KevinMD.com

May 13, 2010May 13, 20102

Although every day can bring surprises in a medical practice, you can develop a clinical team that can optimize the efficiencies of your operation and make it easier for you to see your patients. There are three key areas that…

Although every day can bring surprises in a medical practice, you can develop a clinical team that can optimize the efficiencies of your operation and make it easier for you to see your patients.

There are three key areas that lead to provider frustration in daily operations: preparation and anticipation; the daily dance; and being in the moment. Address these, and your days should go more smoothly.

Preparation and anticipation

Are your charts …

Bartering and whether doctors should be paid with chickens

Doctor Grumpy, MD

May 13, 2010May 13, 201017

Generally, I find my practice works best when I get paid in dollars. They're convenient. They can be transmitted electronically between bank accounts. Mary and Annie like them. I can spend them by swiping a credit card. But, in a…

Generally, I find my practice works best when I get paid in dollars. They’re convenient. They can be transmitted electronically between bank accounts. Mary and Annie like them. I can spend them by swiping a credit card.

But, in a remarkable effort to win the “Let’s See How Stupid I Can Sound” award, a Nevada candidate for U.S. Senate has proposed ditching the idea of paying doctors in money, and going …

Conditions and diseases

Declining autopsy rate, and how that impacts doctors

Ralph Gordon, MD

May 12, 2010May 12, 20106

The role of autopsy in the medical profession is difficult to overestimate. Western medicine takes its roots from comparative studies between patient’s symptoms and the findings on autopsy. Participation in an autopsy was one of the most valuable lessons from…

The role of autopsy in the medical profession is difficult to overestimate. Western medicine takes its roots from comparative studies between patient’s symptoms and the findings on autopsy.

Participation in an autopsy was one of the most valuable lessons from medical school and residency. If you participated in the patient’s care, there is no greater educational tool than witnessing the postmortem exam. It is especially true if the cause of death …

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Health technology

Apple Store is demonstrating iPhone EMR apps to physicians

Iltifat Husain, MD

May 12, 2010May 12, 20108

When I recently walked into my local Apple store to buy an iPad accessory, I saw a group of about 20 people huddled around a large LCD screen while an Apple employee was giving a workshop. When I saw the…

When I recently walked into my local Apple store to buy an iPad accessory, I saw a group of about 20 people huddled around a large LCD screen while an Apple employee was giving a workshop.

When I saw the LCD screen full of medical applications, I was shocked. This wasn’t your run of the mill “how to use your iPhone” workshop.

The people gathered for the workshop consisted of healthcare professionals …

Conditions and diseases

Activities for family members with dementia

Ken Covinsky, MD

May 12, 2010May 12, 20102

There is a lot of focus on what elders with dementia can't do. But what about more discussion of what they can do? When you see a patient with dementia, how do you help family members maintain meaningful interactions with…

There is a lot of focus on what elders with dementia can’t do. But what about more discussion of what they can do?

When you see a patient with dementia, how do you help family members maintain meaningful interactions with their loved ones? I am sad to admit that I don’t do this nearly as well as I should. After all, this is not the type of thing we are taught …

Conditions and diseases

C-section rates as a marker for obstetric care quality

MedPage Today

May 12, 2010May 12, 20107

by Michael Smith When cesarean section rates are lower than expected, adverse maternal or neonatal outcomes are higher, researchers said. But the converse isn't true -- higher-than-expected C-section rates aren't associated with a protective effect, according to Sindhu Srinivas, MD,…

by Michael Smith

When cesarean section rates are lower than expected, adverse maternal or neonatal outcomes are higher, researchers said.

But the converse isn’t true — higher-than-expected C-section rates aren’t associated with a protective effect, according to Sindhu Srinivas, MD, of the University of Pennsylvania, and colleagues.

