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Colorectal cancer in blacks is affected by healthcare utilization

MedPage Today

Conditions and Diseases

April 24, 2010

by Todd Neale

The greater burden of colorectal cancer in the black community appears to be related to healthcare utilization, and not biology, researchers found.

Similar proportions of black and white patients had polyps or masses detected by flexible sigmoidoscopy, but black patients were less likely than whites to have the recommended follow-up colonoscopy (62.6% versus 72.4%), according to Adeyinka Laiyemo, MD, MPH, of Howard University in Washington, and colleagues.

After adjustment for …

Op-ed: Health insurance doesn’t mean doctors will be available

Kevin

Health Policy

April 24, 2010

The following op-ed was published on March 30th, 2010 in AOL News.

Health reform has passed, and the United States is poised to join the rest of the industrialized world in providing most of its citizens with affordable health coverage.

But having health insurance doesn’t necessarily mean it will be easy to find a doctor. Even before reform, reports projected a shortfall of 40,000 primary care physicians over the …

Bret Michaels has a subarachnoid hemorrhage, and what that means

Kevin

Conditions and Diseases

April 23, 2010

Bret Michaels is in critical condition from a subarachnoid hemorrhage.

I’ve been watching Celebrity Apprentice recently, and he comes across as a genuine person who, of course, has been raising awareness for Type 1 diabetes. As most people know, he has battled various diabetic complications on the show, and recently underwent an emergency appendectomy.

What’s his prognosis like?

Not good, I’m …

Palliative care physicians confronting their own mortality

Lyle Fettig, MD

Conditions and Diseases

April 23, 2010

Dr. Desiree Pardi was the palliative care medical director at Weill Cornell Medical Center in New York. She died of metastatic breast cancer in 2009 at the age of 41.

Her story provides palliative care clinicians an opportunity to reflect on how our own personal mortality interacts with our professional lives.

I did not personally know Dr. Pardi. I write this post knowing that many readers did indeed know her, some …

Medicaid physician payment rates hurts primary care doctors

David B. Nash, MD, MBA

Health Policy

April 23, 2010

Across the country, state Medicaid health insurance programs serving low-income children and families, people with disabilities, and older adults are struggling in an environment of chronic underfunding.

Consider that, nationwide, at least one child in four relies on Medicaid for health coverage. Medicaid funds healthcare services for two out of every five births and fills in gaps in Medicare coverage for the elderly and disabled.

But inadequate payments and outmoded methods of …

Patient adherence to drugs is low and what doctors can do

Shantanu Nundy, MD

Medications

April 22, 2010

Frequently in preventive health we ask patients to take medications that will reduce the risk of a certain bad medical outcome years down the road: cholesterol-lowering agents that lower the risk of a heart attack, blood pressure-lowering agents that reduce the risk of kidney disease, glucose-lowering medications that reduce the risk of diabetes-related complications.

Sometimes these medications make patients feel better — for example, insulin in patients with symptomatic diabetes or …

Psychiatric patients detained in the ER

Edwin Leap, MD

Physician

April 22, 2010

Our state of South Carolina is a delight. From wonderful people to beautiful landscapes, from a vibrant Southern culture to excellent food like shrimp and grits, it’s a place I’m thrilled to live. But we do lack a few things. And one of the most striking is adequate mental health care.

The state budget, like so many state budgets, has been trimming anything and everything. And of course, mental health coverage …

Read more…

Psychiatric patients detained in the ER

Dementia affects the entire family

Emily P. Walker

Conditions and Diseases

April 22, 2010

by Emily P. Walker

My grandfather recently died of pancreatic cancer.

My grandpa was a WWII veteran, a nature enthusiast, an animal-lover, a chiropractor until the 1980s, and a firm believer in natural medicine. He helped my grandmother give birth to five children in her bed, and neither of them had ever taken any drugs except when both were hospitalized one winter with pneumonia.

As someone with a major respect for medical doctors …

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Dementia affects the entire family

Patient satisfaction scores improve when doctors sit

Kevin

Physician

April 22, 2010

Patient satisfaction, as I wrote previously, is being increasingly focused upon.

Doctors are often pressed for time, and appear rushed — which can potentially lead to unhappy patients.

I saw this small study showing that the simple act of sitting down while talking to patients can have a profound effect. Many doctors I know already do this, but now there’s some data to support sitting.

According to the study, performed at …

High blood pressure treatment that patients need to know

Erin Marcus, MD

Conditions and Diseases

April 21, 2010

When her gynecologist told her she had high blood pressure, Marie had a simple solution: switch doctors. After all, she had gone to him for a different problem, and this was the first time he had ever checked her blood pressure.

“He said, ‘Oh my God, you’re like a bomb waiting to explode.’ I said, ‘I didn’t come here for that, I came here for something else,’” she explained.

