KevinMD.com

April 3, 2012Apr 3, 201220

If Dr. Ezekiel Emanuel gets his wish, tomorrow’s physicians won’t deserve to be paid as well as physicians today because they won’t be as well trained. Dr. Emanuel, a brother of Chicago Mayor Rahm Emanuel and a chief apologist for…

If Dr. Ezekiel Emanuel gets his wish, tomorrow’s physicians won’t deserve to be paid as well as physicians today because they won’t be as well trained.

Dr. Emanuel, a brother of Chicago Mayor Rahm Emanuel and a chief apologist for the Affordable Care Act, is the lead author of a startling opinion column in the March 21 Journal of the American Medical Association. He argues that there is “substantial waste” in …

Physician voices

Why more colonoscopies need anesthesiologists

Skeptical Scalpel, MD

April 2, 2012Apr 2, 20126

Using data from Medicare and private insurers, analysts at the RAND Corporation found that the rate of involvement of anesthesiologists for upper GI endoscopy and colonoscopy in low-risk patients had risen steadily over the last few years and is estimated to add $1.1 billion in what may be unnecessary health care costs. There was wide regional variation in the use of anesthesiologists which suggests that some or most of the …

Health policy

Is medicine a science?

Jan Henderson, PhD

April 2, 2012Apr 2, 201217

Here’s something I read recently in a blog post (The Limits of (Neuro)science at Neuroskeptic) that started me thinking: "Will science ever understand the brain? … The notion that humans are complex and hard, while nature is easy, is an…

Here’s something I read recently in a blog post (The Limits of (Neuro)science at Neuroskeptic) that started me thinking: “Will science ever understand the brain? … The notion that humans are complex and hard, while nature is easy, is an illusion created (ironically) by the successes of reductionist science. Some of the biggest questions facing mankind for eons have [been] answered so well, that we don’t even …

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Is medicine a science?

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Social media in medicine

Why I’m not hiding social media from residency interviews

Danielle Jones, MD

April 2, 2012Apr 2, 20124

As Match Day for the Class of 2012 quickly fades into the background and residency applications for my class begin to appear on the horizon, I find my classmates starting to disappear from Facebook and other socially-oriented websites. "Are you…

“Are you taking your blog down for application and interview season?” someone innocently asked, “I mean, some program directors just may not appreciate the social media involvement as much as you do.”

The question, …

Medical education

The cutthroat pre-med culture needs to change

Roheet Kakaday

April 2, 2012Apr 2, 201215

I eyed my chat screen with a good amount of suspicion. A friend of a friend who I had rarely spoken to had initiated a chat conversation with me with the opening line “How are medical school apps going?” The…

I began to think about possible ulterior motives that she, another pre-medical student, could have had. Perhaps she just wanted to use me as a comparison for …

Health policy

Disruptive changes are coming to the delivery system

Stephen C. Schimpff, MD

April 2, 2012Apr 2, 20127

More chronic illnesses, more diseases of old age, consumers demanding more quality and safety, physicians no longer in typical private practice, and high deductible health care polices are each about to cause major changes in the practice of medicine and…

Health care delivery will change substantially in the coming years. This is …

Physician voices

The problem of regulatory oversight and ICD implantation

John Mandrola, MD & Wes Fisher, MD

April 2, 2012Apr 2, 2012

Slightly over a year ago, the Department of Justice (DOJ) launched an investigation of a large number of institutions regarding concerns that implantable cardiac defibrillator (ICD) procedures were performed for reasons outside of the criteria set forth in Medicare’s National Coverage Decision (NCD). This investigation occurred just after Al-Khatib and others published a report January 4, 2011 in JAMA that suggested as many as 22.5% of implantable defibrillators implanted …

Physician voices

Christopher Hitchens and the universal experience of dying

Christian Sinclair, MD

April 1, 2012Apr 1, 20124

Christopher Hitchens, noted author and philosopher, died December 15, 2011 leaving behind many essays, books, and other writings as well as contributing to several lectures, ethics/religion debates, and TV talk shows. His acerbic style often ruffled feathers as he attacked…

As one of the most famous outspoken atheists of this era, his thoughts on being diagnosed with an incurable disease would be a powerful insight into how atheists might approach …

Health policy

Will physicians ever support the Affordable Care Act?

Colin Son, MD

April 1, 2012Apr 1, 20124

A recent survey by Deloitte of physicians opinions on health care reform has drawn some very differing conclusions from partisan commentators. The 501 physicians answered a number of questions, the most notable of which included a dichotomous question on whether…

A recent survey by Deloitte of physicians opinions on health care reform has drawn some very differing conclusions from partisan commentators.

The 501 physicians answered a number of questions, the most notable of which included a dichotomous question on whether the Affordable Care Act was “A good start” or “A step in the wrong direction.” The question was split 44% to 44%. All respect for Mr. Pollack and Dr. Murthy writing …

Health policy

The basic health needs of most Medicare patients left behind by design

Robert Bowman, MD

April 1, 2012Apr 1, 20122

Medicare needs to cut costs. It has chosen methods to cut costs that will damage the basic health care services needed by most Medicare patients. And instead of calling this cost cutting, it uses terms such as “shared savings.” Even worse, the “shared savings” will result in even less health spending in United States locations that already have lowest health spending. Innovative designs are not the problem. The problem is …

Physician voices

How to discuss online health information with your physician

Natasha Burgert, MD

April 1, 2012Apr 1, 20124

Two articles recently caught my eye while I was spending some time on Twitter. First, an op-ed piece was published on Time.com discussing how patients and doctors perceive the use of the online health information. The article was closely followed…

Two articles recently caught my eye while I was spending some time on Twitter. First, an op-ed piece was published on Time.com discussing how patients and doctors perceive the use of the online health information. The article was closely followed by the results of a recent PEW research study which stated that 80% of Americans used the internet to “prepare for or recover from” their doctor visit.

