A domperidone dilemma: A patient’s perspective on ordering from Canada

Meds
March 5, 2015

Three years ago I received some of the best news of my life — that I have dopa-responsive dystonia. (Yes, a neuromuscular disorder was welcome news.) Painful, life-interrupting muscle contractions had made the dystonia diagnosis likely several years before, despite poor response to standard treatments, and I was fighting through graduate school: trying to compensate for medication-induced memory problems, increasing need to work from bed, and a disappearing social life. …

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Ask for Dilaudid, get Dilaudid. No questions asked.

Meds
February 28, 2015

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A local hospital is trying a new, controversial but more efficient approach to medical care. “We have changed our guidelines, if you want Dilaudid you get Dilaudid, if you want Valium, you get Valium. No questions asked,” CEO Michael Shoemaker told reporters Wednesday.

In what experts are calling pure genius, emergency …

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Secrets that your doctors are dying to tell you

Physician
February 27, 2015

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I’ve been thinking about this post for awhile, and finally, am going to spill some “secrets” about me and my colleagues.

We are in debt. I mean, real debt. We are in debt. I mean, real debt. It actually costs most of us almost 1 million dollars to become your doctor.

It has taken us a long time to get here.

Let’s do some …

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Patients are not customers.  Here are 6 reasons why.

Physician
February 27, 2015

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Recently I wrote about the problems with maintenance of certification requirements.  One of the phrases I repeatedly read when I was researching the piece was “the patient as customer.”  Here’s a quote from the online journal produced by Accenture, the management consulting company:

Patients are less forgiving of poor service than they once were, and the bar keeps being raised higher because …

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Ranking your residency for the Match: Red flags to watch out for

Education
February 25, 2015

Physician burnout has been previously described as heartbreaking, and this may be an understatement.  The growing complexities of health care delivery, intricacies of documentation practices as required by Meaningful Use, and difficulties inherent to billing and reimbursement are only a few of the issues faced by residents and attending clinicians these days.

Unfortunately, these topics are still not formally taught in American medical schools.

As students, we really do not know …

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Lessons from my first nasogastric tube

Education
February 23, 2015

I was glad she never asked if I had done this before.

My first nasogastric tube was placed on an elderly woman with chronic liver disease. As her illness worsened, it gradually turned her skin yellow, her abdomen swollen, and her mind foggy. One day, we realized that she was at too high a choking risk to swallow her medications herself. She would need a plastic tube to do it for …

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4 reasons why fecal transplants aren’t mainstream. Yet.

Conditions
February 23, 2015

Fecal microbiota transplantation (FMT) has emerged as an increasingly common treatment for patients with refractory Clostridium difficile infection (CDI). Unlike standard antibiotic approaches, which only exacerbate dysbiosis and may perpetuate CDI recurrence, FMT restores normal gut microbial community structure and function of the gastrointestinal tract. However, a number of challenges need to be overcome before this procedure is widely accepted in mainstream clinical practice.

Before I jump into highlighting …

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No, you don’t need a vagina facial

Conditions
February 20, 2015

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I saw this little news item from Shape Magazine about “vagina facials.”

First of all, the post means vulva. The vagina is inside and the vulva is the outside (where your underwear touches your skin). The vestibule is in between.

This what Shape Magazine had to say about it:

Created by Lisa Palmer, the facial came about after she “looked downstairs” and realized her vulva …

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How the advent of propofol changed the meaning of the term “sedation”

Meds
February 19, 2015

“Twilight! She has to have twilight,” insisted the adult daughter of my frail, 85-year-old patient. “She can’t have general anesthesia. She hasn’t been cleared for general anesthesia!”

We were in the preoperative area of my hospital, where my patient — brightly alert, with a colorful headband and bright red lipstick — was about to undergo surgery. Her skin had broken down on both legs due to poor circulation in her veins, …

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Want to know why your doctor is late? Read this.

Physician
February 19, 2015

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One of my biggest pet peeves in life is tardiness. I hate it when other people are late. It’s as if they are not respecting my time.  But you know what? I hate being late myself even more.  In fact, I cringe at the thought. Conscientious, successful people are on time.

Always.

So you can imagine that nothing irks me more than being …

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Giving test results directly to patients: What’s missing is context

Physician
February 19, 2015

I do not think that word means what you think it means. 
– Inigo Montoya, The Princess Bride

Stick to Facts, sir! … In this life, we want nothing but Facts, sir: nothing but Facts!
– Charles Dickens, Hard Times

“Information without context isn’t transparency” flashed across my Twitter feed. So now I am thinking about context, and communicating context, in medical care.

This quote, from Heather Pierce, JD, MPH, Director of Science Policy and Regulatory …

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How to get your doctor to do what you want

Physician
February 18, 2015

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Sick of phone trees, endless refill requests, packed waiting rooms, out-of-control bills, and other medical misadventures?

Follow these seven simple steps to get your doctor to do what you want.

1. Get organized. Be clear about what you need from your appointment. Make a comprehensive list of all the issues you want to discuss — and your ideal outcomes for each. Patients who are …

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Doctor, why do you enjoy practicing gastroenterology?

Physician
February 16, 2015

Whenever I am asked this question, I can’t help but think of the punchline to a joke that was once supposed to be funny but would now be considered beyond the pale in all respects, so I won’t repeat it. The punch line is: “Just lucky, I guess.” That’s the short answer to why we gastroenterologists work in our field. Despite the distasteful aspect of human waste and the perverse …

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Solving the physician shortage requires these 3 things to happen

Policy
February 16, 2015

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The nationwide shortage of physicians is a very real crisis across all 50 states, causing a huge strain at all levels of health care. Hospitals and clinics are struggling to hire, current physicians are overworked, and ultimately patients have to wait longer.

There are a number of reasons why this has happened, but one thing’s for sure: With the aging population, the …

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Having surgery? Here’s how to manage your medications.

Conditions
February 16, 2015

american society of anesthesiologistsA guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com.

Before undergoing surgery, you should carefully discuss your medications with your surgeon and physician anesthesiologist. You may fare better during the operation and the early recovery phase if you continue required medications, but you might need to avoid some medications that could interfere with your anesthesia. Three …

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Taking care of patients who stop caring about themselves

Education
February 13, 2015

It’s been a long day, and you just want to decompress. My boyfriend tells me about his day. I get to hear about the insane amount of reading he has to do for graduate school, or about the occasional annoying customer he’s had to deal with at his part-time job as a bank teller. When it’s my turn to decompress, I usually gripe about a patient or two from the …

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