KevinMD.com

April 10, 2010Apr 10, 20104

by Crystal Phend Only one person in 40 has an extraordinary ability to do safely what many take for granted in daily life -- talk on a cell phone while driving. These "supertaskers" excelled on a simulated driving exercise and…

by Crystal Phend

Only one person in 40 has an extraordinary ability to do safely what many take for granted in daily life — talk on a cell phone while driving.

These “supertaskers” excelled on a simulated driving exercise and a demanding, simultaneous test of memory and math skills conducted over the phone without any loss in performance on either, according to Jason M. Watson, PhD, and David L. Strayer, PhD, both …

Health policy

Op-ed: Patient satisfaction doesn’t mean the best medical care

Kevin Pho, MD

April 10, 2010Apr 10, 201016

A version of this op-ed was published on March 15th, 2010 in the USA Today. If you recently saw a doctor, you might subsequently receive a survey in the mail asking whether your physician was friendly, spent enough time with…

A version of this op-ed was published on March 15th, 2010 in the USA Today.

If you recently saw a doctor, you might subsequently receive a survey in the mail asking whether your physician was friendly, spent enough time with you, or showed the appropriate level of concern for your medical issues.

Patient satisfaction surveys are being increasingly used in hospitals nationwide. Press Ganey, a leading organization measuring patient satisfaction, counts more …

Drugs and prescribing

Children who are traumatized need more than medication

Claudia M. Gold, MD

April 9, 2010Apr 9, 2010

In the Academy Award winning film, Precious, the main character’s transformation comes about largely through her ability to tell the story of her trauma, specifically in the form of writing. In this endeavor she is encouraged by a loving teacher.…

In the Academy Award winning film, Precious, the main character’s transformation comes about largely through her ability to tell the story of her trauma, specifically in the form of writing. In this endeavor she is encouraged by a loving teacher.

In the book History Beyond Trauma, two French psychoanalysts argue that symptoms their patients exhibit represent the horrors of war that are not spoken of, sometimes for generations. The patient is …

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Patient voices

Patient beliefs and their role in non-adherence

Steve Wilkins, MPH

April 9, 2010Apr 9, 20105

Patient non-adherence is a big problem. Non-adherence among chronic disease patients is associated with higher rates of hospital re-admissions, higher costs and poorer outcomes. Research has identified over 200 possible factors thought to influence patient adherence. According to the experts,…

Patient non-adherence is a big problem. Non-adherence among chronic disease patients is associated with higher rates of hospital re-admissions, higher costs and poorer outcomes.

Research has identified over 200 possible factors thought to influence patient adherence. According to the experts, these factors can be categorized into two groups:

1. unintentional non-adherence
2. intentional non-adherence.

Unintentional non-adherence is related to a patient’s ability and resources to take their medication (e.g., problems with manual …

Physician voices

Retail clinics are starting to do more primary care

MedPage Today

April 9, 2010Apr 9, 201015

by Joyce Frieden Retail clinics aren't just for strep throats any more; they'll also be managing diabetes and other chronic diseases. "It's a new service strategy," Sandra Ryan, CPNP, told attendees at a meeting on retail clinics sponsored by the…

by Joyce Frieden

Retail clinics aren’t just for strep throats any more; they’ll also be managing diabetes and other chronic diseases.

“It’s a new service strategy,” Sandra Ryan, CPNP, told attendees at a meeting on retail clinics sponsored by the Convenient Care Association and the Jefferson School of Population Health.

“We’re evolving our clinic offerings,” said Ryan, chief nurse practitioner officer for Take Care Health Systems, which operates retail clinics inside Walgreens pharmacies, …

Health policy

AMA: Health reform victories for physicians and what still needs to be done

American Medical Association & J. James Rohack, MD

April 8, 2010Apr 8, 201043

A guest column by the American Medical Association, exclusive to KevinMD.com. by J. James Rohack, MD As our country turns the corner on the historic path toward health system reform, many physicians are left with questions as to how this…

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

by J. James Rohack, MD

As our country turns the corner on the historic path toward health system reform, many physicians are left with questions as to how this new law will affect them and their patients.