The results of …

Conditions and diseases

MKSAP: 36-year-old woman with a history of migraine

mksap

April 1, 2012Apr 1, 2012

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 36-year-old woman is evaluated in the office for a history of migraine, with and without aura, since age 16 years. She has an…

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

A 36-year-old woman is evaluated in the office for a history of migraine, with and without aura, since age 16 years. She has an average of three attacks each month and consistently experiences an attack 2 days prior to menstruation; this headache is more difficult to …

Physician voices

Keep statistics simple for primary care doctors

Steven Reznick, MD

March 31, 2012Mar 31, 2012

An article and editorial have appeared in the Annals of Internal Medicine demonstrating that primary care physicians do not understand simple statistical data presented to them regarding screening tests for cancer. The consequences, as outlined in an editorial written by…

An article and editorial have appeared in the Annals of Internal Medicine demonstrating that primary care physicians do not understand simple statistical data presented to them regarding screening tests for cancer. The consequences, as outlined in an editorial written by a former chairperson of the much maligned Institute of Medicine, is that primary care doctors are over-using cancer screening tests because they do not understand the statistical ramifications and conclusions …

Physician voices

Doing the wife’s tummy tuck

John Di Saia, MD

March 31, 2012Mar 31, 20122

One fine fall morning last year my wife turned to me and said: "I want a tummy tuck. There are no rules against you doing that for me are there?" We had talked about tummy tuck surgery for her several…

One fine fall morning last year my wife turned to me and said: “I want a tummy tuck. There are no rules against you doing that for me are there?”

We had talked about tummy tuck surgery for her several times over the years. She had had a gastric bypass a decade before we had met and was a pretty good candidate. No cigarettes. Well she did have a few surgical …

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Doing the wife’s tummy tuck

Patient voices

When patients are my greatest teachers

Carlene Oleksyn

March 31, 2012Mar 31, 20124

I had a patient once. Her name was Alice (not her real name). Alice was in her mid-thirties, diabetic, had chronic pain, high blood pressure and was an alcoholic. She lived on Kuper Island which was just a short ferry ride from the small pharmacy I managed in Chemainus, British Columbia. Alice would come in every month or so to see me for her medication, go over her blood sugar results, take her blood pressure. …

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When patients are my greatest teachers

Health technology

Doubting the cost savings of health information technology

Jennifer Shine Dyer, MD, MPH

March 31, 2012Mar 31, 201211

A recent Health Affairs article casts doubt on the cost-saving prospects of health information technology despite the significant investments made by hospitals, physicians, and the federal government to promote electronic records. Reduced ordering of imaging and other diagnostic studies by…

A recent Health Affairs article casts doubt on the cost-saving prospects of health information technology despite the significant investments made by hospitals, physicians, and the federal government to promote electronic records.

Reduced ordering of imaging and other diagnostic studies by physicians is often cited as a likely mechanism for estimated cost savings due to health information technology. Possible mechanisms include reduction in redundant (duplicated) tests secondary to better access to …

Physician voices

Why full code should not be the default status for patients

Anonymous

March 30, 2012Mar 30, 201211

Full code is the universal default status for patients who haven’t chosen otherwise, but I suspect most physicians believe this policy is wrong. We know in our hearts we’re doing harm when we perform CPR on poor souls at the…

Appropriately timed end-of-life discussions are the supposed answer, but for doctors, they are emotionally draining, interpersonally complex, and …

Health technology

Small opportunities to use mobile technology in medicine

Karim Jessa, MD

March 30, 2012Mar 30, 20122

As citizens of the 21st century, we seem to have adapted personal technology for every conceivable use -- Siri, the iPhone’s newest darling, can literally remind us to call a proctologist. But as physicians, we may be missing some of…

As citizens of the 21st century, we seem to have adapted personal technology for every conceivable use — Siri, the iPhone’s newest darling, can literally remind us to call a proctologist. But as physicians, we may be missing some of the best opportunities to derive “meaningful use” from technology.

I am an emergency physician, and a few nights ago I worked a shift in the ER. It was a typical, …

Health policy

Should family physicians leave the RUC?

Brian Klepper, PhD

March 30, 2012Mar 30, 201213

Last June the American Academy of Family Physicians (AAFP) sent a letter to the AMA’s Relative Value Scale Update Committee (RUC) demanding specific changes to the ways that the RUC conducts its business. Primary care has been severely compromised by the RUC’s recommendations, and there was an implicit threat that the nation’s largest medical society would withdraw if the demands were ignored.

I co-authored a Kaiser Health News article in …

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Should family physicians leave the RUC?

Physician voices

Doctors need to find meaning in their work

Sudeep S. Sodhi, MD

March 30, 2012Mar 30, 20127

"It is getting worse everyday." "Medicare fix at the last moment." "Too much paperwork not enough time with patients." "ACO’s and bundling." The headlines scream at us everyday. If we have one word that underlies the medical community it is…

“It is getting worse everyday.” “Medicare fix at the last moment.” “Too much paperwork not enough time with patients.” “ACO’s and bundling.” The headlines scream at us everyday.

If we have one word that underlies the medical community it is fear.

The looming uncertainties of reimbursement, insurance changes, electronic medical records and new regulations form the main topic of doctor worry talk. The country’s health system remains in perpetual flux and catching …

Real physician voices, twice a week

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