Physicians referring patients to a diagnostic facility they own

Health Policy
April 10, 2011

Federal law generally prohibits physicians from referring their own patients to a diagnostic facility in which they have an ownership issue – a practice called “self-referral” – unless the facility is located in their own practice.

This exemption exists to allow patients with access to a laboratory test, x-ray, or other imaging test at the same time and place as when patients are seeing their physician for an office visit. Less …

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Physicians referring patients to a diagnostic facility they own

Think about medical school tuition debt before becoming a doctor

Medical Education
April 7, 2011

Recently, I received a call from the son of some old friends. This 30-year-old man has been an elementary schoolteacher for the past few years and recently decided that he would like to go to medical school and eventually become a surgeon. He wanted to know what I thought of the idea.

Suppressing the urge to tell him not to even consider …

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Think about medical school tuition debt before becoming a doctor

How the reformulation of Oxycontin has affected patients

Medications
April 7, 2011

Having a healthy level of respect for opioids is critical for any physician. For those of us who prescribe or recommend this class of medicines on a daily basis, this statement rings all the more true.Recent events and research reinforce this reality.

“Oxycontin, Other Opioid Painkillers Tied to Higher Health Risks” was the title of a recent BusinessWeek article …

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How the reformulation of Oxycontin has affected patients

A confident, independent, empowered woman is a force to be reckoned with

Physician
April 5, 2011

I am infinitely blessed by The Girl Effect.  As I look back through the generations of my family, I see it rolling toward me, through me like a wave.

I am sure it started even before my grandmother stole her parents’ car with intent to drive by herself from Austin to Chicago to see the World’s Fair in 1924; I just don’t have much history to work with prior to that.  …

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A confident, independent, empowered woman is a force to be reckoned with

MKSAP: 28 year old woman with easy bruising and bleeding gums

Conditions and Diseases
April 2, 2011

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

A 28-year-old woman has a 3-month history of easy bruising and bleeding gums. She feels otherwise well. Medical and family histories are unremarkable, and she takes no medications.

On physical examination, temperature is normal, blood pressure is 110/70 mm Hg, pulse rate is 64/min, and respiration rate …

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MKSAP: 28 year old woman with easy bruising and bleeding gums

Diagnostic errors and their role in patient safety

Physician
March 31, 2011

American Medical News published an informative essay by Kevin B. O’Reilly on December 13, 2010, about errors in diagnosis and why doctors make them.

According to Gordon Schiff, MD, associate director of the Center for Patient Safety Research and Practice at Brigham and Women’s Hospital, “The problem of diagnostic errors has gotten short shrift in the broader patient safety movement.” The article focused on …

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Diagnostic errors and their role in patient safety

Why medical education needs to be more affordable

Medical Education
March 29, 2011

I was talking to a young man who is starting medical school this fall. His tuition at one of South Carolina’s newer schools will be $40,000 per year. That’s admittedly on the high end. On the low end, it runs a paltry $33,000 per year.

And this is all after college, of course. He and others like him are taking out loans to the tune of $240,000 to pay for their …

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Why medical education needs to be more affordable

Reductionism and daily medical practice

Physician
March 28, 2011

The results of the application of reductionism in modern biomedical research and practice has been nothing short of miraculous, but while wondrous for some things, reductionism alone is incomplete.

The basic premise of reductionism is that by breaking down (or “reducing”) complex biological or medical phenomena into their many parts, one is much more likely to understand a single cause and devise a cure.

Historically, the invention of the microscope, the defining …

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Reductionism and daily medical practice

What to do with a prescription bottle with the wrong pills inside

Medications
March 22, 2011

Have you ever opened a prescription bottle to find the wrong pills inside? If so, you may have found it to be an expensive mistake.

Whatever the reason for the error (and there are numerous possible causes), here is how to best handle the situation.

