KevinMD.com

August 29, 2011Aug 29, 201115

In most other professions, once you’re halfway through your education, you begin to develop confidence; slowly, but surely, fitting into shoes that once seemed too big for your petite, newbie feet. Not so in medicine. Three years into it, and…

Three years into it, and I still feel unsure – unsure of the answer to a rather simple question asked by an attending and unsure of whether I’m fit to be doing this in the first …

Health policy

Health insurers have come up with the idea of the century

Stewart Segal, MD

August 29, 2011Aug 29, 20118

I have come up with the idea of the century. My idea will make your company the richest in the world while attracting millions of new patrons to your credit and debit card services. I don’t know why no one has done it in the past. It has made the insurers of America countless billions of dollars and now you can profit as well. My only request is that you …

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Physician finance

Doctors should learn personal finance during medical school

Kevin Pho, MD

August 28, 2011Aug 28, 20119

I read somewhere in the comments here something to the effect of this: "Physicians are only good for one thing: doctoring." That would explain the general ineptitude of many physicians when it comes to skills outside medicine, such as political…

I read somewhere in the comments here something to the effect of this: “Physicians are only good for one thing: doctoring.”

That would explain the general ineptitude of many physicians when it comes to skills outside medicine, such as political lobbying, or business and personal finance decisions.

The New York Times has written a helpful column that’s required reading for any new …

Physician voices

Celebrating 50 years of coronary angiography

Eric Van De Graaff, MD

August 28, 2011Aug 28, 20112

When I recommend that a patient needs coronary angiography (synonyms: heart catheterization, coronary angiogram, cardiac catheterization, or simply “cath”) I take a moment to bring up the risks of the procedure—complications that include the rare likelihood of stroke or heart attack (less than one in a thousand), a reaction to the dye, and bleeding at the arterial access site (most often the femoral artery in the groin).

Patients …

Medical education

A rural medical school to train rural physicians

Robyn Liu, MD

August 28, 2011Aug 28, 2011

Are big-city academic institutions really necessary to train excellent clinicians? What irreplaceable benefits do they provide? When I attended medical school a decade ago, there was a group of students comprising about 50% of my classmates that I rarely ever…

Are big-city academic institutions really necessary to train excellent clinicians? What irreplaceable benefits do they provide?

When I attended medical school a decade ago, there was a group of students comprising about 50% of my classmates that I rarely ever saw. Most of these were students who had come to medical school straight out of college, and still denied that anything important in the world happened before noon. They skipped …

Health policy

How health reform is like accident reform

Richard Reece, MD

August 28, 2011Aug 28, 20113

"Do you know how many people died in car crashes in the United States in 2010? 32,000. That’s the lowest number since 1949. That’s impressive, but wait: It’s far more impressive than it sounds at first, because people in the…

“Do you know how many people died in car crashes in the United States in 2010? 32,000. That’s the lowest number since 1949. That’s impressive, but wait: It’s far more impressive than it sounds at first, because people in the United States drove about 10 times as many vehicle miles in 2010 as they did in 1949. In other words, if you drove a car or truck in 2010, you …

Patient voices

The effect of therapeutic touch is based on pure chance

George Lundberg, MD

August 28, 2011Aug 28, 20117

There is no "alternative medicine." There is only medicine: Medicine that has been tested and found to be safe and effective. Use it; pay for it. And, medicine that has been tested and found to be unsafe or ineffective. Don't…

There is no “alternative medicine.” There is only medicine:

Medicine that has been tested and found to be safe and effective. Use it; pay for it.
And, medicine that has been tested and found to be unsafe or ineffective. Don’t use it; don’t pay for it.
And, medicine for which there is some plausible reason to believe that it might be safe and effective. Test it and then place it into one

…

Patient voices

Manage malpractice risks with self-diagnosed patients

David Troxel, MD

August 28, 2011Aug 28, 2011

Search engines and the Internet are impacting patient behavior—eight out of 10 people use the Internet to look for health information, but only 25 percent of those people verify the credibility of their information source before self-diagnosing. It gets even…

The debate among physicians about the credibility of online information is as old as the Internet itself. As a caregiver, …

Patient voices

Why I love community health fairs

Dr. Peripatetic, MD

August 27, 2011Aug 27, 2011

There is nothing like a good community health fair. Away from the formal, detached sterility of the office this is an opportunity to meet patients on their turf. No longer adorned with white coat, power outfit and accompanying entourage, physician meets patient as just another member of the community, an equal almost. With a backdrop of blaring music, sweltering heat and flavorful eats people young and old gather, eager to …

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Why I love community health fairs

Drugs and prescribing

The ethics of being on a pharmaceutical advisory board

David B. Nash, MD, MBA

August 27, 2011Aug 27, 20112

While diligently perusing a stack of unread journals, a piece in the July 25, 2011 issue of Modern Healthcare caught my attention. Titled "What's the Agenda?" this special report deftly navigated the murky waters of "physician participation on advisory boards"…

While diligently perusing a stack of unread journals, a piece in the July 25, 2011 issue of Modern Healthcare caught my attention.

Titled “What’s the Agenda?” this special report deftly navigated the murky waters of “physician participation on advisory boards” and managed to present an accurate appraisal of the issues.

Here is a brief recap.

