KevinMD.com

April 21, 2010Apr 21, 20103

by Kristina Fiore If you're surrounded by heavy drinkers, you're more likely to become one, new research shows. An analysis of data on alcohol consumption and social networks found that people are 50% more likely to drink heavily if someone…

by Kristina Fiore

If you’re surrounded by heavy drinkers, you’re more likely to become one, new research shows.

An analysis of data on alcohol consumption and social networks found that people are 50% more likely to drink heavily if someone they’re directly connected to does so, Nicholas Christakis, MD, PhD, of Harvard University, and colleagues reported in the Annals of Internal Medicine.

“We’ve found that the influence of your friends and people you …

Patient voices

Sick friends could use your help

Duncan Cross

April 20, 2010Apr 20, 20105

Illness might be the most isolating and alienating experience a person can know. Lots of well people simply have no clue how to relate to someone with a chronic and catastrophic illness. That sort of thing is scary even just to witness. They hope (or assume) you’ll get better, and then they won’t have to deal with whatever you’re going through – but when that takes too long, they drift …

Read more…

Sick friends could use your help

Physician voices

Palliative care needs a simple and consistent message

Alex Smith, MD

April 20, 2010Apr 20, 20106

I was consulted recently about an elderly woman who refused surgery for a large bowel obstruction from a colonic mass, likely cancer. The inpatient team asked me to help with the transition to hospice and to help make her comfortable.…

I went to see her. She had a nasogastric tube sucking up brown material from her stomach. Her abdomen was swollen and uncomfortable. Her primary goal was to return to walking …

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Physician voices

MRSA control takes consistent time and effort

MedPage Today

April 20, 2010Apr 20, 20102

by Michael Smith It's possible to reduce the burden of drug-resistant pathogens in hard-hit hospitals -- all it takes is consistent effort over time, French researchers say. That's the conclusion after a 15-year, intensive program aimed at reducing the impact…

by Michael Smith

It’s possible to reduce the burden of drug-resistant pathogens in hard-hit hospitals — all it takes is consistent effort over time, French researchers say.

That’s the conclusion after a 15-year, intensive program aimed at reducing the impact of methicillin-resistant Staphylococcus aureus (MRSA) on Parisian hospitals reported in the March 22 Archives of Internal Medicine.

The program started in 1993 in the 38-hospital, 23,000-bed Assistance Publique-Hôpitaux de Paris, the largest …

Medical education

ACP: Challenges for a competency-based framework for residency training

American College of Physicians

April 19, 2010Apr 19, 2010

A guest column by the American College of Physicians, exclusive to KevinMD.com. by Steven Weinberger, MD, FACP Since the Accreditation Council for Graduate Medical Education (ACGME) instituted its Outcome Project approximately 10 years ago, residency training programs have progressively focused…

A guest column by the American College of Physicians, exclusive to KevinMD.com.

by Steven Weinberger, MD, FACP

Since the Accreditation Council for Graduate Medical Education (ACGME) instituted its Outcome Project approximately 10 years ago, residency training programs have progressively focused on how well their residents have acquired knowledge, skills and attitudes in six broad domains. These “general competencies” include medical knowledge, patient care, professionalism, interpersonal and communication skills, systems-based practice, and …

Conditions and diseases

President Obama should have had colonoscopy without sedation

Michael Kirsch, MD

April 19, 2010Apr 19, 20108

by Michael Kirsch, MD Does anyone out there know why President Obama underwent a virtual ‘colonscopy’ (VC) instead of a conventional colonoscopy earlier this year? In my gastroenterology practice, we do not offer colon cancer screening to 48-year-old individuals, unless…

by Michael Kirsch, MD

Does anyone out there know why President Obama underwent a virtual ‘colonscopy’ (VC) instead of a conventional colonoscopy earlier this year?

In my gastroenterology practice, we do not offer colon cancer screening to 48-year-old individuals, unless special risk factors are present. Of course, maintaining the president’s health is in the national interest, so I understand why professional screening guidelines might not apply to him. For …

Physician voices

Primary care needs better physical exam skills

MedPage Today

April 19, 2010Apr 19, 201017

by Joseph Biundo, MD Not long ago, primary care physician Rob Lamberts did a blog post about the economics of seeing Medicare and Medicaid patients, stating that doing so was bad business. While I agree with most of his points,…

by Joseph Biundo, MD

Not long ago, primary care physician Rob Lamberts did a blog post about the economics of seeing Medicare and Medicaid patients, stating that doing so was bad business. While I agree with most of his points, I have a quarrel with his statement that primary care physicians keep down the cost of care by keeping people healthy, away from specialists, and out of the hospital.

