KevinMD.com

Can I do residency again in a better rested environment?

Medical Education

October 13, 2011

“How are residents supposed to prepare for real life as a surgeon if they can’t even work twenty-four hours straight now?”

I hear this complaint about once a month from a someone trained in the Golden Age of hazing. Outside of anecdote, we’ll never know if surgeons are better trained now or twenty years ago, or fifty. But it’s too painful to imagine every-other-night-call wasn’t of critical importance.

Residency resembles the …

Use body language to improve your patient encounter

Niamh van Meines, ANP-BC, EMT

Patient

October 13, 2011

While body language can be interpreted in many ways and it’s not an exact science, it is often possible to read body language and have a basic understanding of a persons mood or dispositions and the rapport that people have with each other through observing non-verbal communication. This issue focuses on reading everything that hands can tell you and ways to use your hands to influence interactions with others.

What’s …

Inspiration for new primary care doctors

Edward J. Volpintesta, MD

Physician

October 13, 2011

Congratulations! You are an amazing group of young men and women. In college, medical school and residency your dedication and discipline, but most of all your idealism helped you to persevere and conquer some difficult challenges. In college, your friends studying philosophy and literature and history wondered how you had the endurance to study biochemistry and organic chemistry and calculus. Not to mention the Krebs Citric Acid Cycle.

You studied hard …

Why Dr. Oz is wrong about arsenic and apple juice

Roy Benaroch, MD

Patient

October 13, 2011

The Dr. Oz show recently featured a scary show about deadly arsenic in apple juice. On his own web site, he trumpets “Dr. Oz’s Extensive National Investigation,” and claims “After testing dozens of samples from three different cities in America, Dr. Oz discovered that some of the nation’s best known brands of apple juice contain arsenic.”

His show further claimed that based on his independent testing, many brands of apple juice …

The decision not to become a surgeon

Jim deMaine, MD

Physician

October 12, 2011

Every medical student goes though a process of elimination when deciding what kind of doctor they want to become. We hear the old saying, “Internists know everything and do nothing; Surgeons know nothing and do everything; Psychiatrists know nothing and do nothing; Pathologists know everything and do everything but it’s too late.” We hear that pediatricians wear bow ties, are short, and love to laugh and play; that surgeons …

Read more…

The decision not to become a surgeon

What does the Explanation of Benefits really mean?

David Williams

Patient

October 12, 2011

I recently had some physical therapy for a minor injury. Since the office forgot to charge my co-pay the first time I went in I received a so-called Explanation of Benefits (EOB) from my insurance carrier, BlueCross BlueShield of Massachusetts. EOBs are a holdover from the mainframe era: arcane, inflexible reports that are hard to interpret. They may have done their job in the day when their only purpose was …

The life of a medical resident in Mexico

Cesar Lucio, MD

Medical Education

October 12, 2011

The average week for a medical resident training in Mexico can easily exceed 90 work hours. Mexico is a country that takes pride in offering full health coverage for 100 million citizens. This is a new policy and free public medical care is being pushed to the limit. The situation is simple, the work load in outpatient clinics, operating rooms, the wards and emergency rooms across the country is …

The United States lacks postpartum support for mothers

Rajka Milanovic Galbraith, MD

Patient

October 12, 2011

Last month, vegan couple Jade Sanders and Lamont Thomas’ appeal of their life in prison sentence was overturned. The couple reportedly starved their 6 week old to death by feeding him only soymilk and apple juice. When reading this, so many questions arise. How could they not know their child was starving? Where was their support? Were they truly negligent? And what happened to all the systems in place to protect children?

In an …

The impact of unnecessary testing and treatment on patients

Brian Goldman, MD

Physician

October 11, 2011

Ask most patients, and they say their doctor has a good reason for ordering tests and prescribing treatments. Turns out their doctor may secretly disagree. That’s the conclusion of a new study. The implications are more than a bit disturbing.

Researchers from the Dartmouth Institute for Health Policy conducted a survey of more than six hundred physicians. Forty-two percent of family doctors admitted that patients in their own practice receive too much care – meaning …

Our easy access to imaging has led to overutilization

Raag Airan, MD

Health Policy

October 11, 2011

With all the debate about cost control, it’s clear that we doctors will have to police ourselves – or else politicians and insurance companies will exert even more influence over our practices than they already do. The main question is:

Are we willing to let our physician colleagues exert influence on our care decisions?

