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Seasoned medical professionals prescribe new medicines sparingly

Medications

December 31, 2018

I prescribe heartburn medicines every day. There’s a gaggle of them now — Prilosec, Nexium, Prevacid, Protonix — to name a few. As far as experts know, their primary effect is to reduce the production of stomach acid. This is why they are so effective at putting out your heartburn fire. In simple terms: no acid, no heartburn.

I am quite sure that well-meaning physicians like myself do not understand or …

To do population health right, think about individuals

Fred N. Pelzman, MD

Health Policy

December 31, 2018

How do we change the way we think about taking care of patients, particularly when it comes to not the individual patient sitting in front of us, but a whole population of patients just like them (or somewhat like them)?

In our practice, we have been struggling with how to best do population health, trying to find the best ways to …

Reflecting on the state of global anesthesia

D. Matthews Hatch, MD, MBA

Physician

December 31, 2018

A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com.

I imagine every physician anesthesiologist has experienced drug or equipment shortages in the last year. How frustrating that even in the world’s largest health care system, basic medications can be unavailable. However, when I step back and look at the big picture, I …

When the buck stops with primary care

Hans Duvefelt, MD

Physician

December 30, 2018

“Red” McDougall had terrible leg pains soon after going to bed. He did have a bad back, and some mild spinal stenosis, but I hadn’t heard much about that in the past few years. He was dealing with the ache in his legs when he was on his feet too long.

A few months ago he saw his vascular surgeon for a routine followup. He’d had a femoral-popliteal bypass to restore …

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When the buck stops with primary care

Solving physician burnout requires so much more than self-care

Linda Girgis, MD

Physician

December 30, 2018

So many people are suggesting that if only doctors practice self-care we could deflect burnout before it overtakes us. Yes, physicians are probably the worst professionals for taking care of ourselves. We work long hours, answer calls at all hours of the night, take little vacation, work in stressful situations, and often face hostility in the workplace. But this is not the reason we are burning out at high rates; …

Health care professionals must always be on their A game

Suneel Dhand, MD

Physician

December 30, 2018

I was having dinner with somebody not so long ago, and the conversation turned to what life is like as a physician. I always find it interesting to have these conversations with people who are not in the medical field, especially those who have got their ideas from watching medical shows on television! The person I was speaking to on this occasion, however, wasn’t about to go down that route, …

5 anomalies about compensation physicians should know about

Halee Fischer-Wright, MD and Todd Evenson, MBA

Health Policy

December 30, 2018

The term “physician compensation” could be among the top phrases in health care this year.

Though it’s always been a hot topic, it got hotter when the Trump administration announced a proposal that would affect nearly 40 percent of Medicare payments. That plan would replace a fee scale that compensated doctors more for seeing sicker patients with …

Just another day in the ER

Irv Danesh, MD

Physician

December 29, 2018

An excerpt from Doctor Brooklyn: Love & Life at the End of a Knife.

“Goddamn, you’re getting married? Are you outta your mind?”

“I’m going to tell Goldie your advice on marriage. I predict you will spend the next twenty years sleeping on that very lumpy couch you own,” Zach said to Ike.

“You are correct, so I’m going to tell Goldie, if you ever mention this conversation to her, that you …

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Just another day in the ER

Medical students and physicians are forever looking to milestones

Bruce Campbell, MD

Medical Education

December 29, 2018

“I don’t want to get to the end of my life and find that I lived just the length of it. I want to have lived the width of it as well.”
– Diane Ackerman

Nathan picks up a pen from the tray next to the dry erase boards.

“OK,” he says. “Here’s what he showed us.”

The rest of our small group watches. Nathan is one of the more intense medical students I …

3 surprising links to medical errors

Health eCareers

Health Policy

December 29, 2018

This article is sponsored by Careers by KevinMD.com.

