KevinMD.com

November 20, 2010Nov 20, 20104

Some time in the years 2002-2005, cardiothoracic surgery hit the wall. The specialty's big time claim to fame, the CABG (coronary artery bypass graft), surgery was on a huge decline. The field of cardiothoracic surgery became super saturated with over…

Some time in the years 2002-2005, cardiothoracic surgery hit the wall.

The specialty’s big time claim to fame, the CABG (coronary artery bypass graft), surgery was on a huge decline. The field of cardiothoracic surgery became super saturated with over trained surgeons who were no longer in demand. The interventional cardiologist had come along and started stenting coronary arteries, saving patients from the chest opening surgery known …

Drugs and prescribing

Quinine, artemisinin and our debt to traditional medical healers

Kevin

November 20, 2010Nov 20, 20102

An excerpt from Sustaining Life: How Human Health Depends on Biodiversity. by Eric Chivian, MD and Aaron Bernstein, MD Ethnobotany, that is, the scientific study of the use of plants by native cultures, including their use as medicines, can be…

An excerpt from Sustaining Life: How Human Health Depends on Biodiversity.

by Eric Chivian, MD and Aaron Bernstein, MD

Ethnobotany, that is, the scientific study of the use of plants by native cultures, including their use as medicines, can be said to have begun with Carl Linnaeus, who in the 1730s published Flora Lapponica, his detailed account of plant use by the Lappish, or Sami, …

Physician voices

When does the duty to provide emergency medical care end?

Lyle Denniston

November 20, 2010Nov 20, 201014

Hospitals know that medical care decisions often have legal consequences, which makes it all the more important to know what the law requires. But when judges can't agree, and there also is some ambiguity in the way government officials see…

Hospitals know that medical care decisions often have legal consequences, which makes it all the more important to know what the law requires. But when judges can’t agree, and there also is some ambiguity in the way government officials see a legal issue affecting care decisions, hospitals may need to go to the ultimate authority – the U.S. Supreme Court – for an answer.

A Southfield, …

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Patient voices

Taxing soft drinks to combat obesity

Arya M. Sharma, MD

November 19, 2010Nov 19, 201042

One commonly heard propositions to combat the obesity epidemic is to tax soft drinks. No doubt, sugary soft drinks are a common and important source of “empty” calories, but will taxing soft drinks really reduce obesity rates? This assumption was…

This assumption was now examined by Yale University’s Jason Fletcher and colleagues, in a paper just published in Contemporary Economic Policy.

The researchers collected information on taxation of soft drinks with respect to specific excise …

Read more…

Taxing soft drinks to combat obesity

Patient voices

Caregiving requires that caregivers need practical and emotional support

Kenneth Lin, MD

November 19, 2010Nov 19, 20102

Mr. B, the patient who first stirred my interest in family medicine, was a spry former World War Two fighter pilot who came to the ER complaining of an irregular heart beat. I remember him regaling me with stories about the Battle of Britain while his wife dutifully stood by his side in the chaos of the crowded emergency room at a private hospital affiliated with my medical school.

It was …

Patient voices

Never hesitate to seek a second medical opinion

Eric Van De Graaff, MD

November 19, 2010Nov 19, 201013

To celebrate your 50th birthday you head to your doctor’s office to get your yearly exam. He rewards you for your diligence by poking and prodding you, sticking you with needles, and arranging for a colonoscopy (happy birthday!). He also…

A slightly abnormal treadmill test leads to …

Conditions and diseases

Teaching Dr. Oz about nosebleeds

Christopher Chang, MD

November 18, 2010Nov 18, 20106

A reader informed me that Dr. Oz did a TV show recently on nosebleeds. I took a look at the video clip and it is my opinion that some information Dr. Oz conveyed is not entirely correct. Again, I should…

A reader informed me that Dr. Oz did a TV show recently on nosebleeds.

I took a look at the video clip and it is my opinion that some information Dr. Oz conveyed is not entirely correct. Again, I should stress that this is just my opinion and I’m sure there will be many who may feel differently.

Error #1:
Contrary to what was said on the show, ice packs …

Read more…

Teaching Dr. Oz about nosebleeds

Health technology

Why EHRs aren’t meaningful to doctors and hospitals

Richard Reece, MD

November 18, 2010Nov 18, 201046

Electronic health record (EHR) advocates in Washington don’t seem to get it. They don’t seem to understand that hospitals and doctors aren’t rushing to install EHRs because many EHRs, despite the constant talk that EHRs are a prerequisite for good…

aren’t ready for prime time
slow productivity
decrease revenues,
show scant returns on investment
don’t talk to one

…

Health policy

A National Quality Strategy can create improve patient safety

David B. Nash, MD, MBA

November 18, 2010Nov 18, 20106

Among the many provisions in the Patient Protection and Affordable Care Act are elements intended to assure that every American has access to healthcare that is patient-centered, affordable, and of the highest clinical quality. In my mind, one of the…

In my mind, one of the act’s most essential goals is to establish a National Health Care Quality Strategy — one that integrates disparate federal and private sector initiatives, building on and expanding current quality assessment and …

Physician voices

Our malpractice system needs to focus on patient safety

Donald H. Taylor, PhD

November 18, 2010Nov 18, 201020

A malpractice lawsuit claims that a doctor treated a patient negligently and that this treatment caused harm, and it seeks monetary compensation. Negligence means that a physician failed to provide the standard of care expected by the prevailing medical custom. Juries decide cases that are tried, but most cases are settled or dropped. Lawyers get paid (typically 35 percent) only when they win or settle a case.

