KevinMD.com

Frustration when a government does not provide the necessary health care

Physician

June 25, 2011

Year: 1988

Setting: Electricite de France clinic at Daya Bay, China
Position: Resident physician

A Japanese encephalitis epidemic has struck southern China and I am in its midst at Daya Bay where Electricite de France is building a nuclear plant for the Chinese government. As the resident physician for the company, I see the local employees and their families. They all get immunized against the disease with the inactivated virus Biken vaccine, …

New fields in general surgery and the rise of the surgical hospitalist

Skeptical Scalpel, MD

Physician

June 24, 2011

As medicine adapts to the 21st century, new specialties arise.

General surgery is seeing two new fields emerge. One is “Acute Care Surgery,” which encompasses three facets of general surgery — emergency surgery, critical care and trauma care. The other is the concept of a surgical hospitalist. That is, a surgeon works only in a hospital and has no office or private practice. The idea is similar to the medical …

Doctors are asking whether the physical exam is becoming a lost art

Jan Henderson, PhD

Physician

June 24, 2011

The physical exam – looking into the eyes and throat, taking the blood pressure, sounding the chest – is part of the process of medical diagnosis. It’s one way a physician attempts to determine the cause of a patient’s complaint.

In recent times, doctors have asked themselves whether the physical exam is becoming a lost art. It’s been replaced by an array of laboratory tests and high tech machines that …

The tragic irony of pharmaceutical coupons

Chris Lillis, MD

Medications

June 24, 2011

As a primary care physician in private practice, I have my own little taste of celebrity.

Every day attractive people come to my office seeking time to speak with me and collect my autograph. They fawn over my partners and I, and bring us food for lunch, and will invite us to the nicest restaurants in town for dinner. These people also used to bring gifts, until they were barred from …

Reasons why your doctor is running late

Emily Gibson, MD

Physician

June 24, 2011

It may not be rabbit season or duck season but it definitely seems to be doctor season.

Physicians are lined up squarely in the gun sights of the media, government agencies and legislators, our health care industry employers and coworkers, not to mention our own dissatisfied patients, all happily acquiring hunting licenses in order to trade off taking aim. It’s not enough any more to wear a bullet proof white coat. …

Read more…

Reasons why your doctor is running late

Tips to make the most out of your national medical meeting

Christian Sinclair, MD

Physician

June 24, 2011

Here is the latest edition of Handy Hints for a National Meeting. The original version was written in 2005 (editions have been more often than yearly).

My first national medical conference was a whirlwind of new ideas and experiences some of which I was not necessarily prepared for.

General

If you are bringing family or a significant other, spend some time with them.
If you don’t bring family or a significant other, leave something nice for …
Read more…

Tips to make the most out of your national medical meeting

Resident responsibility at a Level 1 trauma center

Colin Son, MD

Medical Education

June 23, 2011

Debates over resident autonomy are nothing new. Informed patients are sometimes reasonably concerned about just how much responsibility for their care will be delegated to their doctor’s trainees. Care within academic medicine, especially acute inpatient care in a public system, can and does sometimes mean going a whole admission without meeting the attending physician presumably responsible for your care as a patient. At least in my limited experience. This as …

Physician consolidation places health reformers in an ironic dilemma

Kevin Pho, MD

KevinMD

June 23, 2011

One of the major efforts of the Affordable Care Act is to consolidate physician groups, so they can be modeled after integrated health systems like the Minnesota’s Mayo Clinic or California’s Kaiser Permanente.

According to health reformers, these integrated systems can reduce variation in care, which improves quality, and potentially reduces costs.

There’s been a major effort to re-organize hospitals and physicians under guises of Patient Centered Medical Homes and Read more…

Physician consolidation places health reformers in an ironic dilemma

ACP: ACOs – On to the final rule

American College of Physicians

Health Policy

June 23, 2011

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

by John Tooker, MD, MBA, MACP

Recently, I commented on cost saving, quality, and care coordination requirements in the proposed rule that physician practices will likely need to meet to be eligible for additional Medicare payments.

The public comment period on the proposed rule for …

Read more…

ACP: ACOs – On to the final rule

Bias in top tier academic journals

Derek Lowe, PhD

Medications

June 23, 2011

Venture-capital guy Bruce Booth has a provocative post, based on experience, about how reproducible those papers are that make you say, “Someone should try to start a company around that stuff”:

The unspoken rule is that at least 50% of the studies published even in top tier academic journals – Science, Nature, Cell, PNAS, etc… – can’t be repeated with the same conclusions by an industrial lab. In …

Read more…

Bias in top tier academic journals

2 changes to cut Federal health care expenditures

Joseph Paduda

Health Policy

June 23, 2011

If we’re serious about cutting Federal health care expenditures over the long term, here are two changes that will do just that.

