KevinMD.com

September 30, 2011Sep 30, 201110

Patients may soon be universally able to view their lab results thanks to a new rule proposed by the Department of Health and Human Services. This means patients may access without permission or release by their providers. This is a…

Classically patients do not see their lab results. The busy primary doctors are often left with nothing more than …

Physician voices

Physicians lack harmony in this age of health reform

Gary Oftedahl, MD

September 30, 2011Sep 30, 2011

At every turn, we in health care are being told we must fundamentally change the way we deliver care to the patients who come to us for assistance, advice, and decisions as to how they can, if not maintain health, at least survive in an increasingly burdensome world. Whether referenced as medical home, health care home, advanced primary care, patient-centered approaches, or accountable care organizations, it all sounds the same …

Medical education

Bias in CME due to the presence of commercial support is overrated

Derek Warnick

September 30, 2011Sep 30, 2011

So I missed out on the whole CME outrage that came up earlier this year in a Archives of Internal Medicine study, but I do have a theory about it that I’d like to try out. I’m not interested in…

So I missed out on the whole CME outrage that came up earlier this year in a Archives of Internal Medicine study, but I do have a theory about it that I’d like to try out.

I’m not interested in getting into the “perceived potential bias” vs “actual bias” argument – which is a good one and one Tom Sullivan wrote about extensively – but would rather take a look …

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Physician voices

Doctors should not treat every patient like their mother

James Logan, MD

September 30, 2011Sep 30, 20114

Physicians recommend different treatments for patients than they would choose for themselves. The preceding statement is true according to a similarly titled article recently published in the Archives of Internal Medicine, and has, I will argue, important implications for how…

Physicians recommend different treatments for patients than they would choose for themselves. The preceding statement is true according to a similarly titled article recently published in the Archives of Internal Medicine, and has, I will argue, important implications for how we view the doctor-patient relationship.

In the study, one group of physicians was asked to choose between two hypothetical treatment alternatives for either avian flu or colon cancer as …

Physician voices

Is medical tourism a dire threat to American surgeons?

Richard N. Fogoros, MD

September 30, 2011Sep 30, 20119

In an earlier post, DrRich offered several potential strategies for doctors and patients to consider should healthcare reformers ultimately succeed in their efforts to make it illegal for Americans to seek medical care outside the auspices of Obamacare. To those readers who persist in thinking that DrRich is particularly paranoid in worrying about such a thing, he refers you to his prior work carefully documenting the efforts the Central Authority has already made …

Physician voices

How to isolate problems in your scheduling system

Adam Alpers, DO

September 29, 2011Sep 29, 2011

Though there will always be times when an emergency disrupts your schedule, there is usually little reason for patients to wait more than 20 minutes for their visit. You will also find that continually double booking, arriving late, or having general mayhem in your office will inevitably result in everyone having to stay later than expected. Rather than experiencing all of these problems, you will be well served by isolating …

Physician voices

The only anesthesiologist in this vast hospital

Felicity Billings, MD

September 29, 2011Sep 29, 20113

His blood pressure disappeared. The arterial tracing, a red line on the monitor reassuringly undulating with every beat of his heart, falling from 122/83, 99/64, 80/50, 67/42, then a flat line at 48. I had just come off the elevator,…

His blood pressure disappeared. The arterial tracing, a red line on the monitor reassuringly undulating with every beat of his heart, falling from 122/83, 99/64, 80/50, 67/42, then a flat line at 48.

I had just come off the elevator, ushered in by the surgery resident who found me in the hallway searching for the right room.

