KevinMD.com

August 21, 2010Aug 21, 20105

The opening anecdote of the e-patient white paper tells of a patient who impersonated a doctor in 1994, to get his hands on an article about an operation he was about to have. He got busted. Two years later episode 139 of Seinfeld had something similar – Kramer impersonates a doctor to try to get Elaine’s medical record.

It aired October 17, 1996. It was a turning point in American healthcare: …

Health policy

The public option dissonance in health reform

Brad Wright, PhD

August 20, 2010Aug 20, 201012

Health reform will do a lot of things that most Americans don't realize it will do, and it will not do a lot of things that many Americans mistakenly believe it will do. One of the most recognizable components of…

Health reform will do a lot of things that most Americans don’t realize it will do, and it will not do a lot of things that many Americans mistakenly believe it will do.

One of the most recognizable components of health reform that didn’t actually become law is the public option. The public option was the lighting rod in the health reform debate. After all, it had a concise name, and …

Health policy

Healthcare reform ethical questions

Jeffrey Hall Dobken, MD, MPH

August 20, 2010Aug 20, 201029

Hard choices and healthcare reform are here. Donald Berwick, M.D., has been installed as the administrator for the Centers for Medicare and Medicaid services as a “recess appointment” by President Obama. Dr. Berwick is an academician, a pediatrician who has…

Dr. Berwick is an academician, a pediatrician who has spent the bulk of his professional existence as the CEO of the Institute for Healthcare Improvement of Cambridge, MA. He is an outspoken advocate for the single-payer system, admires Britain’s National …

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Healthcare reform ethical questions

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Health policy

Health care reform needs cooperation and compromise

Paul Levy

August 20, 2010Aug 20, 20102

There are strange things going on in the Massachusetts health care insurance market. For those from out of state, here are some quotes that will give you a sense of the contradictions in the public policy arena. They are, respectively,…

They are, respectively, from two stories that appeared on the same day in the Boston Globe: “Rate cap for insurer overturned” and “Officials give up cutting health perks.”

1. An insurance

…

Physician voices

Balancing a surgeon’s beliefs with the needs of the practice

Peter J. Polack, MD

August 20, 2010Aug 20, 201011

Not long ago, we interviewed a physician for possible partnership in our practice. After showing him around our town, some of us partners had dinner with him to discuss business. He was a quite pleasant fellow, well trained, and seemed to be a good ‘fit’ for our practice. As dessert was being served, he said he needed to get one more thing off his chest: he prays aloud in the …

Health policy

Americans will need doctors but physicians are leaving primary care

Davis Liu, MD

August 20, 2010Aug 20, 201021

Everyone understands the need for a robust primary care workforce in making healthcare more affordable and accessible while keeping those in our care healthy. With the aging of America and healthcare reform, even more Americans will need primary care doctors at precisely the same time doctors are leaving the specialty in droves and medical students shun the career choice. So as a practicing primary care doctor, I’ve watched with …

Drugs and prescribing

Gifts and money influence physician prescribing

Marya Zilberberg, MD, MPH

August 19, 2010Aug 19, 201015

It is not a secret that large sums of money have passed from the pharmaceutical and device manufacturers into physicians' hands. This money has been paid not only for such socially beneficial pursuits as research and consulting, but also for…

It is not a secret that large sums of money have passed from the pharmaceutical and device manufacturers into physicians’ hands.

This money has been paid not only for such socially beneficial pursuits as research and consulting, but also for lavish gifts and junkets. And interestingly, despite disingenuous assertions to the contrary by many a stake holder, these gifts generated a return on investment — surprise! It turns out that the …

Conditions and diseases

Before ordering a test, know what to do with the result

Bruce Campbell, MD

August 19, 2010Aug 19, 20105

Insanity: Doing the same thing over and over and expecting different results. - Albert Einstein As medical students rotating through the wards, we spent a significant portion of each day ordering laboratory tests and then chasing down the results. We…

Insanity: Doing the same thing over and over and expecting different results.
– Albert Einstein

As medical students rotating through the wards, we spent a significant portion of each day ordering laboratory tests and then chasing down the results. We wanted to investigate our patients’ illnesses and, just as importantly, we wanted to be prepared for any question with which our professors might surprise us during Attending Rounds.

One day, as I was …

Physician voices

PCMH and retainer fee medicine are primary care solutions

Juliet K. Mavromatis, MD

August 19, 2010Aug 19, 201016

For years now we’ve been hearing about the trials and tribulations that have evolved in the practice of primary care medicine. However, the discussion has intensified in recent months with passage of national health reform. Recent publications highlight the problems.…

For years now we’ve been hearing about the trials and tribulations that have evolved in the practice of primary care medicine.

However, the discussion has intensified in recent months with passage of national health reform. Recent publications highlight the problems. A paper in the New England Journal of Medicine by Dr. Richard Baron entitled, What Keeps Us So Busy in Primary Care? discusses the time spent by primary care …

Health technology

Why nurses need better EMR design to care for patients

Jared Sinclair, RN

August 19, 2010Aug 19, 201010

There’s always a lot of stink from physicians over usability problems with EHRs: too many clicks, too many contextual menus, etc. The gist of these complaints is, “Physicians aren’t data entry clerks!” The computer is getting in the way of…

Everybody has a finite amount of mental space available at any given moment. Imagine having to transcribe a conversation in real-time. If half of your mental

…

Physician voices

Family doctors cannot be obsolete, for patients’ sake

Pepi Granat, MD

August 19, 2010Aug 19, 20103

Yesterday, and every day, in my office we had one or two patients we call our "Oldie Goldies". People who have been with us since 1971 when I opened my practice, 39 years ago. People whose progress, medical and personal,…

Yesterday, and every day, in my office we had one or two patients we call our “Oldie Goldies”.

