KevinMD.com

June 2, 2010Jun 2, 2010

by Todd Neale British civil servants working three to four hours longer than usual per day appear to have an increased risk of having a coronary heart disease event, a prospective cohort study showed. After accounting for traditional cardiovascular risk…

by Todd Neale

British civil servants working three to four hours longer than usual per day appear to have an increased risk of having a coronary heart disease event, a prospective cohort study showed.

After accounting for traditional cardiovascular risk factors and other variables, those working 11 to 12 hours per day had a 56 percent greater risk of coronary death, nonfatal myocardial infarction, or angina than those who worked normal hours, …

Health policy

Prevention improves health and lowers healthcare costs

Stephen C. Schimpff, MD

June 2, 2010Jun 2, 20108

Prevention is the key to both better health and lower healthcare costs over the long haul. This is where the nation — and each of us as individuals — needs to put energy and resources. In the long run, it is more important than addressing the high cost of new technologies and drugs or their inappropriate overuse.

Today, the U.S. basically has a medical care system rather than a health care …

Medical education

Academic internal medicine as a physician career choice

Robert Centor, MD

June 1, 2010Jun 1, 20104

I received a wonderful inquisitive e-mail from a 1st year medical student. He aspires to an academic internal medicine career and, as a non-traditional student with an MPH, has realistic goals. He asks: What scares me is the prospect of…

What scares me is the prospect of going into a relatively low-paying specialty in such a non-lucrative practice environment with such massive educational debt. Are there any other challenges to going into internal medicine that are unique to

…

Real physician voices, twice a week

Free, and one click to unsubscribe.

Conditions and diseases

Nurse practitioners, doctors, and the lost art of diagnosis

Lucy Hornstein, MD

June 1, 2010Jun 1, 201033

The topic of nurse practitioners in the context of primary care has been resurgent of late, most notably in this post by Maggie Mahar. Much of the conversation is dominated by assertions such as this: …Nurse Practitioners have the needed…

…Nurse Practitioners have the needed training and that, in fact, doctors who have gone through the full medical school curriculum are over-qualified for a job that, today, is more about coordinating

…

Physician voices

Cholesterol can be improved by eating nuts

MedPage Today

June 1, 2010Jun 1, 20106

by Todd Neale Eating nuts improves blood lipid levels, which may help stave off heart disease, researchers found. In a pooled analysis of 25 intervention trials, eating an average of 67 grams of nuts a day (2.4 ounces) reduced total…

by Todd Neale

Eating nuts improves blood lipid levels, which may help stave off heart disease, researchers found.

In a pooled analysis of 25 intervention trials, eating an average of 67 grams of nuts a day (2.4 ounces) reduced total cholesterol by 5.9% and LDL cholesterol by 7.4% (P<0.001 for both), according to Joan Sabaté, MD, DrPH, of Loma Linda University in California, and colleagues.

The ratios of total to HDL cholesterol and …

Physician voices

Clean your healthcare site to become more efficient

Donald Tex Bryant

June 1, 2010Jun 1, 20103

Spring cleaning is a tradition in many homes. The occupants open up the home to the spring air, thoroughly clean the home, and sort through the accumulated goods, getting rid of things not used for a long time and which no one wants anymore. It gives one a sense of accomplishment, makes for a more pleasant surrounding and frees up space.

Is this something that you do at your healthcare site …

Patient voices

Medical compliance from a patient perspective

Dave deBronkart

May 31, 2010May 31, 20102

The new definition of participatory medicine at the Society’s website notes that patients “shift from being mere passengers to responsible drivers of their health, and … providers encourage and value them as full partners.” As with any collaboration, this must…

I recently returned from an extraordinary week in Minnesota, with visits to several thought-provoking care facilities. The week was all about …

Drugs and prescribing

Proton pump inhibitors associated with fracture and C. difficile

MedPage Today

May 31, 2010May 31, 20102

by Charles Bankhead Proton pump inhibitors (PPIs) significantly increased the risk of both fracture and recurrent infection with Clostridium difficile, investigators in separate studies reported. PPI use increased the odds of spine, forearm/wrist, and total fractures by 25% to 50%…

by Charles Bankhead

Proton pump inhibitors (PPIs) significantly increased the risk of both fracture and recurrent infection with Clostridium difficile, investigators in separate studies reported.

