KevinMD.com

May 2, 2011May 2, 2011

I didn’t expect to bump into "Max" on the streets. "I was kicked out of the house by my wife," he sighed. Max shifted around on his feet, eyes puffy and cheeks pink. "Did you start using again?" I asked.…

I didn’t expect to bump into “Max” on the streets.

“I was kicked out of the house by my wife,” he sighed. Max shifted around on his feet, eyes puffy and cheeks pink.

“Did you start using again?” I asked.

Max looked down and didn’t say anything. In the three years I had known Max, an alcoholic and former drug user, he had been clean. But recently he had started struggling. He lost his …

Physician voices

A simpler coding system proposal with a focus on primary care

Paul Fischer, MD

May 2, 2011May 2, 20119

In a recent Wall Street Journal article, Barbara Levy, Chairwoman of the Relative Value Scale Update Committee (RUC), commented on the American Medical Association’s (AMA’s) decision to have minimal primary care participation on the RUC, saying the committee is an…

In a recent Wall Street Journal article, Barbara Levy, Chairwoman of the Relative Value Scale Update Committee (RUC), commented on the American Medical Association’s (AMA’s) decision to have minimal primary care participation on the RUC, saying the committee is an “expert panel” and not meant to be representative.

Since the committee is made up of 27 specialists, one …

Physician voices

Should nurses be fired for fatal medication errors?

Kevin Pho, MD

May 2, 2011May 2, 201131

Kimberly Hiatt was a pediatric critical care nurse who accidentally gave an infant a fatal overdose of calcium chloride last year. By accounts, it was a calculation error. A human mistake. After the incident, the hospital fired her. This past…

Kimberly Hiatt was a pediatric critical care nurse who accidentally gave an infant a fatal overdose of calcium chloride last year.

By accounts, it was a calculation error. A human mistake.

After the incident, the hospital fired her.

This past April, she took her own life.

Although it cannot be concluded that the tragedy was directly responsible for her suicide, the incident clearly …

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Patient voices

Cancer is a crime, and how a tumor board is the courtroom

Katherine O'Brien

May 2, 2011May 2, 2011

Cancer patients usually say they want a cure. Well, of course, that goes without saying. But it’s also kind of annoying. We’ve all, as children and adults, had those "What if" conversations. What if you could have anything you wanted…

Cancer patients usually say they want a cure. Well, of course, that goes without saying. But it’s also kind of annoying.

We’ve all, as children and adults, had those “What if” conversations. What if you could have anything you wanted in the whole world? Depending on the respondents’ ages, people might say anything from “a banana cream …

Physician voices

Why do people decide to become doctors anyway?

Michelle Au, MD, MPH

May 1, 2011May 1, 201114

This Won’t Hurt A Bit (and other white lies): My Education in Medicine and Motherhood. Copyright © 2011 by Michelle Au. Published by Grand Central Publishing. Let’s look at this first purely from the perspective of personal investment and expectation.…

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An excerpt from This Won’t Hurt A Bit (and other white lies): My Education in Medicine and Motherhood. Copyright © 2011 by Michelle Au. Published by Grand Central Publishing.

Let’s look at this first purely from the perspective of personal investment and expectation. To practice …

Health policy

How the ACO model can be successful

Justin Chang, MD

May 1, 2011May 1, 201110

by Justin Chang, MD I think we can all agree — physician, payer, provider, patient, etc. — that the ultimate goal of regulations and reform should be to improve the delivery of healthcare, lowering costs and ultimately, making patients healthier…

by Justin Chang, MD

I think we can all agree — physician, payer, provider, patient, etc. — that the ultimate goal of regulations and reform should be to improve the delivery of healthcare, lowering costs and ultimately, making patients healthier and more satisfied.

