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Tobacco cigarettes should be sold only in pharmacies to people with a permit

Medications

July 31, 2011

I like Iceland. It is a really neat place; great people; terrific scenery; lively nightlife; surprisingly temperate climate, considering the latitude, thanks to the Gulf Stream.

Of course, it is true that some of the Iceland bankers, poorly regulated and without scruples, were even more predatory than many of the American Wall Street investment bankers, taking the money and running to lead a pack of nations into international fiscal calamity, a …

We need a single payment system instead of single payer

Mitchell Brooks, MD

Health Policy

July 30, 2011

One of the great myths of healthcare is that there is an actual “system” in the United States. If such a system exists, I have yet to become familiarized with it. What we have are mountains of paper that slavishly tie the patient, doctor, hospital and insurance carrier alike to a system of coding interpreted by individuals with no sense of what the codes mean or the labor and …

Why Medicare is the solution to the soaring costs of health care

Robert Reich

Health Policy

July 30, 2011

Not only is Social Security on the chopping block in order to respond to Republican extortion. So is Medicare.

But Medicare isn’t the nation’s budgetary problems. It’s the solution. The real problem is the soaring costs of health care that lie beneath Medicare. They’re costs all of us are bearing in the form of soaring premiums, co-payments, and deductibles.

Medicare offers a means of reducing these costs — if Washington would let …

When well people seek medical attention in a system designed to care for the sick

George Lundberg, MD

Patient

July 30, 2011

Over the past several decades, there has been a shift in the kinds of patients seeking medical care.

The progression has been from sick to early sick to well to worried well to worried sick.

The reasons are beyond the scope of this article. There is a subtle and hidden, but potentially very damaging, factor operating in the diagnostic process when large numbers of well people seek medical attention in a …

Why doctors can sometimes be their own worst enemies

Steve Wilkins, MPH

Physician

July 30, 2011

“I don’t have the time … I don’t get reimbursed for that.” This is an all too common refrain from primary care physicians and practice managers when ever the subject of improving physician-patient communications comes up.

I get it. Primary care physicians in particular are under tremendous pressure to produce. Just imagine, physicians in small primary care practices spend about 3.5 hours per week just on dealing with insurance-related paperwork. Then …

MKSAP: 33-year-old man with stretch marks in his groin

mksap

Conditions and Diseases

July 30, 2011

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

A 33-year-old man is evaluated because of the recent appearance of stretch marks in his groin that extend to his thighs. He has a history of long-standing psoriasis that at times has involved much of his body, including his intertriginous areas. His topical treatments include tar-containing …

Planning effective office meetings for your medical practice

Rosemarie Nelson

Physician

July 30, 2011

Do you cringe when you hear the phrase “office meeting”? Some medical practices meet too frequently and some seldom meet, but others have it just right – routine meetings with preparation, an agenda, and follow-up. Your practice can get it right, too.

And make no mistake, meetings are important. Medical practices, regardless of size, have a variety of positions that are not interchangeable, but do interact throughout the day.

To make …

Embracing different cultures in the service of the dying

Niamh van Meines, ANP-BC, EMT

Patient

July 30, 2011

She was overwhelmed with grief when she walked into the room and saw her mother silently and peacefully dead in the hospital bed. Her death was expected, but as always, no-one is ever quite ready to let go. She started to wail loudly and speak directly to her deceased mother about the pain she was inflicting by dying.

She was compelled to hold her prayer beads and started to dance around …

Physicians who treat inmates are at greater risk of litigation

Jeffrey Knuppel, MD

Physician

July 29, 2011

Most psychiatrists and primary care physicians who work in corrections long enough will end up being named in a lawsuit or having a complaint filed against them with their licensing board. So, from a risk-management standpoint, is it worth the potential hassle?

Yes, in most cases I think it is.

It is a fact that physicians who treat inmates are at greater risk of litigation. I don’t have specific figures to give …

Patient tips for your first office visit

Jill of All Trades, MD

Patient

July 29, 2011

Starting a new job can be exciting, a new challenge, while embarking on a new journey. I have the opportunity to meet many new fellow docs, staff, and kind patients. However, I have to admit that it is a tad more challenging in the beginning when starting a new practice from scratch. I do miss the familiar patient faces that knew me and trusted my medical abilities without question. But …

Is there really a physician shortage, and do we need more medical schools?

