KevinMD.com

November 21, 2011Nov 21, 2011

Back to school. Kids get back into a routine, and mom gets her life back, right? Wrong. For most moms, back to school is anything but relaxing. However, for some of us, it's even more tiring. Is this the time…

Back to school. Kids get back into a routine, and mom gets her life back, right? Wrong. For most moms, back to school is anything but relaxing. However, for some of us, it’s even more tiring.

Is this the time of year when you struggle to drag yourself out of bed, despite hitting the sack as soon as you put the kids down for the night?

Is your focus during the day …

Physician voices

Changing the incentives in the operating room

Nicholas Fogelson, MD

November 21, 2011Nov 21, 201115

Last year I wrote about a few strategies for decreasing costs in the operating room. Since being in fellowship operating many days per week, I’ve come up with a new idea, this time a bit more radical. In Freakonomics, Leavitt…

In Freakonomics, Leavitt and Dubner posit that in all things, human beings respond to incentives. If you want to understand human behavior, all you have to do is identify the incentives that drive …

Patient voices

Protecting patients from medical apology programs

Gabriel H. Teninbaum

November 20, 2011Nov 20, 20116

To deal with the aftermath of medical errors, an increasing number of providers are encouraging injured patients to participate in "medical apology programs." The idea, proponents say, is for patients to meet with facility representatives to learn what happened and…

To deal with the aftermath of medical errors, an increasing number of providers are encouraging injured patients to participate in “medical apology programs.” The idea, proponents say, is for patients to meet with facility representatives to learn what happened and why. It gives the patient a chance to ask questions and it gives providers a chance to apologize, and as appropriate, offer compensation. These programs are promoted as humanitarian, and, …

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Physician voices

Looking back at how primary care has changed

Robert H. Gifford, MD

November 20, 2011Nov 20, 201110

It is almost impossible for me to believe that my views on primary care in the United States have changed so radically in fifty years. When I graduated from medical school in 1961, I was determined to become a primary care doctor. I completed residencies in both medicine and pediatrics to prepare for a career as a general physician in rural Vermont. That dream was put on hold by an …

Physician voices

It’s only through humility that we can achieve great things

Claire McCarthy, MD

November 20, 2011Nov 20, 20118

My 6-year-old son is really farsighted, and I had no idea. I completely missed it. To be fair to me and my husband, the ophthalmologist (the esteemed and wonderful Dr. Hunter of Children’s Hospital Boston) said that Liam was compensating…

My 6-year-old son is really farsighted, and I had no idea. I completely missed it.

To be fair to me and my husband, the ophthalmologist (the esteemed and wonderful Dr. Hunter of Children’s Hospital Boston) said that Liam was compensating really well. And until his yearly checkup last month, he had been passing vision tests (which mostly test for nearsightedness). But in retrospect, there were signs we didn’t pay attention to. …

Health policy

Patient safety requires hospital leaders to take personal responsibility

Paul Levy

November 20, 2011Nov 20, 201110

A quality-driven MD colleague writes with frustration about two problems in his academic medical center. I often hear similar comments from nurses and doctors, and so I present the examples for your consideration. This hospital has a poor record with…

This hospital has a poor record with regard to hand hygiene (in the 30% range), and my colleague suggested at an infection control meeting suggested that the rates be publicly posted in the hospital to provide an impetus for …

Physician voices

In Kenya, operating in our comfort zone

Bruce Campbell, MD

November 19, 2011Nov 19, 2011

"Traveling makes one modest – you see what a tiny place you occupy in the world. " -Gustave Flaubert We have come to Kenya, expecting to work outside of our "comfort zones." Our patient has arrived from miles away, riding…

“Traveling makes one modest – you see what a tiny place you occupy in the world. ”
-Gustave Flaubert

We have come to Kenya, expecting to work outside of our “comfort zones.”

Our patient has arrived from miles away, riding on the back of her husband’s bicycle. She has an enlarging, bleeding mass growing off of the side of her neck. There are no pathologists available, so we are uncertain what kind of tumor …

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In Kenya, operating in our comfort zone

Health technology

How mobile health can help child abuse victims

David Lee Scher, MD

November 19, 2011Nov 19, 2011

There has not been a more horrific scandal in the world of sports that I can remember than the child abuse scandal surrounding Pennsylvania State University. Let it be said that I am very impressed with the reaction of much…

There has not been a more horrific scandal in the world of sports that I can remember than the child abuse scandal surrounding Pennsylvania State University.

Let it be said that I am very impressed with the reaction of much of the student body which is one of shock and disdain for the administration charged with covering up alleged abuses of children by a former assistant football coach. According to the …

Conditions and diseases

Major advances in radiation therapy for cancer treatment

Stephen C. Schimpff, MD

November 19, 2011Nov 19, 20112

Radiation therapy has advanced dramatically in the past few decades and the rate of change is increasing rapidly. Innovations as a result of engineering and computer advances along with conceptual advances are making a dramatic difference. Some of the new…

Some of the new technologies include improved computer assisted treatment planning (smarter and faster and has more capability like auto-contouring, smart segmentation and improved algorithms) , continuous imaging guidance (fluoroscopic, stereoscopic, and cone beam CT), …

Physician voices

Considering cancer and heart disease in opposing ways

Norman Silverman, MD

November 18, 2011Nov 18, 20113

The American public seems to consider cancer and cardiovascular disease in diametrically opposing ways. Cancer evokes the threat of relentless, painful suffering and whatever medical science can do to delay the judgement day is appreciated. Therapeutic regimens may involve disfiguring…

Response to treatment of limited incidence and duration are accepted and deemed beneficial. …

Physician voices

Can physicians survive the new world being foist upon us?

