KevinMD.com

November 26, 2010Nov 26, 201023

No shows. It seems that no matter what we do, we always have them. Despite the fact that we call every single person on the schedule to remind them of their appointment the day before (the staff personally makes the…

No shows. It seems that no matter what we do, we always have them.

Despite the fact that we call every single person on the schedule to remind them of their appointment the day before (the staff personally makes the call. We don’t use an automated system) we found that in 2009, we had 389 no-shows.

Slicing the data

Is 389 a high number of no-shows? I guess it depends on the size …

Physician voices

How small private practices can still thrive

Susan Giurleo, PhD

November 26, 2010Nov 26, 20104

Health care is changing at lighting speed. If you don’t know this, or worse, don’t accept it you’re doomed. No. Really. It’s change or close shop. Whether you like it or not, health care reform is going to change the…

Many physicians are choosing to work for large group practices to buffer themselves from directly dealing with change. Mental health providers could do the same, …

Talk with your family about their end of life wishes

Alexandra Drane

November 25, 2010Nov 25, 2010

by Alexandra Drane and the Engage With Grace team For three years running now, many of us bloggers have participated in what we’ve called a “blog rally” to promote Engage With Grace – a movement aimed at making sure all…

by Alexandra Drane and the Engage With Grace team

For three years running now, many of us bloggers have participated in what we’ve called a “blog rally” to promote Engage With Grace – a movement aimed at making sure all of us understand, communicate, and have honored our end-of-life wishes.

The rally is timed to coincide with a weekend when most of us are with the very people with whom we should …

Real physician voices, twice a week

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Conditions and diseases

Bedbug rashes, and how to prevent and get rid of bedbugs

Michele R. Berman, MD

November 24, 2010Nov 24, 2010

There’s a new bunch of bloodsuckers running rampant in cities all over the country. No, they’re not on a new vampire TV show or in a Twilight sequel. They’re bedbugs, and they’ve been showing up in droves in more and…

There’s a new bunch of bloodsuckers running rampant in cities all over the country.

No, they’re not on a new vampire TV show or in a Twilight sequel. They’re bedbugs, and they’ve been showing up in droves in more and more cities across America. And despite what is commonly thought about them, bedbugs do not exist only in the poorest sections of town, they are showing up at 5-star hotels.

That means …

Patient voices

Never forget to advocate for your patient

Anesthesioboist T., MD

November 24, 2010Nov 24, 20107

There are some lessons we learn and keep re-learning in medicine. For me some of these recurring lessons are, Listen to your "gut." Pay attention to the clues. Listen to your team. Don't be afraid to call for help. and…

There are some lessons we learn and keep re-learning in medicine. For me some of these recurring lessons are,

Listen to your “gut.”
Pay attention to the clues.
Listen to your team.
Don’t be afraid to call for help.

and

Stick to your guns when advocating for your patient.

I encountered a young patient recently, just at the cusp of adolescence and adulthood, who had undergone a procedure related to a sports injury. Other people had been …

Drugs and prescribing

Penicillin and the Cocoanut Grove fire in Boston

MedPage Today

November 24, 2010Nov 24, 20102

by Nancy Walsh The recent report of the deliberate infection of Guatemalans with syphilis in the 1940s to see if penicillin could cure and prevent transmission of the disease was a reminder of just how short the time has been…

by Nancy Walsh

The recent report of the deliberate infection of Guatemalans with syphilis in the 1940s to see if penicillin could cure and prevent transmission of the disease was a reminder of just how short the time has been since most infectious diseases were untreatable. Penicillin — discovered by Scottish biologist Alexander Fleming in 1928 but not available for clinical use until the 1940s — …

Drugs and prescribing

Drug reps know what doctors are prescribing

Carl Elliott, MD, PhD

November 24, 2010Nov 24, 20109

An excerpt from White Coat, Black Hat. by Carl Elliott Oldani worked as a rep in the late 1980s and the 1990s, a period when the drug industry was undergoing key transformations. Its ethos was changing from that of the…

An excerpt from White Coat, Black Hat.

by Carl Elliott

[Michael] Oldani worked as a rep in the late 1980s and the 1990s, a period when the drug industry was undergoing key transformations. Its ethos was changing from that of the country-club establishment to the aggressive, new-money entrepreneur.