That may be …

Health policy

Health reform winners and losers, and how it affects doctors

Richard Reece, MD

April 19, 2010Apr 19, 201012

I congratulate President Obama and the Democrats on their historic health reform achievement. Will this bill be able to win approval as it runs the parliamentary gauntlet? Is it an act of political suicide that will become manifest in November?…

I congratulate President Obama and the Democrats on their historic health reform achievement.

Will this bill be able to win approval as it runs the parliamentary gauntlet? Is it an act of political suicide that will become manifest in November? Will it bankrupt the country because of lack of cost controls?

Regardless of where one stands, the bill is a political act of vast ambition and colossal risk.

Now may be a good …

Drugs and prescribing

Dabigatran is superior to warfarin, but at what cost?

John Mandrola, MD

April 18, 2010Apr 18, 20108

Dysrhythmias like atrial fibrillation (AF), more often than not, require medical therapy. The dreaded blood thinner, warfarin (Coumadin) comes to the fore often. In aggregate, I have likely spent months of my life discussing the risks and benefits of this…

Dysrhythmias like atrial fibrillation (AF), more often than not, require medical therapy.

The dreaded blood thinner, warfarin (Coumadin) comes to the fore often. In aggregate, I have likely spent months of my life discussing the risks and benefits of this much maligned drug. Common rat poison is made from the same ingredients as warfarin — only rats keep eating it and die days later of bleeding, while humans have the blood …

Physician voices

Patient appointment scheduling needs flexibility

Rosemarie Nelson

April 18, 2010Apr 18, 20106

The daily appointment schedule is often a sore spot in everyone's day: * Patients aren't completely satisfied because they can't get an appointment when they want one. * Physicians feel they've lost control of their day when the flow is…

The daily appointment schedule is often a sore spot in everyone’s day:

* Patients aren’t completely satisfied because they can’t get an appointment when they want one.
* Physicians feel they’ve lost control of their day when the flow is not running smoothly and they fall behind and patients complain.
* Nurses and medical assistants are frustrated at the hodgepodge of types of appointments that get scheduled seemingly without any consideration for timing …

Conditions and diseases

Prison affects how children relate to their parents

Jeffrey Knuppel, MD

April 18, 2010Apr 18, 2010

It’s an unfortunate scenario I’ve seen time and time again: * Parent goes to prison. * Child, who already felt neglected by parent, becomes more upset when parent ends up behind bars. Child either blames the parent for misbehavior that…

It’s an unfortunate scenario I’ve seen time and time again:

* Parent goes to prison.
* Child, who already felt neglected by parent, becomes more upset when parent ends up behind bars. Child either blames the parent for misbehavior that results in parent being taken away from child and/or blames him or herself (as children often do).
* Parent tries to have contact with child via phone calls, letters, or visits.
* Child decides …

Medical conditions as seen in the movies

Vineet Arora, MD

April 17, 2010Apr 17, 20105

I recently went to see Alice in Wonderland in 3D. This epic creation by part genius–part disturbed director Tim Burton features the wickedly talented method actor Johnny Depp as the ‘Mad Hatter.’ As I was watching Johnny Depp’s orange hair…

I recently went to see Alice in Wonderland in 3D.

This epic creation by part genius–part disturbed director Tim Burton features the wickedly talented method actor Johnny Depp as the ‘Mad Hatter.’ As I was watching Johnny Depp’s orange hair and freakish eyes, it occurred to me that some of the most popular fiction movies over the last several years have featured some notable legends and their medical …

Drugs and prescribing

Diet pills can be dangerous and should be used with caution

MedPage Today

April 17, 2010Apr 17, 2010

by Kristina Fiore Diet pills that are adulterated with undeclared pharmaceutical ingredients can be addictive, researchers say. In a case report, a 29-year-old female patient became addicted to Brazilian diet pills that contained unlabeled ingredients, and suffered subsequent psychiatric comorbidities,…

by Kristina Fiore

Diet pills that are adulterated with undeclared pharmaceutical ingredients can be addictive, researchers say.

In a case report, a 29-year-old female patient became addicted to Brazilian diet pills that contained unlabeled ingredients, and suffered subsequent psychiatric comorbidities, Benjamin R. Smith, BS, and Pieter A. Cohen, MD, of Harvard Medical School reported in The American Journal on Addictions.