Peter J. Weiss, MD

Physician

July 29, 2011

“Whether you think you can, or think you can’t, you’re right,” said Henry Ford noting how our mindset shapes our behavior. Now, let’s talk about our American mindset on healthcare, which is that “more is needed” and that doctors are the most important players.

In a recent message to all physicians, Dr. Cecil B. Wilson, former president of the American Medical Association, calls on us to help take vigorous action to …

Who takes care of doctors when they get sick?

Darrell E. White, MD

Physician

July 29, 2011

I don’t feel so hot. No, that’s not quite right. I feel really lousy. That’s more accurate.

I’m really not much of a complainer. I go to work unless I simply can’t rise from bed and crawl to the shower. The entire staff, my family, and every patient who walks into my office, all feed off my mood. No matter how I feel, how up or down I might be, on the …

Why physicians are clueless about malpractice implications of DVTs

Angry Orthopod, MD

Physician

July 29, 2011

A medical malpractice attorney and an orthopaedic surgeon are on a golf trip. This sounds like the worst joke of all time, but it’s actually the story of my brother and I 20 years ago.

Amidst the rough, he laid some serious philosophy on me. In most families, that might be about life and love and whatnot. Not in our family. We were engaged about deep venous thrombosis (DVT) and …

Diagnosing Alzheimer’s disease sooner or later

James P. Richardson, MD, MPH

Conditions and Diseases

July 29, 2011

A recent Harvard School of Public Health survey of more than 2500 adult in six different countries has found that Alzheimer’s disease is more dreaded than any other disease save cancer. The same survey also demonstrated that 85% of respondents would want to know their diagnosis as soon as possible if they began to show symptoms. The survey was reported recently at the Alzheimer’s Association International Conference (AAIC) meeting …

The survival of Medicare depends on providers and patients

Steven H. Rudolph, MD

Health Policy

July 29, 2011

A few weeks ago a patient came into my office referred for evaluation regarding surgery on her carotid artery. Although she had no symptoms, her primary physician had performed carotid ultrasound and found a severe narrowing on one side. She presented the results of this examination, and several additional diagnostic studies that had been performed recently. As it turned out, the doppler was inaccurate and she did not have any narrowing. …

When to use a new technology and when to die with dignity

Stephen C. Schimpff, MD

Physician

July 29, 2011

American medicine overuses its technologies and innovation triumphs and way underutilizes old fashioned compassion, discussion and good common sense.

Over the past twelve weeks I have given weekly updates of medical megatrends in the fields of genomics, stem cells, transplantation and vaccines. These advances are the representation of innovations and entrepreneurship in biological, computer and engineering science. They are exciting advances and offer promise of hope …

Medical education cost is a health policy imperative

Kevin Pho, MD

KevinMD

July 28, 2011

Whenever I talk about the cost of medical education, I like to bring up this chart. It starkly illustrates just how expensive it is to train a doctor in the United States, compared to Canada and France.

New York Times contributor Pauline Chen wrote a column on the issue recently. Most doctors graduate with a debt exceeding $150,000, and …

How dabigatran is an atrial fibrillation paradigm shift

John Mandrola, MD

Medications

July 28, 2011

My iPhone vibrated with an urgent message that read: “Please call … the INR on your atrial fibrillation patient scheduled for cardioversion is too low. He is on that new blood thinner, Pradaxa. What do you want to do?”

I responded, sounding like an expert: “It’s ok. Pradaxa thins the blood adequately, it just doesn’t change the INR.”

She astutely responded, “How do know the blood is thin? What if …

How health care will change in community health centers after reform

Ricky Choi, MD

Health Policy

July 28, 2011

37 years ago, at the very tail of the civil rights movement, my community health center (CHC) was established in Oakland to fill an unmet and urgent need. A growing population of immigrants were settling in downtown Oakland and had few choices for health care. Community surveys conducted by local leaders confirmed that residents received significantly less health care than the rest of the population largely due to a …

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