KevinMD.com

November 10, 2011Nov 10, 20113

I noticed something different about my driving habits lately. At a traffic light I used to accept the green as an open invitation to drive through unconcerned, confident that other drivers would see the red and do what they are…

I don’t do that anymore. I always look to see if the road is clear, and other drivers have indeed stopped. And then I go. I have …

Patient voices

Why patients with irritable bowel syndrome are angry at their doctors

Sophie Lee

November 10, 2011Nov 10, 201116

I've had irritable bowel syndrome for 20 years, and I'm angry. About the pain, and the suffering, and the limited diet, and the huge impact that it has had on my life. But mostly, I'm angry at my doctors. No,…

I’ve had irritable bowel syndrome for 20 years, and I’m angry. About the pain, and the suffering, and the limited diet, and the huge impact that it has had on my life. But mostly, I’m angry at my doctors. No, they didn’t misdiagnose me. No, they didn’t harm me. No, they didn’t treat me like dirt. But they still made me angry.

Before we go any further, let’s get one thing straight: I know …

Patient voices

Lives focused through the lens of medicine will burn your eyes

Vernon Rowe, MD

November 10, 2011Nov 10, 20115

I am a writer as well as a doctor. My heroes are Keats, Chekhov, Williams, Coulehan, Coles, and other physician writers. And those greats of medicine too, known and unknown, who have spent their lives caring for people. My writing…

My writing is short. Really short. If it isn’t poetry, it scans like poetry. And one act plays. As in The Ride, my latest collection. Someone said if you can’t write poetry, you …

Real physician voices, twice a week

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Conditions and diseases

New approaches to cancer screening and diagnosis

Stephen C. Schimpff, MD

November 10, 2011Nov 10, 2011

I see five major themes in cancer care advances: new approaches to screening and diagnosis, better understanding of the role of viruses as causative agents, targeted therapies, new technologies and improved approaches to ensuring better quality of life. Screening for…

Screening for the most common major cancers has been straight forward for years – women should get an annual mammogram and Pap smear, men should get a PSA test annually, both should get …

Health policy

Legislating the duties that can be performed by a nurse

Donald Tex Bryant

November 9, 2011Nov 9, 20112

Recently the Michigan Task Force on Nursing Practice hosted a regional forum in my area. I was fortunate enough to attend and hear from the RN’s there the many issues that they face, which are varied and challenging. The state wanted to hear from this forum of RN’s what changes were needed in the state’s nursing regulations so that certification could be updated to reflect the current nursing environment. It …

Health policy

The new definition for a medical emergency

Myles Riner, MD

November 9, 2011Nov 9, 2011

The recent budget crisis in many state Medicaid programs has led the directors of these health care programs for the poor to cast about for ways to cut their costs, and many have landed on a ‘solution’ that puts lives at risk and undermine the financial viability of an emergency care safety net that is already severely underfunded and overwhelmed. Some 21 states use a variation of the old definition …

Physician voices

Including communication as a system in work rounds

Daniel Kamin, MD

November 9, 2011Nov 9, 2011

When patients are sick enough to require hospitalization, medical decisions often involve nontrivial tradeoffs between risks and benefits. They require discussions with patients and families from a variety of cultures and backgrounds. And sometimes these discussions break down. Patient-clinician communication…

Patient-clinician communication is increasingly recognized as an integral part of clinician competency. Indeed, family-centered rounding, increasingly practiced at Children’s Hospital Boston, is a critical step in this direction. Fully adopting this practice surely …

Conditions and diseases

Why more cancer screening may not be productive

Richard Just, MD

November 9, 2011Nov 9, 20112

The longer I continue in practice, the more complex it becomes. I thought advances in our understanding of the molecular basis of cancer would clarify decision making; instead answers have led to more questions. In the spirit of the immortal…

The story of screening for colorectal cancer (CRC) and prostate cancer has many similarities. The primary screening and diagnostic tool during my …

Health policy

Why can’t the United States have a smarter health care system?

Maggie Kozel, MD

November 8, 2011Nov 8, 201110

Why can’t the United States have a smarter health care system? That was the frustrating question that kept poking through my train of thought as I read a study from the most recent issue of Pediatrics, the official journal of…

Why can’t the United States have a smarter health care system?

That was the frustrating question that kept poking through my train of thought as I read a study from the most recent issue of Pediatrics, the official journal of the American Academy of Pediatrics (AAP). The study, out of UCLA, examined the association between length of well-child visits and quality of the visits, including things like developmental screening and what …

Patient voices

No act of kindness is ever wasted

Jackie Fox

November 8, 2011Nov 8, 20114

I see my oncologist for my twice-yearly checkup tomorrow, and while my visits have been blissfully mundane over the last three years, this time I actually have a list of questions and a couple of concerns over the lab results from my latest physical. It’s probably nothing, but once you’ve had cancer you can’t help but wonder which “nothing” is actually the edge of trouble’s long shadow. My family doctor sees no cause for …

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No act of kindness is ever wasted

Physician voices

Learning from patients at a geriatric adult home

Maria Yang, MD

November 8, 2011Nov 8, 20112

During my time at PPOH, I spent one day a week working at a geriatric adult home. An adult home is a residence that generally houses people with psychiatric conditions. They can be run by either public or private agencies.…

During my time at PPOH, I spent one day a week working at a geriatric adult home.

