KevinMD.com

A routine brain MRI can lead to incidental findings

MedPage Today

Conditions and Diseases

September 10, 2009

by Nancy Walsh, Contributing Writer, MedPage Today

Almost 3% of healthy, asymptomatic people who underwent MRI brain scans showed incidental abnormalities in a recent study, leading researchers to express concern about psychological and medical fallout from these increasingly popular screenings.

In meta-analysis of MRI brain scans, the prevalence of neoplastic incidental findings was 0.70% (95% CI 0.47 to 0.98), while the …

Family caregivers are the unsung heroes of our health system

Ken Covinsky, MD

Patient

September 9, 2009

Long term care is a hot topic. When people talk about long term care, they are generally talking about nursing homes. Policy makers put a lot of attention on nursing homes because they cost so much money. About half of nursing home care is paid out of public dollars. In California, in the setting of our state budget fiasco, the high cost of nursing home care to the state has …

Does counseling kids to lose weight and increase exercise work?

MedPage Today

Patient

September 9, 2009

by Todd Neale, Staff Writer, MedPage Today

Overweight and obese children who received counseling from a family doctor did not lose more weight or get more exercise than youngsters who did not receive counseling, Melissa Wake, MD, of Royal Children’s Hospital in Melbourne, and colleagues reported online in the British Medical Journal.

Because the screening and counseling are so expensive, …

The value of a cancer diagnosis second opinion

Wendy S. Harpham, MD

Conditions and Diseases

September 8, 2009

Here are words any patient awaiting cancer surgery would be thrilled to hear: “We are canceling your upcoming operation! It turns out that the suspicious changes we saw on your recent biopsy are completely benign.”

This happy turn of events happened in my life recently, thanks to a second opinion from a type of physician few patients realize plays a critical role in their care: the pathologist.

Pathologists are medical doctors who …

Do resident work-hour restrictions increase surgical complications?

MedPage Today

Medical Education

September 8, 2009

by Chris Emery, Contributing Writer, MedPage Today

Reductions in resident physician work-hours at teaching hospitals in 2003 were associated with an increase in complications related to surgery to repair hip fractures, a new study found.

The rates of pneumonia, hematoma, renal complications, and blood transfusions associated with hip surgery rose disproportionally at teaching hospitals compared to other hospitals after resident …

Rising health care costs and the tax preference for employer-based health insurance

Kevin

Health Policy

September 8, 2009

by Robert Berry, MD

In his column, David Brooks of The New York Times effectively compares our rapidly rising health care costs to “a stampede of big ugly rhinos.” What he ignores, however, is the huge elephant in the room that is largely responsible for this rhino stampede – the tax preference for employer-based health insurance.

This tax preference – enjoyed primarily by employees of large businesses and government at …

What Mozart can teach us about superbugs and antibiotic resistance

Kevin

Conditions and Diseases

September 6, 2009

by Maya Sequeira

Composer Wolfgang Amadeus Mozart’s death in 1791 has long been a mystery, but a new study published in the Annals of Internal Medicine suggests that it was, of all things, a common strep infection that killed the maestro at the age of 35.

Researchers speculate that Mozart contracted the strep infection—easily treatable today—from a fellow musician who had been hospitalized at a crowded military hospital in Vienna. It’s not …

The drama of using tPA in stroke within the three-hour window

Doctor Grumpy, MD

Conditions and Diseases

September 6, 2009

Before telling this story, I’m going to have to lay some background for my non-medical readers.

The most obscene word in English, in my opinion, has three letters and is an acronym. It’s tPA (it stands for Tissue Plasminogen Activator).

This drug gets a lot of press as a “clotbuster.” It has the potential to break down clots and reverse a stroke. That potential, however, has a dark side. By breaking down …

eRoentgen for the iPhone puts a radiologist by your side

Kevin

Conditions and Diseases

September 5, 2009

The following is a sponsored guest post by Constantine Brocoum, a radiologist in Concord, NH. I have personally used eRoentgen, and recommend the product without reservation.

by Constantine Brocoum, MD

Like most inventions, eRoentgen was developed to respond to a need. As a practicing radiologist, I take frequent calls from primary care providers who need assistance in choosing the smartest way to diagnose their patients’ illnesses. They often need …

10 things your insured patients need to know about health care reform

Kevin

Health Policy

September 4, 2009

by Paula Hartman Cohen

My husband and I live in Massachusetts, a state that already has health care reform.

