KevinMD.com

February 9, 2012Feb 9, 20125

The orders came indirectly from the government. Reduce hospital re-admissions. Cut costs. So, the hospital contacted the local hospice-palliative care center and asked for help. Of course, overwhelmed with work and understaffed, the project was handed off to me. My…

The orders came indirectly from the government.

Reduce hospital re-admissions. Cut costs.

So, the hospital contacted the local hospice-palliative care center and asked for help. Of course, overwhelmed with work and understaffed, the project was handed off to me.

My task sounded simple. Create a palliative care program at the nursing home. But as I gathered for the first meeting with the administrator, social worker, and clinical staff, I knew there would be …

Conditions and diseases

Why we should eliminate the diagnosis of ADHD

Steve Balt, MD

February 8, 2012Feb 8, 201234

I’m reluctant to write a post about ADHD. It just seems like treacherous ground. Judging by comments I’ve read online and in magazines, and my own personal experience, expressing an opinion about this diagnosis—or just about anything in child psychiatry—will be met with criticism from one side or another. But after reading L. Alan Sroufe’s article (“Ritalin Gone Wild”) in the New York Times, I feel compelled to write.

If …

Health policy

Doctors lobby Congress to repeal the SGR

Bob Doherty

February 8, 2012Feb 8, 20123

One of the things that I like most about my job is engaging with ACP’s physician leadership—the internal medicine doctors who dedicate enormous amounts of time, at great personal sacrifice, to represent the interests of our members and their patients.…

One of the things that I like least is when an ACP member (or non-member physician) caustically dismisses their efforts, usually because they disagree with some aspects of ACP policy. It …

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Physician voices

The foundation of medicine is care

Stewart Segal, MD

February 8, 2012Feb 8, 20126

I recently wrote that "diagnosis is job number one." In sports, there are times when two teams share the number one position. Each team competes to make it to the championship; and, ultimately, one team has to lose its top…

I recently wrote that “diagnosis is job number one.” In sports, there are times when two teams share the number one position. Each team competes to make it to the championship; and, ultimately, one team has to lose its top ranking.

In medicine, care and diagnosis share the number one spot, working together toward a common goal: to promote health. Some would say that, without care, the diagnosis is worthless. Certainly, …

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The foundation of medicine is care

Physician voices

Patients in the waiting room do not know why doctors are running late

Tabor Flickinger, MD

February 8, 2012Feb 8, 201225

I hate running late. I prefer to arrive five minutes early for any meeting. I was that compulsive student who always turned in papers before they were due. Now I turn in conference abstracts, grant applications, and even poetry contest…

I particularly hate running late in clinic. I want to see all my patients on time. It is …

Drugs and prescribing

A look behind the growing cost of cancer drugs

Merrill Goozner

February 7, 2012Feb 7, 20122

Julie Gralow, an oncologist at the Fred Hutchinson Cancer Center in Seattle, recently prescribed an exciting new therapy for a 60-year-old woman with metastatic breast cancer. Three-and-a-half years into her battle against the disease, the patient had already exhausted three…

The newly prescribed drug, Novartis’ Afinitor, is one of the recently approved targeted therapies that have …

Medical education

Advice to prospective family medicine residents

Allen Perkins, MD

February 7, 2012Feb 7, 20123

I don’t like selecting colleagues through the Match. The process was established to allow students to get the best opportunity available and I feel that our program (and our patients who rely on our trainees to provide care) is in jeopardy every year. It always turns out better than I anticipate, so I shouldn’t complain. However, we have to interview 60 prospective residents to fill our six slots so …

Physician voices

Are new technologies really the reason for rising health costs?

Stephen C. Schimpff, MD

February 7, 2012Feb 7, 20125

Over the last four weeks I have written about new technologies and their coming impact on medical care. We generally think of new technologies (and new, branded drugs) as pushing up the cost of healthcare. There is truth to this contention, of course, but often the real problem from a cost perspective is inappropriate use. And this happens all to often in medical practice today because the physician does not …

Conditions and diseases

How I approach ovarian cancer screening with patients

Kevin Pho, MD

February 7, 2012Feb 7, 20129

Ovarian cancer screening clearly touches a nerve. No one doubts that ovarian cancer is a devastating diagnosis, often found when the disease is at an advanced stage. Tests to look for the disease, such as the transvaginal ultrasound or the…

Ovarian cancer screening clearly touches a nerve.

No one doubts that ovarian cancer is a devastating diagnosis, often found when the disease is at an advanced stage. Tests to look for the disease, such as the transvaginal ultrasound or the CA-125 blood test, are not specific enough. That leads to false positive tests that necessitate more studies that may not be …

Conditions and diseases

Treating heart failure on a budget

Molly Kantor

February 7, 2012Feb 7, 20123

As a third year medical student, I spent one afternoon each week at a health clinic at a community hospital affiliated with my medical school. This health clinic was focused on primary care for patients with HIV, and many of our patients were poor, homeless, immigrants, or uninsured. Many were also living with their diagnosis in secrecy and had to hide their medications and medical bills from family members.

