KevinMD.com

How the primary care doctor shortage threatens Obama’s health reform plan

Kevin

Physician

April 27, 2009

Top story in The New York Times.

Excellent.

There’s hope that maybe, just maybe, we’re getting through to the decision makers in Washington.

The article itself is old news to regular readers of this blog, and regurgitates many of the arguments impeding health reform, as well as the problems in solving them.

“Obama administration officials, alarmed at doctor shortages, are looking for ways to increase …

HealthHarbor: Health IT stimulus leads to more questions than answers

Kevin

Health Technology

April 25, 2009

The following is a reader take from the staff at HealthHarbor.

We had a chance to attend the HIMSS conference two weeks ago. HIMSS is healthcare’s premier annual tech expo, and was in Chicago this year. The undeniable theme of this year’s conference was the anticipated expansion of Health Information Technology (HIT) via the Economic Recovery Act. …

Op-ed: Not all screening tests lead to early, better treatment

Kevin

Conditions and Diseases

April 23, 2009

The following op-ed was published on April 23rd, 2009 in the USA Today.

As a primary care doctor, it’s heartening to hear President Obama call for “the largest investment ever in preventive care.” That means more people, for one, will be undergoing tests to screen for various forms of cancer. But this might be one of those cases where what sounds like common sense is actually more …

6 top medical comments, April 19th 2009

Kevin

Uncategorized

April 19, 2009

Here are some of the more interesting comments readers have left recently.

1. Manalive on quality measures:
It is almost always a leap of faith to apply evidence-based guidelines to the frail elderly, to patients with many medical problems, to alcoholics, to the poorly insured — in short, to a large percentage of my practice. Accordingly, I have been on the wrong end of too many …

Read more…

6 top medical comments, April 19th 2009

5 top medical comments, April 12th 2009

Kevin

Uncategorized

April 12, 2009

Here are some of the more interesting comments readers have left recently.

1. Dr. Gwenn on limited health literacy:
For us to do a better job with patients and teach them to be better advocates for themselves, we need more time – plain and simple. At the same time, patients need more community supports to understand the complex health world and build the skills they need …

Read more…

5 top medical comments, April 12th 2009

What happens if you swallow a pair of scissors

Kevin

Potpourri

April 11, 2009

Cool x-rays, but more importantly, why was this man cleaning his teeth with a pair of scissors in the first place?

(via Shadowfax)

What happens if you swallow a pair of scissors

Edwin Leap: Who pays when politicians commit malpractice?

Edwin Leap, MD

Physician

April 2, 2009

My kids love to play Monopoly. They delight in acquiring properties, making money and crushing their siblings. They play with passion and savagery. That is, until recently. A couple of weeks ago I walked past the Monopoly board, spread on the floor between my children and their dear friend Tyler.

“˜How’s it going guys?’

“˜Great game, but we all ran out of money. So, we just put some more money on the …

Most hospitalists are good, but some, like these ones, aren’t

Kevin

Physician

April 1, 2009

It’s a well known phenomenon that hospitalists are taking over inpatient medicine.

And no wonder, the payment system strongly discourages newly minted doctors to practice outpatient medicine, and the demand that hospitals have for inpatient physicians is surging at an unprecedented rate.

It’s a good time to be a hospitalist, but, as this reader writes to me, that may lead to an increasingly variability in the quality …

Half MD: How to fix the scramble before Match Day

Kevin

Medical Education

March 31, 2009

The following is reader take by Half MD.

The third Thursday of March each year is Match Day for fourth-year medical students. There are many smiles and frowns made on this day when soon-to-be doctors discover where they will obtain their first job to continue their medical training. While Match Day is the most famous day of the week, Monday and Tuesday are the …

Nighthawks, dayhawks, and the demise of the American radiologist

Kevin

Physician

March 29, 2009

More hospitals are resorting to so-called “dayhawk” radiology services to read their x-rays.

It’s modeled after the “nighthawk” model, where radiologists (via Shadowfax), in some cases as far away as India, remotely read films in the middle of the night.

