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A look behind the growing cost of cancer drugs

Medications

February 7, 2012

Julie Gralow, an oncologist at the Fred Hutchinson Cancer Center in Seattle, recently prescribed an exciting new therapy for a 60-year-old woman with metastatic breast cancer. Three-and-a-half years into her battle against the disease, the patient had already exhausted three different anti-estrogen therapies, each of which only put a temporary check on the spreading tumors.

The newly prescribed drug, Novartis’ Afinitor, is one of the recently approved targeted therapies that have …

Advice to prospective family medicine residents

Allen Perkins, MD

Medical Education

February 7, 2012

I don’t like selecting colleagues through the Match. The process was established to allow students to get the best opportunity available and I feel that our program (and our patients who rely on our trainees to provide care) is in jeopardy every year. It always turns out better than I anticipate, so I shouldn’t complain. However, we have to interview 60 prospective residents to fill our six slots so …

Are new technologies really the reason for rising health costs?

Stephen C. Schimpff, MD

Physician

February 7, 2012

Over the last four weeks I have written about new technologies and their coming impact on medical care. We generally think of new technologies (and new, branded drugs) as pushing up the cost of healthcare. There is truth to this contention, of course, but often the real problem from a cost perspective is inappropriate use. And this happens all to often in medical practice today because the physician does not …

How I approach ovarian cancer screening with patients

Kevin Pho, MD

KevinMD

February 7, 2012

Ovarian cancer screening clearly touches a nerve.

No one doubts that ovarian cancer is a devastating diagnosis, often found when the disease is at an advanced stage. Tests to look for the disease, such as the transvaginal ultrasound or the CA-125 blood test, are not specific enough. That leads to false positive tests that necessitate more studies that may not be …

Treating heart failure on a budget

Molly Kantor

Conditions and Diseases

February 7, 2012

As a third year medical student, I spent one afternoon each week at a health clinic at a community hospital affiliated with my medical school. This health clinic was focused on primary care for patients with HIV, and many of our patients were poor, homeless, immigrants, or uninsured. Many were also living with their diagnosis in secrecy and had to hide their medications and medical bills from family members.

One of …

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Treating heart failure on a budget

The pitfalls of email communication with patients

Robert Sadaty, MD

Health Technology

February 6, 2012

A recent article in the Wall Street Journal reviewed the emerging role of email in healthcare, arguing that doctors should more aggressively offer their patients the option to communicate with each other through email. Unlike other professionals in the United States, doctors have generally resisted the adoption of email into their practices. But according to the WSJ article, email can result in many benefits to both the doctor and patient. …

The fear of malpractice will always be in the back of my mind

Mandy Huggins, MD

Physician

February 6, 2012

“I wouldn’t hesitate to sue you.”

I’m sorry, what?

That is what I heard from the mother of one of my patients. I was evaluating a high school athlete who had recurrent stingers (nerve injury that affects an upper limb, usually resolves with time) and a possible episode of transient quadriparesis (affecting all limbs this time). I wasn’t on the sidelines for these injuries, so I had to go on the reports …

Why physicians may not buy into ACOs

Anonymous

Health Policy

February 6, 2012

I’m sure Ezekiel Emanuel hates being referred to as Rahm Emanuel’s brother, so I won’t describe him as such. After working as one of Obama’s main health care advisors, he’s now at U-Penn in a job spanning medicine, economics, and ethics. He’s also been writing engaging essays in JAMA about health care reform and economic change that give us an augur into where health care reform might lead us.

Here, …

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Why physicians may not buy into ACOs

Preparing for your visit with someone in hospice care

Linda Watson

Patient

February 6, 2012

Visiting someone who is dying or critically ill is an experience many of us will have in the course of our lives. Whether your visit is to be in the person’s home, a hospice or a hospital, there are a few rules of thumb to guide your time together so that it can be mutually satisfying.

This post introduces some of the basics.

1. Call ahead. Find out what prime visiting times …

MKSAP: 60-year-old woman with pruritic hives

mksap

Conditions and Diseases

February 5, 2012

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

A 60-year-old woman is evaluated for pruritic hives that have persisted for 12 weeks. The lesions appear, resolve within hours, and leave no residual mark but reappear at a later time. She does not associate the hives with any particular foods or exposures. Her medical history …

Hospice professionals have the heart of an amateur

Andy Milligan, RN

Physician

February 5, 2012

Most of us who work in medicine refer to ourselves as professionals and for good reason. Years of education, training, and experience make you the clinician you are. Hospice professionals in particular require a very special set of skills to care for patients and families. You are truly professional in caring for the whole person.

