KevinMD.com

Heavy sleep debt extracts a price for patients

Kevin

October 2, 2010Oct 2, 2010

An excerpt from The Twenty-Four Hour Mind: The Role of Sleep and Dreaming in Our Emotional Lives. by Rosalind D. Cartwright, PhD We live in a culture that values speed; fast foods, fast cars, fast service, and fast decisions. All…

An excerpt from The Twenty-Four Hour Mind: The Role of Sleep and Dreaming in Our Emotional Lives.

by Rosalind D. Cartwright, PhD

We live in a culture that values speed; fast foods, fast cars, fast service, and fast decisions.

All of this takes a toll. Fast food is blamed for the epidemic of obesity, fast cars for motor vehicle accidents, and the wish for fast service and

…

Drugs and prescribing

The benefit of a drug cannot be measured by the law of averages

Arya M. Sharma, MD

October 1, 2010Oct 1, 201014

One of the topics that I have often thought about (especially in light of our seeming inability to develop zero-risk obesity drugs) is the problem of averages. Our entire medical philosophy of “evidence-based” medicine seems built on the “Gaussian” assumption that averages can reflect the true benefit (or risk) of a drug, when in real life (or medical practice) there is no such thing as the truly average patient.

Clearly, a …

Physician voices

Finding a doctor using ratings is a sound idea, but poorly executed

Eric Van De Graaff, MD

October 1, 2010Oct 1, 201018

Let’s say you develop some heart problem and get sent to me for an evaluation. You show up to the office, check in, get ushered into an exam room, then you wait and wait and wait. When I finally come into the room I seem terse, impatient and rushed, and you end up visiting with me for less than 5 minutes. I provide you with a diagnosis, order a couple …

Real physician voices, twice a week

Free, and one click to unsubscribe.

Physician voices

How much staff should a doctor have?

Rosemarie Nelson

October 1, 2010Oct 1, 20102

"How many staffers should we have per doctor?" That's a question I'm asked at almost every seminar I present. Of course, like many good consultants, I almost invariably respond "it depends." One of the factors that needs to be considered…

“How many staffers should we have per doctor?” That’s a question I’m asked at almost every seminar I present. Of course, like many good consultants, I almost invariably respond “it depends.”

One of the factors that needs to be considered is what jobs we’re talking about — clinical or front office. It’s staffing in the clinical area that will do most to enhance a physician’s productivity, so that’s what we’ll focus …

Read more…

How much staff should a doctor have?

Health technology

Coping with the culture clash between nurses and IT

John Rossheim

October 1, 2010Oct 1, 201013

by John Rossheim IT professionals are great at coming up with nifty tools for bringing clinical data to clinicians – as long as nurses are willing to memorize lots of byzantine paths to that information. Nurses are dedicated to providing…

by John Rossheim

IT professionals are great at coming up with nifty tools for bringing clinical data to clinicians – as long as nurses are willing to memorize lots of byzantine paths to that information.

Nurses are dedicated to providing direct care for their patients and advocating for them in every way – as long as it doesn’t mean having to adapt to ever-changing computer systems.

These two stereotypes …

Medical education

Should social justice matter when choosing medical students?

James Gaulte, MD

September 30, 2010Sep 30, 201049

Should medical student applicants be chosen less for their demonstrated ability to master large amounts of knowledge and solve problems and more for their social consciousness and desire to push forward with social justice? That appears to be the suggestion…

That appears to be the suggestion of a panel of experts from the AMA in a project called the Initiative to Transform Medicine (ITM) who believe an altruism deficiency underlies …

Health policy

How judging doctors by the numbers may be meaningless

Richard Reece, MD

September 30, 2010Sep 30, 201014

How do you judge how good a doctor is? By personal interaction? By what relatives and friends say? By whether he or she is on time when you go for your visit? By doctor rating websites on the Internet? By…

Or do you do it by the numbers? The federal …

Conditions and diseases

Chronic cough from laryngeal sensory neuropathy (LSN)

Christopher Chang, MD

September 30, 2010Sep 30, 20104

Laryngeal sensory neuropathy (LSN) is a recently described condition felt to cause a chronic cough in patients when treatment for everything else (allergies, asthma, reflux, etc) has been evaluated and managed. Treatment for this condition is with neuropathic medications including…

Treatment for this condition is with neuropathic medications including Neurontin, Elavil, Lyrica, nortriptyline, etc.

