KevinMD.com

Patients are not the customer

Stephen C. Schimpff, MD

March 13, 2012Mar 13, 201219

Ever been put on hold when calling your insurance carrier? Or had so little time with your physician that you could not discuss everything you thought was important? Our care is generally good in the United States but not as…

Ever been put on hold when calling your insurance carrier? Or had so little time with your physician that you could not discuss everything you thought was important?

Our care is generally good in the United States but not as good as it could be nor as good as it should be. There are multiple problems to consider.

First, ours is a medical care system not a health care system. It is …

Patients are not the customer

Patient voices

Who do you blame for the success of The Heart Attack Grill?

Dominic A. Carone, PhD

March 13, 2012Mar 13, 20127

If you go to Las Vegas, one of the many restaurants you will encounter is the Heart Attack Grill. It is probably the most extreme and unhealthy place to eat in the United States and deliberately courts controversy with its…

If you go to Las Vegas, one of the many restaurants you will encounter is the Heart Attack Grill.

It is probably the most extreme and unhealthy place to eat in the United States and deliberately courts controversy with its use of extreme menu item names, unusual promotions, and unique themes. An example of the extreme food names include Flatliner Fries (French fries made with pure lard), Butterfat Shakes, and the …

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How primary care is sold down the river

Jordan Grumet, MD

March 13, 2012Mar 13, 201210

Dr. Lake used to be a businessman. His books were clean and orderly. His staff was efficient and kind. He steered his ship agilely through troubled waters and still managed to provide the highest quality care. His was not only…

As the political climate changed, Dr. Lake became more distressed concerning his situation. His overhead was increasing and the regulatory culture was expanding. …

How primary care is sold down the river

Health technology

Cardiac device patients should lead patient portal adoption

David Lee Scher, MD

March 13, 2012Mar 13, 2012

I have previously focused on issues specific to patients with implantable cardiac rhythm devices who deserve to access their device’s own data directly via patient portals or PHRs. What I would like to suggest is that if this PHR becomes a reality soon, that it will lead to widespread adoption of patient portals in general. Remote monitoring of implantable cardiac rhythm devices was the first widespread use of remote …

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

Karen S. Sibert, MD

March 12, 2012Mar 12, 201212

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 …

American Medical Association & Peter W. Carmel, MD

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

March 12, 2012Mar 12, 20129

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…

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 make a difference. Since November, the AMA has been working …

Rethinking care delivery and payment models with nimble medicine

Dave Chase

March 12, 2012Mar 12, 20125

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…

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

March 12, 2012Mar 12, 201227

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 …

American Society of Anesthesiologists & Kelly McQueen, MD, MPH

ASA: The global anesthesia crisis in low-income countries

March 11, 2012Mar 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…

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, as well as for acute and chronic pain, is nearly absent in many …

Strategies to prevent physician burnout

Kevin R. Campbell, MD

March 11, 2012Mar 11, 20124

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…

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 …

Strategies to prevent physician burnout

Conditions and diseases

Fat kills, and 2 other obesity myths

Maggie Mahar

March 11, 2012Mar 11, 20124

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…

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 …

Fat kills, and 2 other obesity myths

Conditions and diseases

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

mksap

March 11, 2012Mar 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…

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

March 10, 2012Mar 10, 20127

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 …

The gamble of the ACO monopoly game

Patient voices

The vulnerability of patients needs to be respected and honored

Rev. Christy Thomas

March 10, 2012Mar 10, 20125

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…

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

I have been referred by my primary care physician …

Medical education

What medical education can learn from homeschooling

Anonymous

March 10, 2012Mar 10, 201235

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…

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 …

Conditions and diseases

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

mksap

March 10, 2012Mar 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,…

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 …

Patient voices

The medical exam wasn’t designed to engage patients

Steve Wilkins, MPH

March 9, 2012Mar 9, 201211

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…

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

March 9, 2012Mar 9, 20124

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 …

The limits of telephone medicine