When it comes to sports there is a clear line of distinction between professionals and everyone …

ACP: Medical ethics should be a daily aspect of care

Fred Ralston Jr., MD and Lois Snyder, JD

Physician

February 5, 2012

A guest column by the American College of Physicians, exclusive to KevinMD.com.

Is medical ethics an important aspect of real world medical practice today? Or a quaint notion for the history books based on mom and apple pie generalisms?

For the patient and for the physician in practice, medical ethics is — or should be — a daily aspect of care. …

Why adoption of EHRs is a transformational event for physicians

Marilyn J. Heine, MD

Health Technology

February 5, 2012

Paul Conslato, MD, director of clinical affairs for Lancaster General Medical Group, recently was quoted in the PAMED Better Health Network eZine that the introduction of electronic health records is “the largest transformational event for physicians within the last 50 years.”

Fifty years is a long time and takes us back into the 1960s. Certainly, there have been plenty of changes in the practice of medicine since then. We’ve seen new …

How to avoid HMO gatekeeper problems in medical homes

Dave Chase

Health Policy

February 4, 2012

There’s a great deal of planning and testing of new models of care and delivery to respond to healthcare’s ever increasing costs. We’ve all heard about Accountable Care Organizations (ACO) and medical homes. The common concern is that they become a repeat of HMOs with the accompanying misaligned incentives undermining their effectiveness. An exciting new medical home model is rapidly expanding that avoids the dreaded “gatekeeper” that was the undoing of …

Susan G. Komen and the politics of women’s health care

Dominic A. Carone, PhD

Physician

February 4, 2012

Despite the adversarial political climate that divides so many Americans, there are some topics that most people can agree on regardless of politics. One of those is that early detection and screening for cervical cancer and breast cancer are important initiatives that should be supported because early detection leads to earlier treatment which, in turn, saves lives. While many women have such exams paid for by their health care insurance, …

Patient preferences may not be rational, but they are not irrelevant

David B. Nash, MD, MBA

Health Policy

February 4, 2012

Everyone in our industry — policymakers, clinicians, healthcare facility administrators, public and private payers, technicians, pharmacists — shares concerns about the state of healthcare in the U.S., each of us from a slightly different viewpoint.

The thread that joins us all is that one day each of us will be a patient.

As its title suggests, patients are central to almost every provision of the Patient Protection and Affordable Care Act (Act), …

Why we need to go from e-patient to i-patient

Jackie Fox

Patient

February 3, 2012

I found a recent Associated Press article on an aspect of the new health care law that many of us may have overlooked. It requires consumer-friendly summaries of what insurance plans cover, a provision that now seems to be at risk. The insurance industry is up in arms about implementation costs and added regulatory burdens. (There’s a good story at NPR, which includes a link to an example of what …

Identical twins with different ideas about health care

Anonymous

Health Policy

February 3, 2012

Jack and John are identical twins but have varying interests in life. One day Jack, 43 years old, decides he has had enough of these headaches and calls his family doctor and asks what he should do. He is told that his doctor can see him in 4 days and to take some over-the-counter ibuprofen. And to go to the ER if the headaches worsen.

John, who has also been having …

Experiencing an uninvited gift

Carlene Oleksyn

Physician

February 3, 2012

It’s been five years since she was told she was cancer free. Today she was told it was back, and the future was quite grim.

My job was to make sure she understood how to properly take the medication that would reduce the swelling around the tumor so radiation could start as soon as possible.

That was my job. Clinically speaking it wasn’t the most challenging or difficult issue of the day as I …

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Experiencing an uninvited gift

How the CA-125 became a $50,000 blood test

Keith Marton, MD

Conditions and Diseases

February 3, 2012

What could be so simple as a blood test?

A quick prick with a needle, a wait of a day or two for results and a discussion with the doctor about those results. In the words of our vaunted politicians, it would be an “up or down vote” on whether there was anything to deal with.

That was the thinking of my wife’s physician when she ordered a test called the “CA-125.” …