KevinMD.com

December 26, 2016Dec 26, 2016

Have you heard of Dr. Kildare? When I was a kid, he was the most popular doctor in the world. He was smart, courageous, and handsome, and every week he did something amazing at Blair General Hospital. Thanks to my…

Thanks to my mother, I grew up hearing stories about a real-life Dr. Kildare. We’ll call him Dr. B, and he was a legend in my home state of North Carolina.

My mother was a …

Health Technology

The communication revolution in health care may be doing more harm than good

Jim Schroeder, PhD

December 26, 2016Dec 26, 2016

It happened again. Yesterday, I was charting on the recently launched streamlined version of our electronic health records and a new note popped up in the right lower corner of the screen: "Welcome to (our new texting system). Now you…

It happened again. Yesterday, I was charting on the recently launched streamlined version of our electronic health records and a new note popped up in the right lower corner of the screen:

“Welcome to (our new texting system). Now you can instantly and securely text about patient care with all of your colleagues.”

A few seconds later, a message popped up. “You have one unread message.” As with most other communication systems, …

Health Policy

Pay-for-performance is here to stay. Hospitals better pay attention.

Peter Ubel, MD

December 26, 2016Dec 26, 2016

It used to be that hospitals billed Medicare for the services they provided, and Medicare -- I know this is crazy! - simply paid the bills. Those days are rapidly receding into history. Soon, a significant chunk of hospital revenue…

It used to be that hospitals billed Medicare for the services they provided, and Medicare — I know this is crazy! – simply paid the bills.

Those days are rapidly receding into history. Soon, a significant chunk of hospital revenue will be at risk, under a series of Medicare pay-for-performance programs. The idea behind P4P (as the cool kids call it) is simple. Third-party payers, like insurance companies or the Medicare …

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Medical Education

Are surgical residents really doing the cases they scrub on?

Skeptical Scalpel, MD

December 25, 2016Dec 25, 2016

According to the Residency Review Committee for Surgery, "A resident may be considered the surgeon only when he or she can document a significant role in the following aspects of management: determination or confirmation of the diagnosis, provision of preoperative…

According to the Residency Review Committee for Surgery, “A resident may be considered the surgeon only when he or she can document a significant role in the following aspects of management: determination or confirmation of the diagnosis, provision of preoperative care, selection, and accomplishment of the appropriate operative procedure, and direction of the postoperative care.”

In nearly all instances, resident “determination or confirmation of the diagnosis, provision of …

Physician

What this physician learned from writing about psychiatry

Maria Yang, MD

December 25, 2016Dec 25, 2016

Someone presented me with the opportunity to write a section on psychiatry for medical students. This is wonderful (an opportunity to influence future physicians!) and terrible (GAAAAH there’s so much in psychiatry!). Between thinking about psychiatry at multiple levels at work and thinking about the foundations of psychiatry while writing the section, I’ve felt cognitively impaired when thinking about what I should write here.

But the thinking never stops … and …

Conditions and Diseases

What you need to know about migraine headaches in children

Roy Benaroch, MD

December 25, 2016Dec 25, 2016

Parents are sometimes surprised to find out that migraines are the most common cause of recurrent headaches in children. Yes, kids get migraines -- and many adults who get them started getting them as children, even if they weren’t diagnosed…

Parents are sometimes surprised to find out that migraines are the most common cause of recurrent headaches in children. Yes, kids get migraines — and many adults who get them started getting them as children, even if they weren’t diagnosed correctly.

(And many adults who get migraines are still not being diagnosed correctly. Do you get “sinus” headaches? They’re almost certainly migraines. Yes, I know you feel congested with them. Yes, …

Physician

Connecting the lines between father and child

Jordan Grumet, MD

December 24, 2016Dec 24, 2016

I both look forward to and despise Sunday mornings. I awake just before the sun and am on the road by 5:15 a.m. Although I dread being upright so early on the weekend, I rejoice because it is the only trip to work, all week, at a leisurely pace. I see the new admits at the nursing home, run by the hospital if necessary, and return just as my family …

Physician

When can I follow my intuition?

Tracy Cardin, ACNP

December 24, 2016Dec 24, 2016

In modern medicine, we’re surrounded by EMR systems, lab tests and increasingly complex medical equipment. But I sometimes stop and wonder: Where does my intuition fit into the equation? Case in point: The other day, I had one of those…

In modern medicine, we’re surrounded by EMR systems, lab tests and increasingly complex medical equipment. But I sometimes stop and wonder: Where does my intuition fit into the equation?

Case in point: The other day, I had one of those days that happens in hospital medicine where nothing goes right. A patient admitted right at change of shift, with a diabetic foot ulcer as a chief complaint, was found to have …

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When can I follow my intuition?