1. Requiring HHS to negotiate with pharma for Part D drug costs would reduce annual expenditures by over $20 billion.

As I’ve noted repeatedly(but unfortunately few in the mass media have), Part D’s perhaps the biggest deficit problem we have – the ultimate unfunded liability is now over $20 trillion. …

The future of vaccines for infectious diseases

Stephen C. Schimpff, MD

Medications

June 23, 2011

In concert with sanitation and clean water supplies, vaccination has been the most cost effective means of preventing infectious diseases.

Most vaccines have been inexpensive, easy to administer (albeit objected to by the recipient’s arm!), safe and effective. From when I was a child until today the number of new vaccines has multiplied dramatically. This will only continue at an accelerated pace in the coming years. In the future many …

Matters of the heart

Katherine Ellington

Medical Education

June 23, 2011

She whispered to me with bulging eyes of urgency, “something is not right, I’ve been in pain all night.”

Her chief complaint was chest pain. She had a routine work-up and some care with little relief. The news came that all of her test results were normal. Her body appeared tense, she looked panicked and afraid. At bedside, the attending suggested endoscopy offering that her pain …

Read more…

Matters of the heart

Why the annual physical exam is essential to both doctors and patients

Steven Reznick, MD

Physician

June 22, 2011

I have listened to health economists debate the value of an annual physical exam. Is it cost effective? Does it prevent disease? It doesn’t matter. It is an essential part of the development and continuation of the doctor patient relationship.

The annual physical exam is a form of benchmarking. It allows the doctor and patient to review all the pertinent aspects of your health history …

A new organization for primary care

Paul Fischer, MD

Health Policy

June 22, 2011

Recently, the Board of the American Academy of Family Physicians (AAFP) announced that, for now, it would continue participating in the Relative Value Scale Update Committee (RUC), the secretive American Medical Association committee that, through a longstanding relationship with the Centers for Medicare and Medicaid Services (CMS), has heavily influenced physician reimbursement.

At nearly the same time, Medicare announced that it will go broke in 2024, a decade sooner …

Read more…

A new organization for primary care

Difficult testing decisions for parents with premature babies

Jennifer Gunter, MD

Physician

June 22, 2011

Many people think that tests (blood work, x-rays, scans, etc.) mean their doctor is doing something constructive and working hard to figure out what is wrong. But tests are a double-edged sword.

When I trained most diagnoses were derived from careful history and a physical exam. Perhaps because our province did not have funds to have enough CT scanners and we didn’t have an MRI, those tests were on a …

5 strategic tools to solve our healthcare woes

Joe Flower

Health Policy

June 22, 2011

It’s getting scary.

We are facing, before the end of this decade, a bifurcated future. The way things are going now—with the economy wheezing, doctors bailing, chronic disease rising fast, boomers sliding out of the Viagra years into the Depends years, reimbursements getting squeezed ever tighter, Medicaid sputtering on fumes, and 30 million or more new people soon swarming our doors with insurance cards—if we don’t pull a rabbit out …

A medical student doing clinical rotations at the VA

Jessica Gold

Medical Education

June 22, 2011

I do my clinical training at the VA. It is an interesting population because the people are all pretty similar (this will likely change as the army changes, but for now, its just a lot of old guys, and a lot of heart problems).

In our last few weeks, we finally switched to doing histories and physicals on patients (this really just means that we …

Using video games to fight childhood obesity

Ricky Choi, MD

Patient

June 22, 2011

“I don’t study because it gets in the way of my video game time”

-15 year old patient.

Sorry mom and dad, video games are here to stay. In my clinic, this is a topic of discussion every day:

“How many hours of screen time does Mikey get every day?” I ask.
“Tell the truth”, Mom says looking at Mikey.
“brmfbr mbbrm,” says Mikey looking away.
Mother turns to me with the familiar look that …

Read more…

Using video games to fight childhood obesity

Most Popular

Past Week

Past 6 Months

Recent Posts

Subscribe to KevinMD and never miss a story!

Most Popular

Past Week

Past 6 Months

Recent Posts