KevinMD.com

September 22, 2010Sep 22, 20108

My father passed away about two weeks ago after battling a brain tumor for some time. Initially diagnosed with an extensive inoperable mass one and one-half years ago, upon presenting with a focal seizure, he did well with only one…

My father passed away about two weeks ago after battling a brain tumor for some time.

Initially diagnosed with an extensive inoperable mass one and one-half years ago, upon presenting with a focal seizure, he did well with only one medication for seizure control for about ten months. Around Christmas of 2009, however, he landed in the hospital in status epilepticus that took three days to control. After these days of …

Conditions and diseases

When patients are willing to share their stories

Bruce Campbell, MD

September 22, 2010Sep 22, 2010

We say we exchange words when we meet. What we exchange is souls. -Minot J. Savage It was Monday evening. The shelves in the electronics department overflowed with different styles, prices, and brands of headphones, all displayed in sealed plastic…

We say we exchange words when we meet. What we exchange is souls.
-Minot J. Savage

It was Monday evening. The shelves in the electronics department overflowed with different styles, prices, and brands of headphones, all displayed in sealed plastic cases. I was in the mood to buy but was baffled by the array of options in front of me. This was not going to be as simple as I had thought.

A young …

Conditions and diseases

How you can avoid skin cancer risk

Juliet K. Mavromatis, MD

September 22, 2010Sep 22, 2010

Skin cancer is the most common form of cancer diagnosed in the United States. There are three major types: basal cell, squamous cell and melanoma. Of those, basal cell and squamous cell are most common, accounting for about 3.5 million…

Skin cancer is the most common form of cancer diagnosed in the United States.

There are three major types: basal cell, squamous cell and melanoma. Of those, basal cell and squamous cell are most common, accounting for about 3.5 million cases in the United States per year. Although, these types typically do not metastasize, they can be quite disfiguring, particularly after resection when they occur on the face. On a population …

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How you can avoid skin cancer risk

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Conditions and diseases

Why the expansion of Alzheimer’s may not be helpful

George Lundberg, MD

September 22, 2010Sep 22, 20104

You probably saw the July press reports: balmy tropical breezes, azure surf, cerebral plaques and tangles, and new criteria for Alzheimer's. Who could deny an opportunity to spend some time at the best non-oil-spoiled beaches for those who toil at…

You probably saw the July press reports: balmy tropical breezes, azure surf, cerebral plaques and tangles, and new criteria for Alzheimer’s.

Who could deny an opportunity to spend some time at the best non-oil-spoiled beaches for those who toil at the benches and bedsides for Alzheimer’s victims — and on taxpayer money yet.

It seems to me like, just as human hip and knee joints and premolars and molars are not preprogrammed …

Conditions and diseases

10 cancer signs women shouldn’t ignore

Karen Lu, MD

September 22, 2010Sep 22, 20102

If you’re relatively young and healthy, gynecologic cancers probably aren't on your radar. But they should be. This year, more than 80,000 women in the United States will get a gynecologic cancer, such as endometrial (a.k.a. uterine), ovarian or cervical…

If you’re relatively young and healthy, gynecologic cancers probably aren’t on your radar. But they should be.

This year, more than 80,000 women in the United States will get a gynecologic cancer, such as endometrial (a.k.a. uterine), ovarian or cervical cancer. In general, gynecologic cancers occur more frequently in women after menopause, although they can occur in younger women. While all women …

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10 cancer signs women shouldn’t ignore

Health policy

What motivates health care workers is needed to explain health care costs

angienadia, MD

September 21, 2010Sep 21, 201020

As part of the new health care legislation, the government has instituted Medicare's Physician Quality Reporting Initiative (PQRI) in an attempt to motivate health professionals to do the right thing. According to the legislation, PQRI asks physicians to report how…

As part of the new health care legislation, the government has instituted Medicare’s Physician Quality Reporting Initiative (PQRI) in an attempt to motivate health professionals to do the right thing.

According to the legislation, PQRI asks physicians to report how the care they furnish aligns with evidence-based clinical guidelines for a variety of medical conditions, such as diabetes or heart disease. In 2010, physicians who successfully report these measures will receive …

Drugs and prescribing

DTC advertising is annoying but should it be banned?