In the past few months, I have seen a few patients referred to me with chronic cough treated with these medications with minimal or no improvement. All …

Physician voices

People live and die by their chronic illnesses by what they do at home

Shantanu Nundy, MD

September 29, 2010Sep 29, 20102

"You know, what Mr. HD really needs is for his mom or somebody to chain herself to him …" … "But seriously, he needs to be watched over, he needs to be talked to. He needs someone to give him…

“You know, what Mr. HD really needs is for his mom or somebody to chain herself to him …” [the ICU team laughs] … “But seriously, he needs to be watched over, he needs to be talked to. He needs someone to give him his medications, someone to take him to his appointments, someone to take care of him. With that somebody he can live for years to come. Without …

Physician voices

How house calls benefit patients and physicians

a medical resident, MD

September 29, 2010Sep 29, 20102

Physicians used to take care of patients at their homes. Through the 1960s, patients would make a phone call and the doctor would arrive at the doorstep, black bag in hand, eager to serve. This changed in the mid to…

Physicians used to take care of patients at their homes.

Through the 1960s, patients would make a phone call and the doctor would arrive at the doorstep, black bag in hand, eager to serve. This changed in the mid to late-1960s as doctors developed group practices and as medical care expanded to include technology-based studies and specialty referrals, and thus became more hospital-centered. Prior to World War II, 40 percent of …

Physician voices

Bad lifestyle isn’t a medical issue, it’s a social one

Jay Parkinson, MD

September 29, 2010Sep 29, 201022

Almost every Sunday night, I walk to this one restaurant in my neighborhood for some comfort food (we’re creatures of habit aren’t we?). I pass a church on my way where an Alcoholics Anonymous meeting is held almost every night.…

Almost every Sunday night, I walk to this one restaurant in my neighborhood for some comfort food (we’re creatures of habit aren’t we?).

I pass a church on my way where an Alcoholics Anonymous meeting is held almost every night. As I walk through the crowd of smokers, I look at them and they look at me. They don’t know that I know they’re recovering addicts. And they put a smile …

Physician voices

Explaining the critical gap of primary care physicians

David B. Nash, MD, MBA

September 29, 2010Sep 29, 201025

There is a critical gap in the supply of primary care physicians in the U.S., and it should come as no surprise that our existing primary care delivery and payment models are at the heart of the issue. The traditional…

The traditional primary care model — medical care provided by a physician and a small support staff, often without benefit of health information technology (HIT) — was developed at a time when the …

Physician voices

Boston Medical Center gets screwed by the Massachusetts government

Kevin Pho, MD

September 29, 2010Sep 29, 201020

Boston Medical Center has provided care to the underserved and Medicaid population in Boston for almost 150 years. And what's happening to the venerable institution is gut-wrenching to read. I trained at Boston Medical Center (BMC), completing my internal medicine…

Boston Medical Center has provided care to the underserved and Medicaid population in Boston for almost 150 years. And what’s happening to the venerable institution is gut-wrenching to read.

I trained at Boston Medical Center (BMC), completing my internal medicine residency there in 2002. A recent write-up in Boston Magazine highlights the financial trouble the hospital is going through:

Boston Medical Center is almost broke, perilously close to what

…

Patient voices

Nurses expect to be called by their first names, should doctors follow?

