KevinMD.com

March 16, 2011Mar 16, 201113

fatigue |fəˈtēg| noun 1 extreme tiredness, typically resulting from mental or physical exertion or illness : he was nearly dead with fatigue. • a reduction in the efficiency of a muscle or organ after prolonged activity. No, this post is…

fatigue |fəˈtēg|

noun
1 extreme tiredness, typically resulting from mental or physical exertion or illness : he was nearly dead with fatigue.
• a reduction in the efficiency of a muscle or organ after prolonged activity.

No, this post is not a part of my twenty six installment Psychiatry A to Z series.

You’ll have to wait for the next one in that group, which by the way will be looking at a “T” word. …

Physician voices

Gratitude from patients and their families

a medical resident, MD

March 16, 2011Mar 16, 20112

It is hard to imagine that someone can emerge from intern year – 12 months of chaos, little sleep, and hours upon hours spent responding to pages and putting orders in a computer – and know something, anything, about medicine. I did not believe in this training system until now, after my first night as a supervising resident. The knowledge I have absorbed over the …

Physician voices

Physician reputation management in the age of social media

Neil Baum, MD

March 16, 2011Mar 16, 20116

What is the physician's most precious possession? Some might answer that it is his patients. Others might respond it is the training and education that the physician has obtained to practice his (or her's) craft. But the real answer is…

What is the physician’s most precious possession? Some might answer that it is his patients.

Others might respond it is the training and education that the physician has obtained to practice his (or her’s) craft.

But the real answer is that it’s the physician’s reputation.

Doctors live and die by their reputations. Reputations take years to …

Real physician voices, twice a week

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Physician voices

Doctors receive no training on coding, which makes them prone to fraud

Michelle Mudge-Riley, DO

March 16, 2011Mar 16, 20113

How much attention do you pay to your Evaluation and Management (E&M) Coding practices? E&M codes represent the type, setting, and complexity of services provided and the patient status, such as new or established. Providers are responsible for ensuring that…

How much attention do you pay to your Evaluation and Management (E&M) Coding practices?

E&M codes represent the type, setting, and complexity of services provided and the patient status, such as new or established. Providers are responsible for ensuring that the codes they submit accurately reflect the services they provide.

According to the Office of the Inspector General (OIG), Medicare paid $25 …

Health policy

Health costs need to be addressed by doctors, patients, and lawyers

Kevin Pho, MD

March 15, 2011Mar 15, 201128

It's no secret that our health system encourages doctors to order too many tests. Compounded with the widespread belief that more tests equates to better medicine, the reasons why health costs are spiraling out of control aren't a secret. In…

It’s no secret that our health system encourages doctors to order too many tests. Compounded with the widespread belief that more tests equates to better medicine, the reasons why health costs are spiraling out of control aren’t a secret.

In a perspective piece from the New England Journal of Medicine, physician Sean Palfrey notes our dire situation:

Recent advances

…

Physician voices

Do Not Resuscitate and the need for a central line

Ralph Gordon, MD

March 15, 2011Mar 15, 20114

Just the other day I was called to see a patient coming up to the Intensive Care Unit with a diagnosis of pneumonia. Upon my arrival the patient is "hanging in there" with the blood pressure in the 60’ and…

Just the other day I was called to see a patient coming up to the Intensive Care Unit with a diagnosis of pneumonia. Upon my arrival the patient is “hanging in there” with the blood pressure in the 60’ and 70’s systolic.

This is a no-brainer situation – the patient is in sepsis and septic shock.

Early intravenous antibiotics and aggressive resuscitation is what this gentleman needs right now. Per the ER …

Physician voices

Why this medical student found primary care awesome, and boring

Suchita Shah

March 15, 2011Mar 15, 201142

I recently finished another 5-week clinical rotation. This one was primary care (outpatient internal medicine +/- family medicine). First a few words about primary care as a field: I found it to be both awesome and boring. It was awesome…

I recently finished another 5-week clinical rotation. This one was primary care (outpatient internal medicine +/- family medicine).