Taking a case from my field: at a conference this past week I met a radiology resident …

Hospital discharge summaries are a health literacy issue

Hilary Seligman, MD

Patient

October 11, 2011

A couple of years ago, a frail 88 year old Filipino woman came into the emergency department of my hospital complaining of confusion and weakness of her left arm. Her blood sugar level was extraordinarily low, so low that she would have died had she not received immediate treatment.

The emergency room doctors treated her by injecting her with sugar, and then called the team of internists on call to admit …

Knowing the true name of a medical condition

Christopher Johnson, MD

Conditions and Diseases

October 11, 2011

There is a long tradition in folklore, one shared by shamans and occultists, that knowing the true name of something gives you power over it.

Many years ago I had a very sick patient in the PICU who one morning, totally out of the blue, broke out in a bright, red rash all over his body. The boy had many critical problems already and, although the rash didn’t seem to be causing …

Top 5 myths about empowered patients

Steve Wilkins, MPH

Patient

October 10, 2011

Irrational exuberance was a term once used to describe the stock market before the last crash. It also seems an apt description for much of the talk these days about empowered health consumers.

To be sure, patients today have unprecedented access to health information. Patient decision-support tool can be found on just about every provider, payer and self-insured employer website. Consumers can go to any number of websites to find …

Read more…

Top 5 myths about empowered patients

Whose responsibility is childhood obesity?

Doug Tynan, PhD

Conditions and Diseases

October 10, 2011

With the obesity crisis in America, one of the major reasons for increasing health costs, the issue of the causes inevitably arises.

There seem to be two sets of causes postulated by a growing crowd of experts. Unfortunately, each set is aligned in our current polarized political climate with the right or the left. Each set of causes has some basis in reality, but neither fully explains the problem.

On one …

Stem cells, surgery free heart valve repair and nutraceuticals advance heart care

Stephen C. Schimpff, MD

Conditions and Diseases

October 10, 2011

The last post in this series discussed new advances in cardiology – the two themes of genetically informed therapy and technical advances. I will continue with three additional themes – regenerative medicine, minimally invasive approaches and prevention.

The third of the five themes is regenerative medicine. One major area of investigation is whether stem cells can heal the damaged heart. Perhaps the field is “more glamour than fact” just now …

ACP: Relationships enhance patient care

Fred Ralston Jr., MD

Physician

October 10, 2011

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

Up until 2001 I practiced medicine in the hospital where I was born. I still work in the hospital that was built to replace it. In our mobile society that is clearly the exception rather than the rule.

I love what I am able to offer my patients as …

Read more…

ACP: Relationships enhance patient care

Doctors who cross the line by protesting too much

Ford Vox, MD

Physician

October 9, 2011

Doctors are in the cross-hairs of the nation’s politics more than ever. We’re all being asked to achieve more with less. We must cope with nightmare scenarios precipitated by cracks in the social and healthcare infrastructure so often these days that medical schools insist students become effective patient advocates as well as healers. Practicing good medicine necessitates navigating a minefield of competing interests. Doctors are increasingly tempted to just walk …

Are physician services to blame for high health costs?

Cedric Dark, MD, MPH

Health Policy

October 9, 2011

Why does health care cost so much more in the United States than in other countries? The answer is exceedingly complex; pharmaceuticals, hospitals, and physician services (among others) comprise the multiple slices of the health care pie that in the United States is about twice the size of the next largest spender for health care services.

A new study from one of President Obama’s appointees (note: this study was written prior …

Three major cognitive errors physicians make

Jerome Groopman, MD and Pamela Hartzband, MD

Physician

October 9, 2011

As physicians, we all dread missing a diagnosis: indigestion that turns out to be angina, back pain that signals an aortic aneurysm, migraine that proves to be a brain tumor. Although it is only an estimate, several studies in the medical literature indicate that misdiagnosis occurs in 15% to 20% of all cases, and in half of these, there is serious harm to the patient.

Researchers have found that the vast …

Transparency in health care preserves our ability to innovate and grow

Michael Tarnoff, MD

Physician

October 9, 2011

Collaboration between medical professionals and the healthcare products industry has long been vital to advancing patient care and safety. Healthcare professionals help companies better understand unmet clinical needs, while companies invest in innovative research and product development that are squarely focused on improving patient care and enhancing patient safety.

As a society, we should acknowledge the value of these bona fide relationships. Balanced provider input into corporate decision-making has broad …