KevinMD.com

October 16, 2011Oct 16, 20116

It is my strong contention that patients facing cardiac surgery should choose an institution, not a particular heart surgeon. Although individual judgement and technical dexterity are obviously important, best surgical outcomes reflect the performance of many medical providers before, during and after the operation. Professionalism and a competitive business environment both stimulate open heart centers to continuously focus on quality assurance programs to improve patient safety. Also, continuing medical …

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Cardiac surgery is a team sport

Drugs and prescribing

MKSAP: 60-year-old man with type 2 diabetes mellitus and hypertension

mksap

October 16, 2011Oct 16, 2011

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 60-year-old man with type 2 diabetes mellitus and hypertension visits the office to establish medical care. He reports monitoring his blood pressure and…

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

A 60-year-old man with type 2 diabetes mellitus and hypertension visits the office to establish medical care. He reports monitoring his blood pressure and blood glucose measurements at home with good results. He had a cholesterol panel checked approximately 5 years ago, at which time he …

Conditions and diseases

Chest pain is where protocol driven medicine breaks down

Shadowfax, MD

October 15, 2011Oct 15, 201111

On the theme of knowing when and when not to follow the diktats of emergency medicine, one of the greatest challenges for a practicing ER doc is chest pain. Missed MI is still the biggest driver of malpractice costs, and…

On the theme of knowing when and when not to follow the diktats of emergency medicine, one of the greatest challenges for a practicing ER doc is chest pain. Missed MI is still the biggest driver of malpractice costs, and last I hear, ER docs still send home something like 2% of patients who are having MI or unstable angina. Not good. So over the last decade we’ve gotten all …

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Patient voices

A test of faith during Ramadan

The American Doctor, MD

October 15, 2011Oct 15, 2011

Of all possible times, it happened during Ramadan. The test of faith would be extreme. Azka was the first of four children born to Persian parents in a small town thirty miles outside of Tehran, Iran. Being devout Muslims, her…

Of all possible times, it happened during Ramadan. The test of faith would be extreme.

Azka was the first of four children born to Persian parents in a small town thirty miles outside of Tehran, Iran. Being devout Muslims, her father chose the name Azka in part because it meant “pious”. His wife later revealed to Azka that he also liked how the name rolled off the tongue when spoken in …

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A test of faith during Ramadan

Health policy

What exactly is unnecessary care?

Darrell E. White, MD

October 15, 2011Oct 15, 201116

It’s become one of those trendy phrases, "unnecessary care." When you hear it on television or talkshow radio it’s usually said with a sneer. Indeed, the speakers almost spit the phrase out -- "unnecessary care" -- like it tastes bad.…

It’s become one of those trendy phrases, “unnecessary care.” When you hear it on television or talkshow radio it’s usually said with a sneer. Indeed, the speakers almost spit the phrase out — “unnecessary care” — like it tastes bad. It’s almost always accompanied by “fraud and abuse,” or a not so subtle accusation that some doctor is profiting off this unnecessary care at the expense of some poor …

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What exactly is unnecessary care?

Conditions and diseases

A urologist responds to the new prostate cancer screening guidelines

Neil Baum, MD

October 15, 2011Oct 15, 20118

"U.S. Panel Says No to Prostate Screening for Healthy Men" was the title of an article on the front page of the New York Times on October 6, 2011. The article goes on to suggest that healthy men should no…

“U.S. Panel Says No to Prostate Screening for Healthy Men” was the title of an article on the front page of the New York Times on October 6, 2011. The article goes on to suggest that healthy men should no longer receive a PSA blood test to screen for prostate cancer because the test does not save lives over all and often leads to more tests and treatments that needlessly cause pain, impotence and incontinence …

Drugs and prescribing

Do most parents use the alternative vaccine schedule?