“Given the rising prevalence of adulterated diet pills, increasing awareness among clinicians of …

Health policy

Op-ed: Health reform is missing malpractice and primary care fixes

Kevin Pho, MD

April 17, 2010Apr 17, 201034

The following op-ed was published on March 22nd, 2010 in CNN.com. With health reform passing the House, a comprehensive overhaul of our health care system draws another step closer. Coverage will expand to cover nearly 95 percent of legal U.S.…

The following op-ed was published on March 22nd, 2010 in CNN.com.

With health reform passing the House, a comprehensive overhaul of our health care system draws another step closer.

Coverage will expand to cover nearly 95 percent of legal U.S. residents. With a recent study showing that patients without health insurance have a shorter life span, coupled with the number of uninsured approaching 50 million in 2010, that is perhaps the …

Physician voices

Health costs are high, and here’s why

Toni Brayer, MD

April 16, 2010Apr 16, 201016

Health costs are high because the body is complicated and doctors and patients hate ambiguity. The cost is high because a missed diagnosis can lead to death and a large lawsuit. The cost is high because we have many specialists…

Let me give you a real life example.

My patient, Rick, is a brilliant attorney. He …

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Health costs are high, and here’s why

Physician voices

Breastfeeding rates cost the country billions

MedPage Today

April 16, 2010Apr 16, 201011

by Crystal Phend Poor compliance with breastfeeding recommendations costs the nation at least $13 billion each year, with nearly all of the cost related to infant morbidity and mortality, according to a comprehensive economic analysis. If 90% of new mothers…

by Crystal Phend

Poor compliance with breastfeeding recommendations costs the nation at least $13 billion each year, with nearly all of the cost related to infant morbidity and mortality, according to a comprehensive economic analysis.

If 90% of new mothers followed guidelines for six months of exclusive breastfeeding for their children, an estimated 911 deaths would be prevented annually, said authors Melissa Bartick, MD, MSc, of Harvard Medical School, and Arnold Reinhold, …

Medical education

ABIM: Maintenance of Certification – For the public

Chiduzie Madubata, MD

April 15, 2010Apr 15, 201013

A guest column by the American Board of Internal Medicine, exclusive to KevinMD.com. The debate about recertification recently in the New England Journal of Medicine and highlighted earlier this week on KevinMD.com and in an Associated Press article brings to…

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

The debate about recertification recently in the New England Journal of Medicine and highlighted earlier this week on KevinMD.com and in an Associated Press article brings to light some of the real challenges facing the future of the Maintenance of Certification (MOC) program.

I have been through …

Physician voices

Physicians are leaving medicine for alternative careers

Joseph Kim, MD, MPH

April 15, 2010Apr 15, 20107

When physicians choose to leave clinical medicine to pursue alternative careers, what motivates them to make such changes? Is it money? More time with family? Scheduling flexibility? Avoiding litigation? To pursue new challenges? Maybe you're getting bored with medicine. Depending…

Depending on that key motivating factor, physicians end up choosing all types of career paths. For instance, let’s take a look at some of these motivators:

Money. Let’s face it. Some physicians love …

Physician voices

Checklists help reduce hospital deaths

MedPage Today

April 15, 2010Apr 15, 20103

by Michael Smith The use of treatment checklists for 13 common diagnoses was associated with a dramatic reduction in patient deaths at three London hospitals, researchers said. The year the checklists were introduced, the three facilities in the North West…

by Michael Smith

The use of treatment checklists for 13 common diagnoses was associated with a dramatic reduction in patient deaths at three London hospitals, researchers said.

The year the checklists were introduced, the three facilities in the North West London Hospitals NHS Trust registered 255 fewer deaths than the previous year, according to Brian Jarman, PhD, of Imperial College London, and colleagues.

The targeted diagnoses accounted for 174 fewer deaths than the …

Read more…

Checklists help reduce hospital deaths

Physician voices

Primary care doctors are saying farewell

Aldebra Schroll, MD

April 14, 2010Apr 14, 201016

It has been three months since I closed the door on my primary care office for the last time. It was with a heavy heart that I said goodbye to the many patients I cared for over the last six…

It has been three months since I closed the door on my primary care office for the last time. It was with a heavy heart that I said goodbye to the many patients I cared for over the last six years. I am the fourth physician to leave the practice in as many years.

As the economy faltered, I found my private office practice had simply become unsustainable. With the popularity …

Real physician voices, twice a week

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