KevinMD.com

August 21, 2012Aug 21, 20122

Last week I went on my first outreach visit to the homeless. In preparation we stocked up on water, gloves, gauze, and medications, put on our sneakers and headed out to the streets. We exited the front of the building, turned right and walked three blocks until we reached the corner with the highway on-ramp. We started crossing the street and about halfway, just past the service road and before …

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Most of the homeless are invisible

Physician voices

In a financial squeeze, a way forward for academic cardiologists

Wes Fisher, MD

August 21, 2012Aug 21, 2012

If you want to succeed in academic cardiology, get a federal grant for research. Better yet: get a few well-paid industry grants, too. These days lower-paid academic cardiologists are finding it tougher to find protected time for research and speaking…

If you want to succeed in academic cardiology, get a federal grant for research.

Better yet: get a few well-paid industry grants, too.

These days lower-paid academic cardiologists are finding it tougher to find protected time for research and speaking because grants are harder to come by and money from their academic center is getting tight. For instance, the National Heart, Lung and Blood Institute (NHLBI) of the NIH no longer accepts investigator-initiated innovative …

Physician voices

We need a doctor-family partnership on the Internet

Claire McCarthy, MD

August 20, 2012Aug 20, 20124

In early 1996, I sat down at my computer looking for help. My third child, 2 months old, had just been diagnosed with a severe brain malformation called lissencephaly. He won’t be normal, the doctors said grimly. His life will…

In early 1996, I sat down at my computer looking for help.

My third child, 2 months old, had just been diagnosed with a severe brain malformation called lissencephaly. He won’t be normal, the doctors said grimly. His life will be shorter, we were told. He will have seizures and other problems, they said, but it’s hard for us to say what or how bad those problems will be. We were …

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Conditions and diseases

Why brain tumors are my least favorite cancer

James C. Salwitz, MD

August 20, 2012Aug 20, 20123

If I had to choose my “least favorite” cancer, it would be brain tumors. This malady is not only challenging to treat, but it attacks in such a personal and disturbing way. It is hard enough to fight a complex disease, but to do it when the ability to focus and understand is disrupted by brain injury is a terrible curse. Still we have learned a lot and therapy is …

Physician voices

My mother couldn’t advocate for herself when she needed it the most

Leana Wen, MD

August 20, 2012Aug 20, 20127

My mother is my role model and my inspiration for what I do every day. She was diagnosed with breast cancer when she was in her forties, and fought it courageously for seven years until she passed away in 2010.…

There are so many stories I can tell about my mother and her battle with cancer. Let me start with just one. Whenever she’d go to her oncologist, she would go …

Physician voices

Don’t accept advice from physicians until they understand your values

Peter Ubel, MD

August 20, 2012Aug 20, 20123

Facing advanced cancer, who among us wouldn’t look to our oncologist for expert advice on whether another round of chemotherapy makes sense? But do you know what your oncologist cares about, and can you be sure her recommendations map onto…

A recent study lead by Michael Kozminski (I was senior author) shows that American oncologists downplay the value of treatments that improve quality of life, …

Patient voices

Googling cancer information: Tips from a cancer survivor

Andrew Griffith

August 19, 2012Aug 19, 20126

When I got my phone call with the diagnosis of mantle cell lymphoma (MCL), my instinct, like so many of us, was to Google. Today, 3 years later, I have learned about what to look for, what to avoid, and…

The following are suggestions to help others faced with a cancer diagnosis.

Google wisely. Google (and Wikipedia) are a reflex. …

Health policy

What can basketball teach us about health policy?

Andrew Boozary, MD, MPP

August 19, 2012Aug 19, 2012

Basketball imposed my first patient experience in the American health care system. A loose ball and flying elbow saw me to an x-ray machine and a consult with a respected surgeon in New York City. The wait at the hospital was long. CNN blazed through the speakers and the only reading material was a sea of People magazine. For hours, I found myself in a blinking contest between Blitzer or Kardashian.

Once in …

Physician voices

3 simple games to lower doctor stress and prevent burnout

Dike Drummond, MD

August 19, 2012Aug 19, 20122

Burnout is a constant threat for physicians. Research consistently shows an average of 1 in 3 doctors suffering from symptomatic burnout on any given office day. In my work with over stressed and burned out doctors, I have found that most of us work way too hard being the superhero to our staff, patients and families — and don’t have any fun at all. It doesn’t have to be …

Drugs and prescribing

MKSAP: 53-year-old woman with a 4 month history of tremor

mksap

August 19, 2012Aug 19, 2012

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 53-year-old woman is evaluated in the office for a 4-month history of tremor. The tremor affects both upper extremities and is present "most…

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

A 53-year-old woman is evaluated in the office for a 4-month history of tremor. The tremor affects both upper extremities and is present “most of the time.” She has a 15-year history of type 2 diabetes mellitus; she also has a history of hypertension, gastroparesis, and chronic kidney disease. Medications are insulin glargine, insulin …

Patient voices

Put patients to work during their wait time

Steve Wilkins, MPH

August 18, 2012Aug 18, 20128

I talk with lot of physicians about the need to improve the quality of communications between physicians and patients. Regular followers of my work will know that I am an advocate for the adoption of patient-centered communication skills by the…

Physicians with whom I talk seldom disagree as to the need for better physician-patient communications. They know that physician communication skills top the list of patient complaints …

Health policy

Chief Justice Roberts’ health reform ruling analysis: A win-win?