Christopher Johnson, MD

September 29, 2010Sep 29, 201017

I’ve worked in hospitals since I was 16 years old — 42 years ago now. I was first an orderly, then a nurse’s aid, then a practical nurse, and a finally a surgical technician before I became a physician. When…

When I started, female nurses wore caps, the details of which identified which nursing school they had graduated from, as well as a pin that gave the same information. They wore starched, …

Patient voices

Keeping the terminal patient comfortable is the purpose of comfort care

Ralph Gordon, MD

September 28, 2010Sep 28, 20106

Dealing with an incurable illness or terminal condition is an inevitable reality of the practice of medicine. Not uncommonly, especially in the intensive care unit, we care for the patient with no chance for recovery and survival. Keeping that patient…

Occasionally, I hear requests from the family members of the dying patient – “Can you give …

Patient voices

Using denial to control a patient’s anxiety

Alex Lickerman, MD

September 28, 2010Sep 28, 20102

A few years ago, a patient of mine was diagnosed with lung cancer. A metastatic work up revealed a small mass in his liver that had the radiographic appearance of a benign liver cyst. But in the setting of a newly diagnosed lung cancer, we couldn’t be sure it wasn’t a metastatic lesion, so we decided to biopsy it. Due to scheduling issues, we couldn’t get it done for seven …

Patient voices

Confronting the fear of death takes preparation

Brad Stuart, MD

September 28, 2010Sep 28, 20104

Atul Gawande’s brilliant essay in the New Yorker sums up the dilemma we face, whether we’re patients, families, and/or clinicians, as we near the end of life. His point is that we have to face it together: “People die only…

Atul Gawande’s brilliant essay in the New Yorker sums up the dilemma we face, whether we’re patients, families, and/or clinicians, as we near the end of life. His point is that we have to face it together:

“People die only once. They have no experience to draw upon. They need doctors and nurses who are willing to have the hard discussions and say what they …

Patient voices

Are e-Patients expert in their own diseases?

Dr. Martin Young

September 28, 2010Sep 28, 201020

As an e-Doctor, one with some IT literacy, I welcome the e-Patient movement. I think patients should be equipped, enabled, empowered, engaged, equals, and emancipated, as Wikipedia explains. The link also adds “and experts” and here I have a problem,…

As an e-Doctor, one with some IT literacy, I welcome the e-Patient movement.

I think patients should be equipped, enabled, empowered, engaged, equals, and emancipated, as Wikipedia explains. The link also adds “and experts” and here I have a problem, not because I don’t think patients should have access to knowledge or know a lot about their own disease, but because knowing one pattern of pathology, i.e. your own, does not make you an expert.

No more …

Medical education

How a medical student can exacerbate the high cost of health care

Suchita Shah

September 28, 2010Sep 28, 201020

Even as a medical student, I’m already complicit in exacerbating the problem of the high cost of health care. It hit me one day, during my medicine rotation. We were working up a patient, and I was ordering tests with…

Even as a medical student, I’m already complicit in exacerbating the problem of the high cost of health care.

It hit me one day, during my medicine rotation. We were working up a patient, and I was ordering tests with my resident. The patient had liver disease and perhaps some ascites.

He came in for another issue, and this wasn’t of primary concern to us, and we really wouldn’t have …

Drugs and prescribing

Can a pharmacy profit from gouging patients without insurance?

WarmSocks

September 27, 2010Sep 27, 201074

It just shouldn’t be hard to get a refill on the medicines I’m taking: phone the pharmacy to refill prescriptions show up the next day to pick up refills pay Simple, right? Note that this is about my old pharmacy,…

It just shouldn’t be hard to get a refill on the medicines I’m taking:

phone the pharmacy to refill prescriptions
show up the next day to pick up refills
pay

Simple, right?

Note that this is about my old pharmacy, not the new one. For quite a while the pharmacy had been having difficulties, which is why I never trust the pharmacy. Between the distance and the frustrations I had dealing with them, …

Real physician voices, twice a week

The Podcast

Latest episodes

Most popular

The Podcast

Latest episodes

Most popular