KevinMD.com

May 27, 2011May 27, 20114

I love to pick up my two year old from daycare. Her language is becoming increasingly complex with small sentences, lots of gesturing and expression. When I ask how school was, she says, "Miss you. I crying." Or, "I running…

Yesterday, she said, “friend, bite me.”

Her very kind teacher confirmed the event, and asked my daughter to show me …

Physician voices

Why doctors can’t screen patients for every disease

Alex Lickerman, MD

May 26, 2011May 26, 201118

I had a patient once who wanted an exercise stress test even though he had neither symptoms nor risk factors to suggest the presence of coronary artery disease (such as chest pain with exertion). I argued vociferously against it. However, extenuating circumstances (not relevant here) prompted our mutual decision to go ahead with it anyway. To our surprise and dismay, it came …

Patient voices

Poor health literacy linked with unnecessary health complications

Jeffrey I. Kreisberg, PhD

May 26, 2011May 26, 201115

An elderly woman sent home from the hospital develops a life-threatening infection because she doesn’t understand the warning signs listed in the discharge instructions. A man confused by an intake form in a doctor’s office reflexively writes "no" to every…

An elderly woman sent home from the hospital develops a life-threatening infection because she doesn’t understand the warning signs listed in the discharge instructions.

A man confused by an intake form in a doctor’s office reflexively writes “no” to every question because he doesn’t understand what is being asked.

A young mother pours a drug that is supposed to be taken by mouth into her baby’s ear, perforating the eardrum.

And a man in …

Real physician voices, twice a week

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Health policy

Can ACOs reinvent the American health care system?

George Lundberg, MD

May 26, 2011May 26, 20118

The cost curve of American medicine continues to bend up. That is unsustainable. It must begin to bend downward. Two recent headlines focus the problem: New York Times, May 14, 2011: Health Insurers Making Record Profits as Many Postpone Care…

The cost curve of American medicine continues to bend up. That is unsustainable. It must begin to bend downward.

Two recent headlines focus the problem:

New York Times, May 14, 2011: Health Insurers Making Record Profits as Many Postpone Care

And, CNN Money, May 11, 2011 reports “Your family’s healthcare costs $19,393.” That is for a family of four, which has a median income of $75,700 — before taxes.

Opportunity …

Patient voices

Meaningful offline dialogue creates online inspiration

Erin Breedlove

May 26, 2011May 26, 20112

I’m all for the values of social media, as evidenced by my frequent use of Twitter, Facebook, Youtube and LinkedIn. Recently, I realized again the value of a telephone conversation. I was on the phone with someone who I consider…

I’m all for the values of social media, as evidenced by my frequent use of Twitter, Facebook, Youtube and LinkedIn.

Recently, I realized again the value of a telephone conversation. I was on the phone with someone who I consider a mentor, someone who has fiercely guided me through my journey into social media without knowing the power of what was being done. It was the best 20 minutes of …

Physician voices

The three most useful words for a doctor

Dr. Martin Young

May 26, 2011May 26, 201113

Here are the three most useful words for a doctor: "I don’t know." A close second would be "I’m not sure," another three that have got me out of trouble more times than I can remember. The older I get,…

Here are the three most useful words for a doctor: “I don’t know.”

A close second would be “I’m not sure,” another three that have got me out of trouble more times than I can remember. The older I get, and more experience I have, the more useful it becomes.

Pattern recognition is essential in effective medical practice. So often patient complaints are vague and nondescript, and in the absence of physical …

Medical education

Doing the physical exam for the first time as a medical student

Jessica Gold

May 26, 2011May 26, 20114

Armed with tools I have never used or seen before I entered a physical exam practice room for the first day of learning. Having finished history-taking practices last semester, we were now beginning a new chapter, learning to take a…

Armed with tools I have never used or seen before I entered a physical exam practice room for the first day of learning.

Having finished history-taking practices last semester, we were now beginning a new chapter, learning to take a head-to-toe physical exam. Before class began, we were told to read a book and …

Physician voices

Medical malpractice tort reform equals healthcare reform

Darrell E. White, MD

May 26, 2011May 26, 201143

I’m a big game theory guy. I think you can explain the actions of the participants in any structured activity or enterprise by looking at the rules of the game. When you look backwards in time you discover that the…

I’m a big game theory guy.

I think you can explain the actions of the participants in any structured activity or enterprise by looking at the rules of the game. When you look backwards in time you discover that the “players” almost always made choices that represented rational self-interest. This is especially true in games played using zero sum rules: someone wins only if someone else loses. How the game is …

Physician voices

Cancer screening on autopilot in patients with advanced cancer

Alex Smith, MD

May 25, 2011May 25, 20118

by Alex Smith, MD I used to get Sports Illustrated, and my favorite column was titled, "This week's sign that the apocalypse Is upon us." Well, JAMA recently published the medical equivalent. Sima and colleagues at Memorial Sloan Kettering used…

by Alex Smith, MD

I used to get Sports Illustrated, and my favorite column was titled, “This week’s sign that the apocalypse Is upon us.” Well, JAMA recently published the medical equivalent.

Sima and colleagues at Memorial Sloan Kettering used a population based dataset of patients with cancer to compare rates of cancer screening (mammography, PAP smears, …

Health policy

E-prescribe now, or risk a Medicare penalty

Rosemarie Nelson

May 25, 2011May 25, 20117

Doctors who do not successfully e-prescribe 10 times for Medicare patients in the first six months of 2011 using claims-based reporting may be hit with a 1% penalty on their Medicare Part B payments for covered professional services in 2012.…

The penalty will increase to 1.5% in 2013 for those who don’t e-prescribe for 25 Medicare patients during 2011.

Not yet e-prescribing?

