KevinMD.com

November 28, 2011Nov 28, 20119

1. Mobile health technology will increase patient engagement. Most patients do not take the responsibility they should for their own health. They are likely preoccupied with all the stresses of everyday life and might therefore take the ‘I feel good,…

1. Mobile health technology will increase patient engagement. Most patients do not take the responsibility they should for their own health. They are likely preoccupied with all the stresses of everyday life and might therefore take the ‘I feel good, so I must be’ approach. They possibly mutter these words after wiping their faces, hurriedly walking out of McDonald’s for lunch. Or is it because of mistrust of their physician …

Medical education

Problems with the Multiple-Mini Interview for medical school

Reflex Hammer

November 28, 2011Nov 28, 20116

Some medical schools have altered their admissions process by replacing the traditional applicant interview with the Multiple-Mini Interview (MMI). MMI resembles speed-dating: applicants rotate through numerous interview stations, where they act out scenarios and solve puzzles, sometimes alone and sometimes…

As you might expect, schools that have adopted MMI (UCLA and …

Medical education

Medical school is a fragmented, intimate experience

Shara Yurkiewicz

November 28, 2011Nov 28, 20112

His face was four inches away from mine. I tried not to blink as he shined the ophthalmoscope’s light into my left eye and stared into my pupil as though it were the most interesting thing in the world. He frowned, placed his hand on my head, and used his thumb to pry my eyelid higher. He maneuvered for about 45 more seconds while I sat stone still, and then, suddenly, …

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Patient voices

10 ways doctors can lose their patients

Dominic A. Carone, PhD

November 28, 2011Nov 28, 201122

As a neuropsychologist, I have the chance to talk to patients throughout the week in detail about their medical histories, supplemented by a comprehensive medical records review. Part of this involves discussing which provider the patient has seen and if the provider was changed, why. Sometimes, a provider is changed for a benign reason, such as a move or an insurance …

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10 ways doctors can lose their patients

Patient voices

Why this doctor moved to private practice

Jordan Grumet, MD

November 27, 2011Nov 27, 201120

Chief of Medicine Evanston Hospital October 23, 2005 To whom it may concern, I would like to take a moment to express my deep displeasure with one of the interactions I had with a physician in the Church Street location.…

Chief of Medicine
Evanston Hospital
October 23, 2005

To whom it may concern,

I would like to take a moment to express my deep displeasure with one of the interactions I had with a physician in the Church Street location. I use the term “interaction” loosely since the doctor in question, Dr. Jordan, never actually saw me. Apparently he was too busy.

Last Thursday I was shopping in downtown Evanston when I felt the sudden …

Physician voices

We are seeing more terminal patients being referred to hospice

Jim deMaine, MD

November 26, 2011Nov 26, 20113

At the University Hospital in Madison Wisconsin in 1938, a patient was dying from a very painful bone cancer which had produced fractures. The young interns knew that more morphine injections were needed but they feared they might be blamed for giving a lethal dose. So a tacit agreement was reached. Every hour or so,one of them would come into the patient’s room and give a shot of morphine. This …

Drugs and prescribing

Delta Air Lines goes anti-vaccine

Natasha Burgert, MD

November 26, 2011Nov 26, 201121

I have many, many patients and their families who are very active travelers. Business flights, vacation trips … some of you really rack up the miles. It is with shock and disappointment that I must report; Delta Air Lines has…

I have many, many patients and their families who are very active travelers. Business flights, vacation trips … some of you really rack up the miles.

It is with shock and disappointment that I must report; Delta Air Lines has made a very poor choice.

An ad, produced by the National Vaccine Information Center (NVIC), is currently being shown to passengers on Delta flights through the month of November. The ad encourages …

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Delta Air Lines goes anti-vaccine

Health policy

A disconnect between medical resources and health care delivery

Maggie Kozel, MD

November 25, 2011Nov 25, 20119

Imagine what health care in the United States could look like if we devised a system that was based on sound medical practice and proven cost effectiveness. What if we put our brains, energies and passion behind designing the smartest…

That was the question that kept poking through my train of thought as I read a study that appeared in the most recent issue of Pediatrics, the …

Physician voices

I will never be the physician that my father was

Aaron E. Carroll, MD

November 25, 2011Nov 25, 201114

Let me start by saying that I love my father dearly. We have an excellent relationship, and talk regularly. So there’s no bitterness in this post, nor any desire to engage in armchair psychology. My father, now retired, was a…

Let me start by saying that I love my father dearly. We have an excellent relationship, and talk regularly. So there’s no bitterness in this post, nor any desire to engage in armchair psychology.

