KevinMD.com

April 6, 2011Apr 6, 201158

To understand how hard it is going to be to control health care costs, one merely has to consider the outrage surrounding TSA's recent roll-out of "enhanced security" measures - measures which include 'enhanced pat downs' and full body scans.…

To understand how hard it is going to be to control health care costs, one merely has to consider the outrage surrounding TSA’s recent roll-out of “enhanced security” measures – measures which include ‘enhanced pat downs’ and full body scans.

Videos of boys getting patted down personified the problem. But the upset and outrage and anger visible today will be nothing if …

Health policy

Rationing and limitations are inevitable in any health system

Colin Son, MD

April 6, 2011Apr 6, 20118

Healthcare is a limited commodity. It’s limitations are defined by the numbers of professionals supplying it and their physical limitations on the number of patients they’re able to treat, on availability of biomedical equipment and technology, on availability of physical…

And so, not …

Drugs and prescribing

Should doctors give more Oxycontin to chronic pain patients?

Christopher, BA

April 6, 2011Apr 6, 201126

by Christopher, BA We all know of the folly "Just Say No" as it just does not work. I disagree that a physician should ignore the requests of her or his patients, based solely on the perceivable abuse of the…

by Christopher, BA

We all know of the folly “Just Say No” as it just does not work. I disagree that a physician should ignore the requests of her or his patients, based solely on the perceivable abuse of the drug Oxycontin.

This is an opiate that works wonders for patients in chronic pain situations, …

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Drugs and prescribing

Potassium iodide won’t protect you from nuclear reactor radioactive isotopes

Derek Lowe, PhD

April 6, 2011Apr 6, 20113

Well, the nuclear crisis in Japan seems to be causing a run on potassium iodide (KI), and not just in Japan. If news reports are to be believed, people in many other regions (such as the west coast of the…

Well, the nuclear crisis in Japan seems to be causing a run on potassium iodide (KI), and not just in Japan.

If news reports are to be believed, people in many other regions (such as the west coast of the US and Canada) are stocking up, and some of these people may have already started dosing themselves.

Don’t do that. Don’t …

Physician voices

Caring for people is not always easy, but it is what makes us special

Jennifer Gunter, MD

April 5, 2011Apr 5, 20116

My mom is sick. Because of what can only be described as my crazy family dynamics I did not find out for 24 hours that she was taken by ambulance to the hospital in septic shock from pneumonia. She was…

My mom is sick. Because of what can only be described as my crazy family dynamics I did not find out for 24 hours that she was taken by ambulance to the hospital in septic shock from pneumonia.

She was hypotensive on arrival (not good) and pancytopenic (low white cell count, low hemoglobin, and low platelets – not good either). A CT scan showed multiple large, irregular lymph nodes in her …

Health policy

Direct primary care and medical loss ratio will impact health insurers

Dave Chase

April 5, 2011Apr 5, 20115

With my extensive health care background, many people have asked for my opinion during the health reform debate. My response has been that the only way to really "reform" the system is to blow it up and start over, which…

With my extensive health care background, many people have asked for my opinion during the health reform debate. My response has been that the only way to really “reform” the system is to blow it up and start over, which isn’t politically feasible.

After delving deeper into the current legislation, I believe that we are going to see something …

Health policy

Overuse of heart stents and the response of Abbott Labs

Joe Flower

April 5, 2011Apr 5, 20119

"Someone needs to take this writer out and kick his ass." The quote leaped out at me from a New York Times article. Now, maybe I’m a little sensitive about using physical threats to try to silence writers, since I…

“Someone needs to take this writer out and kick his ass.”

The quote leaped out at me from a New York Times article.

Now, maybe I’m a little sensitive about using physical threats to try to silence writers, since I am a writer. Maybe I am especially sensitive about threatening to kick someone’s ass for writing about healthcare. To my eyes, the quote stood out as emblematic of the tumor …

Physician voices

A confident, independent, empowered woman is a force to be reckoned with

Melanie Lane, MD

April 5, 2011Apr 5, 20112

I am infinitely blessed by The Girl Effect. As I look back through the generations of my family, I see it rolling toward me, through me like a wave. I am sure it started even before my grandmother stole her…

I am infinitely blessed by The Girl Effect. As I look back through the generations of my family, I see it rolling toward me, through me like a wave.

I am sure it started even before my grandmother stole her parents’ car with intent to drive by herself from Austin to Chicago to see the World’s Fair in 1924; I just don’t have much history to work with prior to that. …

Medical education

A medical student goes back to the anatomy lab before residency

Christopher Bayne

April 5, 2011Apr 5, 2011

I still remember the first time I entered the anatomy lab. Heck, I remember the first time I entered the hallway leading to the anatomy lab. I wouldn't say an anatomy lab "smells." That is, an anatomy lab doesn't smell…

I still remember the first time I entered the anatomy lab. Heck, I remember the first time I entered the hallway leading to the anatomy lab.

I wouldn’t say an anatomy lab “smells.” That is, an anatomy lab doesn’t smell “bad”: the odor can’t be defined as good or bad. Really, it’s neither. But the scent is distinctive. If you’ve been there, then …

Health policy

The Relative Value Scale Update Committee (or RUC) impact on health care

Brian Klepper, PhD

April 5, 2011Apr 5, 20117

On Kaiser Health News, Barbara Levy MD, the Chair of the AMA’s Relative Value Scale Update Committee (or RUC), published a glowing defense of the RUC’s activities. Her article extols the work of the 29 physician volunteers who, "at no…

On Kaiser Health News, Barbara Levy MD, the Chair of the AMA’s Relative Value Scale Update Committee (or RUC), published a glowing defense of the RUC’s activities.