To err is human, and in the health care arena, avoiding errors is crucial. Efforts to address communication-related or “soft skill” failures have been ongoing since about 20 years ago when the Institute of Medicine (IOM) published reports titled To Err Is Human and Crossing the Quality Chasm. When we rely on …

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3 surprising links to medical errors

MKSAP: 55-year-old man with severe COPD

mksap

Conditions and Diseases

December 29, 2018

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

A 55-year-old man is evaluated in follow-up for severe COPD, which was diagnosed 2 years ago. He has had two exacerbations in the past year requiring hospitalization, and his baseline exercise tolerance is low. He completed pulmonary rehabilitation 3 months ago without much improvement in exercise capacity. He quit smoking 1 year ago. …

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MKSAP: 55-year-old man with severe COPD

What physicians should know about umbrella insurance

Smart Money, MD

Physician Finance

December 28, 2018

Asset protection is a term that gets tossed around quite a bit when we discuss how long and difficult the journey is for doctors to establish their careers. You always want to protect what you’ve worked hard for, right? The principles for asset protection apply not only to doctors but essentially anyone who wishes to have some sort of security for their assets. The key is to make sure you don’t over …

Personal finance strategies to combat physician burnout

Physician on FIRE, MD

Physician Finance

December 28, 2018

Career burnout is becoming increasingly common and is a hot topic lately, particularly for physicians and other health care workers.

The causes are many. Increased demands. Decreased reimbursement and recognition. Longer hours and lower benefits. The feeling that you’re just another wheel in the cog.

In medicine, it’s the ever-thickening red tape. Clumsy electronic health records (EHRs). Prior authorizations. In-baskets that fill up with dozens or hundreds of messages any time you’re …

Applying to residency as an osteopathic medical student: myths and realities

Catherine Vanier, DO

Physician

December 28, 2018

In the last year of medical school, all medical students are faced with important decisions about where they would like to complete their residency. For osteopathic students, one key element of this decision is to what extent do they want to be a minority within their program. I am an osteopathic physician. Osteopathy is core to my identity and pride as a physician. I am one of two osteopathic physicians …

A tipping point for women physicians at the podium

Jennifer Weiss, MD

Physician

December 28, 2018

It has been suggested that once leadership of an organization is made up of 30 percent women, integration and increased success are enjoyed. As an orthopaedic surgeon, the feeling of being surrounded by so many women is not something that I have experienced. But last week I felt something close.

The International Pediatric Orthopaedic Symposium (IPOS) has been held in Orlando, Florida, for the past 12 …

Leaving no veteran behind when it comes to health care access

Ian Tong, MD

Physician

December 27, 2018

Veterans do not only matter one day of the year. Beyond Veterans Day, it is not only important to reflect on the lives lost and the sacrifices made by those who served our country, but to ask: are we doing enough as a nation to give veterans the support and care that they need? Veterans deserve to be more than a political football. We discuss “supporting our troops” and “honoring …

Getting to a minimum viable product (MVP) health care app: Partner with physicians

Jenny Hyun, PhD, MPH and Joshua Tamayo-Sarver, MD, PhD

Health Technology

December 27, 2018

Over the course of several years, IBM’s fledgling Watson for Oncology program has received a wide range of reviews. Among them is a harsh critique published by Gizmodo. The article is filed under the keywords “AI,” “Watson,” “health,” “health care,” and “Doctor: This product is a piece of shit.” The last keyword is courtesy of a provider in Florida commenting on a highly publicized medication error.

While the …

Excellent surgeons are those who are quick to recognize their mistakes

Naeem Rahman, MD

Conditions and Diseases

December 27, 2018

“Dr. Rahman, this is the nurse in OR 12, Dr. H is doing a robotic/laparoscopic hysterectomy. He thinks he’s injured the ureter and is requesting help. Are you available?” I knew what came next was going to be complex — challenging surgically, disruptive to my schedule and potentially risky. I told the nurse that I would be over in about 10 minutes.

Under anesthesia was Michelle C, a 46-year-old African American …

KevinMD’s 2018 top posts: Highlighting the voices of practicing clinicians

Kevin Pho, MD

KevinMD

December 27, 2018

With over 22 million page views for the year, thank you for making 2018 such a success.

KevinMD continues to be the web’s leading platform that highlights the voice of the many who intersect with our health care system, but are rarely heard elsewhere: physicians, advanced practitioners, nurses, medical students, and patients who can share their insight and tell their stories.

This year, I’m …

How religious exemptions will affect Medicaid managed care

Ishaan Shah

Health Policy

December 27, 2018

In the United States, 25 million adult women are insured by their state Medicaid program. Medicaid covers 60 percent of all births in the United States as per federal law, and states must cover all pregnancy-related services for pregnant women with incomes up to 133 percent of the federal poverty line. There are two Medicaid insurance payment models: a fee-for-service model, where the state pays for individual services, and a …

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