KevinMD.com

December 20, 2011Dec 20, 20113

The common perception is that older doctors are more adverse to technology, especially when it comes to electronic medical records. Recent data, however, says that isn't true. According to a study cited in American Medical News, "physicians more than 10…

The common perception is that older doctors are more adverse to technology, especially when it comes to electronic medical records.

Recent data, however, says that isn’t true.

According to a study cited in American Medical News, “physicians more than 10 years out of medical school and those with higher patient volumes were more likely than younger and less busy physicians to …

Physician voices

Reduce sedation in critically ill patients

a medical resident, MD

December 20, 2011Dec 20, 20112

I sit here today, in this small, windowless call room with its low twin bed that is covered in untouched hospital blankets and sheets. Tonight is one of my last nights on a 30-hour call shift in the medical intensive care unit. Yet another mile-marker on this long journey of residency. My day began at the break of dawn, when I and another resident passed each other in the parking …

Physician voices

Quality indicators can harm the elderly

Ken Covinsky, MD

December 19, 2011Dec 19, 201112

Quality indicators are used to measure the quality of health care delivered to patients. Quality indicators are used extensively in the VA health system, and efforts are underway in Medicare to tie reimbursement levels to performance on quality indicators. The…

The motivations for using quality indicators are guided by the best of intentions. There are many problems with the quality of health care in the US, and quality indicators aim to improve …

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Quality indicators can harm the elderly

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Physician voices

A culture of fear permeates the healthcare system

Jeffrey I. Kreisberg, PhD

December 19, 2011Dec 19, 20119

The culture of fear that led to dozens of fatal plane crashes in Korea, the molestation of young boys at Penn State University, and the tens of thousands of deaths of patients in our health care system are all a consequence of unresolved organizational conflict arising from a culture a fear. Unless, we replace fear with trust, conflict won’t be resolved.

In Korean culture, questioning authority is unacceptable and led to …

Physician voices

Conflict between physician and nurse

Sarah Beth Cowherd, RN

December 19, 2011Dec 19, 201115

When it comes to doctor- nurse interactions, when is enough, enough? Recently, I dealt with an upsetting situation involving a physician and nurse. A little background: The nurse has been working on our unit for years (since it first opened).…

When it comes to doctor- nurse interactions, when is enough, enough?

Recently, I dealt with an upsetting situation involving a physician and nurse. A little background: The nurse has been working on our unit for years (since it first opened). She is very smart and savvy when it comes to nursing. She constantly gets feedback from the patients as being one of the kindest, most thorough nurses. I look up to …

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Conflict between physician and nurse

Physician voices

Let physician assistants be part of the primary care answer

Sharon Bahrych, PA-C, MPH

December 19, 2011Dec 19, 201140

There has been so much change in medicine, physicians are leaving primary care, and new ideas are being bantered about such as patient centered medical homes (PCMH) and accountable care organizations (ACO), in an attempt to try to address the problem. To add to this strain, is the knowledge that medicine is going to have to be ready to absorb thousands of additional patients in the near future …

Physician voices

Advance planning should be a public health issue

Jim deMaine, MD

December 18, 2011Dec 18, 20112

"Medical training rarely deals with helping the dying patient find peace and comfort. In fact, most physicians are uncomfortable with the entire subject. I believe it is one of the most neglected aspects of medical care. I have spent my…

“Medical training rarely deals with helping the dying patient find peace and comfort. In fact, most physicians are uncomfortable with the entire subject. I believe it is one of the most neglected aspects of medical care. I have spent my career as a pulmonary and critical care physician, and I have cared for thousands of dying patients. In many cases, both the patients and I knew that they were dying. …

Patient voices

Making tailored health education standard of care

Shantanu Nundy, MD

December 18, 2011Dec 18, 20113

The recently instituted 30-hour-shift work restrictions placed on medical residents have created a need for "dayfloat" services to safeguard potentially unsafe handoffs in patient care and help residents adhere to duty hour limits. The past two weeks I’ve been the…

The recently instituted 30-hour-shift work restrictions placed on medical residents have created a need for “dayfloat” services to safeguard potentially unsafe handoffs in patient care and help residents adhere to duty hour limits. The past two weeks I’ve been the dayfloat resident for the cardiology inpatient service. My job is to round with the post-call team, help them get out of the hospital on time, and then take care of their …

Patient voices

How many parents are failing their children

Stephen C. Schimpff, MD

December 18, 2011Dec 18, 20113

Our children (and grandchildren) are the future and we are responsible for their growth and development. As responsible parties, we are clearly failing. That is my interpretation of the report issued a few days ago by the Centers for Disease…

Our children (and grandchildren) are the future and we are responsible for their growth and development. As responsible parties, we are clearly failing.

That is my interpretation of the report issued a few days ago by the Centers for Disease Control (CDC) on seven criteria known to the associate with ideal cardiovascular health as part of the National Health and Nutrition Examinination Survey. They are defined, briefly, as 1) a diet …

Physician voices

Doctor, why is your hospital better than any other?

Zackary Berger, MD, PhD

December 17, 2011Dec 17, 20115

I took a deep breath. I had to think carefully. It's not that this was unexpected - Johns Hopkins has been anointed the country's best hospital for 21 years running by US News. But I wanted to tell the patient…

I took a deep breath. I had to think carefully. It’s not that this was unexpected – Johns Hopkins has been anointed the country’s best hospital for 21 years running by US News. But I wanted to tell the patient the truth without alienating them or failing to mention the many admirable aspects of my institution.