Now, the phenomenon is happening during business hours as well, which according to radiologist Giles W. L. Boland, means that “some radiologists can no longer assume long-term …

Op-ed: Unbiased research for doctors is good medicine

Kevin

Health Policy

March 26, 2009

The following op-ed was published on March 26th, 2009 in the USA Today.

As a primary care doctor, I am frequently faced with decisions where the choice is not always clear. Do the latest, more expensive drugs work better than the less costly, older medications? Will ordering an MRI help me treat a patient’s lower back pain? Often, the answer to these questions is, “I’m not sure.”

Because …

Should the MCAT grant extra time for students with learning disabilities?

Kevin

Medical Education

March 22, 2009

A recent California court denied extra time for aspiring medical students with dyslexia and attention deficit disorder when taking the MCAT.

The body that administers the test has to straddle a delicate line, in granting extra time to a broadening definition of the disabled student versus maintaining the overall fairness and integrity of the high stakes test.

Despite the ruling, three of the four plaintiffs have gone …

Did the Canadian health system fail Natasha Richardson?

Kevin

Physician

March 20, 2009

Would Natasha Richardson be alive today if she had gone skiing in the United States instead?

I don’t think it would have made a difference.

To recap the tragedy, Ms. Richardson died from an epidural bleed, after she fell while skiing. Her presentation was somewhat classic, with the well-described “lucid” period before she deteriorated.

According to Canada’s Globe and Mail, “ambulance workers were not …

Is Natasha Richardson brain dead? Was an epidural bleed, or “talk and die” syndrome, to blame after her ski accident?

Kevin

Physician

March 18, 2009

Tragic news this morning regarding actress Natasha Richardson, who reportedly, suffered a head injury during a ski lesson in Canada.

According to reports, she fell on a beginner’s ski hill, and did not hit anyone or anything during the fall. There was no obvious sign of injury, and in fact, she was “was walking around and feeling fine for an hour after her accident.”

Things then …

Will reforming the malpractice system be a deal breaker for health reform?

Kevin

Physician

March 17, 2009

In a surprise, President Obama has signaled a willingness to discuss medical liability as part of the health reform process.

Good for him for standing up to the trial lawyers, a core constituency of the left.

That’s a good sign, as the costs of defensive medicine brought on by the broken malpractice system, should be addressed if there is any hope of reducing health care spending.
Read more…

Will reforming the malpractice system be a deal breaker for health reform?

Will patients or doctors be the biggest obstacle impeding health care reform?

Kevin

Health Policy

March 10, 2009

If both patients and doctors don’t accept the changes required of their behavior, no amount of comparative effectiveness studies will cut health care spending.

Two prominent medical journalists write as much in their respective blogs.

First, the NY Times’ Tara Parker-Pope notes that patients have to realize that, yes, they should demand the best care possible. However, that means, “we will have to accept that ‘best’ …

Why do I need a rectal exam, and what can doctors find with the gloved finger?

Kevin

Conditions and Diseases

March 6, 2009

Have you ever wondered why doctors have to perform a digital rectal exam?

Well, look no further, as primary care doctor Rob Lamberts gives us the answers discerning readers demand.

Simply by looking at the rectum, which by the way, indeed “takes some getting used to,” can lead to significant diagnostic findings. Furthermore, does tight sphincter tone matter? And should you be worried about the large hands …

Relative value units, and how the RVU payment system doesn’t allow doctors to practice good medicine

Kevin

Health Policy

March 5, 2009

For those who don’t know, every piece of work that a doctor performs is quantified and measured.

The base unit of physician work is known as the relative value unit (RVU). Most physician salaries are determined by the amount of RVUs a doctor produces in a given year, and in most cases, can range between$35 and $45 per RVU in primary care, depending on geographic location and …

Op-ed: Pads, pens, prescriptions

Kevin

Medications

February 26, 2009

The following op-ed was published on February 26, 2009 in the USA Today.

Have you ever noticed the pens, coffee mugs and prescription pads at your doctor’s office? Chances are, they were prominently adorned with the brand name of the prescription drug its company is touting.

The pharmaceutical industry has been giving these types of small gifts to doctors for years, in hopes of raising physician awareness of …

Read more…

Op-ed: Pads, pens, prescriptions