Her article extols the work of the 29 physician volunteers who, “at no cost to taxpayers … generously volunteer their time, supported by advisers and staff from more than 100 national medical specialty societies and health care professional organizations.”

She fails to mention that the …

Patient voices

Patients can lift doctors up during a challenging day

Linda Pourmassina, MD

April 4, 2011Apr 4, 20112

I will be leaving my current practice in a couple months and starting work at a different clinic in a different city. This type of transition really brings to light how much I had really gotten to know patients on…

One day, I saw a patient on my schedule that had historically required more of my emotional energy. We often …

Health policy

After the ACO regulations: Accountable care organization answers

Jeffrey L. Cohen, Esq

April 4, 2011Apr 4, 201111

by Jeffrey L. Cohen Patient centeredness, fragmentation and value based purchasing are just a few of the terms that are peppered throughout the newly proposed regulations for accountable care organizations (ACOs). The healthcare reform law established the Medicare Shared Savings…

by Jeffrey L. Cohen

Patient centeredness, fragmentation and value based purchasing are just a few of the terms that are peppered throughout the newly proposed regulations for accountable care organizations (ACOs).

The healthcare reform law established the Medicare Shared Savings Program for …

Physician voices

Doctors are trained to prevent death, but not deal with death

S. Irfan Ali, MD

April 4, 2011Apr 4, 20112

It was a dimly lit room, up on the sixth floor. I am not sure why they would not fix the light in that corridor. Even during the day, I would find this area poorly lit. Maybe it was not…

It was a dimly lit room, up on the sixth floor. I am not sure why they would not fix the light in that corridor. Even during the day, I would find this area poorly lit.

Maybe it was not the light but the grim atmosphere of oncology floor. Some of the patients there had terminal illnesses but they would still act like they had decades to live. You would be …

Physician voices

Treatment of chronic pain puts doctors in a no win situation

Edward Pullen, MD

April 4, 2011Apr 4, 201171

First do no harm. Treat every patient with respect and dignity. These are values I try to live by and incorporate into my daily work. Treatment of chronic pain is the scenario that puts me and every practicing primary care…

First do no harm.

Treat every patient with respect and dignity.

These are values I try to live by and incorporate into my daily work. Treatment of chronic pain is the scenario that puts me and every practicing primary care physician in a no-win situation regularly in the office. To try to make physicians feel more comfortable treating pain most states have tried …

Patient voices

Cyberchondria repackaged as new local TV health news

Gary Schwitzer

April 4, 2011Apr 4, 20112

So I'm watching the 6 pm local news last night and see a piece on KARE-11, my local NBC affiliate, about "a new buzzword called 'cyberchonrdria'" -- used to describe people who "Google their symptoms online and then worry over…

So I’m watching the 6 pm local news last night and see a piece on KARE-11, my local NBC affiliate, about “a new buzzword called ‘cyberchonrdria'” — used to describe people who “Google their symptoms online and then worry over the multitude of results and possible diagnosis …”

But it’s clear from what they posted online that this was not …

Patient voices

How to make money off the mentally ill

Dennis Grace

April 3, 2011Apr 3, 20117

by Dennis Grace Recognize the title? It’s from Steve Martin’s 1978 stand-up album, Wild and Crazy Guy. Martin lists How to Make Money Off the Mentally Ill as one of the many books he’s written. The joke is supposed to…

by Dennis Grace

Recognize the title? It’s from Steve Martin’s 1978 stand-up album, Wild and Crazy Guy. Martin lists How to Make Money Off the Mentally Ill as one of the many books he’s written. The joke is supposed to be on Martin himself, inviting us to ask, “What kind of disreputable jerk takes advantage of the mentally ill?”

But it’s just a

…

Read more…

How to make money off the mentally ill

Physician voices

How academic physicians are being used as live bait for journalists

Larry Husten, PhD

April 3, 2011Apr 3, 20114

Here’s something little known outside of the small circle of industry marketers, academic docs, PR flacks, and medical journalists: pharmaceutical and device companies (or their PR agencies) regularly offer to arrange interviews with well-known academic physicians to talk about new…

I receive these sort of invitations all …

Health policy

Can ACOs curb health costs and improve quality of care?

Robert Rowley, MD

April 2, 2011Apr 2, 20113

Accountable Care Organizations (ACOs) have received considerable attention recently, and are the new "hot topic" in healthcare delivery policy circles. They are the latest response to the need to do something to stem the runaway inflation of healthcare costs, while…

Accountable Care Organizations (ACOs) have received considerable attention recently, and are the new “hot topic” in healthcare delivery policy circles. They are the latest response to the need to do something to stem the runaway inflation of healthcare costs, while maintaining or improving measurable health care quality.

According to a …

Conditions and diseases

MKSAP: 28 year old woman with easy bruising and bleeding gums

mksap

April 2, 2011Apr 2, 20112

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 28-year-old woman has a 3-month history of easy bruising and bleeding gums. She feels otherwise well. Medical and family histories are unremarkable, and…

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

A 28-year-old woman has a 3-month history of easy bruising and bleeding gums. She feels otherwise well. Medical and family histories are unremarkable, and she takes no medications.

On physical examination, temperature is normal, blood pressure is 110/70 mm Hg, pulse rate is 64/min, and respiration rate …

Physician voices

The futility of prolonging life and the benefit to patients

ER Stories, MD

April 2, 2011Apr 2, 201119

In case you have not heard about it, there is a very gut wrenching court case St Louis Park, MN. A doctor in the hospital system is going to court to replace a patient’s wife, Lana Barnes, with a substitute decision maker, claiming that she is making futile and reckless decisions to prolong her near-vegetative husband’s life.

He has …

Real physician voices, twice a week

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