Two years later, …

Top doctors may not always be the best physicians

Dr. Charles

Patient

April 21, 2010

I’m sure you’ve read through top doctor rankings and online physician ratings. It is only human to seek perceived leaders. But as sometimes seen in politics, those who have reached the pinnacles are often motivated by ambition, charisma, and gamesmanship instead of altruism, sincerity, and merit.

Beware the top doctors issues found in magazines and newspapers.

Some of these doctors are excellent, but many are simply “notable.” They may be well-connected, in …

Social networks affect alcohol drinking patterns

Kristina Fiore

Conditions and Diseases

April 21, 2010

by Kristina Fiore

If you’re surrounded by heavy drinkers, you’re more likely to become one, new research shows.

An analysis of data on alcohol consumption and social networks found that people are 50% more likely to drink heavily if someone they’re directly connected to does so, Nicholas Christakis, MD, PhD, of Harvard University, and colleagues reported in the Annals of Internal Medicine.

“We’ve found that the influence of your friends and people you …

Sick friends could use your help

Duncan Cross

Patient

April 20, 2010

Illness might be the most isolating and alienating experience a person can know. Lots of well people simply have no clue how to relate to someone with a chronic and catastrophic illness. That sort of thing is scary even just to witness. They hope (or assume) you’ll get better, and then they won’t have to deal with whatever you’re going through – but when that takes too long, they drift …

Read more…

Sick friends could use your help

Palliative care needs a simple and consistent message

Alex Smith, MD

Physician

April 20, 2010

I was consulted recently about an elderly woman who refused surgery for a large bowel obstruction from a colonic mass, likely cancer. The inpatient team asked me to help with the transition to hospice and to help make her comfortable.

I went to see her. She had a nasogastric tube sucking up brown material from her stomach. Her abdomen was swollen and uncomfortable. Her primary goal was to return to walking …

MRSA control takes consistent time and effort

MedPage Today

Physician

April 20, 2010

by Michael Smith

It’s possible to reduce the burden of drug-resistant pathogens in hard-hit hospitals — all it takes is consistent effort over time, French researchers say.

That’s the conclusion after a 15-year, intensive program aimed at reducing the impact of methicillin-resistant Staphylococcus aureus (MRSA) on Parisian hospitals reported in the March 22 Archives of Internal Medicine.

The program started in 1993 in the 38-hospital, 23,000-bed Assistance Publique-Hôpitaux de Paris, the largest …

ACP: Challenges for a competency-based framework for residency training

American College of Physicians

Medical Education

April 19, 2010

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

by Steven Weinberger, MD, FACP

Since the Accreditation Council for Graduate Medical Education (ACGME) instituted its Outcome Project approximately 10 years ago, residency training programs have progressively focused on how well their residents have acquired knowledge, skills and attitudes in six broad domains. These “general competencies” include medical knowledge, patient …

President Obama should have had colonoscopy without sedation

Michael Kirsch, MD

Conditions and Diseases

April 19, 2010

by Michael Kirsch, MD

Does anyone out there know why President Obama underwent a virtual ‘colonscopy’ (VC) instead of a conventional colonoscopy earlier this year?

In my gastroenterology practice, we do not offer colon cancer screening to 48-year-old individuals, unless special risk factors are present. Of course, maintaining the president’s health is in the national interest, so I understand why professional screening guidelines might not apply to him. For …

Primary care needs better physical exam skills

Kevin

Physician

April 19, 2010

by Joseph Biundo, MD

Not long ago, primary care physician Rob Lamberts did a blog post about the economics of seeing Medicare and Medicaid patients, stating that doing so was bad business. While I agree with most of his points, I have a quarrel with his statement that primary care physicians keep down the cost of care by keeping people healthy, away from specialists, and out of the hospital.

That may be …

Health reform winners and losers, and how it affects doctors

Richard Reece, MD

Health Policy

April 19, 2010

I congratulate President Obama and the Democrats on their historic health reform achievement.

Will this bill be able to win approval as it runs the parliamentary gauntlet? Is it an act of political suicide that will become manifest in November? Will it bankrupt the country because of lack of cost controls?

Regardless of where one stands, the bill is a political act of vast ambition and colossal risk.

Now may be a good …

Dabigatran is superior to warfarin, but at what cost?

John Mandrola, MD

Medications

April 18, 2010

Dysrhythmias like atrial fibrillation (AF), more often than not, require medical therapy.

The dreaded blood thinner, warfarin (Coumadin) comes to the fore often. In aggregate, I have likely spent months of my life discussing the risks and benefits of this much maligned drug. Common rat poison is made from the same ingredients as warfarin — only rats keep eating it and die days later of bleeding, while humans have the blood …

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