One of …

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Treating heart failure on a budget

Health technology

The pitfalls of email communication with patients

Robert Sadaty, MD

February 6, 2012Feb 6, 201213

A recent article in the Wall Street Journal reviewed the emerging role of email in healthcare, arguing that doctors should more aggressively offer their patients the option to communicate with each other through email. Unlike other professionals in the United…

A recent article in the Wall Street Journal reviewed the emerging role of email in healthcare, arguing that doctors should more aggressively offer their patients the option to communicate with each other through email. Unlike other professionals in the United States, doctors have generally resisted the adoption of email into their practices. But according to the WSJ article, email can result in many benefits to both the doctor and patient. …

Physician voices

The fear of malpractice will always be in the back of my mind

Mandy Huggins, MD

February 6, 2012Feb 6, 201226

“I wouldn’t hesitate to sue you.” I’m sorry, what? That is what I heard from the mother of one of my patients. I was evaluating a high school athlete who had recurrent stingers (nerve injury that affects an upper limb,…

“I wouldn’t hesitate to sue you.”

I’m sorry, what?

That is what I heard from the mother of one of my patients. I was evaluating a high school athlete who had recurrent stingers (nerve injury that affects an upper limb, usually resolves with time) and a possible episode of transient quadriparesis (affecting all limbs this time). I wasn’t on the sidelines for these injuries, so I had to go on the reports …

Health policy

Why physicians may not buy into ACOs

Anonymous

February 6, 2012Feb 6, 201220

I’m sure Ezekiel Emanuel hates being referred to as Rahm Emanuel’s brother, so I won’t describe him as such. After working as one of Obama’s main health care advisors, he’s now at U-Penn in a job spanning medicine, economics, and ethics. He’s also been writing engaging essays in JAMA about health care reform and economic change that give us an augur into where health care reform might lead us.

Here, …

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Why physicians may not buy into ACOs

Patient voices

Preparing for your visit with someone in hospice care

Linda Watson

February 6, 2012Feb 6, 20124

Visiting someone who is dying or critically ill is an experience many of us will have in the course of our lives. Whether your visit is to be in the person’s home, a hospice or a hospital, there are a…

This post introduces some of the basics.

1. Call ahead. Find out what prime visiting times …

Conditions and diseases

MKSAP: 60-year-old woman with pruritic hives

mksap

February 5, 2012Feb 5, 2012

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 60-year-old woman is evaluated for pruritic hives that have persisted for 12 weeks. The lesions appear, resolve within hours, and leave no residual…

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

A 60-year-old woman is evaluated for pruritic hives that have persisted for 12 weeks. The lesions appear, resolve within hours, and leave no residual mark but reappear at a later time. She does not associate the hives with any particular foods or exposures. Her medical history …

Physician voices

Hospice professionals have the heart of an amateur

Andy Milligan, RN

February 5, 2012Feb 5, 20124

Most of us who work in medicine refer to ourselves as professionals and for good reason. Years of education, training, and experience make you the clinician you are. Hospice professionals in particular require a very special set of skills to…

When it comes to sports there is a clear line of distinction between professionals and everyone …

Physician voices

ACP: Medical ethics should be a daily aspect of care

American College of Physicians & Fred Ralston Jr., MD & Lois Snyder, JD

February 5, 2012Feb 5, 2012

A guest column by the American College of Physicians, exclusive to KevinMD.com. Is medical ethics an important aspect of real world medical practice today? Or a quaint notion for the history books based on mom and apple pie generalisms? For…

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

Is medical ethics an important aspect of real world medical practice today? Or a quaint notion for the history books based on mom and apple pie generalisms?

For the patient and for the physician in practice, medical ethics is — or should be — a daily aspect of care. But that doesn’t make it easy. In fact, it is …

Health technology

Why adoption of EHRs is a transformational event for physicians

Marilyn J. Heine, MD

February 5, 2012Feb 5, 201211

Paul Conslato, MD, director of clinical affairs for Lancaster General Medical Group, recently was quoted in the PAMED Better Health Network eZine that the introduction of electronic health records is “the largest transformational event for physicians within the last 50…

Paul Conslato, MD, director of clinical affairs for Lancaster General Medical Group, recently was quoted in the PAMED Better Health Network eZine that the introduction of electronic health records is “the largest transformational event for physicians within the last 50 years.”

Fifty years is a long time and takes us back into the 1960s. Certainly, there have been plenty of changes in the practice of medicine since then. We’ve seen new …

Health policy

How to avoid HMO gatekeeper problems in medical homes

Dave Chase

February 4, 2012Feb 4, 20125

There's a great deal of planning and testing of new models of care and delivery to respond to healthcare's ever increasing costs. We've all heard about Accountable Care Organizations (ACO) and medical homes. The common concern is that they become…

There’s a great deal of planning and testing of new models of care and delivery to respond to healthcare’s ever increasing costs. We’ve all heard about Accountable Care Organizations (ACO) and medical homes. The common concern is that they become a repeat of HMOs with the accompanying misaligned incentives undermining their effectiveness. An exciting new medical home model is rapidly expanding that avoids the dreaded “gatekeeper” that was the undoing of …

Physician voices

Susan G. Komen and the politics of women’s health care

Dominic A. Carone, PhD

February 4, 2012Feb 4, 201217

Despite the adversarial political climate that divides so many Americans, there are some topics that most people can agree on regardless of politics. One of those is that early detection and screening for cervical cancer and breast cancer are important initiatives that should be supported because early detection leads to earlier treatment which, in turn, saves lives. While many women have such exams paid for by their health care insurance, …

Real physician voices, twice a week

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