KevinMD.com

September 4, 2011Sep 4, 20112

One of the reasons cited for our expensive health care system is that drugs cost more in America (part of our capitalistic system). In June of 2003, a study was published in the New England Journal of Medicine about the…

One of the reasons cited for our expensive health care system is that drugs cost more in America (part of our capitalistic system). In June of 2003, a study was published in the New England Journal of Medicine about the use of a form of progesterone to delay the birth of certain preterm infants. This particular hormone is found in the human body, but the formulation …

Patient voices

A real doctor will first do no harm

Emily Gibson, MD

September 3, 2011Sep 3, 201126

I’m really miserable and need that 5 day antibiotic to get better faster. Ninety eight percent of the time it is a viral infection and will resolve without antibiotics. But I can’t breathe and I can’t sleep. You can use…

I’m really miserable and need that 5 day antibiotic to get better faster.

Ninety eight percent of the time it is a viral infection and will resolve without antibiotics.

But I can’t breathe and I can’t sleep.

You can use salt water rinses and decongestant nose spray.

But my face feels like there is a blown up balloon inside.

Try applying a warm towel to your face.

And I’m feverish and having sweats at night.

Your temp …

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A real doctor will first do no harm

Health technology

Tips for doctors looking for the right EHR

Margalit Gur-Arie

September 3, 2011Sep 3, 20112

Here we are going to talk about the second stage of shopping for an EHR. We are going to assume that you did your homework, defined your goals and constraints and prepared a comprehensive list of requirements for an EHR…

To continue our car shopping analogy, we are now ready to go kick some tires, and …

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Patient voices

How diet and exercise beat high blood pressure

Eric Marcotte, MD

September 3, 2011Sep 3, 2011

All day I badger and cajole my patients to take better care of their bodies: "We really need to get some of this weight off, Mr. Jones." "This blood sugar level means diabetes is right around the corner – it’s…

All day I badger and cajole my patients to take better care of their bodies:

“We really need to get some of this weight off, Mr. Jones.”

“This blood sugar level means diabetes is right around the corner – it’s time to get serious about changing your diet, Ms. Smith.”

“This blood pressure reading tells me that you’re not getting enough exercise, Bill.”

I’ve got pills for everything, it seems. I just wish I …

Health policy

Improving efficiency and requiring Congress to live under our healthcare rules

Mitchell Brooks, MD

September 3, 2011Sep 3, 2011

Here are my next two principles of affordable healthcare reform. First, medicine must be practiced in a manner and in a place that is consistent with economic efficiencies, evidence based outcomes and the needs of the specific community that it…

Here are my next two principles of affordable healthcare reform.

First, medicine must be practiced in a manner and in a place that is consistent with economic efficiencies, evidence based outcomes and the needs of the specific community that it serves.

In healthcare delivery, quantitative must be balanced by qualitative. Specific community needs and the culture of that particular community must have equal and in certain cases, greater value than the …

Conditions and diseases

An informed screening choice for breast cancer

Margaret Polaneczky, MD

September 2, 2011Sep 2, 20112

Most women in their 40′s believe they should have annual mammograms, regardless of what screening regimen their doctor might recommend. So say researchers in Massachusetts who surveyed women (primarily white, highly educated) ages 39-49 presenting for annual checkups. They gave…

Most women in their 40′s believe they should have annual mammograms, regardless of what screening regimen their doctor might recommend.

So say researchers in Massachusetts who surveyed women (primarily white, highly educated) ages 39-49 presenting for annual checkups. They gave the women a fact sheet about the new USPSTF guidelines on mammogram screening in their age group, and asked them to read one of two articles either supporting or …

Conditions and diseases

Heart valve repair without open surgery

Stephen C. Schimpff, MD

September 2, 2011Sep 2, 2011

A major innovation are the recent reports of success in replacing or repairing diseased or damaged aortic or mitral valves via catheter-based techniques instead of open surgery. Mitral regurgitation is when the valve becomes unable to close tightly. Once the…

A major innovation are the recent reports of success in replacing or repairing diseased or damaged aortic or mitral valves via catheter-based techniques instead of open surgery.

Mitral regurgitation is when the valve becomes unable to close tightly. Once the regurgitation becomes sufficiently severe to cause heart failure, the death rate reaches about 5% per year. Most such individuals are referred for cardiac surgery to either try to repair the valve, …

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Heart valve repair without open surgery

Physician voices

Overcoming barriers to building a direct primary care practice

Dave Chase

September 2, 2011Sep 2, 20113

The federal health reform bill included a little-noticed clause allowing for Direct Primary Care (DPC) models to be a part of the state health exchanges. I believe this will fundamentally alter the health insurance market and is leading to what I call a “Do it Yourself Health Reform” movement. That little-noticed clause (item #3 in 1301(a) of HR 3590) should have the effect of massively …

Physician voices

Money keeps a physician practice running

Stewart Segal, MD

September 2, 2011Sep 2, 20115

"Doc, it’s only $10. I can’t believe you’re throwing me out of the practice for a measly $10. You, docs, are all the same. It’s all about the money!" Unfortunately, the money is important. It costs money to keep a…

“Doc, it’s only $10. I can’t believe you’re throwing me out of the practice for a measly $10. You, docs, are all the same. It’s all about the money!”

