KevinMD.com

June 15, 2010Jun 15, 20109

Unless you spent the last two years in a Himalayan monastery, you are certainly aware of the bitter healthcare battle that unfolded in Washington. Underlying the nonsense about death panels from the right and claims of impending doom from the…

Unless you spent the last two years in a Himalayan monastery, you are certainly aware of the bitter healthcare battle that unfolded in Washington.

Underlying the nonsense about death panels from the right and claims of impending doom from the left lies a far more legitimate conflict about how we view healthcare – as a basic human right or as a market service. Conservatives generally ascribe to the latter, viewing non-emergent …

Health policy

Doctors make far less money than most people think

Kevin Pho, MD

June 15, 2010Jun 15, 201041

A video excerpt from The Vanishing Oath, a film directed by Ryan Flesher, MD. The average physician salary in the United States is $146,000 -- which is undeniably a lot of money at face value. But it's a lot less…

A video excerpt from The Vanishing Oath, a film directed by Ryan Flesher, MD.

The average physician salary in the United States is $146,000 — which is undeniably a lot of money at face value.

But it’s a lot less when you factor in the overhead costs that doctors incur. And that’s not including the medical school debt which, on average, exceeds $150,000.

This clip shows how the take home pay of …

Health policy

Medical loss ratios is not all about health insurance profits

David Williams

June 14, 2010Jun 14, 20102

The new health insurance reform law will generally require health plans to pay out at least 80 or 85 percent of premiums in medical expenses, depending on whether they are selling to individuals/small groups or to large groups. Intuitively it makes sense that purchasers would want the medical loss ratio to be as close to 100 percent as possible –- since the purchaser doesn’t derive utility a plan’s administrative expenses …

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Drugs and prescribing

Prescription drugs and its copycats contribute to health waste

Roy Benaroch, MD

June 14, 2010Jun 14, 20109

I’ve recently posted about the insane costs of health care, and about how defensive medicine is a big contributor. Prescription drugs are another huge cost, accounting for about 11% of the 2 trillion spent each year on health care in The United States. And it turns out that the marketplace for prescriptions is also rife with bizarre sources of waste and sneakery.

First, some good news: prescription medications are …

Drugs and prescribing

Statins do not decrease the risk of many cancers

MedPage Today

June 14, 2010Jun 14, 2010

by Kristina Fiore Claims of unintended benefits of statins appear to be largely unsubstantiated and known risks -- including liver and renal problems and myopathy -- confirmed, British researchers concluded based on findings from a large prospective open cohort study.…

by Kristina Fiore

Claims of unintended benefits of statins appear to be largely unsubstantiated and known risks — including liver and renal problems and myopathy — confirmed, British researchers concluded based on findings from a large prospective open cohort study.

The study involving more than two million people, “largely confirmed other studies that reported no clear association between statins and risk of cancers,” Julia Hippisley-Cox, MD, and Carol Coupland, MD, of the …

Physician voices

Primary care is more than just office visits

Robert Wachter, MD

June 13, 2010Jun 13, 20103

If you’ve ever been on a diet, you know that it really helps to keep a food log. Seeing your consumption chronicled in one place is illuminating – and often explains why those love handles aren’t melting away despite two…

In a recent issue of the New England Journal of Medicine, internist Rich Baron Rich Baron chronicles the work of his 5-person Philadelphia office practice …

Health policy

Government and marathon runner motivation

Jeffrey Hall Dobken, MD, MPH

June 13, 2010Jun 13, 20102

Giving advice is usually a thankless business. I have always been mindful of the unconsciously profound summation given by a six-year-old when she was asked to identify Socrates. "Socrates," she stated, "was a really old Greek guy who went around…

Giving advice is usually a thankless business. I have always been mindful of the unconsciously profound summation given by a six-year-old when she was asked to identify Socrates. “Socrates,” she stated, “was a really old Greek guy who went around giving people good advice. They poisoned him.”

But here goes: We do not need government intervention to improve our health, and, by extension, the quality of our lots in life.

This essay …

Physician voices

Primary care doctors at a competitive disadvantage to midlevels

Hans Duvefelt, MD

June 13, 2010Jun 13, 20109

A primary care resident wrote in one of the journals recently about making the limited time she has with each patient matter the most. How refreshing, I thought when she concluded that time ultimately is an absolute and finite resource.…

A primary care resident wrote in one of the journals recently about making the limited time she has with each patient matter the most.

How refreshing, I thought when she concluded that time ultimately is an absolute and finite resource. We often feel as if we are battling time as much as we are battling disease, and we sometimes have trouble admitting when we are losing either one of those battles. …

Physician voices

Don’t let a doctor make you feel uncomfortable

Diana E. Lee

June 12, 2010Jun 12, 20105

by Diana E. Lee One member of my health care team is a migraine specialist in another state. Since we don't have many opportunities to work together in person, we generally try to pack a lot into my periodic two-day…

by Diana E. Lee

One member of my health care team is a migraine specialist in another state. Since we don’t have many opportunities to work together in person, we generally try to pack a lot into my periodic two-day visits.

Last time I was there I had an experience that has left me feeling guilty all these months later.

My doctor, who I respect and admire greatly, asked if I was interested …

Physician voices

Can chest pain patients be evaluated in the ER waiting room?

MedPage Today

June 12, 2010Jun 12, 20106

by John Gever Emergency department patients with chest pain may safely be evaluated in the waiting room when necessary, researchers said. Among 303 patients triaged to waiting-room evaluation in a prospective study, no acute coronary syndromes were missed and adverse…

by John Gever

Emergency department patients with chest pain may safely be evaluated in the waiting room when necessary, researchers said.

