KevinMD.com

Overhauling America’s Healthcare Machine, an excerpt

Health Policy

April 8, 2011

An excerpt from Overhauling America’s Healthcare Machine: Stop the Bleeding and Save Trillions, published by Financial Times Press (2011). Reprinted with permission of FT Press, and imprint of Pearson.

In recent years, more and more of the revenue collected by U.S. healthcare facilities ends up paying for costs that have nothing to do with providing actual healthcare goods and services: things such as administration, billing, documentation, and the cost …

Think about medical school tuition debt before becoming a doctor

Skeptical Scalpel, MD

Medical Education

April 7, 2011

Recently, I received a call from the son of some old friends. This 30-year-old man has been an elementary schoolteacher for the past few years and recently decided that he would like to go to medical school and eventually become a surgeon. He wanted to know what I thought of the idea.

Suppressing the urge to tell him not to even consider …

16 and Pregnant is increasing the awareness of teen pregnancy

Jeff Livingston, MD

Patient

April 7, 2011

Recently, I had the honor of moderating a discussion for the Sex::Tech 2011 Conference with the producers of MTVs 16 and Pregnant Morgan Freeman, Dia Sokol Savage and The National Campaign to Prevent Teen Pregnancy.

I was fascinated by the responses of members in the audience as well as the reactions I read while monitoring the online live stream via Twitter. So what did I conclude?

I concluded that the issue of teen pregnancy …

FDA regulation, and off label use of atypical antipsychotic drugs

Jan Henderson, PhD

Medications

April 7, 2011

Abilify, Seroquel, Zyprexa, Risperal – these are among the atypical antipsychotics for which Americans paid $10 billion in 2008. $6 billion of that was for off-label use.

The FDA only approves drugs when their safety and efficacy have been tested for specific conditions. For example, an antipsychotic might be approved for the treatment of schizophrenia. When it’s prescribed for anxiety or depression, that’s …

How the reformulation of Oxycontin has affected patients

Christian Sinclair, MD

Medications

April 7, 2011

Having a healthy level of respect for opioids is critical for any physician. For those of us who prescribe or recommend this class of medicines on a daily basis, this statement rings all the more true. Recent events and research reinforce this reality.

“Oxycontin, Other Opioid Painkillers Tied to Higher Health Risks” was the title of a recent BusinessWeek …

Differential diagnosis and treating patients as individuals

Stewart Segal, MD

Physician

April 7, 2011

I recently wrote about the importance of a differential diagnosis. Today I want to assume that you have a definitive diagnosis and discuss how we deal with that illness. First, some ground rules.

There are hundreds of medical texts and unlimited amounts of information on Google that help define an illness. They all portray the “textbook” description of how the illness should present, what symptoms …

What you need as a leader of your accountable care organization

Donald Tex Bryant

Health Policy

April 7, 2011

The Michigan Medical Group Managers Association had a conference recently in Mt. Pleasant, MI. The theme of the conference was “Medical Management: Coaching Your Team to a Winning Season.”

Two speakers—Lloyd Carr, former head football coach of the University of Michigan Wolverines, and Lou Rabaut, partner of law firm Warner Norcross & Judd—both delivered excellent lessons on leadership. Several of the …

Why does society frown on doctors earning a reasonable living?

Steven Reznick, MD

Physician

April 6, 2011

Recently, while jogging through my community, I had the pleasure of bumping into a former colleague and his brother who were out for their daily five mile walk.

Dr. G. had attended a local medical school, finished near the top of his class, and had gone on to do his internship and residency at the premier private hospital in Miami Beach, Florida. After completing his residency …

Myths devalue the image of primary care

Paul Fischer, MD

Physician

April 6, 2011

After an exciting and challenging day of caring for patients and teaching students, a third-year medical student on his family medicine rotation says to me, “I really like what you do, but I just cannot afford to go into family practice.”

I realized that by “afford,” he was referring not only to finances but also to the expectations of his parents, friends, and Read more…

Myths devalue the image of primary care

Controlling health care costs requires shared sacrifice

Joseph Paduda

Health Policy

April 6, 2011

To understand how hard it is going to be to control health care costs, one merely has to consider the outrage surrounding TSA’s recent roll-out of “enhanced security” measures – measures which include ‘enhanced pat downs’ and full body scans.

