KevinMD.com

August 2, 2011Aug 2, 201151

If you're a physician or hospital that relies on Medicare payments, grim times are ahead. Yes, even worse than the scheduled 29% payment cut that's scheduled to go into effect in 2013. Emergency physician Shadowfax calls the debt deal "a…

If you’re a physician or hospital that relies on Medicare payments, grim times are ahead. Yes, even worse than the scheduled 29% payment cut that’s scheduled to go into effect in 2013. Emergency physician Shadowfax calls the debt deal “a terrible deal for health care providers.”

Under the contentious debt ceiling agreement, significant cuts in Medicare dollars will be made. But …

Medical education

Showing me how much medicine I’ve never even known existed

Rick Pescatore, DO

August 2, 2011Aug 2, 20113

This is Lokin. Every morning as I enter the hospital, Lokin sits in the same spot. Last week he was covered in gasoline and set aflame by a man in his village -- a dispute over gambling debts. For the…

This is Lokin. Every morning as I enter the hospital, Lokin sits in the same spot. Last week he was covered in gasoline and set aflame by a man in his village — a dispute over gambling debts.

For the past five days I’ve walked silently past this man, torn apart by not knowing what to do. I could tell him all …

Physician voices

Decision aids need to be used for angioplasty and stents

Shannon Brownlee

August 1, 2011Aug 1, 20113

For those who have been following the back and forth over the Less is More blog I posted last week, here's the poster that upset some cardiologists when it was up on the Parsemus Foundation's site. Over the top? Of…

For those who have been following the back and forth over the Less is More blog I posted last week, here’s the poster that upset some cardiologists when it was up on the Parsemus Foundation’s site.

Over the top? Of course it is — it’s satire! And like all good satire, it contains a few grains of truth mixed with a hefty dose of exaggeration.

Still, it’s only fair to point …

Real physician voices, twice a week

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Patient voices

With cancer, sometimes there is no right answer

Stewart Segal, MD

August 1, 2011Aug 1, 20113

Medically speaking, what’s a guy to do when there is no right answer? My patient’s solution is often to ask me what I would do given his particular circumstance. He isn’t happy when I respond with, "I truthfully don’t know."…

In reality, I always know what I would do. I’d gather knowledge, see consultants, and explore every possible option to its fullest. Then, most probably, I would still not be …

Medical education

Improving the relationship between intern and nurse

Albinoblackbear

August 1, 2011Aug 1, 20114

One of my readers astutely pointed out in the comments section of my blog that "nurses will make your life a living hell" if you treat them badly. Some will make your life a living hell, no matter what. As…

One of my readers astutely pointed out in the comments section of my blog that “nurses will make your life a living hell” if you treat them badly. Some will make your life a living hell, no matter what. As in every profession, there are nurses with a chip on the shoulder, as well as those who are simply counting down to retirement. But for the most part, nurses …

Medical education

Psychiatry residents need to learn psychotherapy

Dinah Miller, MD

August 1, 2011Aug 1, 20112

For years, I supervised residents. They would come in each week and tell me about a patient in crisis. If no one was in crisis, they’d say all their patients were fine and they didn’t know what to talk about, even though I had told them to pick a patient they saw weekly and either audio-record the sessions or take detailed process notes. Psychotherapy, I would say, is a …

Physician voices

Medical ethics in the office should not be a private matter

Michael Kirsch, MD

August 1, 2011Aug 1, 20113

Medical ethics has properly gained a foothold in the public square. There is a national conversation about euthanasia, stem cell research, fertilization and embryo implantation techniques, end-of-life care, prenatal diagnosis of serious diseases, defining death to facilitate organ donation, cloning and financial conflicts of interest. Nearly every day, we read (or click) on a headline highlighting one of these or similar ethical controversies. These great issues hover over us.

