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A disconnect between medical resources and health care delivery

Health Policy

November 25, 2011

Imagine what health care in the United States could look like if we devised a system that was based on sound medical practice and proven cost effectiveness. What if we put our brains, energies and passion behind designing the smartest health care system possible?

That was the question that kept poking through my train of thought as I read a study that appeared in the most recent issue of Pediatrics, the …

I will never be the physician that my father was

Aaron E. Carroll, MD

Physician

November 25, 2011

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Let me start by saying that I love my father dearly. We have an excellent relationship, and talk regularly. So there’s no bitterness in this post, nor any desire to engage in armchair psychology.

My father, now retired, was a general and thoracic surgeon, who was triple-boarded in critical care, and ran a trauma unit in inner-city Philadelphia. He was in private …

Grief takes no holidays

Karen S. Sibert, MD

Physician

November 24, 2011

The glittering commercialism and noisy cheer of the holiday season can be stressful for any of us. But for the parent who’s lost a child during the past year, facing the first Thanksgiving and Christmas with an empty place at the table can make already unbearable grief so much worse.

No one in modern America expects a child to die. Children only die in nineteenth century novels and third-world countries, or …

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Grief takes no holidays

Living with chronic illness during the holiday season

Toni Bernhard, JD

Patient

November 23, 2011

In the U.S., we’re getting ready to celebrate Thanksgiving. Soon, people around the world will turn their attention to the holiday season. Chronic health problems can take a toll on relationships any time of the year. Most people have to experience unrelenting pain or illness themselves before they understand how debilitating it is, physically and mentally. Loved-ones (by whom I mean family and close friends) may be in some form …

The culture of medicine needs to change

Sharon Bahrych, PA-C, MPH

Physician

November 23, 2011

I’ve been involved in clinical medicine for more than 20 years and during this time I’ve come across numerous situations that created stress, or emotional upheaval within myself, and even times of burnout. At one point, I came close to permanently leaving my chosen profession. The culture of medicine is not geared towards allowing health care providers to de-stress, acquire emotional support, or discuss in an encouraging environment various conflictive …

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The culture of medicine needs to change

Pancreas cancer: Exposing the silent killer

Daniel Labow, MD

Conditions and Diseases

November 23, 2011

November is Pancreas Cancer Awareness Month and with the recent passing of Patrick Swayze and Steve Jobs, now is as good a time as ever to educate ourselves about this deadly disease. Almost 40,000 people per year will die of this disease in the U.S., making it the 4th most common cancer killer. It is through education and research that we can continue to improve survival and outcome …

Teaching clinicians the teach-back for patient education

Darren A. DeWalt, MD, MPH

Patient

November 23, 2011

I’m a big fan of the teach-back. To my knowledge, it is the only way to confirm that my patient understands my message. I don’t believe avoiding jargon or creating written materials at a favorable readability level can ensure understanding. So, I’m always left with uncertainty until my patient teaches it back to me.

I’ve been teaching clinicians to do the teach-back for about a decade now. For the same amount …

Expecting doctors to be perfect is a setup for dysfunction

Dave deBronkart

Patient

November 22, 2011

Science seeks certainty. The problem in medicine is, the body is complex and our knowledge is incomplete. People who want certainty – physicians or patients – are kidding themselves. And if we expect docs to be perfect, it’s a setup for dysfunction.

Sometimes I hear of patients who believe their physicians dissed a proposed or experimental treatment that’s not understood. (I’m not endorsing wacky treatments here – I’m only talking about uncertainty.) …

ACP: What’s a small group practice to do?

Fred Ralston Jr., MD

Health Policy

November 22, 2011

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

In 1998 I started a period of national service to the American College of Physicians leading to my term as President for 2010-2011. During that time I kept an almost full time private practice in Fayetteville, Tennessee. Moving between the worlds of health policy and “the trenches,” I …

Useless thought experiments during medical school and residency

angienadia, MD

Physician

November 22, 2011

I recently admitted a patient with a pulmonary embolism. Before heparin drip was started, my attending ordered a hoard of eccentric, non-indicated hypercoagulable workup in the hope of avoiding the effect of heparin on these test results, including phosphatidylserine antibody and methylenetetrahydrofolate reductase DNA. I watched in horror as the nurse drew out approximately 13 tubes of blood, since each test needs its own tube.

