KevinMD.com

April 16, 2011Apr 16, 2011

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 63-year-old woman is evaluated during a follow-up visit for a 4-week history of fatigue; pain in the proximal interphalangeal joints, knees, and hips;…

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

A 63-year-old woman is evaluated during a follow-up visit for a 4-week history of fatigue; pain in the proximal interphalangeal joints, knees, and hips; and low-grade fever.

She has not had joint swelling, chest pain, or shortness of breath. Over the past 4 years, she has …

Health technology

Is health care ready for the iPad and other new technology?

Gary Oftedahl, MD

April 16, 2011Apr 16, 2011

I think I may have a problem, but it’s not clear exactly what it is, or if it even truly is a concern. I’m not a “techie” so to speak. I have trouble figuring out how to enter the code…

I think I may have a problem, but it’s not clear exactly what it is, or if it even truly is a concern.

I’m not a “techie” so to speak. I have trouble figuring out how to enter the code for my garage door opener without making some fundamental mistake, due to a deficit embedded in my cerebral cortex at some level. But that is not coupled with an associated lack …

Physician voices

Judicious use of complex medical procedures

Shanti Bansal, MD

April 15, 2011Apr 15, 20114

In the cardiac catheterization lab one Tuesday morning, I encountered a situation that made me reflect on a bit of 18th-century British history. At that time, the British government was overburdened with prisoners. A plan was hatched for sea captains…

In the cardiac catheterization lab one Tuesday morning, I encountered a situation that made me reflect on a bit of 18th-century British history.

At that time, the British government was overburdened with prisoners. A plan was hatched for sea captains to transport many of them to Australia. Due to poor conditions, up to one third died on the voyage. Politicians and clergy members desperately urged the …

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Patient voices

Where an adult can get low cost vaccines

Leslie Ramirez, MD

April 15, 2011Apr 15, 201112

At LesliesList.org we get many emails asking where an adult can get low cost vaccines. It appears the answer is... nowhere. They don't exist-- unless you are an established patient in one of the county-funded or low-cost clinics in your…

At LesliesList.org we get many emails asking where an adult can get low cost vaccines.

It appears the answer is… nowhere. They don’t exist– unless you are an established patient in one of the county-funded or low-cost clinics in your metropolitan area. However, you can save a little money by comparison shopping. I think your best bet is to try one of the walk-in …

Health technology

Should older doctors be allowed to opt out of EMR?

Mike Koriwchak, MD

April 15, 2011Apr 15, 20118

A fair amount has been written on EMR for the individual physician facing retirement. But I have come across a more complicated variation of the question. What if a multi-physician group has one physician approaching retirement who is the "lone…

A fair amount has been written on EMR for the individual physician facing retirement.

But I have come across a more complicated variation of the question. What if a multi-physician group has one physician approaching retirement who is the “lone hold-out,” opposing EMR while the rest of the docs in the group are ready to take the plunge?

The older physician has a …

Physician voices

Can doctors learn surgical skills on YouTube and Facebook?

Dr. Martin Young

April 15, 2011Apr 15, 201112

I am a self-taught bass guitarist in a church band, and, to be honest, it sometimes shows. I know I need to improve my skills, but time commitments make formal lessons difficult. So two days ago I opened up YouTube…

19,000 hits registered. I selected a few that looked good on …

Patient voices

True Grit and sharing decisions on health care with our doctors

Jessie Gruman, PhD

April 15, 2011Apr 15, 20114

In the recent Coen brothers' remake of the 1969 movie True Grit, Mattie Ross, an intrepid 14-year-old, is determined to hunt down and kill the man who murdered her father. To accomplish this, she hires U.S. Marshal Rooster Cogburn, (played…

In the recent Coen brothers’ remake of the 1969 movie True Grit, Mattie Ross, an intrepid 14-year-old, is determined to hunt down and kill the man who murdered her father.

To accomplish this, she hires U.S. Marshal Rooster Cogburn, (played by a mumbling Jeff Bridges) a rough, one-eyed veteran of many such quests – then announces that she plans to come along. She figures she is prepared.

After all, she and her …

Physician voices

Natural forces within us are the true healers of disease

Hans Duvefelt, MD

April 14, 2011Apr 14, 201110

In my forays into the history of medicine I came across these six little words by Hippocrates. They seem strangely modern, almost like something you might find on a Hallmark-card for today’s medical school graduates. I don’t know how old…

In my forays into the history of medicine I came across these six little words by Hippocrates.

They seem strangely modern, almost like something you might find on a Hallmark-card for today’s medical school graduates. I don’t know how old the translation is and I couldn’t understand the original text if I tried – but these simple words really touched me when I …

Physician voices

AMA: Getting the best value for our health care dollars

American Medical Association & Cecil B. Wilson, MD

April 14, 2011Apr 14, 20117

A guest column by the American Medical Association, exclusive to KevinMD.com. As physicians, many of us realize on some level that our practices contribute to our state and national economies - we just lacked the empirical evidence to understand how…

A guest column by the American Medical Association, exclusive to KevinMD.com.

As physicians, many of us realize on some level that our practices contribute to our state and national economies – we just lacked the empirical evidence to understand how much.

That changed last month, when the American Medical Association released a report that studied the economic impact of office-based physicians. While a handful of states have previously studied the economic impact …

Patient voices

How to sabotage a doctor’s appointment

Diana E. Lee

April 14, 2011Apr 14, 201116

by Diana E. Lee None of us really wants to sabotage a doctor's appointment through our own behavior. But it's easy to do just that by not paying attention to the factors within our control that affect the quality of…

by Diana E. Lee

None of us really wants to sabotage a doctor’s appointment through our own behavior. But it’s easy to do just that by not paying attention to the factors within our control that affect the quality of our appointments.

