KevinMD.com

December 6, 2010Dec 6, 2010

Reading the newspapers and watching the news lately would lead you to believe that screening for cancer is largely a waste of time. Yet, in the same week that the NEJM published Norwegian data showing a remarkably small survival benefit…

Reading the newspapers and watching the news lately would lead you to believe that screening for cancer is largely a waste of time.

Yet, in the same week that the NEJM published Norwegian data showing a remarkably small survival benefit of 2% associated with screening mammography, HealthDay reported a decrease in cancer incidence of almost 1% per year from 1999 to 2006 and a decrease in cancer deaths …

Conditions and diseases

Temperament of perfectionism in anorexia nervosa

William R. Yates, MD

December 6, 2010Dec 6, 20102

Temperament is generally defined as innate early emotional and behavioral characteristics that precede puberty and adult development. Felt to have significant genetic components, temperament is also potentially influenced by environmental factors. There are a variety of temperament domains that have…

There are a variety of temperament domains that have received significant attention in childhood, adolescent and adult populations.

Some of the most commonly studied domains include:

neuroticism
harm avoidance
novelty seeking
reward dependence
perfectionism (subdomains have included: concern about mistakes, personal standards, doubts about actions, organization

The …

Patient voices

$11,000 hospital bill from the emergency department

Steve P. Sanders, DO, MBA

December 6, 2010Dec 6, 201075

by Steve Sanders, DO “What am I going to do now Doc?” asked Mike, a down on his luck, 29 year–old recently unemployed truck driver, as he handed me his hospital bill. Mike was seen at our local emergency department…

by Steve Sanders, DO

“What am I going to do now Doc?” asked Mike, a down on his luck, 29 year–old recently unemployed truck driver, as he handed me his hospital bill.

Mike was seen at our local emergency department on a Friday evening with complaints of indigestion. Earlier that day he and his wife Susan celebrated their second anniversary by splitting a store bought pepperoni pizza. …

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Physician voices

Choose your primary care physician with particular care

Colleen Kelly Mellor

December 6, 2010Dec 6, 20106

I told a friend what I did recently to get in to see a dermatologist and she was shocked. “You wrote a letter asking her to take you as patient?” “Wow!” “Yes,” I admitted. “I’d called her office for an…

I told a friend what I did recently to get in to see a dermatologist and she was shocked.

“You wrote a letter asking her to take you as patient?” “Wow!” “Yes,” I admitted. “I’d called her office for an appointment; she wasn’t taking new patients; I needed to resort to an over-the-top approach.”

You see, I’d researched her (ok, I Googled her) and after reading her background, schooling, and patient reviews, …

Health policy

Medicare rates will be influenced by comparative effectiveness

Bob Doherty

December 5, 2010Dec 5, 20106

From its inception, Medicare has been agnostic about the effectiveness of different treatments when it sets payment rates. Once a treatment is found to be "reasonable and necessary," Medicare establishes a payment rate that takes into account complexity and other…

From its inception, Medicare has been agnostic about the effectiveness of different treatments when it sets payment rates. Once a treatment is found to be “reasonable and necessary,” Medicare establishes a payment rate that takes into account complexity and other “inputs” that go into delivering the service. But it is prohibited by law from varying payments based on how well an intervention works.

This would change under a “dynamic pricing” approach …

Conditions and diseases

Redundant tests waste health care dollars

Doctor Grumpy, MD

December 5, 2010Dec 5, 20109

B12. Sounds simple, huh? 1 letter, 2 numbers. One of the B vitamins. It's important in a number of body functions, particularly the nervous system and blood cell production. It's in pretty much all meats and vegetables, and multivitamins you…

B12.

Sounds simple, huh?

1 letter, 2 numbers. One of the B vitamins. It’s important in a number of body functions, particularly the nervous system and blood cell production. It’s in pretty much all meats and vegetables, and multivitamins you can buy.

To me, it’s also a good example of what’s wrong in health care.

Let’s take Mrs. Olde.