An adult home is a residence that generally houses people with psychiatric conditions. They can be run by either public or private agencies. At best, they provide services and supports for the residents so they can live independently. At worst, they provide very little other than shelter; they just take people’s money. (The latter has …

Health policy

How patient satisfaction scores reward rich hospitals

Kevin Pho, MD

November 8, 2011Nov 8, 20117

Medicare is beginning to tie financial bonuses to hospital patient satisfaction scores. Although patient satisfaction is important, I've voiced concern in the past about giving hospitals a financial incentive to cater to patient surveys. In a previous USA Today column,…

Medicare is beginning to tie financial bonuses to hospital patient satisfaction scores.

Although patient satisfaction is important, I’ve voiced concern in the past about giving hospitals a financial incentive to cater to patient surveys.

In a previous USA Today column, I wrote, “already, more than 80% of doctors … said patient pressure influenced their medical decisions. And in primary care, linking …

Physician voices

Let’s stop degree creep in health care

Sharon Bahrych, PA-C, MPH

November 8, 2011Nov 8, 201121

How long ago was it that we were all content with having the physician have a MD or DO title after their name, the clinic or hospital floor nurse having a RN after her name, the pharmacist having RPh after…

Now unless the pharmacist has PharmD after their name they can’t be a pharmacist. And for the nurse, unless they have RN, BSN or RN, MSN after their name …

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Let’s stop degree creep in health care

Health policy

Personal responsibility in promoting individual health

Ishmael Bradley, MD

November 7, 2011Nov 7, 20113

In March 2010 President Barack Obama and the Democratic-led Congress passed the single largest change in the American health care industry since the introduction of Medicare and Medicaid in 1965. The Patient Protection and Affordable Care Act (PPACA) aims to drastically change the way that health care is delivered and financed. It partially draws upon the idea of personal responsibility and its role in promoting individual health. Some states, notably …

Patient voices

Embarrassment is one reason why men don’t see the doctor

Joel Sherman, MD

November 7, 2011Nov 7, 201117

It is well known that men see doctors much less frequently than women. The reasons are multifactorial and not all that well studied. It’s certainly not because men are healthier than women as they die on the average seven years before women. Clearly women are accustomed to seeing doctors at an earlier age than men for reasons relating to childbirth and birth control. Most accept the recommendations to get an …

Conditions and diseases

Doctors and patients cannot win when it comes to chronic pain

Kevin Pho, MD

November 7, 2011Nov 7, 201118

The following op-ed was published on September 18, 2011 in USA Today. A fellow physician recently shared a frustrating clinic visit with me, in which a patient had left by saying, "You doctors need to wake up and realize that…

The following op-ed was published on September 18, 2011 in USA Today.

A fellow physician recently shared a frustrating clinic visit with me, in which a patient had left by saying, “You doctors need to wake up and realize that patients (who are) in pain are in a no-win situation.”

The patient was absolutely right. This summer, the Institute of Medicine released …

Conditions and diseases

The fallacies of screening tests extend beyond false positives

Manoj Jain, MD, MPH

November 7, 2011Nov 7, 201111

Several years ago, during an annual mammogram, my wife, who is in her 40s, was told a mass had been found in one of her breasts. Anxious and uncertain, she had a biopsy, and we braced for the worst. My…

Several years ago, during an annual mammogram, my wife, who is in her 40s, was told a mass had been found in one of her breasts. Anxious and uncertain, she had a biopsy, and we braced for the worst.

My father-in-law, when in his 50s, went through a similarly harrowing experience when a prostate specific antigen (PSA) test given during a routine physical exam came out positive, and he underwent a …

Conditions and diseases

Treating Adele’s vocal cord hemorrhage

Christopher Chang, MD

November 6, 2011Nov 6, 20115

Before going any further, the title to a Los Angeles Times story was "Adele to have surgery to treat vocal cord hemorrhage. What is it?" I sincerely hope that whomever her surgeon is knows not to perform surgery when the…

Before going any further, the title to a Los Angeles Times story was “Adele to have surgery to treat vocal cord hemorrhage. What is it?”

I sincerely hope that whomever her surgeon is knows not to perform surgery when the vocal cord is in the middle of a hemorrhage. You do the surgery when the hemorrhage is gone and the culprit blood vessel is left behind which likely is the reason …

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Treating Adele’s vocal cord hemorrhage

Health policy

Is it possible to implement a list of essential health benefits?

George Lundberg, MD

November 6, 2011Nov 6, 20115

What is an essential health benefit? I suppose that is a health or medical action, product, or process that should be paid for by someone other than the patient, in a society that provides so-called "third party coverage." Many very…

Many very smart people and strong organizations have struggled with this issue for many decades.

Prior answers, such as they are, have come from staff model HMOs like Kaiser Permanente, the Veterans Health Administration, …

Physician voices

When sentimentality is lost

Jordan Grumet, MD

November 6, 2011Nov 6, 2011

I don't know when I lost my sentimentality. Whaaap. With a thud the fish stops flopping up and down. It lays still on the floor of the boat. My camp counselor, a tanned college student, carefully places the paddle on…

I don’t know when I lost my sentimentality.

Whaaap.

With a thud the fish stops flopping up and down. It lays still on the floor of the boat. My camp counselor, a tanned college student, carefully places the paddle on the seat and cuts the fishing line. The hook remains dangling from the lifeless mouth.

He grabs the fish with his bare hand and throws it back into the water. He talks slightly …

Read more…

When sentimentality is lost

Real physician voices, twice a week

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