KevinMD.com

October 21, 2011Oct 21, 201117

Dear future practicing physician, Choose primary care. I know all around you there are pressures to choose to become a specialist. I remember those pressures well. In medical school, one of my favorite mentors was predicting that after I got…

Dear future practicing physician,

Choose primary care. I know all around you there are pressures to choose to become a specialist. I remember those pressures well. In medical school, one of my favorite mentors was predicting that after I got a taste of primary care, I would “come crawling back” to him. I still chuckle about that conversation to this day. In residency, I remember several seminars for us built …

Physician voices

The problem with round the clock hospitalist coverage

Bradley Flansbaum, DO

October 21, 2011Oct 21, 20117

Two recent articles, one from the New York Times, the other from The Hospitalist, initiated some 24/7 staffing issue rumination on my behalf. It stems originally from a recent op-ed by Lucian Leape: "Given the accrediting council’s reluctance to act,…

Two recent articles, one from the New York Times, the other from The Hospitalist, initiated some 24/7 staffing issue rumination on my behalf. It stems originally from a recent op-ed by Lucian Leape: “Given the accrediting council’s reluctance to act, the federal government needs to get tougher. If we are serious about curbing the tide of injuries stemming from medical errors, Medicare should make its funding of graduate medical education …

Conditions and diseases

Makes you want to pull your hair out: Treating trichotillomania

Edwin Suddleson, MD

October 21, 2011Oct 21, 2011

One of the saddest, but more treatable, causes of hair loss in patients is trichotillomania, the impulse control disorder in which a person repeatedly pulls out hair from their body for non-cosmetic reasons. While some people have never even heard of trichotillomania, according to the Trichotillomania Learning Center, as many as ten million Americans (or 4% of the U.S. population) suffer from the disorder.

According to the Diagnositic and Statistical Manual …

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Drugs and prescribing

How can pharma earn the trust of patients?

Richard Meyer

October 20, 2011Oct 20, 20116

Never in recorded history have Americans been more distrustful of how the U.S. government spends its money. According to Gallup poll, Americans on average say that the federal government wastes 51 cents of every tax dollar, the highest level ever recorded since the poll was first taken in 1979. DTC marketers should understand that this mistrust is also leading to mistrust of marketing and advertising as well as big …

Patient voices

Physicians should embrace patient engagement

Kent Bottles, MD

October 20, 2011Oct 20, 20116

The doctor/patient relationship is certainly changing and evolving. A term I hear a lot today is: “patient engagement/activation.” Why is this concept so important and what does it mean? What can physician executives do to make it easier for our…

Judith Hibbard has pioneered the study of patient engagement, and she noted that one needs knowledge, skills, and emotional support to actively engage in one’s …

Physician voices

Why haven’t surgeons been on the front line of public health?

Andrew M. Ibrahim, MD

October 20, 2011Oct 20, 2011

Public health has often focused on prevention tools that impact an entire community or population. Before Henry Bigelow MD described the use of Ether in 1846 to mitigate pain during surgery or Joseph Lister MD discovered the value of sterile technique, surgical candidates were few. Even if one were convinced tolerate the pain of surgery, more than half would die from the risk of infection. For most of surgical …

Patient voices

The difference between male and female patients

Fizzy, MD

October 19, 2011Oct 19, 201119

It's never so obvious to me that there's a big essential difference between men and women as when we take a family trip to Target. First, when you're holding a small baby or even an older baby or even a…

It’s never so obvious to me that there’s a big essential difference between men and women as when we take a family trip to Target.

First, when you’re holding a small baby or even an older baby or even a preschooler, you get a lot of attention. People love to look at small babies. And by “people,” I mean “women” only. When I walk around with the baby, women are constantly …

Physician voices

Why radiology is the cornerstone of any hospital

Paul Dorio, MD

October 19, 2011Oct 19, 20112

Radiology is the cornerstone of any hospital. An efficient, high-quality, well-run radiology department increases patient satisfaction as a result of its ability to improve patient care. Over time, a well-run radiology department adds significant patient volumes to the hospital, which, of course, favorably enhances the hospital’s bottom line. Regardless of whether the hospital is not-for-profit or for-profit, a smooth-sailing radiology department vastly increases the profitability of the hospital. The …

Physician voices

Why nursing homes need more doctors on site

Alan Cato, MD

October 19, 2011Oct 19, 201119

The recent New England Journal of Medicine article, highlighting burdensome healthcare transitions in a subset of nursing home patients, is certainly of documentary value. However, for many of us with real-world experience in the nursing home medical care venue, the…

The recent New England Journal of Medicine article, highlighting burdensome healthcare transitions in a subset of nursing home patients, is certainly of documentary value. However, for many of us with real-world experience in the nursing home medical care venue, the article certainly falls short of newsworthy. Not even mildly surprising really.