A successful malpractice system …

Health technology

EMR is here to stay, which will be good for doctors and patients

Christopher Johnson, MD

November 17, 2010Nov 17, 201012

The electronic medical record, the EMR, is upon us. For those of us who learned medicine entirely with paper charts, some have enthusiastically embraced the EMR and some have refused, to the extent they can, to deal with it at…

The electronic medical record, the EMR, is upon us.

For those of us who learned medicine entirely with paper charts, some have enthusiastically embraced the EMR and some have refused, to the extent they can, to deal with it at all. But most of us have plowed ahead into learning how to use it as best we can. It seems to me that the degree of enthusiasm physicians show for the …

Physician voices

How the health care industry competes for patients

Shantanu Nundy, MD

November 17, 2010Nov 17, 20105

On my drive in to work this past week I came across this: A bus-side advertisement for a local hospital (sadly, not mine) claiming that it was “home to the city’s best transplant outcomes.” Normally I drive right by these…

On my drive in to work this past week I came across this:

A bus-side advertisement for a local hospital (sadly, not mine) claiming that it was “home to the city’s best transplant outcomes.” Normally I drive right by these moving billboards without paying much attention. But this time I immediately got excited, whipped out my cell phone and snapped …

Medical education

Addressing the physician shortage in Texas

Tayson DeLengocky, DO

November 17, 2010Nov 17, 201028

by Tayson DeLengocky, DO The physician shortage in Texas has commanded an unusual amount of public interest in recent weeks. The Houston Chronicle (Oct. 17), Star Telegram (Oct. 19) and Fort Worth Business Press (Oct. 27) all devoted space to…

by Tayson DeLengocky, DO

The physician shortage in Texas has commanded an unusual amount of public interest in recent weeks.

The Houston Chronicle (Oct. 17), Star Telegram (Oct. 19) and Fort Worth Business Press (Oct. 27) all devoted space to the growing shortage of physicians in Texas and the steps necessary to correct the problem. The three articles recognized that the availability of residency slots is the determining factor in addressing the …

Physician voices

CAHPS measures are as important as profit and loss for hospitals

Steve P. Sanders, DO, MBA

November 17, 2010Nov 17, 2010

Are hospitals coming clean? An article recently published in Health Affairs reveals details of a government–required survey conducted in 2008 and 2009. The Hospital Consumer Assessment of Healthcare Providers and Systems survey or CAHPS is required of all hospitals receiving…

Are hospitals coming clean? An article recently published in Health Affairs reveals details of a government–required survey conducted in 2008 and 2009.

The Hospital Consumer Assessment of Healthcare Providers and Systems survey or CAHPS is required of all hospitals receiving and hoping to continue to receive federal funding. Analysts compared CAHPS responses between 2008 and 2009 and gleaned what they believed were meaningful conclusions. The …

Conditions and diseases

Taking a multivitamin, vitamin D and fish oil every day

Mary L. Brandt, MD

November 17, 2010Nov 17, 20108

There is very little doubt that if we eat the diet we were designed to eat and spend adequate time in the sun that we will get most if not all the nutrients we need. That’s the ideal, but not…

There is very little doubt that if we eat the diet we were designed to eat and spend adequate time in the sun that we will get most if not all the nutrients we need.

That’s the ideal, but not the reality for a lot of us. I was recently advised by a group of physicians who are experts in the area that it is reasonable, and probably preferable, for adults …

Patient voices

Medical jargon leads to poor communication between physicians and patients

a medical resident, MD

November 16, 2010Nov 16, 201043

An article in the Wall Street Journal, Taking Medical Jargon Out of Doctor Visits, emphasizes that the use of medical jargon leads to poor communication between physicians and patients, and consequently leads to ineffective medical care. Federal and state officials…

An article in the Wall Street Journal, Taking Medical Jargon Out of Doctor Visits, emphasizes that the use of medical jargon leads to poor communication between physicians and patients, and consequently leads to ineffective medical care. Federal and state officials are now pushing healthcare professionals to use simpler language to communicate medical advice to patients.

I could not agree more with this mission. The gap …

Health policy

What does the NYC Marathon have to do with health reform?

Jeffrey Hall Dobken, MD, MPH

November 16, 2010Nov 16, 2010

Legend tells of an Athenian named Pheidippides who, in 490 B.C., ran from the battlefield at Marathon to Athens, telling of the victory over the Persians. Proclaiming the news that Athens would be spared pillage and fire, the Athenian dropped…

But the marathon, like most things worth doing, does offer both risks and rewards. Because it gives a chance to go beyond usual boundaries, with …

Health policy

Design solutions by truly understanding how humans use tools

Jay Parkinson, MD

November 16, 2010Nov 16, 2010

The Futurama exhibit from the 1939 World’s Fair, although pretty in exhibition form, looks like a terrible place to live. It’s a world of machines, concrete, and efficiency. How boring! Futurists have always imagined the “what can we do?” scenarios.…

What should we do?
What do people want that would make them feel more alive and more happily human?

Jane Jacobs, in her excellent book The Death …

Conditions and diseases

How to create your medical family tree

Karen Lu, MD

November 16, 2010Nov 16, 2010

The holidays are a great opportunity to ask family members about their health history. Learning about your family’s health history can help you answer your doctor’s medical history questions. It can even help your doctor determine if you may be…

The holidays are a great opportunity to ask family members about their health history.

Learning about your family’s health history can help you answer your doctor’s medical history questions. It can even help your doctor determine if you may be at risk for an inherited cancer like breast, colorectal, ovarian, prostate or endometrial cancer, which sometimes run in the family.

Keep in mind that just a small portion of cancers – about 5 …

Read more…

How to create your medical family tree

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