Impressed by the success of AIDS activists in pushing for faster drug approvals, the drug industry increased …

Health policy

Why comparing healthcare access to food is a false analogy

Marya Zilberberg, MD, MPH

November 23, 2010Nov 23, 201056

When I was in training as a resident and a fellow, I remember taking only a couple of sick days over the entire 6-year period. And I had to stay home because I could not stop praying to the porcelain…

When I was in training as a resident and a fellow, I remember taking only a couple of sick days over the entire 6-year period.

And I had to stay home because I could not stop praying to the porcelain Goddess during a bout of a particularly nasty flu, despite a vaccination. I actually took pride in my health record, and attributed it directly to being rather sickly as a child. …

Physician voices

There is no routine procedure in general surgery

Jeffrey Parks, MD

November 23, 2010Nov 23, 20108

The life of a general surgeon is one fraught with contingency, soul-crushing doubt, unexpected disaster, and overwhelming stress. I wouldn't wish it upon my worst enemy. Fortunately, I was brainwashed to a sufficient degree during residency such that I actually…

The life of a general surgeon is one fraught with contingency, soul-crushing doubt, unexpected disaster, and overwhelming stress. I wouldn’t wish it upon my worst enemy. Fortunately, I was brainwashed to a sufficient degree during residency such that I actually don’t mind my job.

One of the reasons general surgery is so tough is that it is nearly impossible to map out your week according to a strict schedule. Maybe at …

Conditions and diseases

Diabetes and leg amputations in McAllen, Texas

Merrill Goozner

November 23, 2010Nov 23, 20106

The Dartmouth Atlas of Health is once again throwing a harsh spotlight on McAllen, Texas. This time the Mexican border town has the highest rate of leg amputations in the nation, a new report released recently showed. McAllen's rate was…

The Dartmouth Atlas of Health is once again throwing a harsh spotlight on McAllen, Texas.

This time the Mexican border town has the highest rate of leg amputations in the nation, a new report released recently showed. McAllen’s rate was ten times the rate of Provo, Utah, which had the lowest rate of leg amputations among the Medicare eligible population. The national average was one-third of McAllen’s rate.

McAllen became notorious earlier …

Health policy

ACP: Health care innovation in the Affordable Care Act

American College of Physicians

November 23, 2010Nov 23, 20107

A guest column by the American College of Physicians, exclusive to KevinMD.com. by John Tooker, MD, MBA, MACP The Patient Protection and Affordable Care Act (PPACA) has important provisions – improved access, safety and quality among them – that have…

A guest column by the American College of Physicians, exclusive to KevinMD.com.

by John Tooker, MD, MBA, MACP

The Patient Protection and Affordable Care Act (PPACA) has important provisions – improved access, safety and quality among them – that have the real potential to improve health and health care and, lower costs.

Two recent reports remind us of the urgent need to improve safety and quality: A report from …

Conditions and diseases

Noninvasive fat removal in plastic surgery

Anthony Youn, MD

November 23, 2010Nov 23, 20104

One of the hottest things in plastic surgery is noninvasive fat removal. I’ve mentioned on Rachael Ray Showthat fat removal without any invasiveness is the ‘holy grail’ of plastic surgery, and I still stand by it. I’ve gone over the…

One of the hottest things in plastic surgery is noninvasive fat removal.

I’ve mentioned on Rachael Ray Showthat fat removal without any invasiveness is the ‘holy grail’ of plastic surgery, and I still stand by it. I’ve gone over the Zerona a few times, but what about Zeltiq, a.k.a. Cryolipolysis? Does this device actually remove fat without surgery or needles?

