KevinMD.com

January 29, 2012Jan 29, 20124

At the end of the year, I find myself thinking about patients usually—and especially those that have passed away. I wonder how their families are coping, how their children are, and whether each day has gotten easier. I think about…

It’s an odd thing …

Health technology

New classes of devices to diet and exercise

Michele R. Berman, MD

January 29, 2012Jan 29, 20123

For many celebrities, their livelihoods depend on their physical appearance and they rely on armies of personal assistants, schedulers, stylists, trainers and chefs to plan, manage and measure their diet and exercise regimens. Obviously, most of us don’t have the…

Obviously, most of us don’t have the time or resources to diet and exercise like celebrities do, but new technologies are closing the gap. As an introduction to some of these new platforms and methods, we describe and …

Health policy

Improve patient safety to improve healthcare quality

Pearl Korn

January 29, 2012Jan 29, 20126

It has taken 13 years for us to revisit the issues in To Err Is Human, the 1999 landmark government report that shocked our nation with its revelation that 98,000 people died yearly in hospitals due to doctors' errors. For…

It has taken 13 years for us to revisit the issues in To Err Is Human, the 1999 landmark government report that shocked our nation with its revelation that 98,000 people died yearly in hospitals due to doctors’ errors. For decades, and through one administration after another, the lack of safety in our healthcare system has gone un-addressed, placing us at greater and greater risk. Hospitals have disappeared, …

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Patient voices

How will the Baby Boomers age and die?

Rev. Amy Ziettlow

January 28, 2012Jan 28, 20127

I love listening to life stories. As a hospice chaplain, I loved sitting with our patients and their loved ones engaging in what many hospice teams call “life review.” When did you meet your spouse? When was Reggie born? What is your favorite holiday? When did you learn you were ill? A few simple questions and the stories come pouring forth.

Of late, I’ve been listening to the life stories of …

Read more…

How will the Baby Boomers age and die?

Health technology

Repetition is the curse of the doctor-patient engagement

Dr. Martin Young

January 28, 2012Jan 28, 201211

How many times as a doctor do you ask the same questions over and over again as part of the routine process of taking a history from your patient? And how often as a patient do you have to answer…

How many times as a doctor do you ask the same questions over and over again as part of the routine process of taking a history from your patient? And how often as a patient do you have to answer those same questions each time you see a new doctor? How long does this take, given that doctors and patients both complain that there is too little time for the …

Physician voices

Patients will understand an honest mistake if the doctor tells the truth

Neil Baum, MD

January 28, 2012Jan 28, 20124

It was 1976 and I was a junior resident in urology at Baylor College of Medicine in Houston, Texas. I was assigned to a rotation in pathology where my job was to process specimens taken at surgery, dictate a gross description of the specimen and then place the specimens into the cassettes that would be used to make the permanent sections. I was transferring a prostate biopsy, approximately 0.5mm x …

Conditions and diseases

MKSAP: 58-year-old woman with acute left-sided flank pain

mksap

January 28, 2012Jan 28, 2012

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 58-year-old woman is hospitalized for acute left-sided flank pain. She has had fever and night sweats for 1 month and a 9.1-kg (20-lb)…

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

A 58-year-old woman is hospitalized for acute left-sided flank pain. She has had fever and night sweats for 1 month and a 9.1-kg (20-lb) weight loss over 6 months.

On physical examination, temperature is 37.7 °C (99.8 °F), blood pressure is 135/88 mm Hg, pulse is 88/min, …

Physician voices

Diagnosing an illness is an art

Stewart Segal, MD

January 27, 2012Jan 27, 20128

Diagnosis is the foundation on which all care and treatments rest. If the diagnosis is wrong, most probably so is the treatment. Diagnosing an illness is an art. A diagnostician needs to be one part scholar, one part detective, and four parts artist. He has to be a good listener, open minded, and capable of assimilating a large amount of sometimes confusing data into an accurate picture of a disease …

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Diagnosing an illness is an art

Patient voices

Patient engagement is the holy grail of health care

Steve Wilkins, MPH

January 27, 2012Jan 27, 201239

For health care professionals, patient engagement is the holy grail of health care. It is the key to patient adherence – a prerequisite to achieving better outcomes, fewer ER visits and hospitalizations and more satisfied patients. It is easy to recognize an engaged patient – they do what their health care providers recommends …what their health care team knows what is right for them.

But doesn’t engagement depend upon your perspective?