Wendy Sue Swanson, MD

October 14, 2011Oct 14, 20112

I see this as a glass half-full, glass half-empty issue. Recently, a study was published in Pediatrics detailing research conducted in May of 2010 about parents’ preferences to use alternative vaccination schedules versus following the recommended CDC vaccination schedule. The…

I see this as a glass half-full, glass half-empty issue. Recently, a study was published in Pediatrics detailing research conducted in May of 2010 about parents’ preferences to use alternative vaccination schedules versus following the recommended CDC vaccination schedule. The majority of the media coverage focused on the finding that over 10% of parents followed a schedule other than the one recommended by the CDC. Not perfect and not ideal …

Health policy

Why 99 percent of health care should be angry

Roy Poses, MD

October 14, 2011Oct 14, 201181

As Occupy Wall Street has gone from an obscure protest covered only on blogs and social media to a national phenomenon, the apparent parallels between the issues it is raising and the issues we have been raising in health care…

A growing number of protesters are calling themselves the “99 Percenters,” referring to those who are not in the top 1% of earners. The top 1% of income is clearly greater than $250,000 per year, and likely …

Physician voices

AMA: Act quickly on Medicare deadlines

American Medical Association & Peter W. Carmel, MD

October 14, 2011Oct 14, 2011

A guest column by the American Medical Association, exclusive to KevinMD.com. There are several upcoming deadlines that are critical to physicians who care for Medicare patients. November 1, November 23 and January 1 are dates that should be marked on…

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

There are several upcoming deadlines that are critical to physicians who care for Medicare patients. November 1, November 23 and January 1 are dates that should be marked on all of our calendars.

The deadline for physicians to apply for a hardship exemption in order to avoid the 2012 Medicare ePrescribing penalty is fast approaching. Under the Centers for Medicare and Medicaid …

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AMA: Act quickly on Medicare deadlines

Conditions and diseases

Steps you can take to prevent developing diabetes

James Haddad

October 14, 2011Oct 14, 2011

In the past decade, the incidence of diabetes in the U.S. has nearly doubled – this is due in large part to the obesity epidemic. Currently, it is estimated that the lifetime risk of developing diabetes is around 1 in 3 for males an 2 in 5 for females born after 2000. When you consider that type II diabetes has a strong genetic component – the risk for a …

Patient voices

Handshakes during viral outbreaks

Emily Gibson, MD

October 14, 2011Oct 14, 20112

Suffice to say, as a physician, I’m not germ phobic. If I were, I wouldn’t work as a health care provider in the “culture media” of an ambulatory care clinic. I certainly respect the pathogens I come in contact with daily, along with the host who harbors them. For the most part, the virus and the patient know I don’t have much effective artillery to fight back with and my …

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Handshakes during viral outbreaks

Medical education

Can I do residency again in a better rested environment?

Chris Porter, MD

October 13, 2011Oct 13, 20117

"How are residents supposed to prepare for real life as a surgeon if they can’t even work twenty-four hours straight now?" I hear this complaint about once a month from a someone trained in the Golden Age of hazing. Outside…

“How are residents supposed to prepare for real life as a surgeon if they can’t even work twenty-four hours straight now?”

I hear this complaint about once a month from a someone trained in the Golden Age of hazing. Outside of anecdote, we’ll never know if surgeons are better trained now or twenty years ago, or fifty. But it’s too painful to imagine every-other-night-call wasn’t of critical importance.

Residency resembles the …

Patient voices

Use body language to improve your patient encounter

Niamh van Meines, ANP-BC, EMT

October 13, 2011Oct 13, 20113

While body language can be interpreted in many ways and it's not an exact science, it is often possible to read body language and have a basic understanding of a persons mood or dispositions and the rapport that people have…

While body language can be interpreted in many ways and it’s not an exact science, it is often possible to read body language and have a basic understanding of a persons mood or dispositions and the rapport that people have with each other through observing non-verbal communication. This issue focuses on reading everything that hands can tell you and ways to use your hands to influence interactions with others.