People who have been with us since 1971 when I opened my practice, 39 years ago. People whose progress, medical and personal, I’ve shared, and who share mine. We know their parents, kids and cousins either because they call us in crisis, or they’re our ongoing patients. And every …

Drugs and prescribing

Physicians should not be used for FDA ad enforcement

Michael Kirsch, MD

August 18, 2010Aug 18, 201013

One of the advantages of marrying an immigrant is having intense exposure to another culture. My wife’s Russian heritage, and her family, have enriched my own life immeasurably. The trip that I took with her and my brother to Russia…

During the early years of our relationship, I heard stories about her family that seemed incredible to an American like …

Drugs and prescribing

Incentives for switching patients from branded drugs to generic

Matthew Mintz, MD

August 18, 2010Aug 18, 20105

There's an interesting video from WCVB in Boston about doctors getting kick backs from the insurance company to switch patients from branded medications to generic medications: New Rules To Protect Prescription Drug Customers. If people were concerned about undue influence…

There’s an interesting video from WCVB in Boston about doctors getting kick backs from the insurance company to switch patients from branded medications to generic medications: New Rules To Protect Prescription Drug Customers.

If people were concerned about undue influence when drug companies used to give physicians pens and other novelties (now currently banned by most companies), they should really be concerned about actual monetary payments.

The patient interviewed in the Boston …

Physician voices

The July Effect and causes of the spike in medication errors

Glenn Laffel, MD, PhD

August 18, 2010Aug 18, 20102

"An apple a day keeps the doctor away," or so goes the old adage. People who believe there’s some truth behind the saying are crunching on a great big Macintosh right now, or at least they will be once they…

“An apple a day keeps the doctor away,” or so goes the old adage.

People who believe there’s some truth behind the saying are crunching on a great big Macintosh right now, or at least they will be once they hear about the results of a study from UC-San Diego which showed that every July, there’s a 10% spike in fatal medication errors in hospitals.

The scientists behind the study suggested that …

Drugs and prescribing

Creatine causing muscle cramps and how supplements may be dangerous

Orly Avitzur, MD

August 18, 2010Aug 18, 20104

About a month ago, a 44-year-old insurance executive came to see me with complaints of headaches and muscle cramps. His pain was caused by the typical cluster headache located behind one eye, accompanied by one-sided tearing and nasal congestion, and often triggered by occasional wine or chocolate. The muscle cramps mainly affected the legs and seemed to worsen after exercise.

When I got the results of his lab work, I was …

Physician voices

Why primary care is like air traffic control

angienadia, MD

August 18, 2010Aug 18, 20109

Recently I had an interesting conversation with a few young doctors regarding the new health care reform that had been passed in the United States. One future specialist asked me why primary care doctors should receive more money than they…

And this is an important question that I think sheds light on the suboptimal state of our current health care system. It is important to specialists because …

Medical education

Teaching family practice residents is rewarding

Jill of All Trades, MD

August 17, 2010Aug 17, 20103

Can the field of family medicine truly become monotonous? I never thought I’d ever find myself in a repetitive routine when selecting family medicine as my specialty. I spent eleven years after high school studying what I know. How can…

Can the field of family medicine truly become monotonous?

I never thought I’d ever find myself in a repetitive routine when selecting family medicine as my specialty. I spent eleven years after high school studying what I know. How can eleven years of material really become mundane? In a way, it’s a great thing – it means I am feeling comfortable and confident in my job.

And I am fortunate enough to …

Conditions and diseases

Heart health depends on healthy behaviors

John Mandrola, MD

August 17, 2010Aug 17, 201015

Everyone knows that the heart health of Americans is dismal. Obesity, diabetes, and high blood pressure are all on the rise. For now, technological advances in cardiac care continue to maintain, or in some cases, lower the death rate from…

Everyone knows that the heart health of Americans is dismal. Obesity, diabetes, and high blood pressure are all on the rise.

For now, technological advances in cardiac care continue to maintain, or in some cases, lower the death rate from heart disease. Squishing blockages, ablating abnormal heart tissue, and installing cardiac devices have successfully kept the abysmal lifestyle habits of so many at bay. Despite all the fury of modern technology …

Physician voices

Consider the family’s perspective in the treatment plan

John Trahanas

August 17, 2010Aug 17, 20103

She was not my patient. Actually, she was nobody’s patient, she was just a wife; she was “the family.” She was a rough, stern looking woman, and with good reason as she had weathered many difficult times. Her husband had…

She was not my patient.

Actually, she was nobody’s patient, she was just a wife; she was “the family.” She was a rough, stern looking woman, and with good reason as she had weathered many difficult times. Her husband had been severely demented for many years; however, it was only in the past few months that he required such intensive inpatient care.

He was not conscious or communicative, but he was clearly …

Physician voices

Doctors need to become whistleblowers after medical error

Dr. Martin Young

August 17, 2010Aug 17, 20107

Perhaps the most important principle in practicing medicine, drummed into medical students and junior doctors time and time again, is to do no harm. Our medical interventions and treatments can be given either too early, too late, or inappropriately, with…

Unfortunately, when doctors have harmed patients, the guidelines of what to do thereafter are not as clear, raising the question, “What should doctors do in these …

Real physician voices, twice a week

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