Too many of our nation’s nursing home staffs suffer from a lack of onsite MDs for evaluating acute …

Physician voices

It’s time for a VBAC court

Amy Tuteur, MD

October 18, 2011Oct 18, 201110

We understand the problem: the VBAC (vaginal birth after cesarean) rate is too low. It's time for a bold solution. We need a "VBAC Court." VBAC is a safe option for most women, and almost 3/4 of women who opt…

We understand the problem: the VBAC (vaginal birth after cesarean) rate is too low. It’s time for a bold solution. We need a “VBAC Court.”

VBAC is a safe option for most women, and almost 3/4 of women who opt a VBAC will deliver vaginally and avoid another C-section. But we also know that approximately 0.8% of women attempting VBAC will end up with a ruptured uterus, a catastrophic complication …

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It’s time for a VBAC court

Physician voices

Sexual harassment in the medical workplace

Gizabeth Shyder, MD

October 18, 2011Oct 18, 201111

Sexual harassment in the workplace is an important topic to discuss, one that is all too often swept under the rug. I recently had an uncomfortable encounter with a clinician in the doctor’s lounge – I work at many hospitals so think I can say this pretty anonymously. He introduced himself, and asked me immediately if I was married. The way he did it – body language and demeanor, mostly …

Physician voices

The art of practicing template medicine

Stewart Segal, MD

October 18, 2011Oct 18, 20119

The art of practicing medicine is dying, soon to be replaced by the art of template medicine. Modern medicine is based on laudable terms: "quality," "outcomes," "cost effective," and "evidence based medicine," which all sound good when sold in infomercials…

The art of practicing medicine is dying, soon to be replaced by the art of template medicine.

Modern medicine is based on laudable terms: “quality,” “outcomes,” “cost effective,” and “evidence based medicine,” which all sound good when sold in infomercials to the medical world and public. When examined closely, all are vague and open to abuse.

Each of these terms is intent on taking the human factor out of medicine. Each …

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The art of practicing template medicine

Health policy

Tort reform and integrated systems in health reform

Mitchell Brooks, MD

October 17, 2011Oct 17, 20115

Here are my next two principles of affordable healthcare reform. First, healthcare reform cannot occur without tort reform. Anything less is akin to a drunk leaning up against a lamppost for support but insisting it is for illumination. It is…

Here are my next two principles of affordable healthcare reform.

First, healthcare reform cannot occur without tort reform. Anything less is akin to a drunk leaning up against a lamppost for support but insisting it is for illumination.

It is well known that fear of malpractice suits accounts for defensive medicine; e.g., performing tests and procedures and making unnecessary referrals to assure staying out of the court room. We are all …

Physician voices

Science makes me a better doctor, faith makes me a better person

Anees Chagpar, MD

October 17, 2011Oct 17, 20119

Some have argued that there is an innate conflict between faith and science. I am not sure that is so. Not only do the two seem to co-exist; but to my mind, they may even be synergistic. A few months…

Some have argued that there is an innate conflict between faith and science. I am not sure that is so. Not only do the two seem to co-exist; but to my mind, they may even be synergistic.

A few months ago, at Schwartz rounds, a case of a pregnant patient who was being given chemotherapy was presented. When the nurse …

Conditions and diseases

tPA is the standard of care for stroke but with significant risks

Charles A. Pilcher, MD

October 17, 2011Oct 17, 20113

Under current guidelines from the American Stroke Association, tissue plasminogen activator (tPA, commonly known as a "clot buster" drug) should be administered within 3-4.5 hours of “last seen normal” – and 1 hour of patient arrival – to potentially ameliorate…

Under current guidelines from the American Stroke Association, tissue plasminogen activator (tPA, commonly known as a “clot buster” drug) should be administered within 3-4.5 hours of “last seen normal” – and 1 hour of patient arrival – to potentially ameliorate a new onset stroke. (“Last seen normal” means exactly what it says. A patient who went to bet at 10 PM and awoke with slurred speech at 6 AM was …

Physician voices

Is Groupon legal for doctors?

Deniza Gertsberg, Esq

October 16, 2011Oct 16, 20114

Groupon and other similar social sites, like Living Social and CoupTessa, are all the rage now. But is it legal for doctors and dentists to advertise their services on these websites? Groupon is a deal-of-the-day website that features discounted gift…

Groupon and other similar social sites, like Living Social and CoupTessa, are all the rage now. But is it legal for doctors and dentists to advertise their services on these websites?

Groupon is a deal-of-the-day website that features discounted gift certificates usable at local or national companies. If a certain number of people sign up for the offer, then the deal becomes available to all; if the predetermined minimum is not met, no one …

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Is Groupon legal for doctors?

Physician voices

The rewards of medicine can be overwhelming

Dr. Martin Young

October 16, 2011Oct 16, 20113

As I greeted my next patient of the morning, I knew from the early folder number that I had seen him six or seven years before. I no longer expect to remember everyone I have ever met professionally. The man before me was tall, fit and well built. There is usually some inkling of recognition, but nothing about him was familiar to me at all.

We made small talk for some …

Real physician voices, twice a week

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