Of course, it is always smart to confirm the medications, quantities and dosages at the pharmacy checkout.  A mistake recognized at the time of purchase can be easily …

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What to do with a prescription bottle with the wrong pills inside

Evaluating dizziness in the cardiologist’s office

Conditions and Diseases
March 20, 2011

I see a lot of patients who are sent to me for evaluation of dizziness.  On the surface you wouldn’t think a cardiologist would have much to do with a symptom that relates more to the head than the heart, but there is some logic to it—poor blood flow to the brain could lead to dizziness and, since blood flow starts in …

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Evaluating dizziness in the cardiologist’s office

Do Not Resuscitate and the need for a central line

Physician
March 15, 2011

Just the other day I was called to see a patient coming up to the Intensive Care Unit with a diagnosis of pneumonia. Upon my arrival the patient is “hanging in there” with the blood pressure in the 60’ and 70’s systolic.

This is a no-brainer situation – the patient is in sepsis and septic shock.

Early intravenous antibiotics and aggressive resuscitation is what this gentleman needs right now. Per the ER …

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Do Not Resuscitate and the need for a central line

Why this medical student found primary care awesome, and boring

Physician
March 15, 2011

I recently finished another 5-week clinical rotation.  This one was primary care (outpatient internal medicine +/- family medicine).

First a few words about primary care as a field:  I found it to be both awesome and boring.

It was awesome because I was the “doctor.”  I had essentially full responsibility for my each patient.  From calling him in from the …

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Why this medical student found primary care awesome, and boring

How to help autistic or delayed children behave and learn

Conditions and Diseases
March 14, 2011

Here are ways doctors can help autistic or delayed children behave and learn.

I certainly do not mean to trivialize the behavior issues that erupt as typical children develop, but the problems of atypical kids are more difficult and less likely to be fully addressed by general pediatricians and society at large.

1.  Understand the ABCs of behavior. Antecedent = What happened immediately before the behavior?  Behavior = A description of the …

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How to help autistic or delayed children behave and learn

Aspects of psychiatry this doctor appreciates

Physician
March 10, 2011

Working as a psychiatrist is very rewarding. It’s stressful in a unique way, and some people may look at me strangely for having an unusual job. But overall I really enjoy it. Here are some of the aspects of psychiatry that I really appreciate.

1. Being trusted. Psychiatrists meet people when they are at their most vulnerable points, and we are entrusted with extremely …

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Aspects of psychiatry this doctor appreciates

Taking Chantix to help smokers quit may be worth the risk

Medications
March 10, 2011

I decided to dedicate a medical blog on  smoking cessation after realizing that too many people in Douglas County (Omaha, Nebraska) smoke. Did you know that despite a smoking ban in restaurants and bars, 18.3% of people in Nebraska are smokers? That’s one in five people. And this number contributes to Omaha’s health ranking of 142 out of 182 cities in …

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Taking Chantix to help smokers quit may be worth the risk

Gout is a common cause for episodic joint pain and swelling

Conditions and Diseases
March 10, 2011

For Christmas Eve dinner, our family congregated at Café Opera, in the Intercontinental Hotel for a scrumptious seafood buffet. Going to a buffet is a little bit evil, as you know that you’re about to commit the sin of gluttony.

I usually tell my patients who suffer with gout to avoid buffets. That 3rd mountain of prawns may precipitate an acute episode of gout. Christmas party season is a dangerous time.

Overindulgence …

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Gout is a common cause for episodic joint pain and swelling

What is a difficult patient, and how doctors may be responsible

KevinMD
March 9, 2011

What, exactly, is a difficult patient?

Doctors can tell many tales of what they term as a difficult encounter.  Just as many patients can recall doctors whom they would say are difficult to work with as well.

According to a study from the Journal of General Internal Medicine, here’s a definition:

Patients deemed difficult included those with more than five symptoms, severe symptoms or an underlying mental disorder or were less functional. These …

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What is a difficult patient, and how doctors may be responsible

Asking a doctor for their opinion on another physician

Physician
March 8, 2011

If one of your patients asked your opinion of another doctor whom you know to be incompetent what would you tell your patient?

Incompetence in a physician is a scary thing! Doctors deal with problems of life and death and try to heal you with dangerous tools. A doc that isn’t competent can be seriously dangerous.

But how do you know who’s on their game and who’s falling down on the job? …

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Asking a doctor for their opinion on another physician

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