by Michael Smith
If you look at the world map, the shapes of South America and Africa look as though they should fit together. Maybe they were once together and then drifted apart.
That theory was first put forward in the late 1500s by a Dutch map maker, but it wasn’t until the 1960s that the discovery of plate tectonics finally put the idea on a — well, …
Flu may be associated with seasonal deficiency of vitamin D
Beginning in the 1970s, the house call began a slow death. As the medical-industrial complex (MIC) burgeoned, with bigger hospitals and a surfeit of technology, it became incumbent on patients to come see us rather than us going to see you.
Yet there are pockets of house calls still left in the U.S.
For the geriatric age group, there has been growth in the care-at-home sector, especially for homebound elders. They can …
Can house calls be revived under health reform?
by Todd Neale
Editors of medical journals should unite in requiring independent statistical analyses of industry-sponsored clinical trials, according to the two top editors of the Journal of the American Medical Association.
Such a measure would help prevent any inappropriate influence from the study sponsors on data analysis and reporting, wrote Catherine DeAngelis, MD, MPH, editor-in-chief of JAMA, and Phil Fontanarosa, MD, MBA, executive deputy editor …
Statistical analysis in medical journals should be unbiased
by Crystal Phend
Only one person in 40 has an extraordinary ability to do safely what many take for granted in daily life — talk on a cell phone while driving.
These “supertaskers” excelled on a simulated driving exercise and a demanding, simultaneous test of memory and math skills conducted over the phone without any loss in performance on either, according to Jason M. Watson, PhD, and David L. Strayer, PhD, both …
Cell phone use and driving requires attention that few have
A version of this op-ed was published on March 15th, 2010 in the USA Today.
If you recently saw a doctor, you might subsequently receive a survey in the mail asking whether your physician was friendly, spent enough time with you, or showed the appropriate level of concern for your medical issues.
Patient satisfaction surveys are being increasingly used in hospitals nationwide. Press Ganey, a leading organization measuring patient satisfaction, counts more …
Op-ed: Patient satisfaction doesn’t mean the best medical care
In the Academy Award winning film, Precious, the main character’s transformation comes about largely through her ability to tell the story of her trauma, specifically in the form of writing. In this endeavor she is encouraged by a loving teacher.
In the book History Beyond Trauma, two French psychoanalysts argue that symptoms their patients exhibit represent the horrors of war that are not spoken of, sometimes for generations. The patient is …
Children who are traumatized need more than medication
Patient non-adherence is a big problem. Non-adherence among chronic disease patients is associated with higher rates of hospital re-admissions, higher costs and poorer outcomes.
Research has identified over 200 possible factors thought to influence patient adherence. According to the experts, these factors can be categorized into two groups:
1. unintentional non-adherence
2. intentional non-adherence.
Unintentional non-adherence is related to a patient’s ability and resources to take their medication (e.g., problems with manual …
Patient beliefs and their role in non-adherence
by Joyce Frieden
Retail clinics aren’t just for strep throats any more; they’ll also be managing diabetes and other chronic diseases.
“It’s a new service strategy,” Sandra Ryan, CPNP, told attendees at a meeting on retail clinics sponsored by the Convenient Care Association and the Jefferson School of Population Health.
“We’re evolving our clinic offerings,” said Ryan, chief nurse practitioner officer for Take Care Health Systems, which operates retail clinics inside Walgreens pharmacies, …
Retail clinics are starting to do more primary care
A guest column by the American Medical Association, exclusive to KevinMD.com.
by J. James Rohack, MD
As our country turns the corner on the historic path toward health system reform, many physicians are left with questions as to how this new law will affect them and their patients.
The AMA has been an active participant in the health reform debate since …
AMA: Health reform victories for physicians and what still needs to be done
by Dr. Whoo, MD
Q. I just found out last week that I’ll be a new mom in November, making me an official mother in medicine! I’ve been reading the blog for a while, because I love hearing what all of you have to say about your lives. Here’s my question: What tips would you give for surviving residency while pregnant, especially 30-hour calls (without caffeine)?
