KevinMD.com

August 8, 2011Aug 8, 20113

I love my job as a primary care doctor, and I enjoy sharing the joy with students who visit me at the community health center where I work. It is terrible to read in the press (and to hear from…

I love my job as a primary care doctor, and I enjoy sharing the joy with students who visit me at the community health center where I work. It is terrible to read in the press (and to hear from students) that angst and frustration are the predominant emotions associated with primary care. While there are sources of frustration in what I do, these are overwhelmingly outweighed by the satisfaction …

Physician voices

Why a neurologist turned down an interesting hospital case

Doctor Grumpy, MD

August 8, 2011Aug 8, 20115

Dr. Grumpy has lost his neurology mojo over time. Actually, I shouldn't say I've lost it, as much as it's been worn down by red tape. Yesterday I turned away a good hospital case, and told them to find someone…

Dr. Grumpy has lost his neurology mojo over time. Actually, I shouldn’t say I’ve lost it, as much as it’s been worn down by red tape.

Yesterday I turned away a good hospital case, and told them to find someone else. The patient was insured. The patient was interesting. Not some run of the mill chronic back pain case.

28-year old guy admitted for abdominal pain and weight loss. Large mass found (possibly lymphoma). …

Patient voices

Your medical information is not private, and it’s sold routinely

Stewart Segal, MD

August 8, 2011Aug 8, 201116

Privacy, is it important to you? Do you believe that your medical and personal information should be kept in strict privacy? Do you expect your doctor to keep your information private? What is the cost of privacy? The computer I…

The computer I am typing this article on is protected by Norton’s Security Suite and by Comcast’s Constant Guard. My friends, family, and patients invest a small fortune every year to keep their …

Real physician voices, twice a week

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Conditions and diseases

ACP: New COPD guideline addresses an important health issue

American College of Physicians & Fred Ralston Jr., MD

August 8, 2011Aug 8, 2011

A guest column by the American College of Physicians, exclusive to KevinMD.com. It is easy to continue practice patterns we establish over the years. In my daily life as a general internist I am more likely to look for more…

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

It is easy to continue practice patterns we establish over the years. In my daily life as a general internist I am more likely to look for more information on a condition I don’t see regularly than on one that I see all the time. While we want to provide the best care for every condition we treat …

Physician voices

Getting insurance to cover a test requires guessing the diagnosis

Deep Ramachandran, MD

August 8, 2011Aug 8, 20114

We had an interesting dilemma in the office. You see, being pulmonologists we treat people with asthma, and one of the more useful drugs we have in the ammunition belt is a medication called omalizumab (Xolair). Among patients in whom…

Among patients in whom it’s indicated, particularly those with severe allergic asthma, the effects can be dramatic and life altering. The problem with this drug is the cost. Actually also the administration. And the anaphylaxis. Not to mention all the …

Health technology

Angry Birds: A psychiatrist explains the addiction

Dinah Miller, MD

August 8, 2011Aug 8, 201110

Joe Frisch is a staff scientist at the SLAC National Accelerator Laboratory at Stanford University. Dr. Frisch writes: "I wonder when we will start seeing really addictive games banned? I don't know what makes games addictive though. Angry birds is…

Joe Frisch is a staff scientist at the SLAC National Accelerator Laboratory at Stanford University. Dr. Frisch writes: “I wonder when we will start seeing really addictive games banned? I don’t know what makes games addictive though. Angry birds is a mystery to me – there is no ongoing story line, you don’t really gain any abilities as the game …

Medical education

Consider the cost when choosing a medical school

Adam Rothschild, MD

August 8, 2011Aug 8, 20116

Over the last two weeks, I have been engaged in an email discussion with a young woman who is trying to decide where to attend medical school. I shall call her Ms. X. Ms. X has been accepted to numerous…

Over the last two weeks, I have been engaged in an email discussion with a young woman who is trying to decide where to attend medical school. I shall call her Ms. X.

Ms. X has been accepted to numerous schools and has narrowed her options to two: School 1 is a private school in Boston (not Harvard), and school 2 is a public school in suburban New York City …

Physician voices

Using RFID tags to track physician movement at conferences

Wes Fisher, MD

August 7, 2011Aug 7, 20113

Not everything that counts can be measured. Not everything that can be measured counts. -Albert Einstein Recently, a disturbing trend of monitoring physician quality and accountability has taken another ominous turn: tracking physician's movements at scientific conferences (so called "tag…

Not everything that counts can be measured.
Not everything that can be measured counts.
-Albert Einstein

Recently, a disturbing trend of monitoring physician quality and accountability has taken another ominous turn: tracking physician’s movements at scientific conferences (so called “tag and release”) using RFID tags embedded in attendees name badges at national scientific sessions. Having had personal experience with the American College of Cardiology meeting, this technology was also embedded in the …

Patient voices

There is no billing code for compassion

Paul Levy

August 7, 2011Aug 7, 201112

Back in 2009, Dr. Amy Ship gave a moving acceptance speech when she received the annual Compassionate Caregiver Award from the Schwartz Center. The most memorable tag line from the speech was, "There is no billing code for compassion." This…

Back in 2009, Dr. Amy Ship gave a moving acceptance speech when she received the annual Compassionate Caregiver Award from the Schwartz Center.

The most memorable tag line from the speech was, “There is no billing code for compassion.” This resonated with so many of us — patients and providers — in part because it set forth the proposition that compassionate care should be an inherent aspect …

Read more…

There is no billing code for compassion

Drugs and prescribing

A cream to fight obesity is being ignored

George Lundberg, MD

August 7, 2011Aug 7, 20112

Do you, or many of your patients, have a little more belly fat around your and their middle than you and they would like? Me, too. Turns out that there are two decent published studies from reputable places that report…

Do you, or many of your patients, have a little more belly fat around your and their middle than you and they would like? Me, too.