Videos of boys getting patted down personified the problem. But the upset and outrage and anger visible today will be nothing if …

Rationing and limitations are inevitable in any health system

Colin Son, MD

Health Policy

April 6, 2011

Healthcare is a limited commodity. It’s limitations are defined by the numbers of professionals supplying it and their physical limitations on the number of patients they’re able to treat, on availability of biomedical equipment and technology, on availability of physical space to safely provide medical care and, underlying all of these, on the funding for such.

And so, not …

Should doctors give more Oxycontin to chronic pain patients?

Kevin

Medications

April 6, 2011

by Christopher, BA

We all know of the folly “Just Say No” as it just does not work. I disagree that a physician should ignore the requests of her or his patients, based solely on the perceivable abuse of the drug Oxycontin.

This is an opiate that works wonders for patients in chronic pain situations, …

Potassium iodide won’t protect you from nuclear reactor radioactive isotopes

Derek Lowe, PhD

Medications

April 6, 2011

Well, the nuclear crisis in Japan seems to be causing a run on potassium iodide (KI), and not just in Japan.

If news reports are to be believed, people in many other regions (such as the west coast of the US and Canada) are stocking up, and some of these people may have already started dosing themselves.

Don’t do that. Don’t …

Caring for people is not always easy, but it is what makes us special

Jennifer Gunter, MD

Physician

April 5, 2011

My mom is sick. Because of what can only be described as my crazy family dynamics I did not find out for 24 hours that she was taken by ambulance to the hospital in septic shock from pneumonia.

She was hypotensive on arrival (not good) and pancytopenic (low white cell count, low hemoglobin, and low platelets – not good either). A CT scan showed multiple large, irregular lymph nodes in her …

Direct primary care and medical loss ratio will impact health insurers

Dave Chase

Health Policy

April 5, 2011

With my extensive health care background, many people have asked for my opinion during the health reform debate. My response has been that the only way to really “reform” the system is to blow it up and start over, which isn’t politically feasible.

After delving deeper into the current legislation, I believe that we are going to see something …

Overuse of heart stents and the response of Abbott Labs

Joe Flower

Health Policy

April 5, 2011

“Someone needs to take this writer out and kick his ass.”

The quote leaped out at me from a New York Times article.

Now, maybe I’m a little sensitive about using physical threats to try to silence writers, since I am a writer. Maybe I am especially sensitive about threatening to kick someone’s ass for writing about healthcare. To my eyes, the quote stood out as emblematic of the tumor …

A confident, independent, empowered woman is a force to be reckoned with

Melanie Lane, MD

Physician

April 5, 2011

I am infinitely blessed by The Girl Effect. As I look back through the generations of my family, I see it rolling toward me, through me like a wave.

I am sure it started even before my grandmother stole her parents’ car with intent to drive by herself from Austin to Chicago to see the World’s Fair in 1924; I just don’t have much history to work with prior to that. …

A medical student goes back to the anatomy lab before residency

Kevin

Medical Education

April 5, 2011

by Christopher Bayne

I still remember the first time I entered the anatomy lab. Heck, I remember the first time I entered the hallway leading to the anatomy lab.

I wouldn’t say an anatomy lab “smells.” That is, an anatomy lab doesn’t smell “bad”: the odor can’t be defined as good or bad. Really, it’s neither. But the scent is distinctive. If you’ve been …

The Relative Value Scale Update Committee (or RUC) impact on health care

Brian Klepper, PhD

Health Policy

April 5, 2011

On Kaiser Health News, Barbara Levy MD, the Chair of the AMA’s Relative Value Scale Update Committee (or RUC), published a glowing defense of the RUC’s activities.

Her article extols the work of the 29 physician volunteers who, “at no cost to taxpayers … generously volunteer their time, supported by advisers and staff from more than 100 national medical specialty societies and health care professional organizations.”

She fails to mention that the …

Patients can lift doctors up during a challenging day

Linda Pourmassina, MD

Patient

April 4, 2011

I will be leaving my current practice in a couple months and starting work at a different clinic in a different city. This type of transition really brings to light how much I had really gotten to know patients on a personal level. This became surprisingly clear not too long ago.

One day, I saw a patient on my schedule that had historically required more of my emotional energy. We often …