Michael Kirsch, MD

September 21, 2010Sep 21, 201011

Should the public be shielded from medical information that can mislead it? Many argue against direct-to-consumer (DTC) advertising, which is omnipresent in print and on the airwaves. Opponents of this practice argue that it promotes the use of expensive medications…

Should the public be shielded from medical information that can mislead it?

Many argue against direct-to-consumer (DTC) advertising, which is omnipresent in print and on the airwaves. Opponents of this practice argue that it promotes the use of expensive medications when patients ask their doctors if the “drug is right for them,” the tag line that appears at the end of every ad. This phrase is the drug company’s limp disclaimer …

Drugs and prescribing

Switching diabetes patients from Avandia to Actos

Matthew Mintz, MD

September 21, 2010Sep 21, 20106

I have a lot of diabetes patients and have been an avid user of the thiazolidinediones (TZD) class. There are many reasons to like the TZD's: The older, generic medicines like metformin and sulfonylureas are known to fail over time.…

I have a lot of diabetes patients and have been an avid user of the thiazolidinediones (TZD) class. There are many reasons to like the TZD’s:

The older, generic medicines like metformin and sulfonylureas are known to fail over time. After 3 years, most patients on one of these drugs lose control of their blood sugar. In contrast, patients on TZD’s maintain glycemic control (at least up to 4-5 years which

…

Physician voices

The Night Shift: Real life in the heart of the ER, an excerpt

Brian Goldman, MD

September 21, 2010Sep 21, 2010

An excerpt from The Night Shift: Real Life In The Heart of The E.R. ©2010 by Dr. Brian Goldman. Published with permission from HarperCollins Publishers Ltd. All rights reserved. Fear and Loathing 12:47 a.m. Two police detectives were waiting for…

Fear and Loathing

12:47 a.m.

Two police detectives were waiting for me near the main triage desk; one was a tall male in a sleek black suit, probably in his early forties. He was ruggedly handsome in the manner of Jean-Paul Belmondo, the …

Conditions and diseases

Prevention is the best influenza protection

William Schaffner, MD

September 21, 2010Sep 21, 20103

For years, we have heard (and I have often said) that an average of 36,000 Americans die from influenza annually. This figure is based on data from 1990-1999. Now the CDC is telling us that the range of annual deaths…

For years, we have heard (and I have often said) that an average of 36,000 Americans die from influenza annually.

This figure is based on data from 1990-1999. Now the CDC is telling us that the range of annual deaths is too wide to continue using that single number. Based on a lot more seasons (1976-2007), the average is closer to 24,000 with a range of about 3,300 to …

Physician voices

ACP: Primary care education and training: Time for change?

American College of Physicians

September 20, 2010Sep 20, 201029

A guest column by the American College of Physicians, exclusive to KevinMD.com. by John Tooker, MD, MBA, MACP The Annals of Internal Medicine recently published an article by Mullan and colleagues on the social mission of medical schools. In the…

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

by John Tooker, MD, MBA, MACP

The Annals of Internal Medicine recently published an article by Mullan and colleagues on the social mission of medical schools. In the article, medical schools were ranked on their record of educating and training physicians to care for the “population as a whole”. …

Physician voices

Health reform vaults the USPSTF into prominence

Glenn Laffel, MD, PhD

September 20, 2010Sep 20, 201012

The most visible impact of Affordable Care Act is surely the expansion of health insurance coverage to 30 million uninsured Americans, but a lesser known provision in the overhaul will have far-reaching implications as well. The provision catapults the US…

The provision catapults the US Preventive Services Task Force (USPSTF) from an obscure agency that produced unenforceable guidelines about screening and preventive services into one whose recommendations directly impact reimbursement.

According to the terms of the new …

Conditions and diseases

How can anyone deny scientifically sound treatment for breast cancer?

Jackie Fox

September 20, 2010Sep 20, 20108

I just don’t understand how someone can live in this day and age and deny the effectiveness of scientifically sound medical treatment when dealing with breast cancer. I was completely flummoxed when I came across the in-depth and thoughtful post “A horrifying breast cancer ‘testimonial’ for ‘holistic’ treatment” on Respectful Insolence, written by a surgeon and scientist who uses the pen name Orac.

Like others who came before and surely will come after …

Conditions and diseases

When does a headache need to be seen at the hospital?