Turns out that there are two decent published studies from reputable places that report that a person may rub a cream on their skin over the fat spots and make the fat go away.

Wow, what a deal.

The first study addresses fat thighs, with each …

Physician voices

Dangers of the hospital press release

Deep Ramachandran, MD

August 7, 2011Aug 7, 20112

You may have noticed the rash of medical news spewing from your favorite news outlets with greater frequency. As a medical professional you probably cringe as you envision the calls that are about to flood your office, “Doctor Smith, I heard a report on the news that this drug you prescribed to help me quit smoking is bad for my health!” or, “I want a referral to The Hoffenheimer Institute …

Read more…

Dangers of the hospital press release

Patient voices

The different types of frail to consider before surgery

Bruce Campbell, MD

August 6, 2011Aug 6, 2011

"If I’d known I was going to live this long, I would have taken better care of myself." -Eubie Blake He leaned forward, energetically listening to my conversation with his daughter. There was more than one cancer treatment option. We…

“If I’d known I was going to live this long, I would have taken better care of myself.”
-Eubie Blake

He leaned forward, energetically listening to my conversation with his daughter. There was more than one cancer treatment option. We reviewed everything and she asked what he could expect with either a major surgery or seven weeks of daily radiation treatments. Soon, both the father and daughter were peppering me with questions about …

Conditions and diseases

How smog affects the human body

Rick Donahue, MD

August 6, 2011Aug 6, 2011

We all know that outdoor aerobic exercises like running and biking are good for your health. But during the hottest days of summer, it’s not just excess heat we have to worry about, but smog, the concentrated air pollution you can often see hovering over the cityscape. During the hot summer months, smog can become a serious health problem in the Boston area. We are often downwind from the Midwest’s …

Read more…

How smog affects the human body

Medical education

During the holidays, our goal should be to provide a holiday for our patients

Scrub, MD

August 6, 2011Aug 6, 2011

During Christmas holidays, many medical students, interns, and residents will not be celebrating the holidays with their families. Instead, they will be on call, or night shifts, or just long schedules, taking care of patients. For life and death, sickness…

For life and death, sickness and health, do not take holidays, and nor should our compassion for taking care of those who are in trying times. I recall working last year on Christmas Eve at …

Patient voices

Being a patient is an unforgettable form of medical education

Carolyn Thomas

August 6, 2011Aug 6, 201115

In his online essay, This Won’t Hurt A Bit, cardiologist Dr. Eric Van De Graaff tells his own story of being a hospital patient after surviving a motorcycle accident while he was in med school. His experiences as a patient will sound very familiar to heart patients, and the lessons he learned while on the other end of the stethoscope may very well have made him a far better doctor.

A …

Conditions and diseases

MKSAP: 76-year-old woman with abnormal thyroid function tests

mksap

August 6, 2011Aug 6, 2011

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 76-year-old woman is reevaluated after results of thyroid function tests performed 2 weeks ago are abnormal. The patient otherwise feels well. She has…

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

A 76-year-old woman is reevaluated after results of thyroid function tests performed 2 weeks ago are abnormal. The patient otherwise feels well. She has a history of hypertension, atrial fibrillation, gastroesophageal reflux disease, and depression. Current medications are metoprolol, amiodarone, warfarin, omeprazole, and sertraline.

On physical examination, …

Physician voices

Absence of joy: A doctor’s journey with depression

Anonymous

August 5, 2011Aug 5, 20116

The scene was picture perfect, an absolute characterization of a tropical island paradise. White deserted beach, overhanging palm trees, crystal clear, gentle lapping waters, and a blood red sun sinking slowly into a Fijian ocean. I found no pleasure in…

I found no pleasure in it. Perhaps it was the heat, or that my new wife and I had been travelling for six months? Or that we had been on many other tropical islands and amazing places in …

Health policy

Banned in Boston: Access to psychiatric care

J. Wesley Boyd, MD, PhD & Rachel Nardin, MD

August 5, 2011Aug 5, 20119

Imagine you have severe depression and go to a Boston emergency room for treatment. You are told to follow up with a psychiatrist within two weeks. You have good health insurance, so this shouldn’t be a problem, right? Wrong. In…

Wrong. In a new study just published in the Annals of Emergency Medicine, we found quite the opposite. Access to outpatient psychiatric care in the greater Boston area is severely limited, even for those with …

Health policy

Rationing is a logical outcome, and any changes must be incremental

Mitchell Brooks, MD

August 5, 2011Aug 5, 20116

This post continues my Ten Principles of Affordable Healthcare Reform. Health care changes should be made in small increments, easily understood by the People. Any changes that are made should be made in small increments and they should be cost…

This post continues my Ten Principles of Affordable Healthcare Reform.

Health care changes should be made in small increments, easily understood by the People.

Any changes that are made should be made in small increments and they should be cost effective and easily accepted by the public. It is clear at this juncture that we cannot afford the breadth and the scope of “reform” that is being currently proposed; to …

Physician voices

Ingredients of a good team meeting in a medical setting

Donald Tex Bryant

August 5, 2011Aug 5, 20112

At Camden Community Hospital (a fictional hospital), Shana, a senior RN, is leading a team meeting to discuss standardizing the handoff of patients between shifts. She quickly looks over the team members, who are chatting among themselves, some not very quietly. “May I have your attention, please,” she says. Some stop talking and others keep on. She raps her hand on the table and now she has everyone’s attention. …

Real physician voices, twice a week

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