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Is self-rationing of medications a good or a bad thing?

Meds

June 6, 2013

In America, the conventional wisdom is that we don’t ration health care. But we do, and there’s no better example than patients rationing themselves when it comes to the medicines they take.

Recently, a young twenty-something I know had a nagging cough—seasonal allergies, her doctor said and prescribed a generic medicine for asthma and allergies. She did not fill the prescription—the $160 price tag was too steep. Although she had health …

Letting your infant cry it out: Will it hurt your baby?

Roy Benaroch, MD

Conditions

June 5, 2013

shutterstock_128923511

Jess, like many parents, has been hearing conflicting information about what crying can do to your baby.

She wrote: “So, my husband and I accidentally let our kiddo (5.5 months) cry it out. So of course, I’m spending all sorts of time on Google finding out that I’ve caused long-term damage to my son and he’ll be more likely to get ADHD and …

Improving informed consent for resuscitation without playing God

Janice Boughton, MD

Physician

June 4, 2013

To resuscitate or not to resuscitate, that is the question. Whether ’tis nobler to beat the heck out of a person on his or her way out in the hope of saving his or her one precious life, or to allow death to proceed at its own pace with expectation of a peaceful passing.

The United States has come a long way in the last 2 decades since 1991 when the …

Doctors think about their patients all the time after they leave

Jennifer Stella, MD

Physician

June 3, 2013

As a third-year med student, I was doing an ER shift when the call came through our dispatch: 56-year-old man, status epilepticus, being flown in from Yosemite, 10 minutes out. I watched the residents snap into a semi-ordered chaos. Ten crucial minutes. Prepping the trauma bay. Anticipating acute management, who was going to do it, half-tying the yellow paper gowns. Anyone who had looked tired didn’t anymore.

We raced in the …

Address the financial burden of medical treatment

Yousuf Zafar, MD

Physician

June 1, 2013

Everyone is talking about health care costs these days. The presentations usually start with a chart of rising health care expenditures, the tip of the line pointing skywards. Next come exhaustive (and exhausting) tables, more charts, all punctuated with a final shrug of uncertainty from the speaker: What is the solution to rising costs? Of course, there is not just one.

But in the morass of data, we can lose the …

Being a psych patient in the emergency department

Greg Smith, MD

Physician

June 1, 2013

So you’re in the emergency department, probably in a small, windowless room, dressed in paper (or, if you’re lucky, crazy green cotton cloth) scrubs. You’re lying in a bed with a plastic mattress and scratchy sheets staring across the room at the door that has a small chicken-wire reinforced tempered glass windowlette in it and is ajar just enough to let you see the shiny black shoe of the security …

Why you shouldn’t give medical advice on Twitter

Iltifat Husain, MD

Social media

May 31, 2013

A few weeks ago I was following an online discussion conducted by a widely followed health site.

During the discussion, they had a physician who was giving out wellness advice to users via Twitter.

That physician had one tweet in particular that terrified me.

Medical-twitter14-338x600

Medical-twitter23

As the above screenshot shows, one tweet mentioned that when in doubt regarding …

Please don’t call me a hospitalist

Suneel Dhand, MD

Physician

May 29, 2013

I must confess that I love my job as a hospital medicine doctor. To me, very few specialties in medicine can be as rewarding as the one I’ve had the privilege of practicing for the last five years. We manage an array of medical illnesses, interact with staff from across the hospital in every different specialty, and follow our patients all the way through their—hopefully very short—hospitalization. We take ownership …

Read more…

Please don’t call me a hospitalist

Migraine is very much a childhood disorder

Roy Benaroch, MD

Conditions

May 29, 2013

“My wife gets migraines—really bad ones—and now my daughter seems to be getting them too. She’s only 7! Is she just copying what her mom does? Can a child really start getting migraines?”

Oh, yes they can. Migraine is very much a childhood disorder. About 5% of adults have migraines, and half of them started having their migraines as kids.

