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Why would anyone believe that cheap surgery is a good choice?

Physician

March 12, 2012

If you live in southern California, you can’t miss the billboards advertising laparoscopic gastric banding at “1-800-GET-THIN” outpatient surgery centers. They feature happy people who’ve lost 100 pounds or more, and urge you to “let your new life begin” by having a “lap band” inserted. Fees at these centers are much lower than they are at university medical centers or other major hospitals.

Recently, however, those surgery centers and their owners …

AMA: Delaying the implementation of ICD-10 is a win for doctors

Peter W. Carmel, MD

Health Policy

March 12, 2012

A guest column by the American Medical Association, exclusive to KevinMD.com.

It will come as no surprise to many of you that it can take a very long time to get things accomplished in Washington, D.C. However, a recent policy change from the Department of Health and Human Services (HHS) shows that when physicians join together for a common cause we can …

Rethinking care delivery and payment models with nimble medicine

Dave Chase

Health Policy

March 12, 2012

The New Yorker’s Dr. Atul Gawande outlined how, at the turn of the 20th century, more than forty per cent of household income went to paying for food and food production consumed nearly half the workforce. Beginning in Texas, a wide array of new methods of food production were piloted. Today, food accounts for 8% of household budgets and 2% of the workforce. As a wide array of small innovations …

The women behind ideological debates about abortion

Eijean Wu, MD

Physician

March 12, 2012

My patient was veiled in layers of heavy black cloth from head to toe. I could see blood staining her white socks as I waited impatiently for a female Arabic translator. Slowly, I told the patient and her sister that I was worried about her pregnancy, and would need to do a pelvic exam. As feared, I soon saw that she had a miscarriage. “Can I see the baby?” she …

ASA: The global anesthesia crisis in low-income countries

Kelly A. McQueen, MD

Physician

March 11, 2012

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

Many are unaware of the global anesthesia crisis in low-income countries around the world. Some countries have less than one physician per 10,000 people and even less than one anesthesiologist per 100,000 people. The ability to provide safe anesthesia for surgery, labor and delivery, and other procedures, …

Strategies to prevent physician burnout

Kevin R. Campbell, MD

Physician

March 11, 2012

In these days of decreased reimbursement, increased workload, and non user-friendly EMRs, physician burnout rates can be quite high.

Stress, depression, and overwhelming fatigue associated with burn-out can interfere with our ability to care for our patients. If we, as providers, are not emotionally healthy, we are not able to provide the very best of ourselves to our patients. When we allow ourselves to become over extended and over committed without …

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Strategies to prevent physician burnout

Fat kills, and 2 other obesity myths

Maggie Mahar

Conditions and Diseases

March 11, 2012

Dr. Nortin Hadler, author of Worried Sick and Stabbed in the Back, is well-known for debunking medical myths. But in his latest book, Rethinking Aging (UNC Press), Hadler, a professor at the University of North Carolina, Chapel Hill, commits what some might call medical heresy, suggesting that, perhaps, as we approach middle-age, “It’s OK to be Overweight.”

Wait a minute. What is Hadler saying? Everyone knows that obese Americans are driving …

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Fat kills, and 2 other obesity myths

MKSAP: 25-year-old woman with bilateral eye pain and redness

mksap

Conditions and Diseases

March 11, 2012

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

A 25-year-old woman presents for evaluation of recurrent, bilateral eye pain and redness. Symptoms began several months ago without a specific inciting event. With each episode, she has deep or boring pain that is constant and has awakened her from sleep. She has had photophobia, tearing, …

The gamble of the ACO monopoly game

Kunmi Sobowale, MD

Health Policy

March 10, 2012

There has never been a more hectic time to be in the business of healthcare. Healthcare reform has brought many players to the table. And the “game” is bound to have winners and losers. This game is analogous to the board game Monopoly — a number of health care companies are buying up property (i.e., hospital and smaller providers) to position themselves as winners in the new shared savings payment …

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The gamble of the ACO monopoly game

The vulnerability of patients needs to be respected and honored

Rev. Christy Thomas

Patient

March 10, 2012

As are many clergy, I am a pastor who is deeply involved in the medical lives of many of my parishioners. Because of what I have seen, particularly but not exclusively with end-of-life issues, I found myself increasingly averse to engaging the medical system for my own health needs.