Unfortunately, the money is important. It costs money to keep a practice running. It costs money just to collect the money owed to the practice.

So, let’s look at some simple facts. Your physician’s office is one of the few places where you …

Health policy

Will replacing fee for service really reduce costs?

Jaan Sidorov, MD

September 2, 2011Sep 2, 20116

In this enlightened era of evidence-based medicine, you'd think that the progressive academics, viziers, and mandarins who are cluttering the policy making commentariat would pay more attention to what was tried before. That should be doubly true if those lessons…

In this enlightened era of evidence-based medicine, you’d think that the progressive academics, viziers, and mandarins who are cluttering the policy making commentariat would pay more attention to what was tried before. That should be doubly true if those lessons come from that health care nirvana called Europe, where enlightened central bureaucracies wisely allocate health care for its caffè sipping, plaza strolling and beret adorned citizenry.

Case in point is …

Conditions and diseases

Control and be responsible for your diabetes

Trey Stephens

September 2, 2011Sep 2, 2011

Diabetes tries to steal moments from me every second of every day. I choose to steal these moments back. Thus, the chosen name for my attitude toward diabetes, Outlaw Diabetic. Unlike the majority of the 360 million diabetics worldwide, I…

Diabetes tries to steal moments from me every second of every day. I choose to steal these moments back. Thus, the chosen name for my attitude toward diabetes, Outlaw Diabetic.

Unlike the majority of the 360 million diabetics worldwide, I did not become a diabetic in my adult life. I became a type I diabetic at 14 months old. As a result, I have never had to change my way …

Health technology

Natural language processing in electronic health records

Joe Petro

September 1, 2011Sep 1, 20113

80 percent of the clinical documentation that exists in healthcare today is unstructured. It is sometimes referred to as "the text blob" and is buried within electronic health records (EHRs). The inherent problem with "the text blob" is that locked…

80 percent of the clinical documentation that exists in healthcare today is unstructured. It is sometimes referred to as “the text blob” and is buried within electronic health records (EHRs). The inherent problem with “the text blob” is that locked within it lies an extraordinary amount of key clinical data – valuable information that can and should be leveraged to make more informed clinical decisions, to ultimately improve patient …

Patient voices

When parents respond to the meaning of a child’s behavior

Claudia M. Gold, MD

September 1, 2011Sep 1, 20116

It was a peaceful Saturday morning at Fuel, a local coffee shop in Great Barrington. People sat quietly murmuring with friends over coffee and muffins, or intently working at their laptops. I was doing the final edits for my forthcoming book Keeping Your Child in Mind, when I looked up to see a small boy of about two years tottering down the narrow aisle holding a plate with an …

Medical education

How medical students can prepare to be hospitalists

Happy Hospitalist, MD

September 1, 2011Sep 1, 20114

A second year medical student reader asked me to comment on what rotations to take in medical school to prepare for an internal medicine or hospitalist medicine career. I am a second year medical student, very interested it practicing the…

A second year medical student reader asked me to comment on what rotations to take in medical school to prepare for an internal medicine or hospitalist medicine career.

I am a second year medical student, very interested it practicing the art of Hospital Medicine, and I was wondering if you had any advice/comments on any specific electives to consider to help prepare me for an Internal Medicine residency.

Great question. As …

Health policy

The medical legacy of Rick Perry

Robert Luedecke, MD

September 1, 2011Sep 1, 201126

While liability reforms have been good for the health of Texans, many laws favored by Governor Perry have damaged health. As a physician on the Committee on Public Health of Bexar County Medical Society, I have been trying for many years to help not only my patients, but also Texans in general. San Antonio, my home for the last 30 years, is reported to have a population mix very similar …

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The medical legacy of Rick Perry

Health policy

How not to convince doctors to embrace single payer

Kevin Pho, MD

September 1, 2011Sep 1, 201124

What would happen to physician salaries if the United States adopted a single payer system? The concept of a single payer system is a progressive ideal, and has been vociferously pursued by some left-leaning physician groups. For a variety of…

What would happen to physician salaries if the United States adopted a single payer system?

The concept of a single payer system is a progressive ideal, and has been vociferously pursued by some left-leaning physician groups. For a variety of reasons, not least of which is the political climate in our country, I think the chances of single payer happening …

Physician voices

How managed care is bad news for pregnant women

Linda Burke, MD

August 31, 2011Aug 31, 201111

I read an article in my local newspaper the other day that gave me reason to pause. The State of Florida intends to hand over 3 million Medicaid patients to managed care companies who will reduce payments to physicians and hospitals. In exchange for accepting these low payments for professional services, doctors are guaranteed through pending legislation that no matter what egregious errors they make, the patient will only receive …

Real physician voices, twice a week

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