These are some behaviors to avoid at all costs:

1. Show up late for appointments. It’s an unfortunate …

Read more…

How to sabotage a doctor’s appointment

Patient voices

A healthy plan for dining out

Sally Scroggs

April 14, 2011Apr 14, 20113

by Sally Scroggs, RD About 130 million Americans will eat out on any given day this year. While dining out shouldn’t mean "pigging out," picking a salad over cheese fries can sometimes be difficult. According to the American Cancer Society,…

by Sally Scroggs, RD

About 130 million Americans will eat out on any given day this year. While dining out shouldn’t mean “pigging out,” picking a salad over cheese fries can sometimes be difficult.

According to the American Cancer Society, making healthy food choices is one of the most important things you can do to reduce your cancer risks. But nutritional experts say many of us don’t make good …

Read more…

A healthy plan for dining out

Health policy

How an ACO will affect physicians and Medicare patients

Benjamin Geisler, MD, MPH

April 14, 2011Apr 14, 20119

by Benjamin P. Geisler, MD, MPH Everybody is talking about Accountable Care Organizations or ACOs these days. The reason being that the Centers for Medicare and Medicaid Services or CMS has released the rules for shared savings between ACOs and…

by Benjamin P. Geisler, MD, MPH

Everybody is talking about Accountable Care Organizations or ACOs these days.

The reason being that the Centers for Medicare and Medicaid Services or CMS has released the rules for shared savings between ACOs and CMS.

The complete proposed rule is 429 pages long and they’re seeking comments on it now until early June.

What is an ACO?

ACOs will take care of …

Physician voices

Sixteen stab wounds, seriously delivered

Sid Schwab, MD

April 13, 2011Apr 13, 2011

She was a Korean woman, spoke passable English. We always exchanged pleasantries, and she called me "doctor" when I picked up my laundry. This time she was notably quiet, distant. I didn't figure it out until I got home and…

She was a Korean woman, spoke passable English. We always exchanged pleasantries, and she called me “doctor” when I picked up my laundry. This time she was notably quiet, distant.

I didn’t figure it out until I got home and hung up my jacket, on the inside of which I noticed she’d pinned an envelope. It contained a photo I’d taken months ago, left and forgotten in one of my pockets. …

Physician voices

What happens when two hockey teams and a defibrillator cross paths?

Vipan Nikore, MD

April 13, 2011Apr 13, 20113

I’ve played over a thousand ice hockey games in my life, but I had no idea that yesterday’s adult men’s league game in Cleveland would be the most memorable. I grew up in Canada, three blocks from Wayne Gretzky, the…

I’ve played over a thousand ice hockey games in my life, but I had no idea that yesterday’s adult men’s league game in Cleveland would be the most memorable.

I grew up in Canada, three blocks from Wayne Gretzky, the greatest hockey player ever, but I wouldn’t be surprised if my game last night was more important than any game that my former neighbor played. Tonight’s game was literally a matter …

Physician voices

Policies prohibiting collaboration between physicians and industry

Thomas Sullivan

April 13, 2011Apr 13, 20113

As the number of restrictions on physicians working with industry continue to grow, and the places where policies prohibit physicians from collaborating with industry expand, close examination of the reasons supporting these policies is necessary. The current trend of academic…

The current trend of academic medical centers (AMCs), professional organizations, and States that have begun adopting policies that restrict permissible interactions and activities between industry and …

Health policy

How the ACO regulations set the stage for Accountable Care Organizations

David Harlow

April 13, 2011Apr 13, 20113

ACO regulations and related federal issuances hit the street, after several months of waiting -- from CMS, OIG, FTC, DOJ and IRS. They cover the waterfront, ranging from the central regulation defining the structure and workings of the ACO, to…

ACO regulations and related federal issuances hit the street, after several months of waiting — from CMS, OIG, FTC, DOJ and IRS.

They cover the waterfront, ranging from the central regulation defining the structure and workings of the ACO, to limited Stark self-referral ban and anti-kickback statute waivers in the fraud and abuse arena, to new frameworks for antitrust analysis, to rules governing joint ventures involving taxable and tax-exempt organizations.

I had …

Patient voices

Screen your sleep lab when evaluating your insomnia

Colleen Kelly Mellor

April 12, 2011Apr 12, 201114

Insomnia plagues me. In that, I’m no different from millions of other Americans. But I am different in that I sought supposed experts to help me deal with this situation. My experience proved to be a nightmare. First, I believed…

First, I believed my sleeplessness due to the fact I feel “on,” all the time, doing too many things in the space of 24 hours. …

Physician voices

Preventing disease saves the crippling costs of tertiary care

Kohar Jones, MD

April 12, 2011Apr 12, 20112

When I was a family medicine intern, I met a diabetic patient in the hospital who had stopped seeing his regular doctor after he lost his job and his health insurance. His untreated diabetes made his feet go numb. He…

When I was a family medicine intern, I met a diabetic patient in the hospital who had stopped seeing his regular doctor after he lost his job and his health insurance.

His untreated diabetes made his feet go numb. He stepped on a nail and didn’t realize it until he noticed …

Conditions and diseases

Google affects how clinicians and the public collect diagnostic information

William R. Yates, MD

April 12, 2011Apr 12, 2011

My Google Reader accidentally picked up an intriguing abstract that examined a research study of resources that medical students use in solving diagnostic cases. The abstract was picked up because it contained the word “exercise” that is one of my…

My Google Reader accidentally picked up an intriguing abstract that examined a research study of resources that medical students use in solving diagnostic cases.

The abstract was picked up because it contained the word “exercise” that is one of my PubMed filter queries. Although we often think that most diagnostic decision-making occurs from learned information stored in physician’s brains, information resources can …

Real physician voices, twice a week

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