However, I could no longer ignore some troubling symptoms. With trepidation, I ventured in.

I have been referred by my primary care physician …

What medical education can learn from homeschooling

Anonymous

Medical Education

March 10, 2012

My wife and I met in medical school. Both of us went “straight through” from high school to college to med school. So, like most of you, we are as educated as it gets.

But when our daughter reached “school age,” we decided to homeschool her. My son, who is two years younger, followed in his big sister’s footsteps, so we are now homeschooling both of our children.

Unlike our traditional paths …

MKSAP: 45-year-old man with a mediastinal germ cell tumor

mksap

Conditions and Diseases

March 10, 2012

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

Seven years ago, a 45-year-old man was diagnosed with a biopsy-proven mediastinal germ cell tumor. The patient was treated with combination chemotherapy (bleomycin, etoposide, and cisplatin) and had a complete radiographic response. He has been disease-free since completing therapy, and follow-up serum tumor marker measurements, chest …

The medical exam wasn’t designed to engage patients

Steve Wilkins, MPH

Patient

March 9, 2012

Primary care physicians are the point of first contact that people like you and I have with a hospital or health systems. We are 13 times more likely to visit a primary care physician in any given year than we are to need a hospital stay.

Primary care physicians are very important. Yes they are they the first line of care for many people. The primary care physician’s office …

The limits of telephone medicine

Stewart Segal, MD

Physician

March 9, 2012

The problem with phone medicine is that you have to trust what you hear and act accordingly. Diagnosing an illness is a multi-dimensional process which incorporates four of the five senses. Phone medicine limits you to the use of only one, hearing, and relies on your patient’s ability to accurately describe what is happening on their end of the phone.

Patient’s mom: “My son is sick. He’s throwing up and has a …

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The limits of telephone medicine

Engaging employees to improve patient satisfaction

Donald Tex Bryant

Physician

March 9, 2012

W. Edwards Deming is recognized as one of the driving forces that led the Japanese in the 1950’s to become a world-class manufacturing nation. The Japanese through the implementation of his principals became leaders in the manufacture of automobiles and electronics. One of his cardinal principles was that a company must delight its customers. It is not enough for a company that wishes to excel to meet the needs and …

How to prep for a successful colonoscopy

Gottumukkala S. Raju, MD

Conditions and Diseases

March 9, 2012

If you really want to know what’s going on inside your colon, don’t show-up for a colonoscopy without a clean colon.

Many say that preparing for the colonoscopy is the worst part of the entire exam. But, it just so happens that it’s also the most important part.

If the prep is done right, it’s easier for your doctor to see not only big polyps but also flat polyps, which can be …

How do the elderly become more resilient?

Bobbi Emel

Patient

March 8, 2012

Several months ago while visiting my ninety-eight-year-old grandmother, I knelt down next to her chair and looked her in the eyes.

“Grandma,” I said with mock seriousness, “I think you’re finally getting old.”

She laughed. “Well, yes, I think I finally am!”

In some ways, I wasn’t kidding. My grandmother has always been active and fit, gleefully turning a somersault for her five-year-old great-grandson when she was seventy-five. Taking care of “the old …

Does leaving against medical advice stick patients with a bill?

John Schumann, MD

Physician

March 8, 2012

(All names and identifying features of characters in this story have been changed.)

Nora, a third year medical student, came to me in moral distress.

Ms. DiFazio, one of the hospitalized patients on her internal medicine rotation, was frightened to undergo an invasive (and expensive) medical procedure: cardiac catheterization.

The first year doctor with whom Nora was paired, Dr. White, vented to her:

“These patients come to us seeking our help and then refuse …

Plastic surgery as an economic indicator

Donald Brown, MD

Physician

March 8, 2012

Since the America Society of Plastic Surgeons (ASPS) released their 2011 plastic surgery statistics, I’ve seen a lot of talk online about how, “despite the economy,” plastic surgery numbers are rebounding from the lows they hit in 2007 and 2008. People say this as if plastic surgery is—against all odds—somehow rising above the general trends and setting unprecedented records.

I can see why it’s tempting to frame it that way—while the …