We …

Patient voices

Why this pediatrician hates bouncy houses

Wendy Sue Swanson, MD

August 1, 2011Aug 1, 20117

I hate the bouncy houses. I mean, I really hate them; I get a sick, nervous stomach when the boys are inside them. And it’s created a parenting perplexity for me. See the photo? I bet my HR is about 160 and my BP 150/90 (translation: high). I’m not kidding, I have a visceral and then flight-type response when the boys jump … it’s one of those instinctive parenting responses …

Drugs and prescribing

Who to blame in fatal medication overdoses

Emily Gibson, MD

July 31, 2011Jul 31, 20113

There was news of yet another high profile death from an uncertain cause in a star with addiction history. Media accounts included reference to the "27 club" -- a lengthy list of famous artists who have perished by their own…

There was news of yet another high profile death from an uncertain cause in a star with addiction history. Media accounts included reference to the “27 club” — a lengthy list of famous artists who have perished by their own hand, often unintentionally, at the age of twenty seven.

The reality is that too many fatal overdoses responsible for the deaths of the famous and not-so-famous are from medications …

Conditions and diseases

How prevalent are false diagnoses of disease?

Clifton Meador, MD & George Lundberg, MD

July 31, 2011Jul 31, 20113

Recently, we expressed concern about the effects on the accuracy of the diagnostic process of the increasing numbers of well and worried well entering the medical care system. One of the consequences of this influx of well people (and the…

Recently, we expressed concern about the effects on the accuracy of the diagnostic process of the increasing numbers of well and worried well entering the medical care system.

One of the consequences of this influx of well people (and the concomitant reduction in disease prevalence) is the generation of more false positive test results and false diagnoses of nonexistent diseases.

The medical literature is filled with studies on the accuracy of …

Conditions and diseases

Advances in cancer treatment are hyped by headlines

Kevin Pho, MD

July 31, 2011Jul 31, 2011

The following op-ed was published on June 5, 2011 in USA Today. A patient recently asked me if I had heard about the new "wonder drugs" used to treat skin cancer. Indeed, I had. In a widely reported story in…

The following op-ed was published on June 5, 2011 in USA Today.

A patient recently asked me if I had heard about the new “wonder drugs” used to treat skin cancer. Indeed, I had. In a widely reported story in early June, two novel cancer drugs were found to benefit patients with advanced melanoma, a devastating form of skin cancer. These …

Conditions and diseases

Complications of pregnancy and the conspiracy of silence

Silvio Aladjem, MD

July 31, 2011Jul 31, 20116

Most pregnancies are completely straightforward. A woman gets pregnant, she has a normal pregnancy that lasts nine months, she delivers a healthy baby, and she takes her baby home. End of story. But not all pregnancies are so straightforward. Complications develop. Challenges arise. Doctors guide their patients through unknown experiences, and parents make choices they couldn’t have dreamed possible before embarking on the road to parenthood.

Complications of pregnancy occur anywhere …

Drugs and prescribing

Tobacco cigarettes should be sold only in pharmacies to people with a permit

George Lundberg, MD

July 31, 2011Jul 31, 201118

I like Iceland. It is a really neat place; great people; terrific scenery; lively nightlife; surprisingly temperate climate, considering the latitude, thanks to the Gulf Stream. Of course, it is true that some of the Iceland bankers, poorly regulated and…

I like Iceland. It is a really neat place; great people; terrific scenery; lively nightlife; surprisingly temperate climate, considering the latitude, thanks to the Gulf Stream.