The finding comes from an attempt to see if the risk-adjusted C-section rate can be used as a marker for the quality of obstetric care, Srinivas …

Physician voices

Outpatient internal medicine needs a consultant track

Robert Centor, MD

May 12, 2010May 12, 20107

I have spent most of the past 2 weeks on the road – first at ACP and this week at SGIM. I have talked with many internists, but several conversations have contributed to writing this post. Each of several leaders…

Here are the main assumptions:

1. Internists by training excel in the care of complexity
2. Pursuing the …

Conditions and diseases

Causes of Beau Biden’s stroke

Kevin Pho, MD

May 11, 2010May 11, 20102

Beau Biden, son of Vice President Joe Biden, suffered a stroke today. He is 41-years old, and is expected to make a full recovery according to the medical director of the Center for Heart and Vascular Surgery at Christiana Care…

Beau Biden, son of Vice President Joe Biden, suffered a stroke today.

He is 41-years old, and is expected to make a full recovery according to the medical director of the Center for Heart and Vascular Surgery at Christiana Care Health System:

Biden has what the doctors “believe to be a mild stroke,” according to Gardner. “[He is] “fully alert,

…

Read more…

Causes of Beau Biden’s stroke

Health policy

Physician assistant name change rubs doctors the wrong way

Marya Zilberberg, MD, MPH

May 11, 2010May 11, 201045

Much like many other news items, I came upon the one about the proposed name change for Physician Assistants quite by accident: it came to me as an e-mail notification of a new topic being discussed on one of the physician only discussion boards that I am a part of. Apparently, after 40+ years of the profession’s existence, there is a grassroots effort afoot to upgrade the name, and presumably …

Medical education

Intern: A Doctor’s Initiation, an audiobook excerpt

Sandeep Jauhar, MD

May 11, 2010May 11, 2010

An audiobook except from Intern: A Doctor's Initiation, now available for download on iTunes. Intern: A Doctor's Initiation -- Click to play audioclip by Sandeep Jauhar, MD Chapter one I had been an intern less than an hour, and already…

An audiobook except from Intern: A Doctor’s Initiation, now available for download on iTunes.

Intern: A Doctor’s Initiation — Click to play audioclip

by Sandeep Jauhar, MD

Chapter one

I had been an intern less than an hour, and already I was running late. The sloping footpath leading up to the hospital was paved with gray cobblestones. My feet ached as my oversize leather …

Health policy

Health insurance will be reformed by a little known department

MedPage Today

May 11, 2010May 11, 20103

by Joyce Frieden In one of those “important but little noticed” announcements that government officials are prone to put out, the Department of Health and Human Services recently let the world know – via the Federal Register -- that it…

by Joyce Frieden

In one of those “important but little noticed” announcements that government officials are prone to put out, the Department of Health and Human Services recently let the world know – via the Federal Register — that it has created an Office of Consumer Information and Insurance Oversight to assist with implementation of the newly passed health insurance reform law.

This new office has four divisions. Here are a …

Conditions and diseases

Treating cancer needs to be an individual patient decision

Bruce Campbell, MD

May 11, 2010May 11, 20104

The heresy of one age becomes the orthodoxy of the next. -Helen Keller The patient returned to my clinic several years after her original thyroid cancer surgery. “The cancer blood test never went completely back to zero,” she told me.…

The heresy of one age becomes the orthodoxy of the next.
-Helen Keller

The patient returned to my clinic several years after her original thyroid cancer surgery. “The cancer blood test never went completely back to zero,” she told me. “We knew there was cancer in there somewhere. Finally, the new ultrasound machine found it! I guess it is time for more surgery!”

I guess. In my patient’s situation, the latest high resolution diagnostic …

Physician voices

ABIM: Quality medical care needs more than strong systems

Christine K. Cassel, MD

May 10, 2010May 10, 20108

A guest column by the American Board of Internal Medicine, exclusive to KevinMD.com. Imagine a sub-par doctor at a vibrant health system with care delivered and coordinated by skilled teams, using robust EHRs and other vital supports for physicians and…

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

Imagine a sub-par doctor at a vibrant health system with care delivered and coordinated by skilled teams, using robust EHRs and other vital supports for physicians and patients. Now imagine an extremely talented, knowledgeable doctor at an underfunded community clinic. This clinic has no real computer system, …

Health policy

Transparent medical pricing lowers health costs

Michael Kirsch, MD

May 10, 2010May 10, 20106

My friend, the Buckeye Surgeon, has resisted reforms in medical residency training programs, that have eased some of the inhumane exhaustion on young interns and residents. I have a different view on the subject. This issue generates spirited debate in…

My friend, the Buckeye Surgeon, has resisted reforms in medical residency training programs, that have eased some of the inhumane exhaustion on young interns and residents.