She goes to her internist, and is complaining of feeling weak and tired. So he checks …

Conditions and diseases

Priapism is indicative of spinal cord injury in trauma

StorytellERdoc, MD

December 4, 2010Dec 4, 2010

It had been a high-speed motor-vehicle accident. One car. A twenty-something male driver without passengers. No seat belt. And now, this same driver had no movement from his waist down and no sensations below his mid-abdomen. According to bystanders, he…

According to bystanders, he had been driving his sedan dangerously fast, some estimates of nearly 100 m.p.h., before losing control. The car veered off the roadway to the right, flipping mid-air before smacking head-on into …

Conditions and diseases

Sleep-breathing, your immune system, and colds

Steven Y. Park, MD

December 4, 2010Dec 4, 2010

Have you ever wondered by some people never get colds? Why do other people get colds at the drop of a sneeze? An opinion piece recently published in the New York Times explains away a common myth—that you have to…

Have you ever wondered by some people never get colds? Why do other people get colds at the drop of a sneeze?

An opinion piece recently published in the New York Times explains away a common myth—that you have to strengthen your immune system to fight a cold. His argument is that your symptoms of a cold are actually your immune system over-reacting to harmless viruses. This is …

Health policy

Why the Pre-Existing Condition Insurance Plan (PCIP) fails

Ray Carlson

December 4, 2010Dec 4, 20107

As we all know, this past March Congress passed and the President signed The Affordable Care Act. One component of the new legislation was the creation of a program called the Pre-Existing Condition Insurance Plan (PCIP). This is a federally funded high risk pool for state residents who – having been denied individual insurance coverage within the past 12 months for a pre-existing condition – would now, theoretically, have ready …

Physician voices

Waste at hospitals in developing countries

Yann Meunier, MD

December 3, 2010Dec 3, 20102

Year: 1993 Setting: Mendi Hospital, Southern Highlands province, Papua New Guinea Position: Chief medical officer for Chevron Chevron is contributing to the budget of Mendi Hospital in the capital city of the Southern Highlands province. Each year, the hospital director…

Year: 1993

Setting: Mendi Hospital, Southern Highlands province, Papua New Guinea
Position: Chief medical officer for Chevron

Chevron is contributing to the budget of Mendi Hospital in the capital city of the Southern Highlands province. Each year, the hospital director sends a financial request to the company’s medical department, and this is my first time to review and approve it. Curious about how the money will be used, I phone the director to …

Conditions and diseases

Appendicitis in children and radiation exposure from CT scans

Skeptical Scalpel, MD

December 3, 2010Dec 3, 201011

Recently, medical writer and pediatrician Perri Klass wrote in the New York Times about evolving issues regarding the diagnosis of appendicitis in children, which are also applicable to adults. There is well-documented concern regarding the excessive radiation exposure associated with…

Recently, medical writer and pediatrician Perri Klass wrote in the New York Times about evolving issues regarding the diagnosis of appendicitis in children, which are also applicable to adults. There is well-documented concern regarding the excessive radiation exposure associated with CT scans.

For example, a recent paper reported that a single abdominal CT scan with contrast delivers a radiation dose equal to undergoing more than 200 regular …

Drugs and prescribing

How the pharmaceutical industry changed psychiatry

Jan Henderson, PhD

December 3, 2010Dec 3, 201015

What’s happened to psychiatry over the last 15 to 20 years? That’s a big subject, discussed in many recent and excellent books. One of those books is by Daniel Carlat, author of Unhinged: The Trouble with Psychiatry – A Doctor’s…

What’s happened to psychiatry over the last 15 to 20 years? That’s a big subject, discussed in many recent and excellent books. One of those books is by Daniel Carlat, author of Unhinged: The Trouble with Psychiatry – A Doctor’s Revelations about a Profession in Crisis.

One of the problems Carlat readily acknowledges is that psychiatry is excessively focused on psychopharmaceuticals at the expense of other effective treatments. …

Physician voices

Educate the patient about their disease and discharge plan

Lyle Fettig, MD

December 3, 2010Dec 3, 20102

Have you ever discharged a patient from the hospital and had a gnawing feeling that maybe you could have done more to educate the patient about their disease, medications, and plan of care? Probably so. A recent survey published in…

Have you ever discharged a patient from the hospital and had a gnawing feeling that maybe you could have done more to educate the patient about their disease, medications, and plan of care?

Probably so. A recent survey published in the Archives of Internal Medicine tells us that this feeling is based in reality (I’m guessing that you already knew this) and that you are not alone.

