We understand the problem: the VBAC (vaginal birth after cesarean) rate is too low. It’s time for a bold solution. We need a “VBAC Court.”
VBAC is a safe option for most women, and almost 3/4 of women who opt a VBAC will deliver vaginally and avoid another C-section. But we also know that approximately 0.8% of women attempting VBAC will end up with a ruptured uterus, a catastrophic complication …
Sexual harassment in the workplace is an important topic to discuss, one that is all too often swept under the rug. I recently had an uncomfortable encounter with a clinician in the doctor’s lounge – I work at many hospitals so think I can say this pretty anonymously. He introduced himself, and asked me immediately if I was married. The way he did it – body language and demeanor, mostly …
Sexual harassment in the medical workplace
Running a medical blog has become much more challenging over the years. It has always been understood by medical and health care bloggers that you should never post information that violates a patient’s privacy. In other words, do not post patient’s names, photographs of patients, or any other information that can specifically be used to identify them.
However, changing patient demographics and limiting the information discussed such that the patient …
The limitation of blogging about patients
The art of practicing medicine is dying, soon to be replaced by the art of template medicine.
Modern medicine is based on laudable terms: “quality,” “outcomes,” “cost effective,” and “evidence based medicine,” which all sound good when sold in infomercials to the medical world and public. When examined closely, all are vague and open to abuse.
Each of these terms is intent on taking the human factor out of medicine. Each …
The art of practicing template medicine
Here are my next two principles of affordable healthcare reform.
First, healthcare reform cannot occur without tort reform. Anything less is akin to a drunk leaning up against a lamppost for support but insisting it is for illumination.
It is well known that fear of malpractice suits accounts for defensive medicine; e.g., performing tests and procedures and making unnecessary referrals to assure staying out of the court room. We are all …
Tort reform and integrated systems in health reform
Some have argued that there is an innate conflict between faith and science. I am not sure that is so. Not only do the two seem to co-exist; but to my mind, they may even be synergistic.
A few months ago, at Schwartz rounds, a case of a pregnant patient who was being given chemotherapy was presented. When the nurse …
Science makes me a better doctor, faith makes me a better person
Under current guidelines from the American Stroke Association, tissue plasminogen activator (tPA, commonly known as a “clot buster” drug) should be administered within 3-4.5 hours of “last seen normal” – and 1 hour of patient arrival – to potentially ameliorate a new onset stroke. (“Last seen normal” means exactly what it says. A patient who went to bet at 10 PM and awoke with slurred speech at 6 AM was …
tPA is the standard of care for stroke but with significant risks
Groupon and other similar social sites, like Living Social and CoupTessa, are all the rage now. But is it legal for doctors and dentists to advertise their services on these websites?
Groupon is a deal-of-the-day website that features discounted gift certificates usable at local or national companies. If a certain number of people sign up for the offer, then the deal becomes available to all; if the predetermined minimum is not met, no one …
As I greeted my next patient of the morning, I knew from the early folder number that I had seen him six or seven years before. I no longer expect to remember everyone I have ever met professionally. The man before me was tall, fit and well built. There is usually some inkling of recognition, but nothing about him was familiar to me at all.
We made small talk for some …
The rewards of medicine can be overwhelming
It is my strong contention that patients facing cardiac surgery should choose an institution, not a particular heart surgeon. Although individual judgement and technical dexterity are obviously important, best surgical outcomes reflect the performance of many medical providers before, during and after the operation. Professionalism and a competitive business environment both stimulate open heart centers to continuously focus on quality assurance programs to improve patient safety. Also, continuing medical …
Cardiac surgery is a team sport
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 60-year-old man with type 2 diabetes mellitus and hypertension visits the office to establish medical care. He reports monitoring his blood pressure and blood glucose measurements at home with good results. He had a cholesterol panel checked approximately 5 years ago, at which time he …
MKSAP: 60-year-old man with type 2 diabetes mellitus and hypertension
On the theme of knowing when and when not to follow the diktats of emergency medicine, one of the greatest challenges for a practicing ER doc is chest pain. Missed MI is still the biggest driver of malpractice costs, and last I hear, ER docs still send home something like 2% of patients who are having MI or unstable angina. Not good. So over the last decade we’ve gotten all …
Chest pain is where protocol driven medicine breaks down
Of all possible times, it happened during Ramadan. The test of faith would be extreme.
Azka was the first of four children born to Persian parents in a small town thirty miles outside of Tehran, Iran. Being devout Muslims, her father chose the name Azka in part because it meant “pious”. His wife later revealed to Azka that he also liked how the name rolled off the tongue when spoken in …
A test of faith during Ramadan
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It’s become one of those trendy phrases, “unnecessary care.” When you hear it on television or talkshow radio it’s usually said with a sneer. Indeed, the speakers almost spit the phrase out — “unnecessary care” — like it tastes bad. It’s almost always accompanied by “fraud and abuse,” or a not so subtle accusation that some doctor is profiting off this unnecessary care at the expense of some poor …
What exactly is unnecessary care?
“U.S. Panel Says No to Prostate Screening for Healthy Men” was the title of an article on the front page of the New York Times on October 6, 2011. The article goes on to suggest that healthy men should no longer receive a PSA blood test to screen for prostate cancer because the test does not save lives over all and often leads to more tests and treatments that needlessly cause pain, impotence and incontinence …
A urologist responds to the new prostate cancer screening guidelines
I see this as a glass half-full, glass half-empty issue. Recently, a study was published in Pediatrics detailing research conducted in May of 2010 about parents’ preferences to use alternative vaccination schedules versus following the recommended CDC vaccination schedule. The majority of the media coverage focused on the finding that over 10% of parents followed a schedule other than the one recommended by the CDC. Not perfect and not ideal …
Do most parents use the alternative vaccine schedule?
As Occupy Wall Street has gone from an obscure protest covered only on blogs and social media to a national phenomenon, the apparent parallels between the issues it is raising and the issues we have been raising in health care grows.
A growing number of protesters are calling themselves the “99 Percenters,” referring to those who are not in the top 1% of earners. The top 1% of income is clearly greater than $250,000 per year, and likely …
Why 99 percent of health care should be angry
A guest column by the American Medical Association, exclusive to KevinMD.com.
There are several upcoming deadlines that are critical to physicians who care for Medicare patients. November 1, November 23 and January 1 are dates that should be marked on all of our calendars.
The deadline for physicians to apply for a hardship exemption in order to avoid the 2012 Medicare ePrescribing penalty …
AMA: Act quickly on Medicare deadlines
In the past decade, the incidence of diabetes in the U.S. has nearly doubled – this is due in large part to the obesity epidemic. Currently, it is estimated that the lifetime risk of developing diabetes is around 1 in 3 for males an 2 in 5 for females born after 2000. When you consider that type II diabetes has a strong genetic component – the risk for a …
Steps you can take to prevent developing diabetes
Suffice to say, as a physician, I’m not germ phobic. If I were, I wouldn’t work as a health care provider in the “culture media” of an ambulatory care clinic. I certainly respect the pathogens I come in contact with daily, along with the host who harbors them. For the most part, the virus and the patient know I don’t have much effective artillery to fight back with and my …
Handshakes during viral outbreaks
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