Jordan Grumet, MD

November 18, 2011Nov 18, 2011

As I walked up the stairs I thought about the history of the building I was about to enter. Although the foundation was the same, almost everything else had changed. The hallways were updated. The patient rooms decked out with comfortable furniture and fancy televisions. I even marveled at the bathroom as I answered nature’s calling. I could have been in a fancy hotel.

Yes. Things were different than when I …

Patient voices

Useful tips when looking for a new doctor

Dominic A. Carone, PhD

November 18, 2011Nov 18, 20114

These days, it is not uncommon for people to need to find a new doctor. The most common reasons include a) moving to a new city, b) dissatisfaction with your former doctor, c) your old doctor no longer accepts your new or old insurance, or d) you were diagnosed with a new medical condition and need specialized treatment.

Often, people go to their insurance company website or provider book, search for …

Conditions and diseases

Running a marathon when pregnant

Linda Burke, MD

November 18, 2011Nov 18, 20115

The fact that Amber Miller did not fall or faint or develop complications while running in the Chicago Marathon is nothing short of a miracle. An ounce of prevention is worth a pound of cure. What on earth was her physician thinking when she was given the green light to half-run half-walk a 26.2 mile marathon? Miller was not your usual runner; she was approximately 39 weeks pregnant.

Although pregnant women …

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Running a marathon when pregnant

Physician voices

Unsupervised anesthesia care by a nurse anesthetist is a threat to patient safety

Karen S. Sibert, MD

November 17, 2011Nov 17, 2011146

No matter how quickly you tried to switch the television channel lately, you probably couldn’t escape the trial of Dr. Conrad Murray or avoid hearing about propofol, an anesthesia drug that can be fatally easy to use. What you may…

What you may not have heard is that the American people just dodged a serious threat to their anesthesia care, and most don’t know how near a miss it was.

The Centers for Medicare and …

Physician voices

The hesitation before shaking a patient’s hand in the hospital

Nonmaleficence

November 17, 2011Nov 17, 201112

Today, during my psychiatry rotation, a very grateful patient confronted my attending and thanked him profusely for saving him. The patient had been severely depressed and was at his wit’s end before they met. The doctor listened to him, analyzed his situation, and came up with a plan to help which included involving the patient’ family as well as using proper medication. The patient had a great response to this …

Physician voices

A cancer survivor’s perspective on wounded warriors

Itzhak Brook, MD

November 17, 2011Nov 17, 2011

I was at the Walter Reed National Medical Center where I get medical care as a retired naval officer, and decided to use my time between medical appointments to get a much needed haircut. I walked into the barber shop, took a number, and sat down to await my turn. The three chairs were occupied by young men getting haircuts. Their chests and lower bodies were covered with long blue aprons to protect them from the …

Physician voices

Your worst days can bring out your best resiliency skills

Bobbi Emel

November 16, 2011Nov 16, 2011

I’ve been talking via email with my stepsister, Lori, whose teenage daughter has Asperger’s Syndrome. Our online conversation was mostly about the highs and lows of raising her neuro-diverse daughter and she shared with me many of the gifts that…

Then, one day, this was the message in my inbox: “Today is a day in the trenches! It’s a battle and I’m bawling …

Health policy

AMA: Health insurance monopolies hurt patients and physicians

American Medical Association & Peter W. Carmel, MD

November 16, 2011Nov 16, 20116

A guest column by the American Medical Association, exclusive to KevinMD.com. Anyone making a major purchase wants to maximize value by exploring their options. Shopping for the best option drives market competition and promotes innovation and efficiency. Shopping for competitive…

A guest column by the American Medical Association, exclusive to KevinMD.com.

Anyone making a major purchase wants to maximize value by exploring their options. Shopping for the best option drives market competition and promotes innovation and efficiency. Shopping for competitive health insurance options can be difficult when a market is controlled by one or two large commercial insurers. The lack a competitive commercial health insurance market is a problem in four out …

Patient voices

How to talk with your teen about marijuana

Nelson Branco, MD

November 16, 2011Nov 16, 20112

Adolescence is filled with challenges - at school, at home, with friends, on stage and in sports. Even their own body betrays them from time to time. Acne, hair, changing bodies and voices, parents, siblings and friends are all possible…

Adolescence is filled with challenges – at school, at home, with friends, on stage and in sports. Even their own body betrays them from time to time. Acne, hair, changing bodies and voices, parents, siblings and friends are all possible sources of gut-wrenching shame for a normal teen. Parents of teens have challenges too – and high on the list is the challenge of talking about important topics like sex, …

Patient voices

A few more minutes with Andy Rooney

Pat Mastors

November 16, 2011Nov 16, 201112

"I died last week, just a month after I said goodbye to you all from this very desk. I had a long and happy life - well, as happy as a cranky old guy could ever be. 92. Not bad.…

“I died last week, just a month after I said goodbye to you all from this very desk. I had a long and happy life – well, as happy as a cranky old guy could ever be. 92. Not bad. And gotta say, seeing my Margie, and Walter, and all my old friends again is great.

But then I read what killed me: ‘serious complications following minor surgery.’

Now what the heck …

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A few more minutes with Andy Rooney

Real physician voices, twice a week

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