KevinMD.com

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

…

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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 …

Patient voices

“I’m a patient, not a consumer”

Jackie Fox

August 17, 2010Aug 17, 201075

I’ve been hearing and reading a lot lately about how the doctor-patient relationship is under siege. There are many reasons for this, ranging from care decisions increasingly being made by insurers to the shortage of primary care physicians, to patient empowerment. I didn’t quite understand how patient empowerment could be a threat, until I started thinking about the recent perceptual shift from patients to health-care consumers.

I agree with the consumer …

Read more…

“I’m a patient, not a consumer”

Patient voices

The emotional state of doctors can affect patient care

Jeffrey Knuppel, MD

August 16, 2010Aug 16, 20103

Great doctors listen to their patients. They start out by asking open-ended questions, and unless patients get too far off-track, they don’t typically interrupt them. Despite having limited time for appointments, they have an unhurried manner. They make eye contact…

Great doctors listen to their patients.

They start out by asking open-ended questions, and unless patients get too far off-track, they don’t typically interrupt them. Despite having limited time for appointments, they have an unhurried manner. They make eye contact with their patients and do not bury their heads in charts and computer screens. Their patients leave their appointments feeling respected and heard.

Of course no doctor is likely to be able …

Health policy

Congress is actually increasing physician Medicare pay

Maggie Mahar

August 16, 2010Aug 16, 201019

Recently, the 21 percent cut in Medicare physician reimbursements was replaced with a 2.2 percent pay hike. Later this year, Congress will have to consider the matter once again, just as it has ever year since 2003. This is the…

Recently, the 21 percent cut in Medicare physician reimbursements was replaced with a 2.2 percent pay hike.

Later this year, Congress will have to consider the matter once again, just as it has ever year since 2003. This is the third time this year that Congress has averted Draconian cuts to physician’s payments. What, you might wonder, is going on?

Here is the back-story. In 1997, Congress enacted a so-called “sustainable growth …

Health policy

Will pilot programs really lead to innovation and save money?

Roger Collier

August 16, 2010Aug 16, 2010

As might be expected of reform legislation, the Patient Protection and Affordable Care Act (PPACA) places a lot of emphasis on innovation. Reasonably enough, most of the potential changes—at least in Medicare—are to be preceded by pilot or demonstration projects…

As might be expected of reform legislation, the Patient Protection and Affordable Care Act (PPACA) places a lot of emphasis on innovation.

Reasonably enough, most of the potential changes—at least in Medicare—are to be preceded by pilot or demonstration projects designed to test their feasibility. In fact, according to one health care blogger with time on his hands, PPACA includes no less than 312 mentions of demonstrations and 80 mentions of …

Physician voices

Why radiology should become more like McDonald’s

Paul Dorio, MD

August 16, 2010Aug 16, 201017

For years, I have been progressively beating a louder and louder drum -- one where my colleagues know that I liken radiology to McDonald's. Most of the bad press out there, it seems to me, has to do with poor…

For years, I have been progressively beating a louder and louder drum — one where my colleagues know that I liken radiology to McDonald’s.

Most of the bad press out there, it seems to me, has to do with poor customer service. Our health care system is often inefficient, and delivers limited, incomplete care. The root of the problem, in my opinion, is that there aren’t enough doctors or hours in …

Physician voices

Stop calling doctors fleas and teaching professionalism

Vineet Arora, MD

August 15, 2010Aug 15, 201010

At the recent AAMC meeting on how to integrate quality into teaching hospitals, the question that kept popping up from speaker after speaker was how to address the fact that doctors in teaching hospitals don’t get along. Unfortunately, all the…

Unfortunately, all the specialty bashing that takes place prevents the adoption of a team based culture necessary to advance quality and safety. As one speaker highlighted, how can we really start to address this …

Patient voices

Being a good mother is not about specific mothering choices

Amy Tuteur, MD

August 15, 2010Aug 15, 20106

Since the subtext of the natural childbirth and attachment parenting movements is the notion of the good mother, it's worth asking what makes a good mother. My whole approach to writing about childbirth and mothering choices is based my rejection…

Since the subtext of the natural childbirth and attachment parenting movements is the notion of the good mother, it’s worth asking what makes a good mother. My whole approach to writing about childbirth and mothering choices is based my rejection of currently popular beliefs about good mothering.

Simply put, I believe that good mothering is about choosing mothering and not about mothering …

Real physician voices, twice a week

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