Well, let’s review the different fat removing technologies:

1. Diet and exercise. The …

Patient voices

Why you should care about prison healthcare

Jan Gurley, MD

November 22, 2010Nov 22, 20105

It was kind of amazing how little coverage the recent report on healthcare in our prison systems got. Heck, you may be thinking, I don’t think that’s amazing – why waste airtime on that topic – why should I fret and worry about the healthcare that prisoners get when my child is burning up with fever and coughing up a lung and I can’t even afford to take her to …

Conditions and diseases

Breast cancer transforms a doctor in training to patient in an instant

Jessica Tekla Les, MD

November 22, 2010Nov 22, 20106

by Jessica Tekla Les, MD During my third year of medical school I was performing a routine breast exam, more for practice than anything else. I was trying the concentric-circles-around-the-nipple technique, one of several I'd been taught. About halfway through…

by Jessica Tekla Les, MD

During my third year of medical school I was performing a routine breast exam, more for practice than anything else. I was trying the concentric-circles-around-the-nipple technique, one of several I’d been taught. About halfway through the right breast I found a lima-bean-sized lump, not far from the breastbone. I took liberties with this particular exam. I poked the lump, tried to …

Physician voices

Will primary care be saved by the community health center?

Allen Perkins, MD

November 22, 2010Nov 22, 20104

As I have written before, the Teaching Health Center is seen as a way to move education into the community (using Community Health Centers as a training resource) and out of the Academic Health Center. Currently, 20 million Americans receive…

Currently, 20 million Americans receive care in a CHC. They serve Americans who are unable to obtain access through more traditional means, either because of location (the community will not support traditional healthcare) or socioeconomic …

Conditions and diseases

Depression and whether a behavioral problem is mental illness

Dr. Joe Kosterich

November 22, 2010Nov 22, 201025

It has been said that depression is the epidemic of the 21st century. Certainly the rates of diagnosis have increased over the last 10-15 years. Some claim that this is due to better recognition of the issue and that actual…

It has been said that depression is the epidemic of the 21^st century. Certainly the rates of diagnosis have increased over the last 10-15 years. Some claim that this is due to better recognition of the issue and that actual rates are unchanged. Others feel that we are collectively more depressed than in years gone by.

The number of Americans prescribed an antidepressant doubled between 1996 and 2005 and those being …

Health technology

Trust your life records to an unnamed chain of software vendors

Margalit Gur-Arie

November 21, 2010Nov 21, 201012

Every day millions of Americans and billions of people around the globe are routinely accepting colorful pieces of paper in return for their labor and placing those hard earned possessions in modern glass buildings whose owners they do not know.…

It took a few hundred years to change how business transactions are conducted, but today, there is very little apprehension about depositing one’s wealth in a bank. Public trust in both …

Health policy

Do posters in the hospital really help patients?

Jaan Sidorov, MD

November 21, 2010Nov 21, 20104

The Disease Management Care Blog received this posting from an experienced nurse with a background in clinical and administrative medicine. We’ve all seen them. Those vacuous workplace posters exhorting teamwork, creativity and other forms of inspiration and accomplishment. A version…

The Disease Management Care Blog received this posting from an experienced nurse with a background in clinical and administrative medicine.

We’ve all seen them. Those vacuous workplace posters exhorting teamwork, creativity and other forms of inspiration and accomplishment. A version has begun to creep into our nation’s health care facilities. reminding everyone of the need for privacy, how infections can be spread and the importance of patient service. And if my …

Drugs and prescribing

Routine use of sleep medication for children

Claudia M. Gold, MD

November 21, 2010Nov 21, 20102

A recent study published in the journal Sleep Medicine revealed that most child psychiatrists prescribe medication for sleep at least once a month, despite the fact that no sleep medications are approved for use in children. The study was funded…

A recent study published in the journal Sleep Medicine revealed that most child psychiatrists prescribe medication for sleep at least once a month, despite the fact that no sleep medications are approved for use in children. The study was funded by Sanofi-Aventis, makers of Ambien.

Managing sleep is one of the greatest challenges of being a parent. It represents the first major separation and can be fraught with complex ambivalent feelings. …

Real physician voices, twice a week

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