Maybe your …

Drugs and prescribing

Omega 3 fatty acids and the prevention of heart disease

PalMD

May 25, 2011May 25, 2011

Omega-3 fatty acids (more properly called “n-3 fatty acids”) are a group of naturally occurring fat molecules. They are found mainly in fish and other marine-derived oils, but some can also be extracted from plants. Omega-3′s are currently very popular,…

Omega-3 fatty acids (more properly called “n-3 fatty acids”) are a group of naturally occurring fat molecules.

They are found mainly in fish and other marine-derived oils, but some can also be extracted from plants. Omega-3′s are currently very popular, but the evidence for their usefulness isn’t so clear. A recent study failed to show any benefit in preventing dementia. A new study out …

Drugs and prescribing

Almost everyone over the age of 60 should receive the zoster vaccine

Stephen C. Schimpff, MD

May 25, 2011May 25, 201116

Herpes zoster (or shingles) is caused by the same virus that causes chicken pox. Zoster increases in incidence with advancing age. It is estimated that over 1 million Americans get shingles annually with the resulting acute discomfort and often chronic…

Herpes zoster (or shingles) is caused by the same virus that causes chicken pox.

Zoster increases in incidence with advancing age. It is estimated that over 1 million Americans get shingles annually with the resulting acute discomfort and often chronic pain thereafter. A vaccine was introduced by Merck in 2006; the initial studies of 38,546 patients indicated …

Health policy

ACP: How accountable care is a team sport

American College of Physicians

May 25, 2011May 25, 20116

A guest column by the American College of Physicians, exclusive to KevinMD.com. by John Tooker, MD, MBA, MACP On March 31, 2011, CMS issued a proposed rule to implement a section of the Patient Protection and Affordable Care Act (ACA)…

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

by John Tooker, MD, MBA, MACP

On March 31, 2011, CMS issued a proposed rule to implement a section of the Patient Protection and Affordable Care Act (ACA) that requires the HHS Secretary to establish a Medicare Shared Savings Program. Under the proposed rule, eligible providers and hospitals that create or join …

Physician voices

Cut hospitalizations to reduce hospital related medical errors

David K. Cundiff, MD

May 25, 2011May 25, 2011

To address the huge problem of errors by health professionals causing injuries and deaths to hospitalized patients, the U.S. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius unveiled the Partnership for Patients initiative. Secretary Sebelius referred to a…

Secretary Sebelius referred to a recent study showing that adverse events in hospitalized patients, including those caused by human errors (i.e., preventable), occur about 10 times …

Physician voices

A psychiatrist on the compulsion behind running and exercise

Jeffrey Knuppel, MD

May 25, 2011May 25, 20114

I love running. I typically run 3-4 miles a day 5 to 6 days per week. It's only about a half hour of time, and it's well worth it. I get 'in the zone' when I run, and I can…

I love running.

I typically run 3-4 miles a day 5 to 6 days per week. It’s only about a half hour of time, and it’s well worth it. I get ‘in the zone’ when I run, and I can tune out the rest of the world and enjoy just being. It feels great physically and mentally each time. It’s helped me immensely to stave off the obesity issues that have …

Physician voices

How basing physician pay on popularity marginalizes some patients

Jan Gurley, MD

May 24, 2011May 24, 201111

Part one of the three-part series, Let's Pay Popular People More! My patient only had 20 minutes to wait for the van headed to detox. The people who had worked to get him into a detox program already numbered in…

Part one of the three-part series, Let’s Pay Popular People More!

My patient only had 20 minutes to wait for the van headed to detox. The people who had worked to get him into a detox program already numbered in the double digits. Sam (not his real name) was the classic public inebriate — he woke on sidewalks with the shakes, vomited blood on a regular basis, had lost most of …

Health technology

Will an Android or iPad platform dominate hospitals?

Jared Sinclair, RN

May 24, 2011May 24, 201110

Felasfa Wodajo, MD has written a post for iMedicalApps on the iPad’s future role in healthcare institutions. The title says it all: Why Locked Android Tablets Will Beat the iPad for Hospital Use. The gist of his argument is that…

Felasfa Wodajo, MD has written a post for iMedicalApps on the iPad’s future role in healthcare institutions. The title says it all: Why Locked Android Tablets Will Beat the iPad for Hospital Use.

The gist of his argument is that Android’s “openness” and hardware-agnosticism will make it more ubiquitous in the market in general, and a more robust and …

Conditions and diseases

Why you shouldn’t ignore a swollen knee

Dr. Irwin Lim

May 24, 2011May 24, 2011

If you develop a swollen knee, please don’t consider it a normal occurrence. If there was a clear cause, such as a fall to the knee, or some twisting injury to the knee, it’s likely that the cause is due…

If you develop a swollen knee, please don’t consider it a normal occurrence.

If there was a clear cause, such as a fall to the knee, or some twisting injury to the knee, it’s likely that the cause is due to some mechanical damage. An easily recognized example would be a football or rugby player sustaining such an injury on the playing field. In that case, its typically serious and when …

Read more…

Why you shouldn’t ignore a swollen knee

Physician voices

How managed care caused the mental health care crisis

George H. Northrup, PhD

May 24, 2011May 24, 201115

by George H. Northrup, PhD No one becomes a mental health professional—in my case, a clinical psychologist—for the financial rewards. With comparable (or less) education, far more lucrative careers exist in law, business, or other health care specialties. Psychotherapy tends…

by George H. Northrup, PhD

No one becomes a mental health professional—in my case, a clinical psychologist—for the financial rewards.

With comparable (or less) education, far more lucrative careers exist in law, business, or other health care specialties. Psychotherapy tends to draw practitioners who are fascinated by the mysteries of the mind and who find satisfaction helping others in distress. Money has typically been a …

Real physician voices, twice a week

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