’ve talked to hundreds of people about the health care options and decisions they face at the end of life. It’s a challenging time and understandably many have little knowledge, while others have misconceptions, and some have bitter disagreements. Here’s…

Here’s a basic primer for two common approaches: hospice and palliative care.

Hospice care

Two myths about hospice care are prevalent. First, many people believe hospice is provided in a place like a hospital. …

Physician voices

My Dad never quit making rounds

Jim deMaine, MD

August 29, 2012Aug 29, 20122

In order to be with my Dad, after dinner I'd go on house calls with him. We'd drive to parts of town I'd never seen, and using the car's spotlight we'd search out the right house number, often with no…

In order to be with my Dad, after dinner I’d go on house calls with him. We’d drive to parts of town I’d never seen, and using the car’s spotlight we’d search out the right house number, often with no small difficulty. I’d usually wait in the car. He hefted up his rather large mysterious black doctor’s bag and headed for the door. He spent about a half hour listening …

Read more…

My Dad never quit making rounds

Physician voices

Only trained physicians should provide interventional pain services

American Society of Anesthesiologists & Asokumar Buvanendran, MD

August 29, 2012Aug 29, 201221

A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com. As an anesthesiologist and pain physician, I understand the complexity of pain management procedures required for chronic pain disease. Chronic pain is a disease like others such as…

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

As an anesthesiologist and pain physician, I understand the complexity of pain management procedures required for chronic pain disease. Chronic pain is a disease like others such as hypertension and cardiac disease. Several interventional pain procedures can be dangerous, even in the hands of the most specially trained interventional physicians, as they are performed near or around the spinal …

Conditions and diseases

Why the diagnosis of bipolar disorder isn’t clear

Steve Balt, MD

August 29, 2012Aug 29, 20124

I have a confession to make. I don’t know what “bipolar disorder” is. And as a psychiatrist, I’ll admit that’s sort of embarrassing. Okay, maybe I’m exaggerating when I say that I don’t know what bipolar disorder is. Actually, if…

I have a confession to make. I don’t know what “bipolar disorder” is. And as a psychiatrist, I’ll admit that’s sort of embarrassing.

Okay, maybe I’m exaggerating when I say that I don’t know what bipolar disorder is. Actually, if you asked me to define it, I’d give you an answer that would probably sound pretty accurate. I’ve read the DSM-IV, had years of training, took my Boards, treated people in …

Health technology

10 ways to make an EMR truly meaningful for doctors

Rob Lamberts, MD

August 29, 2012Aug 29, 201212

I am an EMR geek who isn’t so thrilled with the direction of EMR. So what, I have been asked, would make EMR something that is really meaningful? What would be the things that would truly help, and not just make more hoops for me to jump through? A lot of this is not in the hands of the gods of meaningful use, but in the realm of the demons …

Physician voices

How much should doctors reveal about themselves to patients?

Juliet K. Mavromatis, MD

August 28, 2012Aug 28, 20127

How much should doctors reveal about themselves to patients? Whether or not “self-disclosure” is an effective communication strategy in the doctor-patient relationship has been debated. In fact, some studies have demonstrated that doctors who talk about themselves more are rated…

How much should doctors reveal about themselves to patients?

Whether or not “self-disclosure” is an effective communication strategy in the doctor-patient relationship has been debated. In fact, some studies have demonstrated that doctors who talk about themselves more are rated more poorly by patients than those who are more private. This topic has been of interest to me and I have written about it in my blog: Doctor, Patient, Friend: Blurring the …

Drugs and prescribing

Chronic pain in the elderly: The role of opioids

Steven Reznick, MD

August 28, 2012Aug 28, 20125

An investigative newspaper article published in the Milwaukee Journal Sentinel, in cooperation with online periodical MedPage Today, chronicles the increased use of narcotics for chronic pain relief in the elderly. The article highlights how in 2009 the American Geriatrics Society…

An investigative newspaper article published in the Milwaukee Journal Sentinel, in cooperation with online periodical MedPage Today, chronicles the increased use of narcotics for chronic pain relief in the elderly.