As in adults, migraines in children can be severe and debilitating. However, …

We must change how we discuss procedures with our patients

Kevin R. Campbell, MD

Physician

May 27, 2013

Medicine is about balancing risk and benefit. Certainly, as healthcare providers, we attempt to provide the best care for our patients based on available evidence. Physicians often are seen as shepherds, helping to guide patients through disease and therapy. As I have mentioned in previous blogs, ultimately medicine will be personalized and tailored to one’s particular genetic make-up. However, the need for a clear discussion of treatment options …

Another reason why the house call is dead

James C. Salwitz, MD

Physician

May 27, 2013

We think the reason doctors rarely make house calls is money. Doctors can charge, but it is hard to charge enough to justify the time it takes to drive door-to-door, fill the tank and attend lengthy visits. Thus, the house call has faded into history. However, I have another theory about the end of this valuable service: perhaps it is increased emotional distance between patients and their doctors.

I watched an …

Bedside ultrasound tips for the general internist

Janice Boughton, MD

Tech

May 26, 2013

I first picked up an ultrasound transducer 17 months ago, at an emergency medicine ultrasound course at Harvard University. I had just barely heard about using ultrasound as a clinical tool and was vaguely interested. The course was 3 days long and cost a little under $700 and changed my life forever and made me a better doctor.

Emergency physicians have embraced the …

English is the second language of medical documentation

Yul Ejnes, MD

Tech

May 24, 2013

A guest column by the American College of Physicians, exclusive to KevinMD.com.

English is the international language of medicine, according to many. Regardless of whether that is true, what is becoming increasingly clear is that English is the second language of medical documentation. For those of you who blame EHRs for this, the replacement of English by something else started …

The impact of outdated communications technologies in healthcare

Sean Kelly, MD

Tech

May 23, 2013

As a physician, I experience first-hand the impact that internal communication at a hospital—both good and bad—has on patient care.

If I am able to quickly access clinical systems, analyze patient information and collaborate with colleagues, I can diagnose and interact with the patient much more efficiently and effectively. Conversely, breakdowns and inefficiencies in the communications process can inhibit the delivery of quality patient care by bogging down workflows, creating delays …

Finding a doctor online and researching your physician on the Internet

Kevin Pho, MD

KevinMD

May 23, 2013

Part of the KevinMD toolkit series.

“How can I find a doctor online?”

A seemingly simple question, but patients are often confronted with too much information on the Internet, with variable quality.

Finding a doctor a similar to completing a puzzle. Like puzzle pieces, there are many resources available, including word of mouth, hospitals, insurance companies, and physician …

A surgeon interviews a medical malpractice attorney: Read and decide

Jeffrey Parks, MD

Physician

May 22, 2013

My interview series continues, this time with local litigation attorney Andrew Thompson, Esq. The topic this time is medical malpractice. I asked him a bunch of questions. He answered. See what you think.

1. In your opinion, is there a medical malpractice crisis in this country?

No. This is not even a close issue. The concept of a “crisis” or dramatic increase in the number of medical malpractice cases is a fabrication …

Why physicians need to write

Louise Aronson, MD

Physician

May 21, 2013

Should doctors be able to write?

At first glance, this might seem like a question with an easy answer.

Yes, you might say, doctors receive a doctorate and are trusted with communicating to and about people at critical moments in their lives. Or you could reply, No, they are scientists and so need to be functional communicators able to write basic notes and prescriptions, and …

Read more…

Why physicians need to write

The legal risks of prescribing the AliveCor ECG

Wes Fisher, MD

Tech

May 20, 2013

With the announcement that the FDA granted 510(k) approval for the AliveCor EKG case for the iPhone 4/4S, the device became available to “licensed U.S. medical professionals and prescribed patients to record, display, store, and transfer single-channel electrocardiogram (ECG) rhythms.”

While this sounds nice, how, exactly, does one become a prescribed patient? Once a doctor prescribes such a device, what are his responsibilities? Does …

How to have a hospital stay without pain

Anita Gupta, DO, PharmD

Conditions

May 19, 2013

Too often patients feel like they’re in the passenger seat when entering the hospital. Even in the best of circumstances — such as planned admissions — patients often don’t feel in control of their own care.

One of the most unnecessary issues facing patients when they enter the hospital is untreated (or undertreated) pain. Often the focus of the medical team is to treat a condition, and controlling a patient’s pain …

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