In …

Physician voices

Physicians have a natural role as advocates

Danielle Rosenman, MD

January 27, 2012Jan 27, 20125

As physicians, we are often called upon to be advocates for our patients. Sometimes they have no other person to turn to. At those times, in particular, we evaluate their health in the context of relationship, family, and workplace. Having practiced family medicine for so many years, and now in counseling medicine, I have had the responsibility of advocating for my patients with their health insurance companies, within their families, …

Physician voices

Our society expends huge sums on futile care

Jim deMaine, MD

January 26, 2012Jan 26, 201218

Mike was a runner, outdoors-man, and fitness nut. This was not so much as for health reasons as for "feeling good", but he did hope that it would help him avoid illness. It was worrisome when he started with some…

Mike was a runner, outdoors-man, and fitness nut. This was not so much as for health reasons as for “feeling good”, but he did hope that it would help him avoid illness. It was worrisome when he started with some belly cramping and noticed some blood streaks in his stools. It took about a month until he could be scheduled for a colonoscopy. The news was shocking. “There’s a cancer …

Conditions and diseases

How Patrick Swayze died: Why we should care

Barron H. Lerner, MD

January 26, 2012Jan 26, 20126

When I finished my book on famous patients, the most common question I received was “Are the stories of sick celebrities really relevant to other patients?” My answer was that yes, with some caveats, these experiences are well-worth knowing. The…

The same can be said for the story of Patrick Swayze’s terminal pancreatic cancer, which has now been told by his widow, actress Lisa Niemi Swayze, in a new book, “Worth Fighting …

Conditions and diseases

Reclaim your life from urinary incontinence

Kevin O'Neil, MD

January 26, 2012Jan 26, 20125

“I laughed so hard, tears ran down my leg.” That was a quote from a sign I saw on vacation last summer. While we read it and laugh, we all know what it means. “How’s your bladder working?” is a…

“I laughed so hard, tears ran down my leg.”

That was a quote from a sign I saw on vacation last summer. While we read it and laugh, we all know what it means. “How’s your bladder working?” is a common question that I ask patients in the office. The responses I get include, “fine, except when I ____”, or, I’m fine as long as I know where the bathrooms are. …

Health technology

Why the prognosis of patients is difficult

Ken Covinsky, MD

January 25, 2012Jan 25, 2012

Many clinical decisions in older persons are dependent on life expectancy. For example, as life expectancy declines, cancer screening is likely to do more harm than good. Also, persons who have limited life expectancy may want to plan, discuss their values, and consider palliative care approaches of care in addition to care focused on living as long as possible.

But can one actually predict life expectancy accurately in an individual patient? …

Patient voices

Why do doctors delay hospice referrals?

Sheila Carothers

January 25, 2012Jan 25, 201212

This is a response to Deb Discenza's article requesting a one page informational sheet informing a patient about hospice or palliative care. This would allow the patient and their family to make decisions regarding end of life care before it…

This is a response to Deb Discenza’s article requesting a one page informational sheet informing a patient about hospice or palliative care.

This would allow the patient and their family to make decisions regarding end of life care before it becomes a necessity. I am a crisis care hospice nurse. I am the one who comes to your home, whether it is a million dollar beachfront mansion, or a single wide mobile …

Read more…

Why do doctors delay hospice referrals?

Physician voices

I learned the value of listening to the patient

Peter Elias, MD

January 25, 2012Jan 25, 20123

William Osler famously said (among other things): “Listen to the patient. He is telling you the diagnosis.” I was doing my obstetrical rotation as a first year family practice resident. I had done nearly 100 deliveries and was feeling more…

William Osler famously said (among other things): “Listen to the patient. He is telling you the diagnosis.”

I was doing my obstetrical rotation as a first year family practice resident. I had done nearly 100 deliveries and was feeling more confident in my skills and knowledge than was justified. Although this rotation did not involve actual care for the recently delivered newborns, I loved pediatrics and frequently stopped by the nursery …

Conditions and diseases

Myths and misses about Alzheimer’s Disease

James P. Richardson, MD, MPH

January 25, 2012Jan 25, 20122

Mark Twain, the American author and humorist once said, “It ain’t what you don’t know that gets you into trouble. It’s what you know for sure that just ain’t so.” In my experience as a geriatrician, I’ve encountered many misunderstandings about this degenerative neurologic disease that devastates both patients and their families. Countering these can help patients, families, professionals, and all those who have someone in their lives with Alzheimer’s disease.

1. …

Physician voices

Repeated experiences of shaming are not good for a young child

Claudia M. Gold, MD

January 24, 2012Jan 24, 20128

The little boy, who looked to be about two, darted away in a fit of giggles. His young mother, who seemed thoroughly worn out and exasperated, ran after him, grabbed him by the arm and said in a harsh whisper,…

We were on line waiting to board a Southwest Airlines flight. For those of you not familiar with the Southwest system, there are no assigned seats. Rather, …

Physician voices

Why more primary care doctors are referring patients to specialists

Kevin Pho, MD

January 24, 2012Jan 24, 201233

According to a recent study from the Archives of Internal Medicine, primary care physicians are referring more patients to specialists than ever before. In fact, the rate almost doubled in the 10-year period between 1999 and 2009. This drives up…

According to a recent study from the Archives of Internal Medicine, primary care physicians are referring more patients to specialists than ever before. In fact, the rate almost doubled in the 10-year period between 1999 and 2009.

This drives up the cost of care, as specialist consults tend to be more expensive than primary care visits. Furthermore, specialists tend to …

Real physician voices, twice a week

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