I have a different view on the subject. This issue generates spirited debate in the blogosphere and in teaching hospitals across the country.

Not all medical education reforms, however, provoke controversy. I learned recently from an Ohio medical student that they are now being taught …

Physician voices

Children with fever may not receive antibiotics in the ER

MedPage Today

May 10, 2010May 10, 2010

by John Gever Up to one-third of children with febrile bacterial infections failed to receive antibiotics in a large emergency department, while 20% of youngsters without such infections received antibiotics unnecessarily, Australian researchers said. A computer algorithm based on standard…

by John Gever

Up to one-third of children with febrile bacterial infections failed to receive antibiotics in a large emergency department, while 20% of youngsters without such infections received antibiotics unnecessarily, Australian researchers said.

A computer algorithm based on standard test results could do a better job of assigning feverish children to the correct treatment sooner, Jonathan C. Craig, MBChB, PhD, of the University of Sydney, and colleagues reported online in BMJ.

Although …

Physician voices

False patient contact information worsens emergency care

Kevin Pho, MD

May 10, 2010May 10, 2010

One of the biggest emergency room problems is contacting patients after they leave. Patients sometimes leave false contact information -- which makes it difficult for the emergency room staff should problems arise after the visit. The issue was illustrated in…

One of the biggest emergency room problems is contacting patients after they leave.

Patients sometimes leave false contact information — which makes it difficult for the emergency room staff should problems arise after the visit.

The issue was illustrated in a piece from msnbc.com. Many times, results like blood cultures or x-ray findings take time to return. And if there’s something that needs to be acted upon, contacting the …

Physician voices

Medical malpractice deposition survival tips for doctors

Ilene Brenner, MD

May 9, 2010May 9, 201048

An excerpt from How to Survive a Medical Malpractice Lawsuit: The Physician's Roadmap for Success. by Ilene R. Brenner, MD The most important part of your case is upon you: the pretrial deposition. If you do a poor job, you…

An excerpt from How to Survive a Medical Malpractice Lawsuit: The Physician’s Roadmap for Success.

by Ilene R. Brenner, MD

The most important part of your case is upon you: the pretrial deposition. If you do a poor job, you can ruin your case and make a defensible lawsuit become indefensible.

So what is a deposition? It is the sworn testimony of a witness taken before trial, in a location …

Physician voices

Online dermatology visits for acne can be effective

MedPage Today

May 9, 2010May 9, 2010

by Chris Emery Acne patients who received online treatment from dermatologists had similar outcomes to patients who were treated in the doctor's office, a new study found. Patients who participated in "e-visits" with dermatologists experienced similar reductions in inflammatory lesions…

by Chris Emery

Acne patients who received online treatment from dermatologists had similar outcomes to patients who were treated in the doctor’s office, a new study found.

Patients who participated in “e-visits” with dermatologists experienced similar reductions in inflammatory lesions as those who had office visits, Alice J. Watson, MBChB, MRCP, MPH, of the Center for Connected Health in Boston, and colleagues wrote in the report, published online April 19 in the …

Conditions and diseases

How PCOS can be diagnosed and treated in primary care

Jill of All Trades, MD

May 9, 2010May 9, 2010

Hypothetical case scenario 27-year old female presents to the office with a complaint of irregular periods. Menarche was at age 15, and periods occur about 1-2 times a year. Breast development began at age 9, followed shortly by axillary &…

Hypothetical case scenario

27-year old female presents to the office with a complaint of irregular periods. Menarche was at age 15, and periods occur about 1-2 times a year. Breast development began at age 9, followed shortly by axillary & pubic hair. Growth spurt was at age 13. She’s been trying to get pregnant for the last one year now, and has never been seen before for her irregular periods.

On physical …

Real physician voices, twice a week

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