Epinephrine. Get the code cart. Check for a pulse. The nurse screwed the two halves …

Patient voices

America’s broken disability system

Edwin Leap, MD

September 29, 2011Sep 29, 201127

I once asked a man in his 30’s why he was on disability. He had fallen attempting to ford a swift stream while fishing. He replied: "Well, the judge said I have a bad attitude, I don’t like people and…

I once asked a man in his 30’s why he was on disability. He had fallen attempting to ford a swift stream while fishing. He replied: “Well, the judge said I have a bad attitude, I don’t like people and I can’t hold a job.” Shocking as it sounds, it wasn’t very different from other reasons I’ve heard. “I don’t remember, my Dad put me on it.” “I have anxiety.” …

Read more…

America’s broken disability system

Physician voices

A hospital board needs to understand generative thinking

Kent Bottles, MD

September 29, 2011Sep 29, 20112

Hospital systems and physician groups are faced with unprecedented change demanding decreased per-capita cost and increased quality in American health care. Boards of directors are underutilized resources that must be tapped more effectively in order for such organizations to survive in a time of industry consolidation. Generative thinking is a tool that can help organizations innovate in order to improve patient care and the financial bottom line.

Generative thinking is …

Patient voices

Lethal injections are not good medicine

Katherine Ellington

September 29, 2011Sep 29, 201123

Recently, two executions by lethal injections were carried out in America. One ended the life of Troy Davis in Georgia, the other with too much hate Lawrence Russell Brewer in Texas. Death and dying offer complexity and complications in the profession medicine bound by policies, mandates and laws driven by internal (e.g. professional associations, medical boards) and external (e.g. federal, state, medical center) forces.

Lethal injections involve delivering a fatal dose …

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Lethal injections are not good medicine

Conditions and diseases

An MRI for back pain may only confuse the diagnosis

Kerrie M. Reed, MD

September 29, 2011Sep 29, 20117

"Doc, my back is killing me! I think I need an MRI." I don't know if you've ever uttered those words, but I can tell you I've sure heard them ... more times than I can count. And believe me,…

“Doc, my back is killing me! I think I need an MRI.”

I don’t know if you’ve ever uttered those words, but I can tell you I’ve sure heard them … more times than I can count. And believe me, I get it. When you’re in pain, all you care about is finding out what’s causing it as soon as possible so you can get rid of it as soon as possible. It’s quite tempting to …

Physician voices

It is a rare medical news story that gets high marks

George Lundberg, MD

September 29, 2011Sep 29, 20114

Like you, I receive a whole bunch of breaking medical news every day, from television, radio, newspapers, direct mail, email alerts, press releases, and multiple websites. Is any of it worth my time, my attention, or even a change in…

Like you, I receive a whole bunch of breaking medical news every day, from television, radio, newspapers, direct mail, email alerts, press releases, and multiple websites.

Is any of it worth my time, my attention, or even a change in my knowledge, attitude, behavior, or medical practice? How can I quickly tell?

A medical journalist from Minnesota named Gary Schwitzer recognized this problem many years ago and created a service that …

Patient voices

Patients generally seek attorneys out of anger rather than greed

Jessica Scott, MD, JD

September 28, 2011Sep 28, 20118

Patients often pursue litigation simply to obtain information that has not been forthcoming. Research shows that the three things patients want most in the face of medical error are: information about what happened; a sincere apology; and measures to prevent the error from happening to someone else. Financial compensation is lower on the list. Patients generally seek attorneys out of anger rather than greed. When unanticipated adverse outcomes occur, error …

Patient voices

A bride who wants to register at the Mayo Clinic

Meredith Gould, PhD

September 28, 2011Sep 28, 20116

I’m getting married in November and am not "registered" anywhere. Doing so hadn’t even occurred to me until people started asking, "where are you registered?" At first, I simply laughed. Dan and I have enough for two households. Now I’m…

I’m getting married in November and am not “registered” anywhere. Doing so hadn’t even occurred to me until people started asking, “where are you registered?”

At first, I simply laughed. Dan and I have enough for two households. Now I’m re-thinking the bridal registry thing.

Here comes the under-insured, chronically-ill bride going on two years without primary medical care … and I want to register at the Mayo Clinic.