Conditions and Diseases

MKSAP: 68-year-old woman with progressive abdominal distention

mksap

December 24, 2016Dec 24, 2016

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 68-year-old woman is evaluated for a 3-month history of gradually progressive abdominal distention. Her medical history is notable for a 20-year history of…

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

A 68-year-old woman is evaluated for a 3-month history of gradually progressive abdominal distention. Her medical history is notable for a 20-year history of obesity, type 2 diabetes mellitus, hyperlipidemia, and hypertension. She also has had a 10-year history of elevation of serum aminotransferase levels, which was attributed to nonalcoholic fatty liver disease. …

Physician

These doctors were shamed and bullied for being sick

Pamela Wible, MD

December 23, 2016Dec 23, 2016

We go to the doctor when we are sick. But what happens when doctors get sick? Who cares for them? All too often, physicians are threatened, harassed, even terminated for being ill. After reporting on a psychiatrist fired for having cancer and a pediatrician bullied for her brain tumor, I’ve heard from many more physicians who are now courageously stepping forward to tell the truth — in …

Physician

Marking a melancholy anniversary

Hans Duvefelt, MD

December 23, 2016Dec 23, 2016

Theresa Miller is one of the hardest working women I know. She doesn’t come into the office very often. She no longer needs my prescription for her heartburn medication, as it costs less for her to buy it over the…

Today I saw her for a preoperative clearance. She finally decided to get an operation for her chronically sore shoulder. She had injured it many years ago>. In …

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Marking a melancholy anniversary

Physician

Small moments have a big impact on patients’ lives

Marc Tumerman, MD

December 23, 2016Dec 23, 2016

This is a story of two deaths. These patients' stories intersected on the same morning, in the same building, in two adjacent rooms, has left me thinking about them. I was surprised to see Mrs. Stevens' name on my schedule…

This is a story of two deaths. These patients’ stories intersected on the same morning, in the same building, in two adjacent rooms, has left me thinking about them.

I was surprised to see Mrs. Stevens’ name on my schedule today. She came to the office last week, and I felt sure that she’d be too weak for another visit. But I was glad she’d made it, as I’ve become quite …

Physician

Physicians take note: Get personal with your patients

Suneel Dhand, MD

December 23, 2016Dec 23, 2016

Customer service is all the rage these days in most facets of our lives. America leads the world in this area (however much of the public here take it for granted). I’ve traveled all over the world, and the concept of customer service in many other parts of the globe, including highly advanced and prosperous other Western nations, still leaves a lot to be desired. It’s always reassuring to know …

Physician

Why doctors are rebelling against saving lives

Michael Breen, MD

December 22, 2016Dec 22, 2016

When I was in medical school, “real” doctors saved lives. Period. Specialists who focused on a patient’s quality of life, (the plastic surgeons, bariatric surgeons, holistic practitioners, infertility experts, etc.) were considered sellouts. (We won’t even consider the med school…

When I was in medical school, “real” doctors saved lives. Period.

Specialists who focused on a patient’s quality of life, (the plastic surgeons, bariatric surgeons, holistic practitioners, infertility experts, etc.) were considered sellouts. (We won’t even consider the med school status of future psychiatrists.)

We disparaged these doctors because they could be saving lives and chose not to, because they were often paid (God forbid) out-of-pocket by their patients, and because they …

Physician

8 ways doctors can help patients affected by the impending repeal of Obamacare

Sandeep Palakodeti, MD, MPH

December 22, 2016Dec 22, 2016

If you’re like me, you’re getting a bit restless hearing about what may or may not happen to the Affordable Care Act (Obamacare). As doctors, we are trained to act. While administrators plan new quality improvement programs, we take each…

If you’re like me, you’re getting a bit restless hearing about what may or may not happen to the Affordable Care Act (Obamacare).

As doctors, we are trained to act. While administrators plan new quality improvement programs, we take each day as an opportunity to improve our practice and work more closely with our teams. While our clinics and hospitals try to figure out how to streamline workflows in our EHRs, …

Physician

Holiday reflections from an oncologist

Prateek Mendiratta, MD

December 22, 2016Dec 22, 2016

A Christmas Carol by Charles Dickens is one of the most beloved stories of all time. It is a classic story with a theme that resonates as we end the year and commence a new one. The story revolves around the main character examining his past, present, and future. He realized that key events have shaped his life and turned him into the man he is. Before the story ends, …

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Holiday reflections from an oncologist

Physician

It’s time to start teaching financial literacy to young physicians

Chad Chubb, CFP

December 21, 2016Dec 21, 2016

The ultimate goal of every young physician while in medical school and residency should be to become a remarkable doctor. However, what if one of the biggest factors of being a great doctor was not addressed from the start? Financial…

Financial wellness may not directly correlate with being an incredible doctor, but stress can and does, and today’s young medical professionals have a lot on their plates — beginning with $200,000 in …

Physician

My experience as a physician shaped my views on the LGBTQ community

Dr. Leonard A. Sowah

December 21, 2016Dec 21, 2016

As a physician from Ghana brought up in a very religious family, I must admit that when it comes to gay rights and other issues related to sexual minorities I was as far to the right as anyone could be. My first experience with openly gay individuals was when I came to the United States. Needless to say, gay behavior in Ghana was so stigmatized as to be nonexistent in …

Physician

Can we say that women doctors are just better for everyone?

Dara Kass, MD

December 21, 2016Dec 21, 2016

Recently, my friend had a patient. The guy, patient with a history of autoimmune disease came in with pain, anxiety, and tachycardia. She walked in and felt the psychosomatic overlay. What was her intervention? Meds? Psych? Nope. She closed the…

She closed the door, held his hand, pulled out her mom self and let him tell her for 15 long minutes about his hard life. The nurse watched the monitor as his heart rate dropped in …

Physician

How a family physician gets to know her newly arrived refugee patients

Xandra Rarden, MD

December 21, 2016Dec 21, 2016

The reason for Chandra’s office visit is to fill out form N-648. Chandra* is a fifty-nine-year-old Bhutanese refugee who has been my patient for the last nine months. Form N-648 is a six-page bureaucratic nightmare that is guaranteed to bring my clinic day to a grinding halt. My refugee patients bring me this form to certify that they are unable to take the test to become a U.S. citizen due …

Real physician voices, twice a week

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