Among 303 patients triaged to waiting-room evaluation in a prospective study, no acute coronary syndromes were missed and adverse event rates overall were lower than among 804 patients who were assessed in conventional monitored beds, reported Frank Scheuermeyer, MD, of St. Paul’s Hospital in Vancouver, British Columbia, and colleagues online in …

Drugs and prescribing

Ask your pharmacy to price match prescription drugs

Leslie Ramirez, MD

June 12, 2010Jun 12, 20102

As we have established repeatedly on LesliesList.org, prescription prices can vary a lot from one pharmacy to another. But did you know that some pharmacies will actually match a competitor's price? This could save you a ton of cash, but…

As we have established repeatedly on LesliesList.org, prescription prices can vary a lot from one pharmacy to another.

But did you know that some pharmacies will actually match a competitor’s price? This could save you a ton of cash, but you have to know how, and whom, to ask for this service. Pharmacy retail chains all have different policies. I spoke to a pharmacist recently at each of the seven top …

Health policy

AMA: Senate fails to stop a Medicare meltdown

American Medical Association & J. James Rohack, MD

June 11, 2010Jun 11, 201010

A guest column by the American Medical Association, exclusive to KevinMD.com. by J. James Rohack, MD Unbelievable as it is, for the third time this year the Senate failed to act on time to stop this year’s 21 percent Medicare…

A guest column by the American Medical Association, exclusive to KevinMD.com.

by J. James Rohack, MD

Unbelievable as it is, for the third time this year the Senate failed to act on time to stop this year’s 21 percent Medicare physician payment cut. Senators cut and ran on America’s seniors and their physicians, heading home for the Memorial Day recess before taking action. Now the Senate is …

Conditions and diseases

Diagnosis requires seeing patient problems with a wide lens

Jerome Groopman, MD & Pamela Hartzband, MD

June 11, 2010Jun 11, 20108

Susan Sorensen, FACP, an internist and hematologist in Palo Alto, Calif., told us of a case where the correct diagnosis took more than a year to make. The patient was a 24-year-old woman who had developed weight loss, fatigue and intermittent chest tightness. She was seen in a local emergency department, and was told that she should consult a pulmonary specialist. A chest X-ray and EKG appeared normal.

Over the next …

Conditions and diseases

Wii Sports and Wii Fit Plus exercise equivalents

William R. Yates, MD

June 11, 2010Jun 11, 2010

Regular exercise has been shown to be helpful in the prevention and management of a variety of clinical neuroscience conditions including: Alzheimer's disease, Parkinson's disease, major depression and anxiety disorders. However, motivating people to get involved in a regular exercise…

Regular exercise has been shown to be helpful in the prevention and management of a variety of clinical neuroscience conditions including: Alzheimer’s disease, Parkinson’s disease, major depression and anxiety disorders. However, motivating people to get involved in a regular exercise program is a significant challenge. Wii Sports and Wii Fit Plus may provide the motivation edge for some patients to start and maintain an exercise program.

The Wii video game system …

Physician voices

Residents who specialize in surgery are influenced by family

MedPage Today

June 11, 2010Jun 11, 2010

by Chris Emery Single and childless surgical residents in the U.S. are more likely to pursue specialized surgical fellowships, and a majority of surgical residents believe a successful career depends upon specialty surgical training, a new survey found. Of residents…

by Chris Emery

Single and childless surgical residents in the U.S. are more likely to pursue specialized surgical fellowships, and a majority of surgical residents believe a successful career depends upon specialty surgical training, a new survey found.

Of residents who responded to the survey, 28.7% believed general surgery is becoming an obsolete career path (30.1% of men and 25.9% of women, P=0.004), and 55.1% believed specialty training is necessary for career …

Patient voices

Third world doctors are the real physician heroes

Dr. Martin Young

June 11, 2010Jun 11, 20106

I recently was involved in a web discussion on elective choices with a group of medical students. Financial considerations aside, I was surprised how few were interested in visiting third world countries to see how medicine is practiced outside the…

I recently was involved in a web discussion on elective choices with a group of medical students.

Financial considerations aside, I was surprised how few were interested in visiting third world countries to see how medicine is practiced outside the first world comfort zone of unlimited expertise, investigation and therapy — where “want” often exceeds “need.”

The third world however is completely different. It’s an environment where doctors and nurses are in …

Conditions and diseases

Treating a child with fever and leukemia

StorytellERdoc, MD

June 10, 2010Jun 10, 20105

I walked into Room 35 to find a three year-old lying on the hospital cot. Her father sat alongside her bed, whispering softly to her. The patient appeared quite tired, wiped-out even, and if it weren't for her complacent eyes…

She was visiting our ER because, after a few days of cough and congestion, she had developed a fever. …

Health technology

Electronic medical records and detail obsessed doctors

Paul Sax, MD

June 10, 2010Jun 10, 20105

When it comes to writing consult notes, it often seems as if we ID specialists have a blatant form of obsessive-compulsive disorder. Every detail is fair game — travel history, dietary habits, all sorts of seemingly trivial exposures, and of…

I’ll never forget receiving sign-out from the graduating first-year ID fellow when I started my fellowship. It included a photocopy of a …

Medical education

ABIM responds to doctors sharing board certification questions

Christine K. Cassel, MD

June 10, 2010Jun 10, 201012

A guest column by the American Board of Internal Medicine, exclusive to KevinMD.com. The American Board of Internal Medicine (ABIM) is sending a clear message to doctors this week: Compromise the integrity of the certification process and face swift and…

A guest column by the American Board of Internal Medicine, exclusive to KevinMD.com.

The American Board of Internal Medicine (ABIM) is sending a clear message to doctors this week: Compromise the integrity of the certification process and face swift and serious penalties.

ABIM is sanctioning 139 physicians for sharing, buying, or soliciting confidential, copyrighted questions that were part of the exam …

Real physician voices, twice a week

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