My bridal registry wish list …

Health policy

Physicians need to be part of the overall wellness process

Joseph Boffa, DDS, MPH

September 28, 2011Sep 28, 2011

After nearing the brink of political collapse, Congress and the President reached agreement on a plan for deficit reduction. Part of the agreement is that a "super committee"will cut an additional $1.5 trillion from the federal budget. Cuts are being…

After nearing the brink of political collapse, Congress and the President reached agreement on a plan for deficit reduction. Part of the agreement is that a “super committee”will cut an additional $1.5 trillion from the federal budget. Cuts are being considered for a range of programs, including Medicare. As director of a wellness program for retirees, however, I remain acutely concerned about the impact Medicare cuts will have on …

Physician voices

Doctors with great bedside manner can also provide great clinical care

Davis Liu, MD

September 28, 2011Sep 28, 20119

The New York Times recently published an article titled, Finding a Quality Doctor, Dr. Danielle Ofri an internist at NYU, laments how she was unable to perform as well as expected in the areas of patient care as it related…

The New York Times recently published an article titled, Finding a Quality Doctor, Dr. Danielle Ofri an internist at NYU, laments how she was unable to perform as well as expected in the areas of patient care as it related to diabetes. From a New England Journal of Medicine article, Dr. Ofri notes that her report card showed the following – 33% of patients with diabetes have glycated hemoglobin …

Physician voices

Honesty between doctors and patients goes both ways

Stewart Segal, MD

September 28, 2011Sep 28, 20116

Yesterday, someone asked me, "Can I be perfectly honest with you?" I wanted to reply, "No, just be dishonest, I like it better that way!" "Can I be" implies that, in past conversations, my patient has been dishonest. Dishonesty is…

Yesterday, someone asked me, “Can I be perfectly honest with you?” I wanted to reply, “No, just be dishonest, I like it better that way!” “Can I be” implies that, in past conversations, my patient has been dishonest. Dishonesty is a relationship breaker. Dishonesty leads to distrust and if I cannot trust what a patient is telling me, I cannot be effective; the doctor-patient relationship is terminated.

Am I being too …

Physician voices

Father and son, doctor and grieving family member

Jordan Grumet, MD

September 28, 2011Sep 28, 2011

The edges of Cameron's lips rise undeniably toward the clear blue sky. His legs move methodically. One motionless on the scooter and the other periodically kicking to propel himself forward. He weaves in and out dodging my shadow as I…

The edges of Cameron’s lips rise undeniably toward the clear blue sky. His legs move methodically. One motionless on the scooter and the other periodically kicking to propel himself forward. He weaves in and out dodging my shadow as I jog beside him.

I struggle to keep pace. My breathing unsteady and labored. My joints aching. And my brain foggy from lack of sleep and replaying the events of the day.

***

The …

Patient voices

It is not easy being a patient-consumer, but it can be done

Jeffrey Rice, MD, JD

September 28, 2011Sep 28, 20118

I would like to share a story about my son’s recent surgery that, while only one simple case, reveals the foundational problem with the U.S. health care system. I write this story as a father of a 12 year old…

I would like to share a story about my son’s recent surgery that, while only one simple case, reveals the foundational problem with the U.S. health care system.

I write this story as a father of a 12 year old boy who has cerebral palsy. Jack is fortunate to be healthy and active with minor medical needs. As he has grown he experienced some issues with contractures in his right lower …

Physician voices

If you need to say you’re all about the patient, you aren’t

Sanford C. Sharp, MD

September 27, 2011Sep 27, 2011

Sir William of Ockham has achieved a degree of mortality via the wide promulgation of an aphorism, now generally known at Occam's Razor (I'll use the more economical spelling). There are many iterations of the razor, but my favorite is…

Sir William of Ockham has achieved a degree of mortality via the wide promulgation of an aphorism, now generally known at Occam’s Razor (I’ll use the more economical spelling). There are many iterations of the razor, but my favorite is this: “simpler explanations are, other things being equal, generally better than more complex ones.” That trips off the tongue more easily than, say, “plurality should not be posited without necessity.”

In …

Real physician voices, twice a week

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