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Discussing cancer treatment with the terminal patient

Conditions and Diseases

January 1, 2011

For everything, there is a season…
– Ecclesiastes

“Are you giving up on me?” My patient looks at me severely. “There must be other treatment options! Aren’t there some experimental drugs out there? I have beaten this cancer twice before. Are you saying that I can’t beat it again?”

No one can ever know with absolute certainty whether my patient’s newly recurrent cancer might miraculously disappear with one more treatment. His recurrence, however, has …

Lessons learned from asthma therapy

Juliet K. Mavromatis, MD

Conditions and Diseases

December 31, 2010

As a kid I had allergies and asthma.

Because of this, for several years, my mother wrote a note excusing me from the 600 meter run in elementary school. My father took me to weekly allergy shots. At times I had eczema on my forearms and eyes, and according to my allergist, whose notes I later read, I had moderate allergic shiners (also known as dark circles under my eyes). My …

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Lessons learned from asthma therapy

Will medical school as we know it exist in a decade?

Scrub, MD

Medical Education

December 31, 2010

A century ago in the U.S., the American Medical Association (AMA) created the Council of Medical Education (CME) to evaluate the standard of medical education.

In 1908, the committee recruited the Carnegie Foundation to survey the 155 medical schools operating at the time in order to see whether they met the standard of medical education set by the CME. The Carnegie Foundation in turn asked Abraham Flexner, a professional educator, to …

Heart attack symptoms in women, in their own words

Carolyn Thomas

Patient

December 31, 2010

heart attack symptoms in women

Having a heart attack felt nothing like I thought it would feel. For one thing, unlike sudden cardiac arrest, in which the heart stops beating and you stop breathing, during my heart attack (myocardial infarction), my heart continued beating, and I was conscious throughout despite horrific symptoms – so how could I possibly be having a heart …

Adding tiotropium (Spiriva) to an inhaled steroid a mistake?

Matthew Mintz, MD

Medications

December 30, 2010

There is a lot of press about a study recently published in the New England Journal of Medicine that shows that adding tiotropium (Spiriva) to an inhaled steroid might have benefit in asthmatic patients. This study is creating a lot of buzz due to recent concerns of ICS/LABA safety and might prompt doctors and patients to start switching (some already have before this study came out). However, this …

Take responsibility for your own health

Peter J. Weiss, MD

Patient

December 30, 2010

An excerpt from More Health Less Care: How to Take Charge of Your Medical Care and Write Your Own Personal Prescription for Lifelong Health.

Bob Baker is a patient of Dr. Lisa Martin. Bob works as an engineer for a Fortune 500 company that holds major commercial and Department of Defense contracts. He’s 45 years old and happily married with two college-age children. Bob’s lifestyle is stressful. He travels …

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Take responsibility for your own health

Hospital meals make it difficult to control blood sugars

Roxanne B. Sukol, MD

Physician

December 30, 2010

My mom doesn’t take any diabetes medicine. She keeps her blood sugars normal through a combination of common sense and careful carbohydrate consumption.

A few months ago, she had to be hospitalized for what she calls a “minor procedure.” The procedure went fine, but not the food. The first meal they brought her consisted of breaded fish (frozen), mashed potatoes (instant), corn (canned), a dinner roll (frozen), and tea (2 sugar …

Should surgeons tell patients how much sleep they had?

Kevin Pho, MD

KevinMD

December 30, 2010

In a recent New England Journal of Medicine, a perspective piece on what to do with fatigued surgeons is generating debate.

The issue of work-hour restrictions has been a controversial issue when it comes to doctors in training, something that I wrote about earlier in the year in USA Today. But once doctors graduate and practice in the real world, there are no rules.

As summarized in the WSJ’s Health Blog, …

Health care economics and the relationship between doctor and patient

Maggie Kozel, MD

Patient

December 29, 2010

I used to practice pediatrics. It has been several years since I decided to leave medicine, but people still ask me about it, and I find myself offering neat explanations between gulps of coffee. Of course, the full truth is much more complicated. The full truth has as much to do with our health care system and our culture as it does with me.

My journey in pediatrics was not entirely …

Your attention deficit disorder may be an anxiety disorder

Srini Pillay, MD

Conditions and Diseases

December 29, 2010

Are you one of those people who simply cannot concentrate for long enough? Do you find that no sooner than you start doing something, that your attention is scattered all over the place? Do you find that you log onto your computer and within minutes are surfing every possible tangential site that you find?

Your problem may not be a problem with your attention. In fact, it may be that the …

How American physicians should be paid

George Lundberg, MD

Health Policy

December 29, 2010

How do you think American physicians should be paid?