David B. Nash, MD, MBA

August 18, 2012Aug 18, 20124

The decision is in – and it is likely to have a substantial impact on this year's elections, the Congress, the Court, the healthcare industry, and all Americans. Of all the commentary I've read in the wake of the recent…

The decision is in – and it is likely to have a substantial impact on this year’s elections, the Congress, the Court, the healthcare industry, and all Americans.

Of all the commentary I’ve read in the wake of the recent Supreme Court decision, Time Magazine‘s “Special Report: The Health Care Decision” struck me as the most balanced and comprehensive.

In the lead article, “Roberts Rules,” author David Von Drehle skillfully dissected the …

Drugs and prescribing

The largest health care fraud settlement in history: Is it big enough?

George Lundberg, MD

August 18, 2012Aug 18, 20124

A law is a rule of conduct or action formally recognized as binding and enforced by a controlling authority. Law enforcement broadly refers to any system by which some members of society act in an organized manner to promote adherence…

The purposes of punishment for crimes include:

1. Punishment will stop them from committing further crimes.
2. Punishment …

Conditions and diseases

MKSAP: 62-year-old man with a 2 month history of progressive fatigue

mksap

August 18, 2012Aug 18, 2012

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 62-year-old man is evaluated for a 2-month history of progressive fatigue, dyspnea on exertion, anorexia, and nausea. He has no other medical problems…

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

A 62-year-old man is evaluated for a 2-month history of progressive fatigue, dyspnea on exertion, anorexia, and nausea. He has no other medical problems and takes no medications.

On physical examination, temperature is normal, blood pressure is 157/88 mm Hg, pulse rate is 86/min, and respiration rate is 22/min. BMI is 31. The conjunctivae are …

Physician voices

Doctors in no win situations: Damned if you do or don’t

Skeptical Scalpel, MD

August 17, 2012Aug 17, 20123

Here’s a little story from the early days of my first job as a chairman of surgery. Shortly after I assumed the role of surgical chairman in a community teaching hospital at the ripe old age of 40 and having…

Here’s a little story from the early days of my first job as a chairman of surgery.

Shortly after I assumed the role of surgical chairman in a community teaching hospital at the ripe old age of 40 and having absolutely no administrative experience, I visited a mentor of mine whom I had known since I was a medical student. He had been serving in a similar role at a larger …

Conditions and diseases

How to think like a doctor: Start with differential diagnosis

Suzanne Koven, MD

August 17, 2012Aug 17, 20122

"What would you do if you were your doctor?" Mary asked me. Mary is my physical therapist and she was trying to figure out why the rehab after my shoulder surgery was progressing so slowly. A month after my operation…

“What would you do if you were your doctor?” Mary asked me. Mary is my physical therapist and she was trying to figure out why the rehab after my shoulder surgery was progressing so slowly. A month after my operation I was still in pain and still not moving the joint well.

Without hesitation I replied: “I’d come up with a differential diagnosis.”

Differential diagnosis is a two word summary of how …

Health technology

7 iPhone apps that need to be created for doctors

David Sack, MD

August 17, 2012Aug 17, 20123

I read a few months ago that the number of available iPhone apps had exceeded a million, with new apps now appearing that are intended to help sort through the mountain of other apps. We have reached the age of meta-apps. Parenthetically, I have always loved that “meta”concept. In college, when people asked why I majored in philosophy despite the fact that I was pre-med, I explained that my intention was to become …

Conditions and diseases

Helping cancer survivors fight neuropathy

Cindy Tofthagen, PhD, ARNP

August 16, 2012Aug 16, 201210

As an oncology nurse, I see more and more people fighting—and winning—the battle against cancer these days thanks to earlier detection and a variety of new treatment approaches. But, like many healthcare professionals, I also see many cancer survivors struggle…

Cancer-related neuropathy is a common long-term health effect impacting a third of cancer survivors. It can result …

Health policy

Real health reform cannot happen without a primary care foundation

Andrew Morris-Singer, MD

August 16, 2012Aug 16, 201213

Annie Lowrey’s July 28 article “Doctor shortage likely to worsen with health law” in the New York Times noted the growing shortage of primary care doctors particularly in economically disadvantaged communities, both in rural and inner-city America. This problem will…

Annie Lowrey’s July 28 article “Doctor shortage likely to worsen with health law” in the New York Times noted the growing shortage of primary care doctors particularly in economically disadvantaged communities, both in rural and inner-city America. This problem will likely get worse before it gets better as more Americans gain coverage and seek a regular source of care. As the article suggests, training more doctors and incentivizing them …

Physician voices

Mandating care in the ER but not payment: Why that’s a problem

Thomas Pane, MD, MBA

August 16, 2012Aug 16, 20129

A recent case from Dayton, OH highlights the tangled mess of emergency department specialty coverage, federal law, and out-of-network insurance benefits. When these interact, patients, doctors, insurers and hospitals can be left frustrated and perplexed. Here’s a brief summary. A…

Here’s a brief summary.

A 6-year old boy suffered a fingertip injury and the emergency staff called the covering plastic surgeon, who repaired the injury. The surgeon, who does not participate with insurance, submitted a bill for …

Real physician voices, twice a week

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