KevinMD.com

May 31, 2011May 31, 20118

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…

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 …

Physician voices

What medical professionalism has to do with the federal debt

Rosemary Gibson

May 31, 2011May 31, 20117

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,…

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 …

Health technology

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

Ron Sterling

May 31, 2011May 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…

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 …

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Physician voices

Shared decision making in the golden years

Mary McNaughton-Collins, MD, MPH

May 31, 2011May 31, 20112

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…

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 for those 65 and …

Physician voices

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

Shantanu Nundy, MD

May 31, 2011May 31, 20114

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…

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 …

Patient voices

Guiding patients through fragmented health care

Jessie Gruman, PhD

May 31, 2011May 31, 20114

"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…

“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 …

Medical education

Would free medical school be enough to save primary care?

Kevin Pho, MD

May 31, 2011May 31, 201133

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…

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 …

Physician voices

Helping with the psychosocial needs of patients

Kohar Jones, MD

May 31, 2011May 31, 20115

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…

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 …

Physician voices

Physicians should blame themselves for why they are unhappy in medicine

Setu Mazumdar, MD

May 30, 2011May 30, 201134

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.…

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 my mind about …

Health technology

How the VA looks at population level data to analyze outcomes

Suchita Shah

May 30, 2011May 30, 20113

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 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, …

Health policy

The evolution of hospitals and the present state of health policy

Tom Glendinning

May 30, 2011May 30, 20114

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…

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. …

Physician voices

Should doctors be addressed by their first name?

Jennifer Middleton, MD

May 29, 2011May 29, 2011132

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.,…

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, …

Patient voices

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

WarmSocks

May 29, 2011May 29, 201123

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…

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 …

Physician voices

How PAs and NPs impact emergency room care

a medical resident, MD

May 28, 2011May 28, 201119

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…

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 …

Conditions and diseases

MKSAP: Healthy 68-year-old man with a cigarette smoking history

mksap

May 28, 2011May 28, 20112

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 68-year-old man is evaluated during a routine examination. He has a 5 pack-year cigarette smoking history but stopped 12 years ago. He has…

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

A 68-year-old man is evaluated during a routine examination. He has a 5 pack-year cigarette smoking history but stopped 12 years ago. He has no history of hypertension, diabetes mellitus, stroke, or transient ischemic attack. He has no claudication. He is being treated for hyperlipidemia. There …

Patient voices

Benefits of chance meetings with other cancer patients

Steve Wilkins, MPH

May 28, 2011May 28, 2011

My wife had just finished meeting with her medical oncologist for her bi-annual check-up at MD Anderson’s Thoracic Clinic. We were sitting in an area called "the Park" rehashing what her doctor had said when a mother and her daughter…

My wife had just finished meeting with her medical oncologist for her bi-annual check-up at MD Anderson’s Thoracic Clinic.

We were sitting in an area called “the Park” rehashing what her doctor had said when a mother and her daughter sat down at our table. There were lots of empty seats in area but for some reason they decided to sit with us. Call it serendipity. …

Physician voices

Why cookbook medicine detracts from compassionate care

Greg Smith, MD

May 27, 2011May 27, 20116

by Greg Smith, MD As a psychiatrist, part of my job is to listen as you tell me about symptoms that bother you every day. If I can help you put these symptoms into a framework such as a syndrome…

by Greg Smith, MD

As a psychiatrist, part of my job is to listen as you tell me about symptoms that bother you every day.

If I can help you put these symptoms into a framework such as a syndrome or a disease, then we can work together on trying to figure out how to treat them. Often times in …

Patient voices

How protocols are taking the decisions away from nurses

Sarah Beth Cowherd, RN

May 27, 2011May 27, 20116

If you have been at your nursing job for a while, you’ve probably almost forgotten. Forgotten what it was like to come in to the healthcare system you now work for and realize there are hundreds of new protocols for…

If you have been at your nursing job for a while, you’ve probably almost forgotten.

Forgotten what it was like to come in to the healthcare system you now work for and realize there are hundreds of new protocols for you to learn and adhere by as a nurse. After years of routine, you now go about your day as if you actually have some choice in the way you give …

Drugs and prescribing

How stem cells will impact medical care

Stephen C. Schimpff, MD

May 27, 2011May 27, 20116

Stem cells will usher in the era of regenerative medicine, allowing the creation of cells, tissues and organs to treat or cure diseases and injuries. This will be a fundamental alteration in our approach to medical care and a transformational medical megatrend. And it will be very “personalized medicine” to provide the specific individual with custom tailored new cells and tissues for organ repair or …

Read more…

How stem cells will impact medical care

Patient voices

The patient is a partner in their illness management and health maintenance

Emily Gibson, MD

May 27, 2011May 27, 20118

Sixty five years ago my maternal grandmother, having experiencing months of fatigue, abdominal discomfort and weight loss, underwent exploratory abdominal surgery, the only truly diagnostic tool available at the time. One brief look by the surgeon told him everything he…

One brief look by the surgeon told him everything he needed to know: her liver and omentum were riddled with tumor, clearly advanced, with the primary source unknown and ultimately unimportant. He quickly closed her up and went to speak with …

Real physician voices, twice a week

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