KevinMD.com

November 16, 2010Nov 16, 20105

Recently, AAFP News Now released an article titled, Unprofessional Conduct Among U.S. Medical Students Linked to Burnout. It focused on an article recently released in JAMA entitled, Relationship Between Burnout and Professional Conduct and Attitudes Among US Medical Students. I…

Recently, AAFP News Now released an article titled, Unprofessional Conduct Among U.S. Medical Students Linked to Burnout.

It focused on an article recently released in JAMA entitled, Relationship Between Burnout and Professional Conduct and Attitudes Among US Medical Students.

I had the opportunity to be interviewed for this article and was featured on an inset within the article that shared a minority of my interview. As …

Physician voices

EMTALA threatens the safety net of community care

Suchita Shah

November 15, 2010Nov 15, 201011

President Bush once said something along the lines of, "We do have universal health care in this country — just go to the emergency room." EMTALA. The law requiring emergency rooms to treat everyone’s emergent conditions, a well meaning act…

President Bush once said something along the lines of, “We do have universal health care in this country — just go to the emergency room.”

EMTALA. The law requiring emergency rooms to treat everyone’s emergent conditions, a well meaning act that has had disastrous consequences for hospitals’ bottom lines. A disgustingly flawed law on many levels.

How do you prove it is not an emergency condition? You work it up. …

Conditions and diseases

Neoplastic epidural spinal cord compression is an oncologic emergency

Ralph Gordon, MD

November 15, 2010Nov 15, 2010

There are very few oncologic emergencies. Neoplastic epidural spinal cord compression is one of them. The delay in diagnosis and treatment is often explained by the non-specific nature of the presenting signs and symptoms. The patient developed urinary retention a…

The patient developed urinary retention a couple of weeks prior to presentation. On the morning of admission he was fully functional. Later he sat down to have a cup of coffee and boom – he couldn’t feel …

Real physician voices, twice a week

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Medical education

Physicians the government wants to see

Edwin Leap, MD

November 15, 2010Nov 15, 201030

I was talking with a pre-med student recently. He had completed his very first medical school interview and was, understandably, excited. But he told me the interviewer had asked him what he thought would be the outcome of the current…

I laughed to myself. After 17 years in practice, even I don’t know the outcome, though I have my suspicions. It seemed a loaded, almost unfair question. After …

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Physicians the government wants to see

Patient voices

First aid rules that everyone needs to know

Alex Lickerman, MD

November 14, 2010Nov 14, 20105

First aid is defined as the immediate care given to an acutely injured or ill person. It can literally be life-saving so it behooves all of us to know some basic principles. What follows are some rules that cover common…

First aid is defined as the immediate care given to an acutely injured or ill person. It can literally be life-saving so it behooves all of us to know some basic principles.

What follows are some rules that cover common conditions and general practices:

Don’t panic. Panic clouds thinking and causes mistakes. When I was an intern and learning what to do when confronted with an unresponsive patient, a wise resident advised

…

Medical education

Medical students taking a mandatory rotation in geriatrics

Eric Widera, MD

November 14, 2010Nov 14, 20104

What happens when you randomly assign medical students to either a mandatory two week rotation in specialized geriatric training or to a traditional non-geriatric clerkship that sees a lot of old people? Will there be any difference in the knowledge…

Will there be any difference in the knowledge of geriatric conditions, the attitudes toward older adults, or geriatric clinical skills between the two groups? Or does mere exposure to an aging patient population give students the training they need to …

Drugs and prescribing

Side effects of medication sometimes confuse patients

WarmSocks

November 14, 2010Nov 14, 20102

Side effects. Every medication has them. Some are mild, some are annoying, and some are downright dangerous. When doctors write a prescription, they mention that some people experience side effects, and if certain bizarre things happen, the patient should phone…

Side effects. Every medication has them. Some are mild, some are annoying, and some are downright dangerous.

When doctors write a prescription, they mention that some people experience side effects, and if certain bizarre things happen, the patient should phone the doctor.

How do we keep track?

