KevinMD.com

Work should be about optimizing your productivity and health

Patient

June 1, 2011

Do you spend 8 hours in front of a screen at work? Do you then spend your free time watching TV or poking around the internet when you get home? How much time are you spending cooking healthy meals to eat with friends and family? How much time are you doing physical activities that make you happy?

A recent study in the Journal of the American College of Cardiology entitled, Screen-Based …

Pain control in a patient with rib fractures and a spinal cord transection

Ralph Gordon, MD

Physician

June 1, 2011

When I was called to see the patient after a motorcycle accident I expected the worst. The patient sustained a thoracic spine injury with cord transection at T5 level as well as significant chest wall injury on the right side.

Multiple ribs were broken; some with a significant displacement. Managing patients with a significant chest wall trauma could be a nightmare. Pain control is only one of the challenges.

Practical advice for medical students starting clinical rotations

Mary L. Brandt, MD

Medical Education

June 1, 2011

Here’s some advice to think about before starting clinical rotations during the third year of medical school.

Don’t sit in the back of the plane

The basic sciences are important to learn the vocabulary and grammar of medicine. Clinical rotations are different – it’s where you actually learn to be a physician. If you use the analogy of learning to fly, …

The legal issues of doctors and chiropractors working together

Kevin

Physician

June 1, 2011

by Jeffrey L. Cohen and Albert R. Meyer

Chiropractors and medical doctors (or D.O.s) have had a long and somewhat complex relationship.

Though they approach healthcare issues differently, there are many instances where they share care or even work together. Such “M.D./D.C.” relationships are legally complex, but often prove to be rewarding in many respects. Properly constructing the arrangements is critical, especially since government regulators and payers tend …

When communication is broken, the quality of care is diminished

Kevin

Patient

June 1, 2011

by Alison McKnight

I have been in and out of the doctor’s office ever since I was little, and I have had my share of good and bad experiences during this time.

These experiences can shape the expectations of both the physician and the patient, in both negative and positive ways. While the perfect relationship between …

What happened inside the hospital during the Joplin, MO tornado

Kevin J. Kikta, DO

Physician

May 31, 2011

joplin hospital tornado

Dr. Kevin Kikta was one of two emergency physicians on duty at St. John’s Regional Medical Center in Joplin, MO on Sunday, May 22, 2011, when an EF-5 tornado struck the hospital.

You never know that it will be the most important day of your life until the day is over. The day started like any other day for me: …

Why medical students should be closely observed with patients

Christopher Johnson, MD

Medical Education

May 31, 2011

I went off to medical school thirty-seven years ago.

For the era, I went to what folks regarded as a very progressive place. It had a curriculum that was quite revolutionary for the time. Among other things, we started having interactions with actual patients during our first year, rather than the third year, as was traditional then.

These days many, probably most, medical schools …

What medical professionalism has to do with the federal debt

Rosemary Gibson

Physician

May 31, 2011

In recent weeks, headline news has been reporting on the battle to curb the federal debt. What does this have to do with medical professionalism?

The federal government must borrow forty cents of every dollar it spends. In health care, it needs to borrow from China and other lenders to reimburse doctors, hospitals and other providers who bill federal programs.

The government’s debt totals $14.3 trillion. It is …

Questions to ask before moving from a paper chart to an EHR

Ron Sterling

Health Technology

May 31, 2011

The transition from paper to EHR is a major policy decision that can have repercussions on patient service, your operations and even your medical professional liability (MPL).

Unfortunately, many practices are not taking the time to analyze their options and responsibilities from a patient care and compliance standpoint. In order to set the correct framework for your effort, you should think …

Shared decision making in the golden years

Kevin

Physician

May 31, 2011

by Mary McNaughton-Collins, MD, MPH

Aging does not have to be all about appointments, pills, tests, treatments and procedures – instead aging should be about celebrating life and rewarding those older individuals who are “living well” by encouraging pursuits outside of the medical realm.