I think many of the current methods are insane. Case in point:

In the 1980s, during a meeting of the board of trustees of the American Medical Association, I experienced sudden unexpected unilateral loss of hearing. You might say that was lucky. But I was scared and went right to my ENT’s office.

He looked in my ear and extracted a large wad of …

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How American physicians should be paid

Tips to find a good psychiatrist

Dinah Miller, MD

Physician

December 29, 2010

Seems like a simple enough question: How do you find a psychiatrist?

It’s not that easy to answer. There are all sorts of psychiatrists who do all sorts of things (therapy, not therapy, specific forms of therapy like psychoanalysis or CBT), and then there’s the overriding insurance question. Not to mention location, location, location.

We’ve talked before about insurance, and if you haven’t read Why Shrinks Don’t Take Your …

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Tips to find a good psychiatrist

CT scans and x-rays draw patients into risk and overutilization

Michael Kirsch, MD

Conditions and Diseases

December 28, 2010

Many patients erroneously believe that x-rays and CAT scans have no risk.

In their minds, they are non-invasive studies that can cause no harm. Since there are no incisions or anesthesia, they regard the experience as having the same risk as taking a family photograph. How wrong they are. In my mind the danger from non-invasive radiology studies may surpass the risk of hard core medical treatment. True, radiology tests won’t …

Are chaperones a hindrance to patient privacy?

Joel Sherman, MD

Patient

December 28, 2010

Chaperones are increasingly recommended for routine use in Western medicine. There are semi-official recommendations in both the UK and USA. The AMA has long had this.

The rationale for using chaperones is twofold. In theory their primary purpose is to protect, comfort and assist the patient. In reality though, the usual purpose is to protect the physician against claims of sexual assault or harassment.

Preferably, chaperones should be real professionals, ideally …

Reduce phone calls in your medical practice

Rosemarie Nelson

Physician

December 28, 2010

A physician approached me at the end of a talk on optimizing practice efficiency and improving service to patients and said, “I dream of an office with no phones.”

Do you have days where the phones are ringing off the hook? Or the phone message forms in your in-box seem to be reproducing? Maybe it’s been one of those days when you can never get your nurse’s help because she’s been …

Responsibility, respect and relationships are important for patients

Jackie Fox

Patient

December 28, 2010

At the risk of dating myself, I recall a time when “The Three Rs” summed up American education. In case you aren’t familiar with this phrase, it stands for “Reading, ‘Riting, and ‘Rithmetic.”

I think it’s high time we develop “Three Rs” for patients. Right now, Patient World is ruled by “E” words such as “empowered” and “engaged,” with “empowered” the big one. I think “empowered” is turning into a label, …

Patient complaints do not fit the primary care office visit

Kevin Pho, MD

KevinMD

December 28, 2010

Primary care physicians often have to see patients with a litany of issues. Often within a span of a 15-minute office visit.

This places the doctor in the middle of a tension — spend more time with the patient to address all of the concerns, but risk the wrath of patients scheduled afterwards, who are then forced to wait.

And, in some cases, it’s simply impossible to adequately address every patient question …

Posts of the year on KevinMD.com, 2010 edition

Kevin

Potpourri

December 25, 2010

Merry Christmas!

I’d like to thank everyone for your continued readership.

Doctors, patients and other health care professionals need to be heard, and there’s no better place to do so than here, on social media’s leading physician voice.

This year, KevinMD.com had a regular rotation of 175 guest contributors, and surpassed 1.75 million visits, 2.95 million pageviews, 33,000 followers on Facebook and Twitter, and 40,000 RSS subscribers.

I am truly …

Successful surgery rotation tips

MomTFH, DO

Medical Education

December 24, 2010

I recently finished my two months of surgery rotations.

I am happy to say that I really enjoyed my surgery rotations. I thought I was going to be intimidated by the OR, but I found it fascinating. I am relieved, since surgery is a big part of OB/GYN.

Here are a few things I learned on my surgery rotation:

Scrub in before the surgeon but after the OR nurse.
Before you scrub in, introduce …
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Successful surgery rotation tips

Minimize the potentially harmful effects of DTC advertising

Ishmael Bradley, MD

Medications

December 24, 2010

Part 3 of a series. Please read part 1, DTC advertising, and its history with the FDA, and part 2, Economic and commercial impact of DTC advertising.

In the first two parts of this article, we explored the historical and legal contexts of direct-to-consumer (DTC) advertising, the effects of these ads on prescribing behavior, and the economic incentives to advertise.

In this final installment, we will …

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