KevinMD.com

September 8, 2011Sep 8, 201111

When I use the term "telemedicine," what does it mean to you? In current parlance, it usually refers to radiologists looking at digital images of x-rays and other scans from locations remote from the site of acquisition. Think "outsourcing" where…

When I use the term “telemedicine,” what does it mean to you?

In current parlance, it usually refers to radiologists looking at digital images of x-rays and other scans from locations remote from the site of acquisition. Think “outsourcing” where the radiologist could even be as far away as India.

But according to a recent conference I attended, telemedicine could mean so much more. It can range from synchronous video chat …

Physician voices

How a doctor reviews cases for both plaintiff and defense attorneys

Charles A. Pilcher, MD

September 7, 2011Sep 7, 201122

Early in my career, a local defense attorney working with my hospital would occasionally ask me to review a case in which another physician client of her firm was the defendant. As Medical Director of Evergreen Hospital Emergency Department, I was comfortable with hospital records, knowing where to look in a record for information – both recorded and not recorded – that either helps or hurts a case. I found …

Patient voices

An incorrectly coded $1,000 billing error

Michaela Dinan

September 7, 2011Sep 7, 20116

As a graduate student in the health field I often get phone calls from various family members and friends asking what I happen to know about different drugs, procedures, and devices. I was having one such conversation with my younger sister last spring. She had just completed her undergraduate education, started a new job, and was very proudly financially self-sufficient for the first time.

We were talking about birth control. Her …

Real physician voices, twice a week

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Conditions and diseases

When is the right time to introduce solid foods to an infant’s diet?

Michael Gonzalez, MD

September 7, 2011Sep 7, 20117

Parents often wonder when is the appropriate time to introduce solid foods to their infant's diet. It seems like a simple question. So simple that the American Academy of Pediatrics (AAP) cannot agree on the answer. The AAP Committee on…

Parents often wonder when is the appropriate time to introduce solid foods to their infant’s diet. It seems like a simple question. So simple that the American Academy of Pediatrics (AAP) cannot agree on the answer. The AAP Committee on Breastfeeding recommends starting complementary foods (rice cereal and baby foods) after six months of age and the Committee on Nutrition recommends the introduction of complementary foods between four to six …

Physician voices

Promoting a rational approach for the reduction of cardiovascular risk

Michel Accad, MD

September 7, 2011Sep 7, 20115

It is a rare occasion nowadays when academic journals treat us to an editorial debate of some substance. The staff at the Journal of the American College of Cardiology can be applauded for publishing last summer two articles representing fundamentally…

It is a rare occasion nowadays when academic journals treat us to an editorial debate of some substance. The staff at the Journal of the American College of Cardiology can be applauded for publishing last summer two articles representing fundamentally opposed viewpoints on the best strategy to avoid cardiovascular illness. Amusingly, both claimed in the title of their piece the distinction of promoting a “rational approach” for the reduction …

Health policy

Government austerity with Medicare reform as a top priority

Nathanael Heckmann

September 7, 2011Sep 7, 20117

Medicare needs to be reformed, but there's no easy solution to the problem. As the average life expectancy increases, more-and-more politicians have proposed an increase in the Medicare eligibility age. This increase in life expectancy, however, is an issue that…

Medicare needs to be reformed, but there’s no easy solution to the problem. As the average life expectancy increases, more-and-more politicians have proposed an increase in the Medicare eligibility age. This increase in life expectancy, however, is an issue that only affects the wealthiest half of America — the people that need Medicare the least — because the life expectancy has only increased significantly in the richest half of …

Physician voices

When people decide not to vaccinate their children, I take it personally

Michelle Au, MD, MPH

September 6, 2011Sep 6, 2011158

If the media and Internet are to be believed (and these days, really, what is the difference?), the act of parenting has become a full-scale cultural war. How to raise your kids. On what to raise your kids. How your kids sleep, eat, play, and practice “Little White Donkey” on the piano–nowadays, these are all grist for the mill.

But if modern parenting feels like a war, its bloodiest battlefield surely …

Patient voices

Slipping through the cracks in our health care system

Kelly Cheramy

September 6, 2011Sep 6, 20112

Between the cracks is a frightening place to be. During the course of trying to improve our family’s financial stability, my husband and I were blind-sided by one hidden detail: We’d face $10,000 in costs to continue my husband’s serious…

Between the cracks is a frightening place to be.

During the course of trying to improve our family’s financial stability, my husband and I were blind-sided by one hidden detail: We’d face $10,000 in costs to continue my husband’s serious medical treatment because we found ourselves unexpectedly without coverage for 30 days.

This was money we simply did not have. We had been prepared to foot the full bill for good health …

Conditions and diseases

Should teenagers be screened to prevent sudden cardiac death?