The article highlights how in 2009 the American Geriatrics Society put together a panel of geriatric pain specialists who published geriatric narcotic pain relief guidelines that have led to the dramatic increase in use of narcotics in the elderly. There is apparently …

Physician voices

How long do I have? The question of prognosis has no simple answer

James C. Salwitz, MD

August 28, 2012Aug 28, 2012

“The question” comes in several forms: “Doc, what stage is my cancer?” “What is my prognosis?” “Can it be cured?” “Am I going to die?” “Have long have I got?” These tough honest words require courage. “The question” superficially asks for a simple answer. Time to live. However, in the real world of life and death, these questions and therefore the answers are far more complex and subtle.

Years ago we …

Physician voices

Creating doctors practicing to the Penn State standard

Wes Fisher, MD

August 28, 2012Aug 28, 20123

There is a moment in everyone’s life, for oneself or a loved one, when one receives the “diagnosis.” In that moment, eyes meet across the desk and the shell-shocked individual looks up and asks, “Doctor, what should I do?” In that instant, the patient is putting all of their trust in another human being who is trying nothing less than to save a life.

A good doctor has always been a …

Physician voices

Choose your doctor: Astute diagnostician or empathic practitioner?

Michael Kirsch, MD

August 27, 2012Aug 27, 20124

Would you rather your physician be an astute diagnostician or a compassionate and empathic practitioner? Of course, we want our physicians to be blends of these qualities. We want it all. We want them to be chimeras of Drs. House…

I can’t say. I suspect that it is easier to cultivate soft bedside manners than it is to teach medical acumen, although the latter was …

Physician voices

I cherish the relationships I’m able to build with my patients

Karly Pippitt, MD

August 27, 2012Aug 27, 20122

I spent my first two years of medical school at the University of Utah frantically cramming for Step 1. My limited exposure to patients was restricted to shadowing only. My actual interactions with them were spotty at best. Those first two years of medical school didn’t at all reflect what I would go on to love about primary care: building relationships with patients that would span many years.

I now teach …

Physician voices

A connection is lost when we outsource the physical exam

Suzanne Koven, MD

August 27, 2012Aug 27, 20123

I remember my first visit home at the end of my second year of medical school. I’d just received my black doctor’s bag loaded with medical equipment. Like a 16-year-old with a new driver’s license, begging to do the very errands she’ll soon groan about, I went around my parents’ living room and took everyone’s blood pressure, looked in their ears and throats — and then made my “rounds” again.

While …

Physician voices

When politicians decide a woman’s fate

Jennifer Gunter, MD

August 27, 2012Aug 27, 20126

“I have a 20-year-old with what I can only describe as a poorly repaired heart defect and, uh, suboptimal follow-up,” the cardiologist’s voice was rushed. “That’s no good,” I said. “Yeah, well, it gets worse. She had baby two years…

“I have a 20-year-old with what I can only describe as a poorly repaired heart defect and, uh, suboptimal follow-up,” the cardiologist’s voice was rushed.

“That’s no good,” I said.

“Yeah, well, it gets worse. She had baby two years ago. Went into heart failure around 36 weeks. I’ve got the records. I have no idea how she made it home.” And then he added, “She had a c-section, but no one …

Read more…

When politicians decide a woman’s fate

Medical education

Pre-meds: Do what it takes to get into medical school

Marc N. Katz, MD

August 26, 2012Aug 26, 201231

I sit at my home in New Jersey as I anxiously await my 6am flight two days from now that will take me to the Caribbean island of Dominica where I will begin to take my first steps in the…

I sit at my home in New Jersey as I anxiously await my 6am flight two days from now that will take me to the Caribbean island of Dominica where I will begin to take my first steps in the journey of becoming a doctor at Ross University School of Medicine.

Many people attempted to discourage me from continuing on the path I started on. Doctors I shadowed would warn me …

Medical education

Patient centered care starts in medical school

Kathryn Nix

August 26, 2012Aug 26, 20123

For thousands of first-year medical students, including myself, last week marked the beginning of classes and our official entrance into the medical profession. We sat through lectures on the normal functions of the body, and many of us even set…

At my school, we didn’t just delve back into the basic sciences—on day two, we also began a class that will …

Patient voices

The healing art of listening: Life lessons learned from my great aunt

Laura Webb, RN

August 26, 2012Aug 26, 20124

Years ago, I attended college near the home of a favorite great aunt. Aunt Lucy lived alone in a tidy apartment with a tiny courtyard balcony, overlooking a busy Pasadena street. Sometimes, I would make the short, chaotic drive through…

I visited Aunt Lucy when I was in need of a …

Real physician voices, twice a week

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