Coupled with driving toward the results defined by CMS, this requires some fairly significant changes …

Read more…

How the ACO model can be successful

Physician voices

Interviewing a primary care doctor to better understand her professional day

Pearl Korn

May 1, 2011May 1, 20116

As a young primary care doctor in Kiev, Ukraine (then part of the Soviet Union), Dr. Elena Rogova learned her craft well, working in a hospital that catered to scientists, celebrities, artists, musicians and senior government officials. As a top…

As a top medical student, this hospital had sought her services, and she enjoyed her work there. Dr. Rogova had no intention of leaving …

Physician voices

A neurosurgeon considers stepping out of her comfort zone

gcs15, MD

April 30, 2011Apr 30, 20115

There are few things I enjoy more than talking about the spine and the brain. Therefore, it stands to reason that I enjoyed our state neurosurgical society meeting recently. I don't like big national meetings, being an introvert at heart.…

There are few things I enjoy more than talking about the spine and the brain.

Therefore, it stands to reason that I enjoyed our state neurosurgical society meeting recently. I don’t like big national meetings, being an introvert at heart. Our state meeting, however, is small; this makes for a more intimate atmosphere and more outspoken dialogue. Colleagues from across the state can exchange ideas, new techniques, and opinions. We also …

Conditions and diseases

MKSAP: 24-year-old woman is evaluated for irregular menses and infertility

mksap

April 30, 2011Apr 30, 2011

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 24-year-old woman is evaluated for irregular menses and infertility. She reports having had normal puberty but having irregular menses until she started taking…

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

A 24-year-old woman is evaluated for irregular menses and infertility. She reports having had normal puberty but having irregular menses until she started taking an oral contraceptive pill.

She has been unable to become pregnant since marrying 1 year ago despite regular intercourse and discontinuing the …

Patient voices

The paradoxical life of a palliative care nurse practitioner who’s an EMT

Niamh van Meines, ANP-BC, EMT

April 30, 2011Apr 30, 20113

I am a nurse practitioner committed to expert level end of life care. I a consultant for hospice and palliative care organizations, a clinical educator and a volunteer in my town on the local emergency medical service. My life is…

It’s not a happy partnership having a palliative mind and responding to 911 emergency calls to save lives.

It’s not …

Conditions and diseases

The war on pubic hair must end

Emily Gibson, MD

April 29, 2011Apr 29, 201132

I must have missed the declaration of war on pubic hair. It must have happened sometime in the last decade because the amount of time, energy, money and emotion both genders spend on abolishing every hair from their genitals is…

I must have missed the declaration of war on pubic hair.

It must have happened sometime in the last decade because the amount of time, energy, money and emotion both genders spend on abolishing every hair from their genitals is astronomical. The genital hair removal industry, including medical professionals who advertise their specialty services to those seeking the “clean and bare” look, …

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The war on pubic hair must end

Health policy

How the IPAB takes policy and puts it in the hands of health care experts

Shadowfax, MD

April 29, 2011Apr 29, 20112

Everyone knows that the excess growth in health care costs is driving the fiscal crisis in our country. The problem is that while everybody wants to somehow cut the cost of Medicare/Medicaid, in theory, when it comes time to actually…

Everyone knows that the excess growth in health care costs is driving the fiscal crisis in our country.

The problem is that while everybody wants to somehow cut the cost of Medicare/Medicaid, in theory, when it comes time to actually make cuts, the courage of our politicians fails in the face of unrelenting public opposition to cuts in Medicare.

…

Health technology

Doctors find incentives elusive for meaningful use of electronic records

Scot Silverstein, MD

April 29, 2011Apr 29, 20115

A reader, Dr. Scott Monteith, a psychiatrist, shared his thoughts on government-mandated 'Meaningful Use' of Electronic Medical Records ('MU') with me after reading a number of my EHR posts, and asked if he could share his thoughts via Health Care…

A reader, Dr. Scott Monteith, a psychiatrist, shared his thoughts on government-mandated ‘Meaningful Use’ of Electronic Medical Records (‘MU’) with me after reading a number of my EHR posts, and asked if he could share his thoughts via Health Care Renewal.

Dr. Monteith is a graduate of the University of Michigan and Michigan State University where he was chief resident.

