Practices have failed to analyze the clinical content of their EHR

Tech
August 20, 2011

Clinical content refers to the various checklists, documents, and forms that address an area of medicine when using an EHR.  For example, a pediatric practice would be interested in documentation tools for a newborn visit. Not all EHRs have clinical content for all areas of medicine.  For example, some EHRs have clinical content for internal medicine, but lack the details needed for dermatology or cardiology.

A disturbing number of practices …

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What do tonsils do and why would we take them out?

Conditions
August 19, 2011

There are some important new recommendations about tonsillectomy — taking out the tonsils — as a treatment for recurrent strep throats.

Some of us can recall a time when getting your tonsils out was one of the rites of passage of childhood. Usually a related procedure is added — an adenoidectomy, removing the adenoids as well. It’s called a T&A in the medical world, and it’s one of the …

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Female doctors and the physician shortage

Physician
August 13, 2011

Someone has gone and rained the facts down on what is generally considered a feel–good story in American medicine, the dramatic increase in female doctors in America.

In response to Dr. Herbert Parde’s “The Coming Doctor Shortage” article in the Wall Street Journal, Dr. Curtis Markel pointed out that there is a difference between the raw, gross number of physicians in America, and the effective number of practicing physicians.  Not only …

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Why doctors should accept protocol medicine

Policy
August 13, 2011

We hear that doctors do not like “protocol medicine” – they do not want to follow a “cookbook” when every patient is different. It is not a good understanding of the issues.

Some years ago when I worked in a branch of he National Cancer Institute and then the University of Maryland Cancer Center, we admitted many patients with acute leukemia. The treatment approach including the necessary special tests to …

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What medicine will be like 20 years from now

Tech
August 13, 2011

I was asked recently to predict the practice of medicine in 20 years. After stating that any such prediction is massively speculative, I indulged because it is massively fun.

I am persuaded by Clayton Christensen’s arguments in The Innovator’s Prescription that healthcare will go the way of other massively disrupted industries, wherein healthcare will follow the arc of decentralization.

Using the music industry as an example, the arc begins …

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6 reasons why doctors won’t call patients back

Physician
August 12, 2011

Patients want to know why they can’t get a return call from their doctor’s office – here are six reasons why the calls have increased and physician offices are having trouble meeting the needs of their patients.

1. Medication questions and requests for a prescription change. The average number of retail prescriptions per capita increased from 10.1 in 1999 to 12.6 in 2009 (Kaiser Family Foundation calculations using data from …

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How a nephrologist assesses your kidney function

Conditions
August 12, 2011

Doctors use laboratory values to interpret your medical condition.  With respect to kidney disease, the BUN and the creatinine help your nephrologist (as well as your internist and family physician) determine if your kidneys are working correctly. These two tests are commonly ordered for many reasons and are invaluable tools to help your doctor assess your condition. Let’s define what BUN (pronounced by spelling out the letters “B”, “U”, …

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Women with these 5 pelvic symptoms should call their doctor

Conditions
August 11, 2011

For most women, a couple of irregular menstrual cycles or an occasional yeast infection are just a part of life — nothing that time or simple treatment won’t cure.

However, there are a few symptoms that warrant a call to the doctor.  This article will cover when you should call your doctor for problems “down there”?

1. Pelvic pain. Pain at the time of ovulation is referred to as Mittelschmerz.  However, if …

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Why the third year is the greatest year of medical school

Education
August 10, 2011

This post is dedicated to the many 3rd year students whom I have had the privilege to teach over the past 35 years.  They continue to inspire me to help them become great physicians.  They care.

The third year of medical school is wonderful, but it is a year of great change.  Those readers who are physicians will completely understand, and I will try to explain to the non-physicians.

During the third …

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Angry Birds: A psychiatrist explains the addicition

Tech
August 8, 2011

Joe Frisch is a staff scientist at the SLAC National Accelerator Laboratory at Stanford University. Dr. Frisch writes: “I wonder when we will start seeing really addictive games banned? I don’t know what makes games addictive though. Angry birds is a mystery to me – there is no ongoing story line, you don’t really gain any abilities as the game …

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A cream to fight obesity is being ignored

Meds
August 7, 2011

Do you, or many of your patients, have a little more belly fat around your and their middle than you and they would like? Me, too.

Turns out that there are two decent published studies from reputable places that report that a person may rub a cream on their skin over the fat spots and make the fat go away.

Wow, what a deal.

The first study addresses fat thighs, with each …

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MKSAP: 76-year-old woman with abnormal thyroid function tests

Conditions
August 6, 2011

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 76-year-old woman is reevaluated after results of thyroid function tests performed 2 weeks ago are abnormal. The patient otherwise feels well. She has a history of hypertension, atrial fibrillation, gastroesophageal reflux disease, and depression. Current medications are metoprolol, amiodarone, warfarin, omeprazole, and sertraline.

On physical examination, …

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Absence of joy: A doctor’s journey with depression

Physician
August 5, 2011

The scene was picture perfect, an absolute characterization of a tropical island paradise.  White deserted beach, overhanging palm trees, crystal clear, gentle lapping waters, and a blood red sun sinking slowly into a Fijian ocean.

I found no pleasure in it.  Perhaps it was the heat, or that my new wife and I had been travelling for six months?  Or that we had been on many other tropical islands and amazing places in …

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When specialists try to practice primary care

Physician
August 5, 2011

Recently a good friend asked me to recommend an excellent primary care physician in New York City. When no one immediately came to mind, I asked a couple of doctor-friends who trained in New York. One friend, a cardiologist, gave me two names—one was a rheumatologist, who also practices general medicine, and the other an infectious disease doctor by training. My initial reaction to my cardiologist friend’s suggestion that …

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The different ways hysterectomy can be performed

Conditions
August 3, 2011

When you and your gynecologist have decided on hysterectomy as the treatment of choice for your gynecologic diagnosis, there are several routes by which a hysterectomy may be accomplished. A total hysterectomy is the surgical removal of the uterus, and when indicated, the additional removal of the fallopian tubes and ovaries (termed salpingoophorectomy) may be recommended.

There are several routes by which a hysterectomy can be performed. You and your gynecologist …

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MKSAP: 33-year-old man with stretch marks in his groin

Conditions
July 30, 2011

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 33-year-old man is evaluated because of the recent appearance of stretch marks in his groin that extend to his thighs. He has a history of long-standing psoriasis that at times has involved much of his body, including his intertriginous areas. His topical treatments include tar-containing …

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Planning effective office meetings for your medical practice

Physician
July 30, 2011

Do you cringe when you hear the phrase “office meeting”? Some medical practices meet too frequently and some seldom meet, but others have it just right – routine meetings with preparation, an agenda, and follow-up. Your practice can get it right, too.

And make no mistake, meetings are important. Medical practices, regardless of size, have a variety of positions that are not interchangeable, but do interact throughout the day.

To make …

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