Chris Rangel, MD

September 6, 2011Sep 6, 20113

It seems as if teenage student athletes have been dying by the month in often spectacular and dramatic fashion. Last September Texas high school senior Reggie Garrett died suddenly just after throwing a touchdown pass . Last week a 16-year-old Michigan basketball player died dramatically just after becoming a hero by scoring the winning basket to preserve an undefeated season. Then just a week later another 16 …

Conditions and diseases

Phil Mickelson’s psoriatic arthritis explained

Michele R. Berman, MD

September 6, 2011Sep 6, 20112

Golfer Phil Mickelson has had a rough year and a half. First, his wife and mother are diagnosed with breast cancer, and then he has a health scare of his own. Last year, after the US Open, Mickelson began to…

In an interview with Extra’s AJ Calloway, Mickelson opened up about what was going on: “After the U.S. Open last year, I wasn’t able to …

Physician voices

Private rooms in the ICU can reduce length of stay

Marya Zilberberg, MD, MPH

September 6, 2011Sep 6, 2011

We have known for quite some time now that the patient's environment in a hospital matters to his/her outcomes. The concept of biophilia was applied by Roger Ulrich back in the 1980s to surgical patients in a series of experiments.…

We have known for quite some time now that the patient’s environment in a hospital matters to his/her outcomes. The concept of biophilia was applied by Roger Ulrich back in the 1980s to surgical patients in a series of experiments. Famously, this work showed that looking out your hospital room’s window on a bunch trees is associated with better and less eventful post-operative recovery than staring at a brick wall, …

Physician voices

10 ways to make a difference in the lives of your patients

Jan Gurley, MD

September 5, 2011Sep 5, 20114

Most of us who write about health believe that knowledge can make a difference. But is the primary health issue facing us today a lack of knowledge? Or is it, instead, something I'd call the tenth-patient-of-the-day challenge? Here's what I…

Most of us who write about health believe that knowledge can make a difference. But is the primary health issue facing us today a lack of knowledge? Or is it, instead, something I’d call the tenth-patient-of-the-day challenge?

Here’s what I mean: You pick up a chart and head to Exam Room B, reading as you speed-walk. Your patient’s blood sugar is running high again, she didn’t show at the smoking cessation …

Physician voices

Medical practice unintended consequences

Brandon Betancourt

September 5, 2011Sep 5, 2011

The airlines, in an effort to recoup revenue, started charging passengers to check luggage a while back. Seems like a great strategy. Not only are they recuperating revenue, they are giving passengers a reason not to bring luggage they don’t…

The result? More bags in the main cabin.

Since there is an incentive not to check a bag, more people bring their bags as …

Physician voices

Don’t always blame anesthesia for problems in the OR

Anesthesioboist T., MD

September 5, 2011Sep 5, 2011

People blame anesthesia personnel for everything. You name it, they blame us for it. They call us by the umbrella name "Anesthesia" and if there's a problem, it's always "Anesthesia's" fault. Got into the room late? Blame Anesthesia. (Even though…

People blame anesthesia personnel for everything. You name it, they blame us for it. They call us by the umbrella name “Anesthesia” and if there’s a problem, it’s always “Anesthesia’s” fault.

Got into the room late? Blame Anesthesia. (Even though the anesthetist’s been sitting at the bedside for twenty minutes waiting for the surgeon or the nurses to be ready.)

Patient craving ice cream when she woke up? Must be Anesthesia’s fault.

No …

Conditions and diseases

The problem with early detection of disease in medicine

Dr. Joe Kosterich

September 5, 2011Sep 5, 20116

Medicine is presented as being highly scientific. This is until information comes out which questions certain assumptions that underpin the practice of medicine. One of the mantras of modern medicine is that early detection is good. This seems logical enough.…

Medicine is presented as being highly scientific. This is until information comes out which questions certain assumptions that underpin the practice of medicine.

One of the mantras of modern medicine is that early detection is good. This seems logical enough.

However there is an underlying assumption. That is that there will be a worsening of the condition if it is not detected and that treatment will improve the situation. What would happen …

Conditions and diseases

MKSAP: 20-year-old with fever, myalgia, headache, and a rash

mksap

September 5, 2011Sep 5, 2011

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 20-year-old female college student is evaluated in December because of a 12-hour history of fever, myalgia, headache, and a rash. Her only medication…

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

A 20-year-old female college student is evaluated in December because of a 12-hour history of fever, myalgia, headache, and a rash. Her only medication is an oral contraceptive agent.

On physical examination, the patient appears ill. Temperature is 38.8 °C (101.8 °F), blood pressure is 90/45 mm …

Physician voices

The CSI effect and high tech medicine are driving up tests

Evan Falchuk

September 4, 2011Sep 4, 20114

I’m in Israel, home to some of the most innovative care in the world. Doctors here wanted to know if the high-tech tests that are an increasing part of their work help. A couple of weeks ago, they published their…

It turns out that in about 90% of cases, it didn’t matter.

A physical exam, the patient’s history, and the basic set of tests that doctors have done for decades …

Drugs and prescribing

Should the elderly with dementia be given anti-psychotic drugs?

Merrill Goozner

September 4, 2011Sep 4, 201110

The inspector general of HHS recently reported that nearly half of the anti-psychotic drugs fed to the demented elderly in nursing homes are inappropriately prescribed. That’s about one in fourteen nursing home residents. Forget about cost, which is over a…

Forget about cost, which is over a quarter billion dollars a year. “Government, taxpayers, nursing home residents as well as their families and caregivers should be outraged and seek solutions,” wrote Daniel R. Levinson, the HHS I.G. wrote …

Real physician voices, twice a week

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