PPI use increased the odds of spine, forearm/wrist, and total fractures by 25% to 50% over three years, but had no effect on the risk of hip fracture. Overall, the acid-fighters had a modest effect on bone mineral density (BMD), Seattle researchers reported in the May 10 …

Physician voices

How the oil shortage will affect hospitals and healthcare

Marya Zilberberg, MD, MPH

May 31, 2010May 31, 201011

I believe in the peak oil theory. Think about it, in a closed system nothing is infinite. Since oil is a product of millions of years of decay, unless we use it at the same rate that is it produced,…

I believe in the peak oil theory.

Think about it, in a closed system nothing is infinite. Since oil is a product of millions of years of decay, unless we use it at the same rate that is it produced, we will run out. I do not have a crystal ball any more than anyone else I know, so I will not hang my hat on when, but will commit to …

Health policy

Paperwork results in wasted work for doctors, insurers and patients

MedPage Today

May 30, 2010May 30, 20109

by Marianne Mattera "I Hate " Not long ago I sent an e-mail with those headline words as the subject line -- I have withheld the name of the insurer to protect . . . , well, myself. A combination…

by Marianne Mattera

“I Hate [Insert Health Insurer Here]”

Not long ago I sent an e-mail with those headline words as the subject line — I have withheld the name of the insurer to protect . . . , well, myself.

A combination of circumstances has led to massive hassles costing me what is easily 100 hours of checking, rechecking, e-mailing, and phone calling over the last 3 months. …

Physician voices

Waiting is a part of surgery, and how a surgeon perceives time

Bruce Campbell, MD

May 30, 2010May 30, 20104

People like us, who believe in physics, know that the distinction between past, present, and future is only a stubbornly persistent illusion. - Albert Einstein The surgical case is delayed for ten minutes and I am getting restless. I anticipate…

People like us, who believe in physics, know that the distinction between past, present, and future is only a stubbornly persistent illusion.
– Albert Einstein

The surgical case is delayed for ten minutes and I am getting restless. I anticipate a very difficult dissection. The cancer has returned after extensive prior treatment with surgery, chemotherapy and radiation. I have enlisted additional help to make certain that everything goes as smoothly as possible. …

Conditions and diseases

Virtual colonoscopy access may not reduce lower endoscopy rates

MedPage Today

May 29, 2010May 29, 20102

by John Gever Easy access to CT colonoscopy may not reduce the number of conventional colonoscopies performed. After the University of Wisconsin's (UW) health system persuaded local insurers to cover the imaging-based screens in 2004, there was little sign that…

by John Gever

Easy access to CT colonoscopy may not reduce the number of conventional colonoscopies performed.

After the University of Wisconsin’s (UW) health system persuaded local insurers to cover the imaging-based screens in 2004, there was little sign that patients preferred them to standard endoscopic exams, according to Patrick Pfau, MD, the university’s director of clinical gastroenterology.

Mean quarterly counts of optical colonoscopies performed at UW rose from 1,104 in 2003 to …

Health policy

HSA-compatible high deductible health plan advantages

Ray Carlson

May 29, 2010May 29, 201010

With so many health insurance consumers familiar with standard “PPO” or Preferred Provider Organization health plans that feature lower annual deductibles, the HSA-compatible health plan might be getting overlooked. These same consumers who – because of the downturn in the…

These same consumers who – because of the downturn in the economy and subsequent job loss – are now shopping for, or considering shopping for, a new individual or family health plan might gravitate towards a PPO that features the lower deductibles …