— From a future mom and …
Medicine residency survival tips during pregnancy
by Crystal Phend
Advance planning improves end-of-life care for elderly patients and helps families cope with the loss, researchers found.
In a randomized trial, hospitalized patients over age 80 who were formally assisted with documenting their end-of-life treatment wishes and with designating a surrogate were almost three times more likely to have those wishes followed (86% versus 30% in usual care, P<0.001).
Family members of patients in the advance planning intervention reported significantly …
Advance planning helps families cope with loss
If there’s one thing everyone agrees on, it’s that preventive care is always a good thing. Well, I’m a doctor and I’m afraid of preventive medicine.
The theory behind preventive medicine is sound. It is better to treat prevent disease than to treat it. It is better to refrain from smoking and never get lung cancer than it is to treat lung cancer. It is better to refrain from alcohol abuse …
Preventive medicine may not always help patients
I want to touch on what is probably the hottest topic in psychiatry: whether psychologists should obtain prescription privileges. This is topical because Oregon just overwhelmingly passed a law authorizing prescriptive privileges for psychologists, although it is unclear whether the governor will sign the bill.
I endorse psychologists prescribing, and here’s why: it would be the single best thing that could happen to psychiatry.
Yes, I know it sounds ridiculous, but …
Psychiatry benefits when psychologists prescribe drugs
ADVERTISEMENT
Now, as you know, I am a big fan of epidemiology. I do not believe that a randomized controlled trial is the be-all-and-end-all in evidence generation, and a well done observational study can add to our reservoir of knowledge much more efficiently. Of course, I, as many others, acknowledge certain limitations of epidemiologic design. However, many of them can be overcome with careful design and analysis.
I have to confess, though, …
Epidemiology and how confounding statistics can confuse
by Nancy Walsh
Children who are irritable or disobedient, or who steal or bully others, are at risk for chronic pain in middle age, a large prospective study found.
Youngsters who had persistent behavior problems at ages seven, 11, and 16 years had more than twice the risk of widespread chronic pain at age 45 as other children (RR 2.14, 95% CI 1.43 to 3.21), according to Dong Pang, PhD, of the …
Chronic pain patients may have been disobedient children
When someone dies at home we call it ‘going to a better place.’ When someone dies in the hospital we call it a ‘code.’
Recently, working in the cardiac ICU, I have been thinking a lot about code status. Code status is the medical term that describes what a patient’s wishes are should his or her heart stop or lungs fail. While code status is not a topic that typically …
Patient advance directives are critical in the ICU
A sweet little lady came to the emergency department recently. She said she felt short of breath and sweaty at home. In the department, she looked like a rose! Normal oxygen levels, normal labs. Her chest x-ray had a faint area that ‘one might possibly imagine could perhaps be’ a pneumonia. It looked remarkably like her previous film.
But her history was concerning to me, and it was concerning to …
Hospital admissions may require watching and waiting
I had been anxiously awaiting the arrival of my iPad. This is the form factor I have been asking (begging) of all the vendors for years. I’m very happy to say that it appears to be living up to my high expectations.
The screen is gorgeous. It’s very clear and bright, I had no trouble seeing the screen in bright outdoor light. The machine seems extremely responsive — it …
iPad in the ER, a hands on physician review
While the health reform bill will have many effects, one of its most profound will be to unshackle the Centers for Medicare & Medicaid Services (CMS).
Under the legislation, CMS is now far freer to undertake a variety of pilot programs and demonstration projects designed to improve quality, safety and efficiency, and to convert the successful ones into policy. And, if that wasn’t enough for those who have long been praying …
Don Berwick to lead Medicare and Medicaid
With the explosion of social media, I am amazed at how many doctors I encounter who know little to nothing about blogs, Twitter, Facebook, Google Buzz and the like. “I’m too busy.” “Who has time for that stuff?” “I wouldn’t have time for anything else.” “How can I possibly keep up?”
And yet today, as more and more patients reach out to the web to find medical information or, more importantly, …
Twitter for doctors, a guide for health care professionals
Get free updates delivered free to your inbox.