The AMA has been an active participant in the health reform debate since the beginning and guided by our House of Delegates, …

Medical education

Medicine residency survival tips during pregnancy

Anonymous

April 8, 2010Apr 8, 20105

Q. I just found out last week that I'll be a new mom in November, making me an official mother in medicine! I've been reading the blog for a while, because I love hearing what all of you have to…

Q. I just found out last week that I’ll be a new mom in November, making me an official mother in medicine! I’ve been reading the blog for a while, because I love hearing what all of you have to say about your lives. Here’s my question: What tips would you give for surviving residency while pregnant, especially 30-hour calls (without caffeine)?

— From a future mom and Family Medicine resident …

Patient voices

Advance planning helps families cope with loss

MedPage Today

April 8, 2010Apr 8, 2010

by Crystal Phend Advance planning improves end-of-life care for elderly patients and helps families cope with the loss, researchers found. In a randomized trial, hospitalized patients over age 80 who were formally assisted with documenting their end-of-life treatment wishes and…

by Crystal Phend

Advance planning improves end-of-life care for elderly patients and helps families cope with the loss, researchers found.

In a randomized trial, hospitalized patients over age 80 who were formally assisted with documenting their end-of-life treatment wishes and with designating a surrogate were almost three times more likely to have those wishes followed (86% versus 30% in usual care, P<0.001).

Family members of patients in the advance planning intervention reported significantly …

Physician voices

Preventive medicine may not always help patients

Amy Tuteur, MD

April 8, 2010Apr 8, 201014

If there's one thing everyone agrees on, it's that preventive care is always a good thing. Well, I'm a doctor and I'm afraid of preventive medicine. The theory behind preventive medicine is sound. It is better to treat prevent disease…

If there’s one thing everyone agrees on, it’s that preventive care is always a good thing. Well, I’m a doctor and I’m afraid of preventive medicine.

The theory behind preventive medicine is sound. It is better to treat prevent disease than to treat it. It is better to refrain from smoking and never get lung cancer than it is to treat lung cancer. It is better to refrain from alcohol abuse …

Drugs and prescribing

Psychiatry benefits when psychologists prescribe drugs

Daniel J. Carlat, MD

April 7, 2010Apr 7, 201030

I want to touch on what is probably the hottest topic in psychiatry: whether psychologists should obtain prescription privileges. This is topical because Oregon just overwhelmingly passed a law authorizing prescriptive privileges for psychologists, although it is unclear whether the…

I endorse psychologists prescribing, and here’s why: it would be the single best thing that could happen to psychiatry.

Yes, I know it sounds ridiculous, but …

Conditions and diseases

Epidemiology and how confounding statistics can confuse

Marya Zilberberg, MD, MPH

April 7, 2010Apr 7, 2010

Now, as you know, I am a big fan of epidemiology. I do not believe that a randomized controlled trial is the be-all-and-end-all in evidence generation, and a well done observational study can add to our reservoir of knowledge much more efficiently. Of course, I, as many others, acknowledge certain limitations of epidemiologic design. However, many of them can be overcome with careful design and analysis.

I have to confess, though, …

Drugs and prescribing

Chronic pain patients may have been disobedient children

MedPage Today

April 7, 2010Apr 7, 201018

by Nancy Walsh Children who are irritable or disobedient, or who steal or bully others, are at risk for chronic pain in middle age, a large prospective study found. Youngsters who had persistent behavior problems at ages seven, 11, and…

by Nancy Walsh

Children who are irritable or disobedient, or who steal or bully others, are at risk for chronic pain in middle age, a large prospective study found.

Youngsters who had persistent behavior problems at ages seven, 11, and 16 years had more than twice the risk of widespread chronic pain at age 45 as other children (RR 2.14, 95% CI 1.43 to 3.21), according to Dong Pang, PhD, of the …

Physician voices

Patient advance directives are critical in the ICU

Shantanu Nundy, MD

April 6, 2010Apr 6, 20103

When someone dies at home we call it ‘going to a better place.’ When someone dies in the hospital we call it a ‘code.’ Recently, working in the cardiac ICU, I have been thinking a lot about code status. Code…

When someone dies at home we call it ‘going to a better place.’ When someone dies in the hospital we call it a ‘code.’