First a few words about primary care as a field: I found it to be both awesome and boring.

It was awesome because I was the “doctor.” I had essentially full responsibility for my each patient. From calling him in from the …

Patient voices

Why this patient recommends her family physician

WarmSocks

March 15, 2011Mar 15, 201110

"Do you know a good doctor?" is a question tossed around in conversation sometimes. If the person is reasonably nice/intelligent, I’m happy to hand out my doctor’s name and phone number. Recently, I referred more friends to my all-time favorite…

“Do you know a good doctor?” is a question tossed around in conversation sometimes. If the person is reasonably nice/intelligent, I’m happy to hand out my doctor’s name and phone number.

Recently, I referred more friends to my all-time favorite doctor. Instead of just taking his name and phone number, the couple wanted to know why I like him. That’s a fair enough …

Physician voices

How to prevent suicide in physicians

Zakari Tata, MD

March 15, 2011Mar 15, 20116

Many articles have been written on physician suicides. Yet nothing practical has been implemented. The problem is probably much larger than reported, as families will try to avoid publicity where possible. In medicine, just as in the rest of society,…

In medicine, just as in the rest of society, people diagnosed with depression are wrongly labeled as weak, and discrimination, especially the subtle passive type, exists. Physicians …

Read more…

How to prevent suicide in physicians

Drugs and prescribing

Alternative medicine problems patients need to know about

Alex Lickerman, MD

March 14, 2011Mar 14, 201117

Americans spend an astounding 34 billion dollars on alternative medicine annually. Given that so many of us put our faith in alternative care, I wanted to clear up some common misconceptions about it to help people make wiser choices when…

What is alternative medicine?

In general, alternative medicine is used to describe practices outside the bounds of conventional medicine. …

Drugs and prescribing

ASA addresses drug shortages to ensure patient safety

American Society of Anesthesiologists

March 14, 2011Mar 14, 20112

A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com. by Arnold J. Berry, MD, MPH Drug shortages continue to impact patients across the nation. Over the past year, anesthesiologists have been faced with the challenge of finding…

A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com.

by Arnold J. Berry, MD, MPH

Drug shortages continue to impact patients across the nation. Over the past year, anesthesiologists have been faced with the challenge of finding alternatives for several unique drugs needed to safely provide anesthesia for patients having surgical, diagnostic or therapeutic procedures.

Anesthesiologists have the knowledge and training to work around the severe shortages of some drugs …

Conditions and diseases

How to help autistic or delayed children behave and learn

dr_som, MD

March 14, 2011Mar 14, 20114

Here are ways doctors can help autistic or delayed children behave and learn. I certainly do not mean to trivialize the behavior issues that erupt as typical children develop, but the problems of atypical kids are more difficult and less…

Here are ways doctors can help autistic or delayed children behave and learn.

I certainly do not mean to trivialize the behavior issues that erupt as typical children develop, but the problems of atypical kids are more difficult and less likely to be fully addressed by general pediatricians and society at large.

1. Understand the ABCs of behavior. Antecedent = What happened immediately before the behavior? Behavior = A description of the …

Conditions and diseases

TMA: Vaccines, autism, and Andrew Wakefield’s wake

Steve Levine

March 14, 2011Mar 14, 201117

by Steve Levine The sad story of the fraud Dr. Andrew Wakefield perpetrated on the world’s autism community lies at the intersection of my personal and professional lives. Could these latest revelations be the final chapter? As chief of communications…

by Steve Levine

The sad story of the fraud Dr. Andrew Wakefield perpetrated on the world’s autism community lies at the intersection of my personal and professional lives. Could these latest revelations be the final chapter?

As chief of communications at Texas Medical Association, I promote the …

Patient voices

Bullying among nurses needs to stop

Sarah Beth Cowherd, RN

March 14, 2011Mar 14, 201118

I do not wish simply to use the buzz word of the hour. Nor do I wish to assert that I have all the answers. I genuinely desire to bring to light an interesting conflict that has plagued the nursing…

I do not wish simply to use the buzz word of the hour. Nor do I wish to assert that I have all the answers.

