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Medicare “Advantage” for my indigent patients

Policy

December 4, 2022

Despite the aggressive marketing, Medicare Advantage plans offer little benefit for poor and vulnerable patients.

Consider my patient C, who was in pain from her knee arthritis. She was often in pain, but now her new pain medication helped her less than her previous one. She also wanted her old asthma inhaler back as the new one was harder to use. We had changed all her medications since her new Medicare …

7 things I’ve learned after 12 years of private relationship-based direct care in Canada

Jean Paul Brutus, MD

Physician

December 4, 2022

I’m a hand surgeon. After six years of academic practice, I opted out of the public and universal health care system my country is famous for to create the first private hand surgery practice in Montreal, Canada. That was 12 years ago.

Opting out of the system means that I do not get any payment or reimbursement from the government in a country where private insurance does not pay for private …

Don’t blame Big Pharma for insulin’s problems

Rushi Nagalla

Policy

December 4, 2022

For diabetics, insulin matters as much as H2O. Unfortunately, insulin’s a hell of a lot more expensive than bottled water. High insulin prices force approximately nine million Americans to balance their wallet and well-being.

The American Action Forum reported that a type-one diabetic’s average yearly expense for insulin was $~6000 (i.e., $500/month). It’s easy to lambast Big Pharma companies for the current state of insulin’s affairs, but history and market behavior …

Bulletproof backpacks: There’s more we can do [PODCAST]

The Podcast by KevinMD

Podcast

December 3, 2022

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“As a parent of elementary school children, every mass shooting, particularly ones killing school children like in Uvalde, jolts my doing-the-mom-thing-just-keep-busy-can’t-stop denial. On the last day of school before summer vacation, when the bus doors squeaked open, …

The unstoppable momentum of a medical “fact” with no source

Katrina Firlik, MD

Physician

December 3, 2022

When I started my company in 2009, personal experience was a driving force in identifying the problem I wanted to help solve. As a neurosurgeon, I often treated patients who were neurologically devastated by acute bleeding in the brain after years’ worth of poorly controlled high blood pressure. In many cases, when I asked the family why the patient quit taking their hypertension medication, they described the patient as “not …

Bring the real You to your workplace

Randall S. Fong, MD

Physician

December 3, 2022

Life is short, so make yours extraordinary. Capitalize on what makes you, YOU, and be your own unapologetic self.

The Almighty designed us as unique but imperfect and flawed individuals, prone to sin and blundering error. But that’s the great part of being human; we’re expected to sin, blunder, and make mistakes. We’re made to err for the sake of learning and growth; otherwise, we’d wither into uninspiring nothingness. Keep this …

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Bring the real You to your workplace

Migrants need and deserve access to healthy lives in the U.S.

Padraic Stanley, MSW, LCSW

Policy

December 3, 2022

Anti-immigrant rhetoric was at an all-time high during the midterm election season, and now as the 2024 presidential election gathers momentum, it is urgent to note how it fosters violence against immigrant communities and creates a chilling effect.

Texas Gov. Greg Abbott continues busing immigrants to sanctuary cities from Texas, including new arrivals in Philadelphia, and Florida Gov. Ron DeSantis defends his practice of sending immigrants to …

Preventing prostate cancer with simple, proactive choices [PODCAST]

The Podcast by KevinMD

Podcast

December 2, 2022

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“You have the power to make healthier choices to reduce your risk for prostate cancer. While things like genetics are out of your control, there is a wealth of research showing that there are simple ways to …

A case against real estate syndications

Harry Nima Zegarra, MD

Finance

December 2, 2022

If you like real estate, you may have heard the term “real estate syndications.” This is a fancy term for group investment, where several people get together to acquire a big asset (like an apartment complex), they form an LLC, and there are active investors who manage the property and passive investors who help with the capital for the down payment, and they get to share the profits with the …

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A case against real estate syndications

From Uber driver to Harvard Medical School

Oscar A. Leyva, MD

Education

December 2, 2022

“What happens to a dream deferred?
Does it dry up
like a raisin in the sun?

Or fester like a sore—
And then run?
Does it stink like rotten meat?

Or crust and sugar over—
like a syrupy sweet?

Maybe it just sags
like a heavy load.