Chaim Colen, MD

September 20, 2010Sep 20, 2010

As a neurosurgeon, I encounter a lot of people who are concerned with ruptured brain aneurysms (blood vessel blisters). Ruptured brain aneurysms typically present with severe headache. I am incessantly asked, “When is a headache more than just a headache?…

A headache is considered to be pain located anywhere in the region of the upper …

Conditions and diseases

Social anxiety assumptions and their solutions

Srini Pillay, MD

September 20, 2010Sep 20, 2010

Social anxiety refers to the fear of being around people due to the threat of embarrassment. People who are socially anxious frequently freeze and are unable to seek the very company their hearts desire. They may make adaptations: they may…

Social anxiety refers to the fear of being around people due to the threat of embarrassment.

People who are socially anxious frequently freeze and are unable to seek the very company their hearts desire. They may make adaptations: they may decide that they “hate” being around people; they may isolate and play video games; they may absorb themselves in their work, but no matter what they do, this anxiety always exists …

Patient voices

Why answering a cell phone during an office visit is a problem

Jill of All Trades, MD

September 19, 2010Sep 19, 201018

Here is an unfortunate, but almost daily not-so-secret occurrence in my practice: I am in the midst of an intricate follow-up visit with a rather complicated patient with diabetes, high cholesterol, and high blood pressure. I am feeling as though…

Here is an unfortunate, but almost daily not-so-secret occurrence in my practice:

I am in the midst of an intricate follow-up visit with a rather complicated patient with diabetes, high cholesterol, and high blood pressure. I am feeling as though I am a CIA agent in a rather mission impossible assignment: she is here for lab results, is complaining of low back pain, and presents with an elevated blood pressure of …

Health policy

Patient Protection and Affordable Care Act individual mandate controversy

Roger Collier

September 19, 2010Sep 19, 2010

The individual mandate is the single most controversial feature of the Patient Protection and Affordable Care Act. Everyone who can afford coverage—unless an undocumented immigrant or exempted on religious grounds—is required to have it or pay a penalty of $695…

The rationale is straightforward: without a mandate, many people would wait until they needed care before buying insurance, driving up premiums for those with ongoing coverage, …

Patient voices

Is it the doctor’s fault if an obese patient cannot lose weight?

John Mandrola, MD

September 19, 2010Sep 19, 201030

I need help. In dealing with obesity as a medical problem, that is. I am pretty solid at arrhythmia management, but as an obesity doctor, not so much. If I was the teacher, and my obese patients were the students,…

I need help. In dealing with obesity as a medical problem, that is.

I am pretty solid at arrhythmia management, but as an obesity doctor, not so much. If I was the teacher, and my obese patients were the students, I would surely be fired for poor student test performance. At least, if the core measure was the patient’s BMI.

If a student does poorly on an achievement test, is it the student’s …

Drugs and prescribing

DTC advertising, and its history with the FDA

Ishmael Bradley, MD

September 18, 2010Sep 18, 20102

Advertising is everywhere. That should come as no surprise to anyone who has lived in modern America. It is impossible to turn on the television, ride the subway, or even sort through the daily mail without coming across an ad…

Advertising is everywhere.

That should come as no surprise to anyone who has lived in modern America. It is impossible to turn on the television, ride the subway, or even sort through the daily mail without coming across an ad for a new car, a soft drink, or the latest digital toy. These advertisements have only one goal: to entice you to buy their products. This is harmless enough when these …

Conditions and diseases

Do all people with disturbing behavior have a psychiatric illness?

Jeffrey Knuppel, MD

September 18, 2010Sep 18, 20103

“Hey Doc, this guy needs some help.” I’ve heard that statement from countless correctional officers over the years. Its meaning is very simple: Someone is exhibiting thoughts or behaviors that the officers find disturbing and “not normal.” I appreciate the…

“Hey Doc, this guy needs some help.”

I’ve heard that statement from countless correctional officers over the years. Its meaning is very simple: Someone is exhibiting thoughts or behaviors that the officers find disturbing and “not normal.”

I appreciate the officers expressing concern. Without their input I often would not be aware of cases where I might be able to be of assistance.

But, one of the questions that always pops into my …

Real physician voices, twice a week

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