On April 12, 2006, our state legislature enacted a law requiring all residents to have health insurance.

They could buy it themselves, they could buy it from their employer through a group plan or, if their income was below a certain level, they could buy it from the state at a reduced rate. This …

Does being on the America’s Best Hospitals list affect patient outcomes?

Charles Bankhead

Physician

September 4, 2009

by Charles Bankhead, Staff Writer, MedPage Today

A news magazine’s rankings of top-rated hospitals for heart failure care did not include many hospitals that performed at least as well as the ranked centers, according to a comparison of the magazine’s list and government data.

Hospitals that made the U.S. News & World Report list had a better 30-day mortality than …

How hospitalists can provide high quality patient care at the lowest possible cost

Robert Wachter, MD

Physician

September 3, 2009

Much has been made of the superior performance – on both cost and quality – of integrated health care organizations like the Mayo and Geisinger Clinics. But since the defining characteristic of these standout systems is at least 50 years of integrated history, few believe that the rest of us – namely the docs and hospitals that provide the bulk of American health care – can quickly achieve such seamless …

The ultrasound that saved a baby girl’s life

Kevin

Patient

September 3, 2009

by Linda Lee, MD

Bob Hebert, in his column in The New York Times, recently wrote that, “Life in the United States is mind-bogglingly violent. But we should take particular notice of the staggering amounts of violence brought down on the nation’s women and girls each and every day for no other reason than who they are. They are attacked because they are female.”

As a family physician I can …

What can health reform in the United States learn from Africa?

Dr. Martin Young

Health Policy

September 2, 2009

As an outside observer of the American health reform debate, I cannot help but notice the disparity of views, the fractured arguments, the protectionism and desperation. My country is in a similar struggle for health care reform, with the main difference being America is a rich nation, and we are poor by comparison. In both debates, however, I have looked for the humanitarian argument, and in many cases found it …

Is alternative health a form of fundamentalism?

Amy Tuteur, MD

Physician

September 1, 2009

There once was a time when all food was organic and no pesticides were used. Health problems were treated with folk wisdom and natural remedies. There was no obesity, and people got lots of exercise. And in that time gone by, the average lifespan was … 35!

That’s right. For most of human existence, according to fossil and anthropological data, the average human lifespan was 35 years. As recently as 1900, …

Health care reform: The uncivil war dividing America

American College of Physicians

Health Policy

August 31, 2009

The following is part of a series of original guest columns by the American College of Physicians.

by Steven Weinberger, MD, FACP

The unfettered debate about ideas that characterizes the democratic process in the United States operates best when there is a truthful presentation of the issues, and when the process is civil and respectful. Unfortunately, the debate about health care reform has evolved to the point that it …

How a wealth of information takes attention away from the patient

Kevin

Patient

August 31, 2009

by Abraham Verghese, MD

This month I am the attending physician overseeing an internal medicine team, one of four such teams that admit patients to my teaching hospital. It’s a great time to be an attending physician. I have seasoned interns who in just a few weeks will be junior residents, and I have even more seasoned senior residents on their way to entering practice or entering subspecialty training. The team …

Health care as a futures exchange

Kevin

Health Policy

August 30, 2009

by Susan H

It seems that health insurers are serving as exchange and clearing firm for “health futures” traders. Traders of “health futures” are potential patients, and health care providers. Patients are synthetic buyers of futures on health care provision, doctors and providers of medical goods and services are short sellers of those futures. The exchange and clearing firm (health insurer) represents that it serves to stand as guarantor in the …

Read more…

Health care as a futures exchange

Why following a delayed vaccine schedule may be dangerous

Kevin

Conditions and Diseases

August 29, 2009

by Steve Perry, MD

I recently read a post by Dr. Bob Sears which listed several “Vaccine Friendly Doctors” in Colorado and across the nation.

As a pediatrician and vaccine advocate, I thought I’d be on this list. I am “vaccine-friendly doctor” who works with moms and dads to find the best health care plan for their babies. I read the information on both sides of the issue and weighed the science …

Are relationships being lost in medicine, and are hospitalists partly responsible?

Edwin Leap, MD

Physician

August 29, 2009

An emergency physician, like me, may be the worst possible person to discuss relationships with patients. I mean, one of the reasons I chose this specialty was that I didn’t want long-term relationships with my patients. I see, now, that God has a great sense of humor.

See, the county I landed in after residency is small enough that I do know many of my patients, and I do see them …