I genuinely desire to bring to light an interesting conflict that has plagued the nursing profession for decades.

Bullying.

Why in a profession centered around the concepts of compassion, caring, and healing has a mindset of bullying permeated the culture. Even more confusing is that most often, this …

Read more…

Bullying among nurses needs to stop

Patient voices

Danger of multiple emergency room visits to different hospitals

Jeffrey I. Kreisberg, PhD

March 13, 2011Mar 13, 2011

If you are one of the more than 100 million Americans who visit emergency rooms (ER) at least once a year, you’re not alone. Americans, insured and not, make ample use of hospital emergency rooms. One out of every five…

If you are one of the more than 100 million Americans who visit emergency rooms (ER) at least once a year, you’re not alone.

Americans, insured and not, make ample use of hospital emergency rooms. One out of every five visited an ER at least once in 2007, the latest year for which the National Center for Health Statistics …

Health policy

The differences between comparative and clinical effectiveness

Peter J. Pitts

March 13, 2011Mar 13, 20113

by Peter J. Pitts "Newspeak," the language of Big Brother, was designed "not to extend but to diminish the range of thought." Some well-known examples of Newspeak are Bellyfeel (a blind, enthusiastic acceptance of an idea), Duckspeak (meaning literally to…

by Peter J. Pitts

“Newspeak,” the language of Big Brother, was designed “not to extend but to diminish the range of thought.”

Some well-known examples of Newspeak are Bellyfeel (a blind, enthusiastic acceptance of an idea), Duckspeak (meaning literally to quack like a duck or to speak without thinking), Crimethink (the Newspeak word for thought crime) and Goodthink (or “political orthodoxy”).

Which brings us from the nightmare fantasy of “1984” to the health …

Patient voices

Achieving balance in life with cerebral palsy

Erin Breedlove

March 13, 2011Mar 13, 20113

As in anyone’s life, the hardest thing to achieve in life is a balance. Whether it’s work, school, home, or play, it’s just plain tough. For those of us with challenges such as cerebral palsy, it brings a new set…

Task execution takes longer. Where it might take my sister thirty minutes to get herself ready and out the door in the mornings, it will take me …

Health policy

Withholding liver transplants for Medicaid recipients in Arizona

Gary Levin, MD

March 12, 2011Mar 12, 201112

Governor Brewer’s decision to withhold liver transplants for Medicaid recipients in Arizona should serve as a loud warning to the electorate regarding governmental intrusions into health care financing and health care operations. The decision was ill advised on the basis…

The decision was ill advised on the basis of multiple factors. The survival rates differ from one facility to another.

What is the liver transplant survival rate and what information needs to be considered when looking at such numbers?

For example, …

Medical education

Humility in medicine and our academic training environments

Ken Covinsky, MD

March 12, 2011Mar 12, 20115

I sometimes wonder if we spend too much time talking about professionalism. It is not that I don't think we should promote professionalism. Of course we should. But many discussions of professionalism descend into overly academic and scholarly treatises that…

I sometimes wonder if we spend too much time talking about professionalism.

It is not that I don’t think we should promote professionalism. Of course we should. But many discussions of professionalism descend into overly academic and scholarly treatises that end up obscuring rather than clarifying the values such discussions hope to promote. It may be a mistake to overly …

Physician voices

Why team based primary care won’t help evidence based medicine soon

Kevin Pho, MD

March 11, 2011Mar 11, 201114

Despite the advances in evidence-based medicine, not every patient benefits. In a recent column from the New York Times, Pauline Chen looks at a study showing exploring the issue: For many patients, evidence-based medicine isn’t working. Two-thirds of patients with…

Despite the advances in evidence-based medicine, not every patient benefits.

In a recent column from the New York Times, Pauline Chen looks at a study showing exploring the issue:

For many patients, evidence-based medicine isn’t working. Two-thirds of patients with diabetes, a disease with some of the strongest evidence-based guidelines available, continue to have trouble controlling their blood sugar levels; and only half of all

…

Real physician voices, twice a week

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