KevinMD.com

Watchful waiting is a powerful diagnostic tool

Conditions and Diseases

July 31, 2010

Childhood is full of self-limited illnesses. Kids get sick and kids get better. The majority of childhood illnesses will get better on their own. Because of this, observation and “watchful waiting” is often the most useful diagnostic test at the pediatrician’s disposal.

Parents are often confused about the need for testing. Their experiences with adult medicine is typically full of lab tests and imaging studies. Unfortunately some parents equate the quantity …

Early dialysis may not improve kidney failure outcomes

MedPage Today

Conditions and Diseases

July 31, 2010

by Nancy Walsh

Planned early initiation of dialysis in patients with chronic kidney disease did not improve survival or other clinical outcomes, a multicenter randomized trial conducted in Australia and New Zealand found.

The hazard ratio for death among patients who had an early start of dialysis, when the estimated glomerular filtration rate (GFR) was 10 to 14 mL/min, was 1.04 (95% CI 0.83 to 1.30, P=0.75), according to Bruce A. Cooper, …

Greed is not good when it comes to doctors, patients and medicine

Chris Rangel, MD

Health Policy

July 31, 2010

Gordon Gekko is wrong. Greed is not good. Not when it comes to health care providers.

The socioeconomic study of what motivates people is a fascinating field of study, not the least of which is because of how counter-intuitive it is. For example, it seems normal to assume that the more someone is rewarded for their efforts, the more effort they will put forth toward those rewards.

These rewards (increasing salary, bonuses, …

When a biopsy cannot completely rule out cancer

Jeffrey Parks, MD

Conditions and Diseases

July 30, 2010

Pathologists and radiologists don’t have the luxury of spending time with actual patients so they have to render professional judgments and determinations based on indirect data (radiographs, a mashed up slice of breast tissue, etc.).

I don’t envy them; the utter detachment from patient care would make me miserable. But they do have a tough job. They get one shot at getting it right. There’s no patient follow up. They never …

Decision support can help doctors order scans

Kevin

Patient

July 30, 2010

by Scott Cowsill

A third or more of scans may be unnecessary or repetitive, studies show, and in scans that are medically appropriate, radiation doses could be dramatically reduced without hurting the quality of images.

As pointed out by Robert Centor, MD, “one cannot easily develop rules for testing because the presentations that we see vary so greatly.” That being said, guidelines for diagnostic …

Diabetes is responsible for many heart disease deaths

Kristina Fiore

Conditions and Diseases

July 30, 2010

by Kristina Fiore

More than one in 10 heart disease deaths may be attributable to diabetes, researchers say.

In a meta-analysis of more than 100 studies, diabetes was associated with a twofold increased risk of the disease and was estimated to be accountable for 11% of vascular deaths, according to Nadeem Sarwar, MD, of the University of Cambridge in England, and colleagues.

They reported their findings online in The Lancet and will present …

Non-clinical physician job starting salaries

Joseph Kim, MD, MPH

Physician

July 30, 2010

What are entry-level non-clinical physician job salaries?

Let me clarify what I mean by “entry-level” here: I’m referring to non-clinical jobs that physicians may find if they leave clinical medicine to pursue a non-clinical job in a company (such as a medical communications company, a health IT company, pharmaceutical, biotechnology, or a consulting company).

So, let’s look at several examples:

* A primary care physician who’s making $120k/year leaves clinical medicine and begins …

How industry money continues to influence orthopedics

Ford Vox, MD

Physician

July 30, 2010

Three years ago, the Department of Justice took stock of the orthopedic medical device industry–represented by the five big makers of orthopedic implants–and concluded that it was rampantly violating federal anti-kickback laws with the bribes and favors it was offering to surgeons. Such bribes often came in the form of training grants for those just starting out in the profession, or as lucrative consulting contracts for influential academic orthopedists.

The …

What to do if your doctor quits and leaves medicine

Jan Gurley, MD

Patient

July 29, 2010

The news that Dr. Marcus Conant has quit practicing medicine is a blow to healthcare here in the Bay Area.

And a sad symbol of all that is wrong with healthcare – and in particularly, the way we treat primary care practitioners – in America today. It would be hard to find a doctor more symbolic of the best of medicine than Marcus Conant – a man willing to devote …

Let consumers decide if they want the patient centered medical home

Jaan Sidorov, MD

Health Technology

July 29, 2010

Is the Patient Centered Medical Home (PCMH) the panacea for all that ails health care?

Have we exhausted all the allegories related to the term “home?” The answer to both questions apparently is no, thanks to this American Journal of Managed Care article by Timothy Hoff titled The Shaky Foundation of the Patient Centered Medical Home.