What’s …

Physician voices

Inspiration for new primary care doctors

Edward J. Volpintesta, MD

October 13, 2011Oct 13, 20113

Congratulations! You are an amazing group of young men and women. In college, medical school and residency your dedication and discipline, but most of all your idealism helped you to persevere and conquer some difficult challenges. In college, your friends studying philosophy and literature and history wondered how you had the endurance to study biochemistry and organic chemistry and calculus. Not to mention the Krebs Citric Acid Cycle.

You studied hard …

Patient voices

Why Dr. Oz is wrong about arsenic and apple juice

Roy Benaroch, MD

October 13, 2011Oct 13, 20116

The Dr. Oz show recently featured a scary show about deadly arsenic in apple juice. On his own web site, he trumpets "Dr. Oz’s Extensive National Investigation," and claims "After testing dozens of samples from three different cities in America,…

The Dr. Oz show recently featured a scary show about deadly arsenic in apple juice. On his own web site, he trumpets “Dr. Oz’s Extensive National Investigation,” and claims “After testing dozens of samples from three different cities in America, Dr. Oz discovered that some of the nation’s best known brands of apple juice contain arsenic.”

His show further claimed that based on his independent testing, many brands of apple juice …

Physician voices

The decision not to become a surgeon

Jim deMaine, MD

October 12, 2011Oct 12, 2011

Every medical student goes though a process of elimination when deciding what kind of doctor they want to become. We hear the old saying, "Internists know everything and do nothing; Surgeons know nothing and do everything; Psychiatrists know nothing and…

Every medical student goes though a process of elimination when deciding what kind of doctor they want to become. We hear the old saying, “Internists know everything and do nothing; Surgeons know nothing and do everything; Psychiatrists know nothing and do nothing; Pathologists know everything and do everything but it’s too late.” We hear that pediatricians wear bow ties, are short, and love to laugh and play; that surgeons …

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The decision not to become a surgeon

Patient voices

What does the Explanation of Benefits really mean?

David Williams

October 12, 2011Oct 12, 20115

I recently had some physical therapy for a minor injury. Since the office forgot to charge my co-pay the first time I went in I received a so-called Explanation of Benefits (EOB) from my insurance carrier, BlueCross BlueShield of Massachusetts. EOBs are a holdover from the mainframe era: arcane, inflexible reports that are hard to interpret. They may have done their job in the day when their only purpose was …

Medical education

The life of a medical resident in Mexico

Cesar Lucio, MD

October 12, 2011Oct 12, 201112

The average week for a medical resident training in Mexico can easily exceed 90 work hours. Mexico is a country that takes pride in offering full health coverage for 100 million citizens. This is a new policy and free public medical care is being pushed to the limit. The situation is simple, the work load in outpatient clinics, operating rooms, the wards and emergency rooms across the country is …

Patient voices

The United States lacks postpartum support for mothers

Rajka Milanovic Galbraith, MD

October 12, 2011Oct 12, 201116

Last month, vegan couple Jade Sanders and Lamont Thomas’ appeal of their life in prison sentence was overturned. The couple reportedly starved their 6 week old to death by feeding him only soymilk and apple juice. When reading this, so many questions arise. How could they not know their child was starving? Where was their support? Were they truly negligent? And what happened to all the systems in place to protect children?

In an …

Physician voices

The impact of unnecessary testing and treatment on patients

Brian Goldman, MD

October 11, 2011Oct 11, 20114

Ask most patients, and they say their doctor has a good reason for ordering tests and prescribing treatments. Turns out their doctor may secretly disagree. That's the conclusion of a new study. The implications are more than a bit disturbing.…

Ask most patients, and they say their doctor has a good reason for ordering tests and prescribing treatments. Turns out their doctor may secretly disagree. That’s the conclusion of a new study. The implications are more than a bit disturbing.

Researchers from the Dartmouth Institute for Health Policy conducted a survey of more than six hundred physicians. Forty-two percent of family doctors admitted that patients in their own practice receive too much care – meaning …

Real physician voices, twice a week

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