One truth, however, cannot be denied: to call one hospital the best is not simple.

Let’s start with …

Physician voices

Did hospital politics lead to physician suicide?

Skeptical Scalpel, MD

December 17, 2011Dec 17, 201113

What causes a doctor to commit suicide? A story about a radiation oncologist from Springfield, IL brought this strange case to my attention. Dr. Thomas G. Shanahan committed suicide by cutting his throat in November of 2011. He was respected…

What causes a doctor to commit suicide?

A story about a radiation oncologist from Springfield, IL brought this strange case to my attention. Dr. Thomas G. Shanahan committed suicide by cutting his throat in November of 2011. He was respected in his field, having published many research papers and traveled the world helping to set up brachytherapy clinics in several countries. He also had been an acting alderman in his …

Conditions and diseases

MKSAP: 38-year-old woman with increasingly frequent headache

mksap

December 17, 2011Dec 17, 2011

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 38-year-old woman is evaluated in the office for a 10-month history of increasingly frequent headache. The headache is often worse in the morning…

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

A 38-year-old woman is evaluated in the office for a 10-month history of increasingly frequent headache. The headache is often worse in the morning on awakening. She has recently started keeping a headache diary, which reveals episodes on approximately 25 days of each month. The headache …

Physician voices

The possibility of zebras in primary care

Emily Gibson, MD

December 16, 2011Dec 16, 201112

It is critical for physicians to share unusual patient diagnoses that present to clinic with routine type symptoms. In a hospital setting, these are cases for discussion and debate at Grand Rounds. In a primary care setting, we do case reviews when we can with informal sharing for the purpose of teaching and learning. The bottom line, whether in a formal academic setting, or an informal setting around the lunch …

Patient voices

The powerful connection of emotions in healthcare

Joyce Hyam, RN

December 16, 2011Dec 16, 20114

I remember like it was yesterday. My patient was a young blond female with two beautiful Samoan dogs. Her name was Margaret. I was only two years younger than she was. The diagnosis was poor. She was friendly when I introduced myself. And she proceeded to tell me about her health issues, how she was diagnosed and what treatment she was receiving. Marge as she wanted to be called was …

Health policy

A medical student meets Donald Berwick

Taylor J. Christensen, MD

December 16, 2011Dec 16, 2011

While attending the Institute for Healthcare Improvement Annual Forum recently, my friend, Jared Conley, and I had the good fortune of finding ourselves standing a table away from Don Berwick in a relatively empty conference room. As MD/PhD in Health Policy students, we were interested in asking him a question about ACOs, so we approached him and introduced ourselves, hastily adding, “We know you’re busy, so we just have …

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A medical student meets Donald Berwick

Health policy

The emergency department in an ACO world

Mark Crockett, MD

December 16, 2011Dec 16, 201110

In the era of accountable care, you’ll notice that many hospitals and health systems are already driving towards more collaborative workflow. The integrated delivery network (IDN) is changing significantly, and for the better. But in high-acuity care areas, like the emergency department (ED), the challenge of treating patients more holistically in what is already a fast-paced environment is concerning for physicians evaluating the pay-for-performance model.

In today’s ED, patients may …

Physician voices

Patient identity fraud in the emergency department

Sean Scorvo, MD

December 15, 2011Dec 15, 20116

Almost four years ago now, I left my practice as an emergency medicine physician to enter the business world. However, the medical world isn’t easy to escape. I just couldn’t seem to forget some of the problems I used to…

The most intractable problem for me was fraud, especially as it related …

Medical education

Lessons from applying to medical school

Amir Razmjou

December 15, 2011Dec 15, 20115

I’ve heard applying to medical schools can be a soul crushing process, but I didn’t really quite get it until I got hurled into the process myself. Although I still wouldn’t describe this as “soul crushing,” it has certainly brought out a lot of insecurities in me and my accomplishments. Do they not like my stated reasons for pursuing medicine? Do my extracurricular activities seem phony and under-whelming? Is this …

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Lessons from applying to medical school

Drugs and prescribing

How medications are like vehicles

Stewart Segal, MD

December 15, 2011Dec 15, 20115

I usually cringe when I see a pharmaceutical company ad on TV. I think most pharma commercials do more harm than good. The ads scare patients out of taking medications they need. Actor: Do you have uncontrollable diarrhea? I did,…

I usually cringe when I see a pharmaceutical company ad on TV. I think most pharma commercials do more harm than good. The ads scare patients out of taking medications they need.

Actor: Do you have uncontrollable diarrhea? I did, and then my doctor prescribed “No-More-Poop!” Now I feel great and don’t have to worry about embarrassing accidents.

Commentator: Clinical studies done at a leading university prove that “No-More-Poop” cures 99% of …

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How medications are like vehicles

Health technology

Solving distracted doctoring from smartphones and tablets

Kevin Pho, MD

December 15, 2011Dec 15, 20115

Imagine that your neurosurgeon, during surgery, was talking on his cellphone using a headset. Unthinkable? Well, no. A recent article in the New York Times cites a case where a patient was left paralyzed and the neurosurgeon was sued, in…

Imagine that your neurosurgeon, during surgery, was talking on his cellphone using a headset.

Unthinkable?

Well, no. A recent article in the New York Times cites a case where a patient was left paralyzed and the neurosurgeon was sued, in part, for being distracted. He made 10 personal calls during the operation.

The proliferation of portable electronic devices, smartphones, tablets, and the …

Real physician voices, twice a week

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