Dr. Hoff appropriately shelves PCMH policy and looks at the topic with a market-based perspective. From …

Kombucha tea can be dangerous to your health

Michele R. Berman, MD

Potpourri

July 29, 2010

Celebrities are powerful role models and are important to consumers concerned with their health because of the perception that famous people have access to the best health practices and medical care. The public looks to celebrities for hope and inspiration as they struggle with their own health issues and fight disease. However the health practices that celebrities promote are often questionable and misleading.

One currently popular folk remedy, kombucha tea, is …

Homocysteine lowering does not reduce heart attack risk

Crystal Phend

Medications

July 29, 2010

by Crystal Phend

Homocysteine-lowering supplements do not help prevent further cardiovascular events in heart attack survivors, a large randomized trial affirmed.

The trial, which followed more than 12,000 heart attack survivors over nearly seven years, found that folic acid plus vitamin B12 effectively reduced homocysteine levels, but did not reduce major vascular events overall nor any other individual endpoint compared with placebo, reported Jane M. Armitage, BM BChBSc, MBBS, of the University …

Why patients are wary of the primary care medical home

Kevin Pho, MD

Physician

July 29, 2010

Say the words, “Patient-centered medical home,” and you’re bound to get a variety of opinions.

On this blog alone, there are a variety of guest pieces critical of the effort, saying it does not increase patient satisfaction, nor does it save money.

And that’s not good news for its advocates, who are pinning primary care’s last hopes on the model.

Medical homes hit the …

How essential is industry funding for university CME?

Daniel J. Carlat, MD

Medical Education

July 29, 2010

As originally reported in a New York Times article recently, with more coverage in MedPage Today, the University of Michigan School of Medicine has decided to end all industry support of CME as of January 1, 2011.

According to the dean of the medical school, “the decision was based on a review of literature about the influence on clinical faculty of industry-funded CME.” Apparently the decision was made after a …

How the Massachusetts gift ban hurts primary care doctors

Kevin

Physician

July 29, 2010

by Kate Atkinson, MD

Six years ago, I organized a group of female healthcare practitioners for a women’s medical journal club. A multidisciplinary team of doctors and NPs from primary care and sub-specialties regularly attended monthly dinners. Invited speakers presented on a variety of topics and over the course of a meeting we exchanged insights while challenging each other on how best to manage our challenging patients.

Our group grew …

Should we worry about physician privacy in the EHR era?

Margalit Gur-Arie

Health Technology

July 28, 2010

As we move to electronic health records (EHR), the debates over security and privacy are becoming more frequent and more poignant.

We of course have HIPAA laws on the books and Office of the National Coordinator for Health Information Technology (ONC) has a Tiger team assembled to recommend privacy and security policies to Secretary Sebelius.

CIOs and entire IT departments are all focused on protecting the privacy of patients and their Personal …

ADHD and how drugs impede meaningful help for children

Claudia M. Gold, MD

Medications

July 28, 2010

I recently received a call from a mother that made me both want to cry and scream out in frustration.

Several months ago I wrote a post entitled Drugs for Children May Silence Stories, in which I described a young boy who had suffered severe neglect as an infant. His adoptive parents had sought help from me when he was four, but when I recommended intervention for the whole family …

Cell towers do not increase childhood cancer risk

Crystal Phend

Conditions and Diseases

July 28, 2010

by Crystal Phend

Mobile phone base station towers boost cell reception, not childhood cancer risk, a British population-based study showed.

Children whose mothers lived near a high-output cell phone antenna mast while pregnant were no more likely to develop childhood cancer than those who lived farther away, found Paul Elliott, MBBS, PhD, of Imperial College London, and colleagues.

Exposure to an intermediate level of cell tower power output was associated with an adjusted …

New medical student summer tips

Kevin

Medical Education

July 28, 2010

by Shawn Vuong

Incoming medical students, I know you’re excited about medical school. I was in your same exact position about 2 years ago to the day. Every day I went to sleep and thought about how cool medical school was going to be, how much cool stuff I was going to learn, and how much my life was going to change.

I asked myself many questions. Am I going …

Read more…

New medical student summer tips

Obesity should not require specialists to manage

Arya M. Sharma, MD

Conditions and Diseases

July 28, 2010

Medical school trains us to deal with a wide range of medical problems.

No matter what our current practice or specialty, at some point during medical school we will have had to study and demonstrate our knowledge and competency in dealing with common disorders like diabetes, hypertension, depression, chronic pain and countless other ailments. In addition, we will have spent hours poring over much rarer disorders, conditions that many of us …

Most Popular

Past Week

Past 6 Months

Recent Posts

Subscribe to KevinMD and never miss a story!

Most Popular

Past Week

Past 6 Months

Recent Posts