If you get one antibiotic to take for two weeks, it isn’t so hard. First, because it’s for a short time period, and also because it’s …

Physician voices

How dietary guidelines can help prevent disease

Stephen C. Schimpff, MD

November 13, 2010Nov 13, 20106

Most of the illnesses that occur today are chronic like diabetes, heart disease, cancer or kidney disease. These stay with us for the rest of our lives, are debilitating, and are expensive to treat. But in many cases they are…

Most of the illnesses that occur today are chronic like diabetes, heart disease, cancer or kidney disease.

These stay with us for the rest of our lives, are debilitating, and are expensive to treat. But in many cases they are not all that difficult to prevent. Unfortunately, our dietary guidelines are of little or no help in this regard but could be.

In 1941, following studies that demonstrated …

Medical education

Making the decision to go to medical school

PalMD

November 13, 2010Nov 13, 20105

First, this piece is not a how-to guide for getting into medical school. But I use this ploy for good, and not for evil. Through conversations with a number of non-medical colleagues, I’ve been forced to think a bit more…

First, this piece is not a how-to guide for getting into medical school.

But I use this ploy for good, and not for evil. Through conversations with a number of non-medical colleagues, I’ve been forced to think a bit more about premedical and medical education. A letter from a reader (which is presented in a highly altered version below) made me decide to more thoroughly and …

Patient voices

Get a straight answer from your doctor

Doctor D, MD

November 13, 2010Nov 13, 20105

How can patients get a straight answer from a doctor? The answer is really very simple: Don’t accept a non-answer answer from a doctor on a question that really matters to you! If you get a dodgy, vague, or useless…

How can patients get a straight answer from a doctor?

The answer is really very simple: Don’t accept a non-answer answer from a doctor on a question that really matters to you!

If you get a dodgy, vague, or useless answer don’t take it lying down. Politely insist that the doctor elaborate and clarify until you get a reply that you understand.

We doctors are totally scary, but if you have to have …

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Get a straight answer from your doctor

Health policy

Preventive care as a cost saving measure is a fallacy

Lucy Hornstein, MD

November 12, 2010Nov 12, 201056

I like reading Maggie Mahar’s Health Beat. She usually gets it, from the function of insurance to the complexities of assorted payment systems, I get the sense that she is generally rational when it comes to paying for health care.…

I like reading Maggie Mahar’s Health Beat.

She usually gets it, from the function of insurance to the complexities of assorted payment systems, I get the sense that she is generally rational when it comes to paying for health care. This doesn’t mean there aren’t times when she gets it wrong. Her embrace of primary care provided by nurse practitioners shows a truly spectacular …

Drugs and prescribing

Help patients synchronize their prescription drugs

Michael Aaronson, MD

November 12, 2010Nov 12, 20107

Here's the scenario: on the 2nd of the month, a patient with diabetes on metformin and high blood pressure on benazepril sees her family physician for a routine follow up. The patient's blood pressure is elevated and the decision is…

Here’s the scenario: on the 2nd of the month, a patient with diabetes on metformin and high blood pressure on benazepril sees her family physician for a routine follow up.

The patient’s blood pressure is elevated and the decision is made to add carvedilol to help get the blood pressure to goal. The patient’s metformin and benazepril “drop” (are renewed) at the pharmacy on the 18th of every month, a date …

Medical education

Autonomy versus supervision for residents is a fine line

Nicholas Fogelson, MD

November 12, 2010Nov 12, 20107

When one is a medical student, pretty much everything one does is directly supervised. Though a student is allowed to assess patients and make recommendations, rarely is a student given the autonomy to make decisions that will affect patients. They…

Once a student becomes a resident, things start to change. As residents are physicians, they have the power to write …

Health policy

Why patients in Grand Junction, Colorado have better health outcomes

Gary Levin, MD

November 12, 2010Nov 12, 20104

The New England Journal of Medicine analyzed Medicare statistics from the beloved Dartmouth Atlas of Health Care study revealing a wide disparity in the number of coronary bypass procedures in Golden Colorado compared to other areas. The report reveals a…

The New England Journal of Medicine analyzed Medicare statistics from the beloved Dartmouth Atlas of Health Care study revealing a wide disparity in the number of coronary bypass procedures in Golden Colorado compared to other areas.