Of course, it is true that some of the Iceland bankers, poorly regulated and without scruples, were even more predatory than many of the American Wall Street investment bankers, taking the money and running to lead a pack of nations into international fiscal calamity, a …

Health policy

We need a single payment system instead of single payer

Mitchell Brooks, MD

July 30, 2011Jul 30, 201123

One of the great myths of healthcare is that there is an actual "system" in the United States. If such a system exists, I have yet to become familiarized with it. What we have are mountains of paper that slavishly…

One of the great myths of healthcare is that there is an actual “system” in the United States. If such a system exists, I have yet to become familiarized with it. What we have are mountains of paper that slavishly tie the patient, doctor, hospital and insurance carrier alike to a system of coding interpreted by individuals with no sense of what the codes mean or the labor and …

Health policy

Why Medicare is the solution to the soaring costs of health care

Robert Reich

July 30, 2011Jul 30, 201118

Not only is Social Security on the chopping block in order to respond to Republican extortion. So is Medicare. But Medicare isn’t the nation’s budgetary problems. It’s the solution. The real problem is the soaring costs of health care that…

Not only is Social Security on the chopping block in order to respond to Republican extortion. So is Medicare.

But Medicare isn’t the nation’s budgetary problems. It’s the solution. The real problem is the soaring costs of health care that lie beneath Medicare. They’re costs all of us are bearing in the form of soaring premiums, co-payments, and deductibles.

Medicare offers a means of reducing these costs — if Washington would let …

Patient voices

When well people seek medical attention in a system designed to care for the sick

George Lundberg, MD

July 30, 2011Jul 30, 20112

Over the past several decades, there has been a shift in the kinds of patients seeking medical care. The progression has been from sick to early sick to well to worried well to worried sick. The reasons are beyond the…

Over the past several decades, there has been a shift in the kinds of patients seeking medical care.

The progression has been from sick to early sick to well to worried well to worried sick.

The reasons are beyond the scope of this article. There is a subtle and hidden, but potentially very damaging, factor operating in the diagnostic process when large numbers of well people seek medical attention in a …

Physician voices

Why doctors can sometimes be their own worst enemies

Steve Wilkins, MPH

July 30, 2011Jul 30, 201111

"I don’t have the time … I don’t get reimbursed for that." This is an all too common refrain from primary care physicians and practice managers when ever the subject of improving physician-patient communications comes up. I get it. Primary…

“I don’t have the time … I don’t get reimbursed for that.” This is an all too common refrain from primary care physicians and practice managers when ever the subject of improving physician-patient communications comes up.

I get it. Primary care physicians in particular are under tremendous pressure to produce. Just imagine, physicians in small primary care practices spend about 3.5 hours per week just on dealing with insurance-related paperwork. Then …

Conditions and diseases

MKSAP: 33-year-old man with stretch marks in his groin

mksap

July 30, 2011Jul 30, 2011

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 33-year-old man is evaluated because of the recent appearance of stretch marks in his groin that extend to his thighs. He has a…

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

A 33-year-old man is evaluated because of the recent appearance of stretch marks in his groin that extend to his thighs. He has a history of long-standing psoriasis that at times has involved much of his body, including his intertriginous areas. His topical treatments include tar-containing …

Physician voices

Planning effective office meetings for your medical practice

Rosemarie Nelson

July 30, 2011Jul 30, 2011

Do you cringe when you hear the phrase "office meeting"? Some medical practices meet too frequently and some seldom meet, but others have it just right – routine meetings with preparation, an agenda, and follow-up. Your practice can get it…

Do you cringe when you hear the phrase “office meeting”? Some medical practices meet too frequently and some seldom meet, but others have it just right – routine meetings with preparation, an agenda, and follow-up. Your practice can get it right, too.

And make no mistake, meetings are important. Medical practices, regardless of size, have a variety of positions that are not interchangeable, but do interact throughout the day.

To make …

Patient voices

Embracing different cultures in the service of the dying

Niamh van Meines, ANP-BC, EMT

July 30, 2011Jul 30, 20112

She was overwhelmed with grief when she walked into the room and saw her mother silently and peacefully dead in the hospital bed. Her death was expected, but as always, no-one is ever quite ready to let go. She started to wail loudly and speak directly to her deceased mother about the pain she was inflicting by dying.

She was compelled to hold her prayer beads and started to dance around …

Real physician voices, twice a week

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