The current state of our health care system tends to revolve around the idea that “more is better,” however, that is not always true — especially when caring …

In medicine, the greatest save is not having to make a save at all

Shantanu Nundy, MD

Physician

May 31, 2011

In the real world of medicine, “great saves” are rare. Most patients that you expect to die will die, and those who experience a cardiac arrest or code rarely survive. Mr. GR is the closest I’ve seen to an exception to both of these rules, and his story illustrates the best but also the worst of what our health care system achieves.

I first met Mr. GR in the emergency room. As …

Guiding patients through fragmented health care

Jessie Gruman, PhD

Patient

May 31, 2011

“The most important thing I learned was that different doctors know different things: I need to ask my internist different questions than I do my oncologist.”

This was not some sweet ingénue recounting the early lessons she learned from a recent encounter with health care. Nope. It was a 62-year-old woman whose husband has been struggling with multiple myeloma for …

Would free medical school be enough to save primary care?

Kevin Pho, MD

KevinMD

May 31, 2011

Medical school should be free.

That’s an argument made by physicians Peter B. Bach and Robert Kocher in the New York Times.

This isn’t a new concept. I’ve discussed whether medical school should be free for students who choose primary care. And, for some in the country, it’s already happening. Like at Case Western Reserve University, for instance. The Cleveland Clinic …

Helping with the psychosocial needs of patients

Kohar Jones, MD

Physician

May 31, 2011

The psychosocial needs of patients can feel overwhelming for a doctor.

Our rite of passage as medical students, after all, is anatomy, not sociology. Even now, after a family medicine residency specializing in the biopsychosocial approach to medicine, I still brace myself for surprises before asking routine mental health screening questions of the patients in …

Physicians should blame themselves for why they are unhappy in medicine

Kevin

Physician

May 30, 2011

by Setu Mazumdar, MD

Everywhere I go I see unhappy doctors.

All everyone does is complain about rising malpractice premiums, more paperwork, declining pay, and 60 hour workweeks. This includes physicians just graduating from residency and physicians who’ve been practicing medicine for several decades.

All of those complaints are legitimate, but one question I always have in …

How the VA looks at population level data to analyze outcomes

Suchita Shah

Health Technology

May 30, 2011

The VA isn’t perfect, but definitely is better than other health care systems I have worked in so far. It embraces the idea of patient-centered medical home, where a primary care physician coordinates and takes responsibility for a patient’s care … the old-school definition of good medical care that has recently become popular again, …

The evolution of hospitals and the present state of health policy

Tom Glendinning

Health Policy

May 30, 2011

My first exposure to KevinMD.com is reading Healthcare costs can be reduced with emerging business models by Joe Flower.

While I am not informed about the medical business models to which he refers, I am experienced in business. I hail from a family of doctors and hospital owners. While I did lose touch with the industry for several years, I have noted several changes which do not make sense. …

Should doctors be addressed by their first name?

Jennifer Middleton, MD

Physician

May 29, 2011

I was sitting next to a resident in the preceptor room yesterday. He was calling a patient to discuss lab results, and introduced himself on the phone by his first name and last name … but not with “Doctor.” (e.g., “Hi, this is John Smith from the Family Health Center.”)

I occasionally see the residents’ patients for urgent visits. When I ask them who their regular PCP is at the office, …

Compliance happens when it’s the patient’s treatment plan

WarmSocks

Patient

May 29, 2011

Compliance. I really hate that word! The general impression given throughout the blogosphere is that patients:

don’t take their medicine
prevaricate

A few typical quotes:

Comp-LIE-ance: ”There are only 2 settings where compliance actually takes place; controlled substances and patients with high copays/no free ride.“
On Your Own With Multiple Meds: “Even though people ‘know’ they should take their pills as directed, for the most part, they don’t.“

It drives me crazy to read accusations such …

How PAs and NPs impact emergency room care

a medical resident, MD

Physician

May 28, 2011

A recent survey in the American Journal of Bioethics, indicates that 80 percent of patients expect to see a physician when they come to the emergency department.

Parents were more insistent about their child see a physician or resident for even a minor condition such as a sprained ankle.

Patients indicated a preference for seeing a resident alone for non-urgent conditions (60%) and compared to a physician …