KevinMD.com

October 11, 2011Oct 11, 20113

With all the debate about cost control, it’s clear that we doctors will have to police ourselves – or else politicians and insurance companies will exert even more influence over our practices than they already do. The main question is:…

Are we willing to let our physician colleagues exert influence on our care decisions?

Taking a case from my field: at a conference this past week I met a radiology resident …

Patient voices

Hospital discharge summaries are a health literacy issue

Hilary Seligman, MD

October 11, 2011Oct 11, 20114

A couple of years ago, a frail 88 year old Filipino woman came into the emergency department of my hospital complaining of confusion and weakness of her left arm. Her blood sugar level was extraordinarily low, so low that she…

The emergency room doctors treated her by injecting her with sugar, and then called the team of internists on call to admit …

Conditions and diseases

Knowing the true name of a medical condition

Christopher Johnson, MD

October 11, 2011Oct 11, 2011

There is a long tradition in folklore, one shared by shamans and occultists, that knowing the true name of something gives you power over it. Many years ago I had a very sick patient in the PICU who one morning,…

There is a long tradition in folklore, one shared by shamans and occultists, that knowing the true name of something gives you power over it.

Many years ago I had a very sick patient in the PICU who one morning, totally out of the blue, broke out in a bright, red rash all over his body. The boy had many critical problems already and, although the rash didn’t seem to be causing …

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Patient voices

Top 5 myths about empowered patients

Steve Wilkins, MPH

October 10, 2011Oct 10, 20116

Irrational exuberance was a term once used to describe the stock market before the last crash. It also seems an apt description for much of the talk these days about empowered health consumers. To be sure, patients today have unprecedented…

Irrational exuberance was a term once used to describe the stock market before the last crash. It also seems an apt description for much of the talk these days about empowered health consumers.

To be sure, patients today have unprecedented access to health information. Patient decision-support tool can be found on just about every provider, payer and self-insured employer website. Consumers can go to any number of websites to find …

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Top 5 myths about empowered patients

Conditions and diseases

Whose responsibility is childhood obesity?

Doug Tynan, PhD

October 10, 2011Oct 10, 201111

With the obesity crisis in America, one of the major reasons for increasing health costs, the issue of the causes inevitably arises. There seem to be two sets of causes postulated by a growing crowd of experts. Unfortunately, each set…

With the obesity crisis in America, one of the major reasons for increasing health costs, the issue of the causes inevitably arises.

There seem to be two sets of causes postulated by a growing crowd of experts. Unfortunately, each set is aligned in our current polarized political climate with the right or the left. Each set of causes has some basis in reality, but neither fully explains the problem.

On one …

Conditions and diseases

Stem cells, surgery free heart valve repair and nutraceuticals advance heart care

Stephen C. Schimpff, MD

October 10, 2011Oct 10, 20113

The last post in this series discussed new advances in cardiology – the two themes of genetically informed therapy and technical advances. I will continue with three additional themes – regenerative medicine, minimally invasive approaches and prevention. The third of…

The third of the five themes is regenerative medicine. One major area of investigation is whether stem cells can heal the damaged heart. Perhaps the field is “more glamour than fact” just now …

Physician voices

ACP: Relationships enhance patient care

American College of Physicians & Fred Ralston Jr., MD

October 10, 2011Oct 10, 20112

A guest column by the American College of Physicians, exclusive to KevinMD.com. Up until 2001 I practiced medicine in the hospital where I was born. I still work in the hospital that was built to replace it. In our mobile…

A guest column by the American College of Physicians, exclusive to KevinMD.com.

Up until 2001 I practiced medicine in the hospital where I was born. I still work in the hospital that was built to replace it. In our mobile society that is clearly the exception rather than the rule.

I love what I am able to offer my patients as a general internist in a community where my family has …

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ACP: Relationships enhance patient care

Physician voices

Doctors who cross the line by protesting too much

Ford Vox, MD

October 9, 2011Oct 9, 20113

Doctors are in the cross-hairs of the nation's politics more than ever. We're all being asked to achieve more with less. We must cope with nightmare scenarios precipitated by cracks in the social and healthcare infrastructure so often these days…

Doctors are in the cross-hairs of the nation’s politics more than ever. We’re all being asked to achieve more with less. We must cope with nightmare scenarios precipitated by cracks in the social and healthcare infrastructure so often these days that medical schools insist students become effective patient advocates as well as healers. Practicing good medicine necessitates navigating a minefield of competing interests. Doctors are increasingly tempted to just walk …

Health policy

Are physician services to blame for high health costs?

Cedric Dark, MD, MPH

October 9, 2011Oct 9, 201113

Why does health care cost so much more in the United States than in other countries? The answer is exceedingly complex; pharmaceuticals, hospitals, and physician services (among others) comprise the multiple slices of the health care pie that in the…

A new study from one of President Obama’s appointees (note: this study was written prior …

Physician voices

Three major cognitive errors physicians make

Jerome Groopman, MD & Pamela Hartzband, MD

October 9, 2011Oct 9, 20115

As physicians, we all dread missing a diagnosis: indigestion that turns out to be angina, back pain that signals an aortic aneurysm, migraine that proves to be a brain tumor. Although it is only an estimate, several studies in the medical literature indicate that misdiagnosis occurs in 15% to 20% of all cases, and in half of these, there is serious harm to the patient.