The report reveals a 60% reduction in the number of procedures as compared to Miami, Florida. The Dartmouth Atlas Study has been used to justify changes in payment systems by Medicare. The study has …

Patient voices

Using the internet for health information before surgery

Lisa Gualtieri, PhD

November 11, 2010Nov 11, 2010

Diana Cole told me, “The internet saved my life,” and recounted a story about using the internet to identify a bat bite and learn about rabies in bats, leading to an emergency room trip. She later introduced me to her…

Diana Cole told me, “The internet saved my life,” and recounted a story about using the internet to identify a bat bite and learn about rabies in bats, leading to an emergency room trip.

She later introduced me to her sister, Carolyn Kingston, who attributed her successful outcome from hip replacement surgery to her use of the internet. I asked Carolyn about her general use of the internet for health, her …

Health policy

AMA: Patients and physicians call on Congress to stop Medicare cut

American Medical Association & Cecil B. Wilson, MD

November 11, 2010Nov 11, 201012

A guest column by the American Medical Association, exclusive to KevinMD.com. Medicare physician payment cuts are once again looming in the immediate future, with a cut of 25 percent now threatening to hurt access to care for seniors and military…

A guest column by the American Medical Association, exclusive to KevinMD.com.

Medicare physician payment cuts are once again looming in the immediate future, with a cut of 25 percent now threatening to hurt access to care for seniors and military families. As many doctors know all too well, the looming cut is forcing physicians to make difficult decisions about the continuing role Medicare can play in their practices.

The AMA is working on …

Medical education

Using servant leadership to teach medical students

Robert Centor, MD

November 11, 2010Nov 11, 20105

I spend much time talking with medical students. It is part of my job, but more than that I like medical students. What should be the goal of medical schools? I believe we have an obligation to help our students…

I spend much time talking with medical students. It is part of my job, but more than that I like medical students.

What should be the goal of medical schools? I believe we have an obligation to help our students grow into great physicians. What philosophical principles should we use?

Perhaps the answer to success is Servant Leadership. As I learn more about this concept, I hope that have become a servant …

Health policy

Why moral hazard fails in health care

Aaron E. Carroll, MD

November 11, 2010Nov 11, 201010

I’m going to take the time to review a topic that is one my pet peeves, one you hear bandied about all the time in discussions of more consumer directed health care. It’s a topic I came back to repeatedly…

Basically, the moral hazard is the idea that people insulated from risk behave differently than people exposed to risk. For instance, …

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Why moral hazard fails in health care

Health policy

Medical malpractice reform in exchange for paying doctors less

Kevin Pho, MD

November 11, 2010Nov 11, 201036

The bipartisan debt commission appointed by President Obama recently released its recommendations on how to pare the country's debt. Of interest to doctors is the suggestion to change the way doctors are paid. Physician lobbies have been advocating for removal…

The bipartisan debt commission appointed by President Obama recently released its recommendations on how to pare the country’s debt.

Of interest to doctors is the suggestion to change the way doctors are paid. Physician lobbies have been advocating for removal of the Sustainable Growth Rate formula — the flawed method by which Medicare, and subsequently private insurers, pays doctors.

According to this method, physicians are due for a pay cut of …

Medical education

How medical students can improve our health system

Aaron J. Stupple, MD

November 11, 2010Nov 11, 20102

Many fellow medical students are eager to improve "the system." However, an overeager attitude offers both promise and peril -- promise that budding physicians are inspired to improve the inner workings of their chosen field, peril in that our naiveté…

Many fellow medical students are eager to improve “the system.”

However, an overeager attitude offers both promise and peril — promise that budding physicians are inspired to improve the inner workings of their chosen field, peril in that our naiveté may simply clutter the very complexities we seek to improve.

How do we strike a balance between getting involved and getting in the way?

I found guidance in law professors Raustiala’s and Sprigman’s …

Real physician voices, twice a week

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