Back in the days before “medical ethics” issues were commonplace, pharmaceutical and medical device manufacturers were accustomed …

Patient voices

The trouble with Dr. Google

Dr. Martin Young

August 27, 2011Aug 27, 201148

Things have been a bit tough of late, the bad economy is starting to bite, and you’re feeling the pressure. To top it all, your body has been acting strangely in ways it never has before. Your muscles twitch in funny areas for hours at a time, you tire easily, and you have fleeting pins and needles in your limbs. Over the weeks these symptoms have become worse. The last …

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The trouble with Dr. Google

Conditions and diseases

MKSAP: 58-year-old man is evaluated for increasing fatigue

mksap

August 27, 2011Aug 27, 2011

A 58-year-old man is evaluated for increasing fatigue of 2 months' duration. The patient has hypertension and hyperlipidemia treated with lisinopril and atorvastatin. A sister has hypothyroidism. On physical examination, temperature is normal, blood pressure is 135/80 mm Hg, pulse…

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

A 58-year-old man is evaluated for increasing fatigue of 2 months’ duration. The patient has hypertension and hyperlipidemia treated with lisinopril and atorvastatin. A sister has hypothyroidism.

On physical examination, temperature is normal, blood pressure is 135/80 mm Hg, pulse rate is 72/min, and respiration rate …

Conditions and diseases

Intuition saved this patient from a potentially fatal diagnosis

Sharon Bahrych, PA-C, MPH

August 27, 2011Aug 27, 20118

I was working in a rural health clinic when I went into to see a new patient. Amy was 18 years old, with her 6 day old newborn son by her side. I introduced myself and then asked, "what brings…

I was working in a rural health clinic when I went into to see a new patient. Amy was 18 years old, with her 6 day old newborn son by her side.

I introduced myself and then asked, “what brings you into the clinic?”

Amy responded, “Shortly after giving birth, I started having problems with shortness of breath, ankle swelling, and high blood pressure. I told the OB residents and they brushed …

Patient voices

Your consumer powers when choosing a hospital

Steven Kussin, MD

August 26, 2011Aug 26, 201110

An excerpt from Doctor, Your Patient Will See You Now: Gaining the Upper Hand in Your Medical Care (Rowman & Littlefield). The casual attitude people demonstrate when choosing doctors incurs a steep price. Let's direct our attention to your consumer…

An excerpt from Doctor, Your Patient Will See You Now: Gaining the Upper Hand in Your Medical Care (Rowman & Littlefield).

The casual attitude people demonstrate when choosing doctors incurs a steep price. Let’s direct our attention to your consumer powers when choosing a hospital.

The imperative ‘caveat emptor’ (let the buyer beware) carries the most consequence when you purchase health care. When it comes to hiring a hospital’s services, it’s …

Physician voices

Work hour restrictions seem painful now, but are a gift

Vipan Nikore, MD

August 26, 2011Aug 26, 20112

When I completed my overnight shift and left the medical ICU the morning of July 1, I raised my arms victoriously. I uttered, "Finally, internship is done!" I may have been one of the last to speak such words. As…

When I completed my overnight shift and left the medical ICU the morning of July 1, I raised my arms victoriously. I uttered, “Finally, internship is done!” I may have been one of the last to speak such words.

As of July 1, 2011, intern year forever changed. In the world of medicine the first year of residency, or intern year, is when doctors earn their stripes. Traditionally it is …

Drugs and prescribing

Fair balance gives natural pills and supplements an advantage

Stewart Segal, MD

August 26, 2011Aug 26, 201110

The reality is that my job constantly challenges my sanity. Sometimes, I just want to scream. Patient: "Doc, I don’t want to put any poisons in my body! Isn’t there a 'natural' remedy I can take?" Doc: "No, I want…

The reality is that my job constantly challenges my sanity. Sometimes, I just want to scream.

Patient: “Doc, I don’t want to put any poisons in my body! Isn’t there a ‘natural’ remedy I can take?”

Doc: “No, I want you to take my poison! I haven’t poisoned my quota of patients this month and need to reach my goal.”

Poisoning patients really isn’t good for business. Why would a patient believe that …

Patient voices

Why patients flock to alternative medicine providers

Jason A. Luban, LAc

August 26, 2011Aug 26, 201126

As medical practitioners, we are trained to fight disease, becoming familiar with all the metaphors of war, victory, failure, and the Cartesian views of deductive reasoning and mind being separate from body. Through said reasoning, we come to believe in a passive view of health; that health is an absence of something, in this case dis-ease. From that vantage point, it is no wonder medical practitioners have such high rates of burnout, …

Physician voices

Malpractice risks with special needs patients

Jock Hoffman

August 26, 2011Aug 26, 20113

Can you properly examine and treat a 400lb patient in your office setting? How about a four-year-old in your ED? A deaf woman in Labor and Delivery? An 82-year-old in the endoscopy clinic? Do patients who present with challenges beyond…

Once-accepted practices, e.g., jerry-rigging adult medical equipment for a toddler, guesstimating the weight of a patient who exceeds …

Conditions and diseases

Does acupuncture work for headaches?

Dana Winegarner, DO

August 26, 2011Aug 26, 20113

One interesting therapy for headaches, which generates a lot of questions from patients, is acupuncture. Acupuncture is a traditional Chinese therapy which has been around for centuries but only came around to wide spread use in the West (United States…

There are many misconceptions about acupuncture. One question I get regularly is “Do you think acupuncture works?” This is a difficult question to answer because …

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Does acupuncture work for headaches?

Real physician voices, twice a week

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