Researchers have found that the vast …

Physician voices

Transparency in health care preserves our ability to innovate and grow

Michael Tarnoff, MD

October 9, 2011Oct 9, 2011

Collaboration between medical professionals and the healthcare products industry has long been vital to advancing patient care and safety. Healthcare professionals help companies better understand unmet clinical needs, while companies invest in innovative research and product development that are squarely…

As a society, we should acknowledge the value of these bona fide relationships. Balanced provider input into corporate decision-making has broad …

Health policy

Shared decision making is impossible in a government run health system

Norman Briffa, MD

October 8, 2011Oct 8, 201114

The relationship between doctors and their patients has changed dramatically over the past few years. Medical beneficence became paternalism and is now near obsolete. Shared decision making is the new lofty ideal we should all be striving for. It is guiding new health policy both in the UK, with the new mantra “nothing about me without me,” and in the US.

We are at the start of the Century of the …

Drugs and prescribing

Observing the Primatene Mist controversy as an asthma specialist

Paul M. Ehrlich, MD

October 8, 2011Oct 8, 2011

As the clock ticks away on Primatene Mist, the only over-the-counter asthma inhaler left on the market, it is being ginned up as an argument against regulatory overreach by the Obama administration. I have been observing the Primatene controversy for decades as an asthma specialist. I have to say that there’s blame enough on many sides of this discussion, not just pro and con government regulation, but both the pharmaceutical …

Physician voices

Time to put a little bit of Disney into medicine

Anonymous

October 8, 2011Oct 8, 201112

Why is a trip to the doctor's office more like going to the DMV than to Disney World? Both the DMV and Disney World involve waiting in long lines, but Disney has made the entire experience fun and exciting, while…

Why is a trip to the doctor’s office more like going to the DMV than to Disney World? Both the DMV and Disney World involve waiting in long lines, but Disney has made the entire experience fun and exciting, while the DMV has made it cold and frustrating.

“But medicine is different,” you may say. After all, seeing the doctor was never meant to be a fun or exciting experience. When …

Conditions and diseases

MKSAP: 72-year-old woman with fatigue and decreased exercise capacity

mksap

October 8, 2011Oct 8, 2011

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 72-year-old woman is evaluated for fatigue and decreased exercise capacity. The patient has severe chronic obstructive pulmonary disease, which was first diagnosed 10…

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

A 72-year-old woman is evaluated for fatigue and decreased exercise capacity. The patient has severe chronic obstructive pulmonary disease, which was first diagnosed 10 years ago, and was hospitalized for her second exacerbation 1 month ago. She is a former smoker, having stopped smoking 5 years …

Physician voices

Why medical scientists should share data

Eugen Tarnow, PhD & George Lundberg, MD

October 7, 2011Oct 7, 2011

Our kindergarten teachers and Hippocrates taught us to share. But after school, capitalism takes over among American medical researchers. Eric Campbell writes in "Data Withholding in Academic Genetics" that it was frequent for investigators to be denied access to data.…

Our kindergarten teachers and Hippocrates taught us to share. But after school, capitalism takes over among American medical researchers.

Eric Campbell writes in “Data Withholding in Academic Genetics” that it was frequent for investigators to be denied access to data. The reasons for denials include “too much effort” and protecting potential publications of students and themselves.

The respondents expressed only a little worry about protecting the commercial value of results: …

Physician voices

Psychiatry should not be a tool for social justice

Steve Balt, MD

October 7, 2011Oct 7, 201118

A doctor’s primary responsibility is to heal, and all of our efforts and resources should be devoted to that goal. At times, it is impossible to restore a patient to perfect health and he or she must unfortunately deal with some degree of chronic disability. Still other times, though, the line between “perfect health” and “disability” is blurred, and nowhere is this more problematic than in psychiatry.

To illustrate, consider …

Health policy

Palliative care physicians can enhance patient decision making

Mark Novotny, MD

October 7, 2011Oct 7, 20112

Data from the Dartmouth Atlas show patients with chronic illness in their last two years of life account for about 32 percent of total Medicare spending, with much of that expense going toward physician and hospital fees associated with repeated…

Opportunities to reduce medical expenditures during the last 2 years of life are often looked upon as a way to reduce the cost of healthcare while actually improving the …

Conditions and diseases

USPSTF prostate cancer screening guidelines need emotion to resonate

Kevin Pho, MD

October 7, 2011Oct 7, 201113

Prostate cancer screening has always been controversial. Now, with the USPSTF is recommending against screening for prostate cancer, gas is about to be poured on the proverbial fire. Recently, the New York Times Magazine published a lengthy piece on the…

Prostate cancer screening has always been controversial.

Now, with the USPSTF is recommending against screening for prostate cancer, gas is about to be poured on the proverbial fire.

Recently, the New York Times Magazine published a lengthy piece on the issue, perhaps not coincidentally, perfectly timed with the Task Force’s announcement.

In 2009, advocates for breast cancer screening were up …

Conditions and diseases

5 ways to cut breast cancer risk

Therese B. Bevers, MD

October 7, 2011Oct 7, 20114

Breast cancer may be the most common cancer among women. But, that doesn’t mean you can’t do something to help prevent it. Researchers have found certain risk factors that increase a woman’s chances of getting breast cancer. We can’t change…

Breast cancer may be the most common cancer among women. But, that doesn’t mean you can’t do something to help prevent it.

Researchers have found certain risk factors that increase a woman’s chances of getting breast cancer. We can’t change some of these factors, like age or race. But we can try to control others, like weight gain and alcohol use.

And, taking responsibility for the things you can control may …

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5 ways to cut breast cancer risk

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