Recently, working in the cardiac ICU, I have been thinking a lot about code status. Code status is the medical term that describes what a patient’s wishes are should his or her heart stop or lungs fail. While code status is not a topic that typically …

Physician voices

Hospital admissions may require watching and waiting

Edwin Leap, MD

April 6, 2010Apr 6, 20107

A sweet little lady came to the emergency department recently. She said she felt short of breath and sweaty at home. In the department, she looked like a rose! Normal oxygen levels, normal labs. Her chest x-ray had a faint area that ‘one might possibly imagine could perhaps be’ a pneumonia. It looked remarkably like her previous film.

But her history was concerning to me, and it was concerning to …

Health technology

iPad in the ER, a hands on physician review

Larry Nathanson, MD

April 6, 2010Apr 6, 20107

I had been anxiously awaiting the arrival of my iPad. This is the form factor I have been asking (begging) of all the vendors for years. I'm very happy to say that it appears to be living up to my…

I had been anxiously awaiting the arrival of my iPad. This is the form factor I have been asking (begging) of all the vendors for years. I’m very happy to say that it appears to be living up to my high expectations.

The screen is gorgeous. It’s very clear and bright, I had no trouble seeing the screen in bright outdoor light. The machine seems extremely responsive — it …

Health policy

Don Berwick to lead Medicare and Medicaid

Robert Wachter, MD

April 6, 2010Apr 6, 20102

While the health reform bill will have many effects, one of its most profound will be to unshackle the Centers for Medicare & Medicaid Services (CMS). Under the legislation, CMS is now far freer to undertake a variety of pilot…

While the health reform bill will have many effects, one of its most profound will be to unshackle the Centers for Medicare & Medicaid Services (CMS).

Under the legislation, CMS is now far freer to undertake a variety of pilot programs and demonstration projects designed to improve quality, safety and efficiency, and to convert the successful ones into policy. And, if that wasn’t enough for those who have long been praying …

Physician voices

Social work is key to quality patient care

Ken Covinsky, MD

April 5, 2010Apr 5, 20104

In 1927, Francis Peabody remarked that, "The secret of the care of the patient is in caring for the patient." Medicine has made much progress since those days, but some might argue that some of the humanitarian cornerstones of caring…

In 1927, Francis Peabody remarked that, “The secret of the care of the patient is in caring for the patient.”

Medicine has made much progress since those days, but some might argue that some of the humanitarian cornerstones of caring that concerned Peabody have been lost. Of course, there are many health professionals that still embody this caring ethic. And in today’s era, perhaps the group that best personifies this central …

Health policy

Medicare denies a brain tumor drug after a patient moves

John Fauber

April 5, 2010Apr 5, 201010

For nearly a decade, Paula Oertel's brain tumor was kept at bay by a drug that was not approved to treat her condition. Then Oertel did something she never imagined would jeopardize her health. She moved -- less than 30…

For nearly a decade, Paula Oertel’s brain tumor was kept at bay by a drug that was not approved to treat her condition. Then Oertel did something she never imagined would jeopardize her health.

She moved — less than 30 miles — from one county in Wisconsin to another.

That move triggered a review of her health insurance from Medicare, which eventually led to a loss of coverage, including the drug.

The …

Physician voices

Aortic dissection symptoms and current treatment options

Joseph Lombardi, MD

April 4, 2010Apr 4, 2010

by Joseph Lombardi, MD You probably remember the tragic death of actor John Ritter in 2003. Recently, his family partnered with the Thoracic Aortic Disease (TAD) Coalition to shed light on the condition that took his life: aortic dissection. In…

by Joseph Lombardi, MD

You probably remember the tragic death of actor John Ritter in 2003.

Recently, his family partnered with the Thoracic Aortic Disease (TAD) Coalition to shed light on the condition that took his life: aortic dissection.

In addition to TAD Coalition’s “Ritter Rules,” which focus on recognizing, treating and preventing the condition, the American Heart Association and American College of Cardiology also released new guidelines designed to prevent unnecessary …

Real physician voices, twice a week

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