Or does it explode?”
– “Harlem” by Langston Hughes

“$23.46,” the Walmart cashier distractedly mentioned to me as I got ready for my first ride. I had signed up and passed the background check. My …

Much more than simple white coat syndrome

Murray Keith Wadsworth

Conditions

December 2, 2022

Ongoing consultations with a new-to-me internist have raised attention to my in-office blood pressure measurements. In preparation for my next appointment, I regularly record my BP, sometimes several times a day. In other office visits, for cancer talks and such, I simply explain I regularly home and grocery store measure my BP, which always seems to be in the established normal range. I am confident that these in-office rises are …

Time constraints in physical therapy [PODCAST]

The Podcast by KevinMD

Podcast

December 1, 2022

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“Picture this. A patient in a hospital or rehab facility has just finished exercising with therapy. He is thirsty, and he thinks he might as well ask for a snack now because he will be hungry in 30 minutes. …

We get what we incentivize

Kristin Puhl, MD

Physician

December 1, 2022

We get what we incentivize.

This is a basic rule. I’d love to say it’s a basic rule of humanity, but unfortunately, I have a background in psychology, so I know it goes a lot deeper than that—it’s a basic rule of every living creature. Humans are, in many ways, just very big pigeons. We reliably prioritize certain rewards. We prefer smaller sooner rewards to larger later rewards; we push the …

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We get what we incentivize

The immediate impact of the transition to a pass/fail Step 1 exam

Megan R. Moore, Sarah E. Toates, and Prasun Sharma

Education

December 1, 2022

Historically, students’ three-digit scores on the United States Medical Licensing Exam (USMLE) Step 1 were a main factor in determining competitiveness for residency programs. In February 2020, the world of medical education shifted drastically when it was announced that the USMLE Step 1 would transition to a pass/fail scoring system. One of the main factors driving this change was that medical students and residency programs were attributing too much …

Why even doctors need regular doctor visits

Zahid Awan, MD

Physician

December 1, 2022

After a great game of doubles tennis, a good friend brought up a recent visit with his primary care physician while sitting with friends, trying to cool down. He expressed appreciation for his position but complained about the need to see his doctor every three or six months, all the while acknowledging various medical problems being addressed.

This led to general comments by several non-physician friends about how they feel that …

Effective doctors need to be challenged [PODCAST]

The Podcast by KevinMD

Podcast

November 30, 2022

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“Empathy, intelligence, and commitment are crucial traits every doctor must have to succeed. However, there is one trait that stands above the rest. One of the most important aspects of an effective doctor is the desire to …

Prudence and promise in psychedelic-assisted therapy

Charles Saylor and Jacob M. Appel, MD, JD, MPH

Meds

November 30, 2022

Psychedelic-assisted therapy (PAT) represents one of the most promising developments in psychiatry in decades. The treatment typically involves the infusion of a compound such as LSD, psilocybin, or MDMA during an extended therapy session with licensed professionals.

Although it lacks widespread regulatory approval or clinical use, significant advances have been made in the study of PAT in the past decade, with a pronounced increase in recent years. Recently, a Read more…

Prudence and promise in psychedelic-assisted therapy

A doctor’s grief

Humeira Badsha, MD

Physician

November 30, 2022

Last evening I crumbled in the arms of my patient and wept. This was unknown territory to me, an unexpected role reversal. For three weeks after my Mom’s death, I maintained a stoic distance as patients offered their condolences, as they asked about my mother, and empathized. We doctors have been trained to do this, to face death, to keep our emotions at arm’s length. But this patient, who has …

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A doctor’s grief

When your letter to the editor is rejected or ignored

Sami El-Dalati, MD

Physician

November 30, 2022

Dear Dr. El-Dalati,

I am sorry that we will not be able to publish your recent letter to the editor regarding the Chowdhury article of 16-Sep-2021. The space available for correspondence is very limited, and we must use our judgment to present a representative selection of the material received. Many worthwhile communications must be declined for lack of space.

The response from The New England Journal of Medicine (NEJM) seemed simple and …

Let doctors in recovery be able to recover their careers [PODCAST]

The Podcast by KevinMD

Podcast

November 29, 2022

Subscribe to The Podcast by KevinMD. Catch up on old episodes!

“During addiction, the brain becomes ‘hijacked,’ which then ‘exaggerates the need for the drug and minimizes the dangers associated with the use of the drug.’ This is so affirming because the chemicals in my brain told me …

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