He is a board certified psychiatrist, clinical assistant professor in the departments …

Conditions and diseases

Tips to prevent heart disease in women

Barbara Ficarra, RN, MPA

April 29, 2011Apr 29, 20112

American Heart Month may be officially over, but don’t let the lack of media attention fool you into thinking heart disease isn’t a critical issue. We still need to be mindful of the fact that heart disease is the number…

American Heart Month may be officially over, but don’t let the lack of media attention fool you into thinking heart disease isn’t a critical issue.

We still need to be mindful of the fact that heart disease is the number one killer of women.

There are simple lifestyle choices you can make to help prevent you from heart disease.

I hope after reading this post you don’t just move on, but I hope …

Read more…

Tips to prevent heart disease in women

Health technology

Organizations that link their IT systems to share electronic health records

George Lundberg, MD

April 29, 2011Apr 29, 20116

Glory be. There's good news tonight in American healthcare. It did not come from laws, regulations, or government edict, although there has been much government activity in the field; it did not come from the behemoths of information technology like…

Glory be. There’s good news tonight in American healthcare.

It did not come from laws, regulations, or government edict, although there has been much government activity in the field; it did not come from the behemoths of information technology like Google, Microsoft, Oracle or Cisco, although much hard work in IT did precede it; it did not come from the for-profit healthcare industry giants like GE, Big Pharma, United Healthcare, or …

Physician voices

How a family conference affects the decision for surgery

Chris Porter, MD

April 29, 2011Apr 29, 20114

"Treat your patients as you would your own loved ones," is advice taught throughout training in health care. Great advice. I use it constantly. Mr. Davis is dying of multiple organ failure in the ICU after exploratory abdominal surgery. His…

“Treat your patients as you would your own loved ones,” is advice taught throughout training in health care.

Great advice. I use it constantly. Mr. Davis is dying of multiple organ failure in the ICU after exploratory abdominal surgery. His siblings and children trickle in from Florida and Montana.

I’m always sorry for the last to arrive, who visits his dying brother’s bedside minutes before the family conference. …

Patient voices

How a patient’s organs could live on and be life saving to a recipient

Jim deMaine, MD

April 28, 2011Apr 28, 20114

Sam was late and Ella was furious. "Now why isn't that man back by now? He knows it's time to leave for church." The hours began to pass and Ella became frightened. Sam had gone out for his usual two…

Sam was late and Ella was furious. “Now why isn’t that man back by now? He knows it’s time to leave for church.”

The hours began to pass and Ella became frightened. Sam had gone out for his usual two mile run and had simply disappeared. Ella called friends and neighbors but no one had seen him. Panic began to set in so Ella called 911 who connected her to the …

Conditions and diseases

Why depression continues to go undiagnosed and untreated in primary care

Steve Wilkins, MPH

April 28, 2011Apr 28, 201119

What medical condition is the most costly to employers? I’ll give you a hint. It is also a medical condition that is likely to go unrecognized and undiagnosed by primary care physicians. If you guessed depression you are correct. If…

What medical condition is the most costly to employers? I’ll give you a hint. It is also a medical condition that is likely to go unrecognized and undiagnosed by primary care physicians.

If you guessed depression you are correct. If you mentioned obesity you get a gold star since that comes in right behind depression for both …

Physician voices

Social workers can reduce preventable readmissions

Vineet Arora, MD

April 28, 2011Apr 28, 20112

I just finished another 2 weeks on service. This time, I had also had a shadower, but one of a different kind. As part of our Institute for Healthcare Improvement (IHI) Open School, we are making an effort to have collaborative learning opportunities for our medicine and health administration program students. Achieving true interprofessional learning is challenging for schools like ours without …

Physician voices

Alcohol does not discriminate when it destroys the human body

The American Doctor, MD

April 28, 2011Apr 28, 20113

There was a time when Herb was living the American dream in the sunny state of California. He was married with 2 children, a big house in the suburbs, a golden Labrador retriever, and a well-paying job as an executive…

His two sons were stellar athletes and students, both moving on to attend nationally ranked colleges upon graduation from high school. They were the pride and joy …

Real physician voices, twice a week

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