On rounds, the attending of course …

Choosing a doctor should be like the Amazon shopping experience

Nick Dawson

Patient

November 22, 2011

Have I told you how much I love Amazon? Its the awesome! Let’s say I need something – an external hard drive. So I go to Amazon and I type in “external hard drives.” Boom. I get a list of, not surprisingly, external hard drives. Which one do I chose? Fortunately, Amazon has some great data and filtering options. I want a desktop drive, not portable, so I filter those out. …

EHR adopters give advice to those considering electronic medical records

Peter J. Polack, MD

Health Technology

November 21, 2011

Our practice went live with our own EMR system in late 2008. For the most part, this was uneventful. The reason for this was mainly due to proper planning. And credit for our implementation plan goes primarily to our administrator, our IT director, and staff members of our appointed EMR committee. Although some of the physicians were an integral part of the committee, we tried our best not to micromanage …

What happens if the Supreme Court strikes down the individual mandate?

Brad Wright, PhD

Health Policy

November 21, 2011

Any ruling by the Supreme Court on the constitutionality of the Affordable Care Act’s controversial individual mandate isn’t likely for at least another several months, but it’s worth thinking about what might happen after the case is decided. The first scenario is easy: If the Court upholds the mandate, the ACA goes forward as planned to the continued objections of many conservative Americans and politicians. The second scenario is less …

Back to school fatigue can be caused by environmental allergies

Sakina Shikari Bajowala, MD

Conditions and Diseases

November 21, 2011

Back to school. Kids get back into a routine, and mom gets her life back, right? Wrong. For most moms, back to school is anything but relaxing. However, for some of us, it’s even more tiring.

Is this the time of year when you struggle to drag yourself out of bed, despite hitting the sack as soon as you put the kids down for the night?

Is your focus during the day …

Changing the incentives in the operating room

Nicholas Fogelson, MD

Physician

November 21, 2011

Last year I wrote about a few strategies for decreasing costs in the operating room. Since being in fellowship operating many days per week, I’ve come up with a new idea, this time a bit more radical.

In Freakonomics, Leavitt and Dubner posit that in all things, human beings respond to incentives. If you want to understand human behavior, all you have to do is identify the incentives that drive …

Protecting patients from medical apology programs

Gabriel H. Teninbaum

Patient

November 20, 2011

To deal with the aftermath of medical errors, an increasing number of providers are encouraging injured patients to participate in “medical apology programs.” The idea, proponents say, is for patients to meet with facility representatives to learn what happened and why. It gives the patient a chance to ask questions and it gives providers a chance to apologize, and as appropriate, offer compensation. These programs are promoted as humanitarian, and, …

Looking back at how primary care has changed

Robert H. Gifford, MD

Physician

November 20, 2011

It is almost impossible for me to believe that my views on primary care in the United States have changed so radically in fifty years. When I graduated from medical school in 1961, I was determined to become a primary care doctor. I completed residencies in both medicine and pediatrics to prepare for a career as a general physician in rural Vermont. That dream was put on hold by an …

It’s only through humility that we can achieve great things

Claire McCarthy, MD

Physician

November 20, 2011

My 6-year-old son is really farsighted, and I had no idea. I completely missed it.

To be fair to me and my husband, the ophthalmologist (the esteemed and wonderful Dr. Hunter of Children’s Hospital Boston) said that Liam was compensating really well. And until his yearly checkup last month, he had been passing vision tests (which mostly test for nearsightedness). But in retrospect, there were signs we didn’t pay attention to. …

Patient safety requires hospital leaders to take personal responsibility

Paul Levy

Health Policy

November 20, 2011

A quality-driven MD colleague writes with frustration about two problems in his academic medical center. I often hear similar comments from nurses and doctors, and so I present the examples for your consideration.

This hospital has a poor record with regard to hand hygiene (in the 30% range), and my colleague suggested at an infection control meeting suggested that the rates be publicly posted in the hospital to provide an impetus for …

In Kenya, operating in our comfort zone

Bruce Campbell, MD

Physician

November 19, 2011

“Traveling makes one modest – you see what a tiny place you occupy in the world. ”
-Gustave Flaubert

We have come to Kenya, expecting to work outside of our “comfort zones.”

Our patient has arrived from miles away, riding on the back of her husband’s bicycle. She has an enlarging, bleeding mass growing off of the side of her neck. There are no pathologists available, so we are uncertain what kind of tumor …

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In Kenya, operating in our comfort zone

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