The …

Health technology

A better system is needed to migrate to electronic health records

Steven Reznick, MD

December 2, 2010Dec 2, 201019

Five years ago my associate and I invested sixty thousand dollars to purchase and set up an electronic health record system and eliminate extensive paper use. We researched all available systems and decided upon MediNotes because it was a large…

Five years ago my associate and I invested sixty thousand dollars to purchase and set up an electronic health record system and eliminate extensive paper use.

We researched all available systems and decided upon MediNotes because it was a large company with an excellent record of service and their system met all the national requirements for certification. We worked through our local computer vendor’s family …

Health policy

Learning from the Massachusetts experiment in universal coverage

Joseph Paduda

December 2, 2010Dec 2, 20105

We're learning a lot from Massachusetts' experiment in universal coverage - and some of the lessons are rather enlightening. According to Bestwire, Lora Pellegrini, president of the Massachusetts Association of Health Plans, said something along the lines of "That's the…

We’re learning a lot from Massachusetts’ experiment in universal coverage – and some of the lessons are rather enlightening.

According to Bestwire, Lora Pellegrini, president of the Massachusetts Association of Health Plans, said something along the lines of “That’s the problem with the new U.S. health care reform law … it offers millions of uninsured Americans access to health insurance but doesn’t address underlying medical costs, which are contributing to costly …

Health policy

Integration and virtual accountable care organizations in health reform

Joe Flower

December 2, 2010Dec 2, 20104

They are coming in fast under the radar, out of peripheral vision, in the magician’s other hand—and they will change everything. New ideas, surprising networks, stealth business models that may change health care profoundly, are bubbling up in pilot programs, experiments and full-on corporate transformations. There is something here that does not yet have a name, that no one is yet calling a movement, that no one is yet seeing …

Physician voices

Lifestyle matters for specialties that want to survive

Kevin Pho, MD

December 2, 2010Dec 2, 20103

Medical students today consider lifestyle an essential criteria when choosing a specialty. It's become a cliche that most are looking towards the ROAD (radiology, ophthalmology, anesthesiology and dermatology) to happiness. There's been some recent media attention at how women are…

Medical students today consider lifestyle an essential criteria when choosing a specialty.

It’s become a cliche that most are looking towards the ROAD (radiology, ophthalmology, anesthesiology and dermatology) to happiness.

There’s been some recent media attention at how women are lured to specialties that offer a greater balance between their family lifestyle and professional demands.

Claudia Golden, a Harvard economics professor, recently noted that,

high-paying careers that offer more help in balancing work

…

Conditions and diseases

Creativity and ADHD may share some common genetic vulnerabilities

Shelley Carson, PhD

December 2, 2010Dec 2, 20105

Both highly creative individuals and ADHD-diagnosed individuals often report feeling out of place, like a square peg in a round hole. (In fact, in my creativity research questionnaires I actually ask the question “Do you often feel like a square…

Both highly creative individuals and ADHD-diagnosed individuals often report feeling out of place, like a square peg in a round hole.

(In fact, in my creativity research questionnaires I actually ask the question “Do you often feel like a square peg in a round hole?” Participants who score high on the Creative Achievement Questionnaire have …

Conditions and diseases

MKSAP: 70-year-old woman with hypothyroidism and a fractured hip

mksap

December 2, 2010Dec 2, 2010

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 70-year-old woman with hypothyroidism fell and fractured her hip. During preoperative evaluation for hip fracture repair, she mentions recent mild fatigue, which has…

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

A 70-year-old woman with hypothyroidism fell and fractured her hip. During preoperative evaluation for hip fracture repair, she mentions recent mild fatigue, which has not significantly limited performance of her daily activities, and ongoing right upper-quadrant abdominal pain after eating. She takes levothyroxine, 0.075 …

Medical education

A neurosurgical resident’s typical day

Colin Son, MD

December 1, 2010Dec 1, 201010

I’ve made some fairly outrageous claims about the workload of a neurosurgical resident recently. Seems like a reasonable time to lay out exactly what a day on call can be like for me and my fellow residents. To be fair…

To be fair an average experience may be hard to articulate. Different rotations and different days yield different … adventures. Right now I’m on a service that could hardly be called grueling, but I …

Read more…

A neurosurgical resident’s typical day

Real physician voices, twice a week

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