Drugs and prescribing

Your asthma or COPD inhaler is not available, and what to do

Matthew Mintz, MD

May 28, 2010May 28, 2010

As reported in MedPage Today, the FDA announced the end for CFC-propelled inhalers. Of the seven inhalers with deadlines for removal, only three are still being made: Flunisolide (Aerobid Inhaler System) on June 30, 2011 Albuterol and ipratropium combination (Combivent…

As reported in MedPage Today, the FDA announced the end for CFC-propelled inhalers. Of the seven inhalers with deadlines for removal, only three are still being made:

Flunisolide (Aerobid Inhaler System) on June 30, 2011
Albuterol and ipratropium combination (Combivent Inhalation Aerosol) on Dec. 31, 2013
Pirbuterol (Maxair Autohaler) on Dec. 31, 2013

The reason for this is because CFC’s are harmful for the environment, and the newer inhalers have to be replaced with …

Physician voices

How doctors choose which specialists they refer to

Michael Kirsch, MD

May 28, 2010May 28, 201011

There is an aspect of professional sports that I greatly admire. This transcends the athleticism and skill of the athletes, the work ethic, coaching expertise, teamwork and the thrill of the game. This is one of the only institutions that is a pure meritocracy. The philosophy is simple and not blurred by arguments for diversity or massaging the qualifications for admission to serve another agenda. Coaches, managers and owners want …

Drugs and prescribing

How primary care should manage chronic pain patients

Juliet K. Mavromatis, MD

May 28, 2010May 28, 201018

In April 2010 the American Society of Anesthesiologists (ASA) published updated guidelines for the management of chronic pain. The guidelines were based on a review of recent scientific evidence as well as a survey of expert opinion. As I read through the guidelines, summarizing the efficacy of various therapies for chronic pain ranging from epidural injection to medication management, some of my most challenging clinical cases involving pain management …

Conditions and diseases

Female sexual dysfunction treatment options

Jill of All Trades, MD

May 27, 2010May 27, 20104

Female sexual dysfunction has been reported in up to 40% of women, and described as causing actual distress in approximately 12% of women. Therefore, it is an important topic to familiarize with and screen for as a primary care physician,…

Female sexual dysfunction has been reported in up to 40% of women, and described as causing actual distress in approximately 12% of women.

Therefore, it is an important topic to familiarize with and screen for as a primary care physician, as many patients may not report these symptoms unless they are elicited during the history taking process of the patient encounter. Female sexual dysfunction is often multifactorial and complex; it is …

Health policy

Healthcare needs to be simpler and more like real economics

John Mandrola, MD

May 27, 2010May 27, 201013

A middle aged patient whom I have seen in the past for benign palpitations called today because of atypical chest pain. Although I have criticized the overuse of nuclear imaging studies, and probably order the fewest of any cardiologist in the city, there are times when they are appropriate –this was one of those occasions. Symptoms did not rise to the level of an invasive angiogram, but could not be …

Health technology

EMR use may not save money but can save lives

MedPage Today

May 27, 2010May 27, 20108

by Joyce Frieden Two new studies of electronic medical records (EMRs) have come to different conclusions: one found that they don't save money or staffing time, but the other suggested that at least one part of EMR -- electronic prescribing…

by Joyce Frieden

Two new studies of electronic medical records (EMRs) have come to different conclusions: one found that they don’t save money or staffing time, but the other suggested that at least one part of EMR — electronic prescribing — does save lives.

In the electronic prescribing study, at a single California hospital, the mean monthly adjusted mortality rate decreased by 20% …

Patient voices

Patient relationships with their doctors over time

Sandeep Grewal, MD

May 27, 2010May 27, 20109

We as doctors and patients as well as medicine as a whole have evolved over time. What used to be a simple conversation of between a doctor and a patient has turned into a melee of medical issues, legal issues,…

Conversation between a doctor and patient in 1960s:

Patient: Sir, I am having a sore …

Real physician voices, twice a week

The Podcast

Latest episodes

Most popular

The Podcast

Latest episodes

Most popular