My father, now retired, was a general and thoracic surgeon, who was triple-boarded in critical care, and ran a trauma unit in inner-city Philadelphia. He was in private …

Physician voices

Grief takes no holidays

Karen S. Sibert, MD

November 24, 2011Nov 24, 20115

The glittering commercialism and noisy cheer of the holiday season can be stressful for any of us. But for the parent who’s lost a child during the past year, facing the first Thanksgiving and Christmas with an empty place at…

No one in modern America expects a child to die. Children only die in nineteenth century novels and third-world countries, or …

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Grief takes no holidays

Patient voices

Living with chronic illness during the holiday season

Toni Bernhard, JD

November 23, 2011Nov 23, 201112

In the U.S., we’re getting ready to celebrate Thanksgiving. Soon, people around the world will turn their attention to the holiday season. Chronic health problems can take a toll on relationships any time of the year. Most people have to experience unrelenting pain or illness themselves before they understand how debilitating it is, physically and mentally. Loved-ones (by whom I mean family and close friends) may be in some form …

Physician voices

The culture of medicine needs to change

Sharon Bahrych, PA-C, MPH

November 23, 2011Nov 23, 20117

I’ve been involved in clinical medicine for more than 20 years and during this time I’ve come across numerous situations that created stress, or emotional upheaval within myself, and even times of burnout. At one point, I came close to permanently leaving my chosen profession. The culture of medicine is not geared towards allowing health care providers to de-stress, acquire emotional support, or discuss in an encouraging environment various conflictive …

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The culture of medicine needs to change

Conditions and diseases

Pancreas cancer: Exposing the silent killer

Daniel Labow, MD

November 23, 2011Nov 23, 20116

November is Pancreas Cancer Awareness Month and with the recent passing of Patrick Swayze and Steve Jobs, now is as good a time as ever to educate ourselves about this deadly disease. Almost 40,000 people per year will die of this disease in the U.S., making it the 4th most common cancer killer. It is through education and research that we can continue to improve survival and outcome …

Patient voices

Teaching clinicians the teach-back for patient education

Darren A. DeWalt, MD, MPH

November 23, 2011Nov 23, 20115

I’m a big fan of the teach-back. To my knowledge, it is the only way to confirm that my patient understands my message. I don’t believe avoiding jargon or creating written materials at a favorable readability level can ensure understanding.…

I’ve been teaching clinicians to do the teach-back for about a decade now. For the same amount …

Patient voices

Expecting doctors to be perfect is a setup for dysfunction

Dave deBronkart

November 22, 2011Nov 22, 20115

Science seeks certainty. The problem in medicine is, the body is complex and our knowledge is incomplete. People who want certainty – physicians or patients – are kidding themselves. And if we expect docs to be perfect, it’s a setup…

Sometimes I hear of patients who believe their physicians dissed a proposed or experimental treatment that’s not understood. (I’m not endorsing wacky treatments here – I’m only talking about uncertainty.) …

Health policy

ACP: What’s a small group practice to do?

American College of Physicians & Fred Ralston Jr., MD

November 22, 2011Nov 22, 20117

A guest column by the American College of Physicians, exclusive to KevinMD.com. In 1998 I started a period of national service to the American College of Physicians leading to my term as President for 2010-2011. During that time I kept…

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

In 1998 I started a period of national service to the American College of Physicians leading to my term as President for 2010-2011. During that time I kept an almost full time private practice in Fayetteville, Tennessee. Moving between the worlds of health policy and “the trenches,” I understand better than many the tremendous challenges we face in …

Physician voices

Useless thought experiments during medical school and residency

angienadia, MD

November 22, 2011Nov 22, 201113

I recently admitted a patient with a pulmonary embolism. Before heparin drip was started, my attending ordered a hoard of eccentric, non-indicated hypercoagulable workup in the hope of avoiding the effect of heparin on these test results, including phosphatidylserine antibody and methylenetetrahydrofolate reductase DNA. I watched in horror as the nurse drew out approximately 13 tubes of blood, since each test needs its own tube.

On rounds, the attending of course …

Patient voices

Choosing a doctor should be like the Amazon shopping experience

Nick Dawson

November 22, 2011Nov 22, 201128

Have I told you how much I love Amazon? Its the awesome! Let’s say I need something – an external hard drive. So I go to Amazon and I type in "external hard drives." Boom. I get a list of,…

Have I told you how much I love Amazon? Its the awesome! Let’s say I need something – an external hard drive. So I go to Amazon and I type in “external hard drives.” Boom. I get a list of, not surprisingly, external hard drives. Which one do I chose? Fortunately, Amazon has some great data and filtering options. I want a desktop drive, not portable, so I filter those out. …

Health technology

EHR adopters give advice to those considering electronic medical records

Peter J. Polack, MD

November 21, 2011Nov 21, 2011

Our practice went live with our own EMR system in late 2008. For the most part, this was uneventful. The reason for this was mainly due to proper planning. And credit for our implementation plan goes primarily to our administrator, our IT director, and staff members of our appointed EMR committee. Although some of the physicians were an integral part of the committee, we tried our best not to micromanage …

Health policy

What happens if the Supreme Court strikes down the individual mandate?

Brad Wright, PhD

November 21, 2011Nov 21, 201116

Any ruling by the Supreme Court on the constitutionality of the Affordable Care Act's controversial individual mandate isn't likely for at least another several months, but it's worth thinking about what might happen after the case is decided. The first…

Any ruling by the Supreme Court on the constitutionality of the Affordable Care Act’s controversial individual mandate isn’t likely for at least another several months, but it’s worth thinking about what might happen after the case is decided. The first scenario is easy: If the Court upholds the mandate, the ACA goes forward as planned to the continued objections of many conservative Americans and politicians. The second scenario is less …

Real physician voices, twice a week

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