Kenneth Lin, MD

Kenneth Lin is a family physician who blogs at Common Sense Family Doctor.

Will high tech innovations actually improve health outcomes?

Physician

May 21, 2013

One of my students told me about his experience at TEDMED, the future-oriented medical conference that bills itself as “a celebration of human achievement and the power of connecting the unconnected in creative ways to change our world in health and medicine.”

He recounted how one speaker showed off the Remote Presence Virtual + Independent Telemedicine Assistant, which news outlets quickly dubbed the “Robo-Doc.” This high-priced gadget is designed …

Reduce the chance that you will be harmed by an incidentaloma

Kenneth Lin, MD

Physician

April 18, 2013

Mrs. Smith (not her real name) fidgeted in her chair in my examination room as I scanned the radiology report she had given me. She had visited the emergency room the previous evening with severe abdominal pain that had eventually been diagnosed as gastritis, or swelling of the stomach lining due to a virus. During her evaluation, the ER physician had ordered a CT scan of her abdomen and pelvis. …

Empower whistleblowers to improve the health of all Americans

Kenneth Lin, MD

Physician

March 18, 2013

The first instinct of a bureaucracy is self-preservation, and health care bureaucracies are no exception. This rule applies not only to government agencies, but to academic and industry settings as well. This was the conclusion I came to after listening to a panel of scientist and physician “whistleblowers” at the Selling Sickness 2013 conference in Washington, DC.

One by one, they described their painful discoveries that widely prescribed medications …

Overdiagnosis: An epidemic or minor concern?

Kenneth Lin, MD

Conditions

January 24, 2013

An editorial by two oncologists in the New Year’s issue of Annals of Internal Medicine discusses overdiagnosis, a controversial health problem that some have called “a modern epidemic” but others, including the editorialists, feel is a minor concern. Although many chronic conditions are overdiagnosed, cancer is the most thoroughly studied, as well as the most emotionally charged.

I am a generally healthy man with no family history …

People are fallible, but health systems need not be

Kenneth Lin, MD

Physician

January 8, 2013

When I heard in October that Superstorm Sandy was projected to make landfall somewhere in the vicinity of DC and Maryland, I prepared for the worst. I stocked up on non-perishable goods and evacuated to higher ground. (The rest of my family was already coincidentally out of town and harm’s way.)

I put fresh batteries into two flashlights and installed a flashlight app on my smartphone for good measure. Although I …

It’s time to rethink the role of antivirals in flu treatment

Kenneth Lin, MD

Meds

December 31, 2012

Flu season has begun in the U.S., and in addition to familiarizing themselves with the Advisory Committee on Immunization Practice’s vaccination guidelines for the 2012-13 season (offer influenza vaccine to everyone 6 months of age or older), physicians should consider how they plan to diagnose patients with suspected influenza. Despite the availability of multiple antiviral medications for influenza, whom to treat remains a …

How cancer awareness efforts can backfire

Kenneth Lin, MD

Physician

November 8, 2012

The American Cancer Society designated an October weekend weekend “Suits and Sneakers Awareness Weekend” as part of its annual Coaches vs. Cancer program that featured well-dressed basketball coaches wearing “sneakers instead of dress shoes with their usual game attire during weekend games to demonstrate their support for the Society and the fight against cancer.”

The idea is to encourage people to exercise and eat a healthy diet to reduce …

The CDC recommends hepatitis C screening: Should they be followed?

Kenneth Lin, MD

Conditions

October 5, 2012

Recently, the Centers for Disease Control and Prevention finalized new recommendations for one-time screening for the hepatitis C virus (HCV) in all persons born between 1945 and 1965, a generation better known as the “Baby Boomers.”

The CDC’s new recommendations were published in the Annals of Internal Medicine. Previously, the CDC only recommended that persons with behavioral or medical risk factors for HCV be routinely tested. Its rationale …

Policy experts need to lead by storytelling

Kenneth Lin, MD

Physician

September 26, 2012

Public health leaders must often tell people things that they don’t really want to hear. “Stop smoking.” “Eat a healthier diet.” “Exercise for at least 30 minutes each day.” To motivate people to heed these messages, leaders construct simple narratives to communicate the potential harms of undesired health behaviors and the benefits of desired ones. Who wants to spend their golden years tethered to an oxygen tank for every moment …

CT scans for lung cancer screening: Look closely at the statistics

Kenneth Lin, MD

Conditions

September 16, 2012

Enthusiasm for lung cancer screening has never been higher, following last year’s report from the National Lung Screening Trial (NLST) that heavy smokers who underwent 3 rounds of low-dose computed tomography (CT) screening were 20 percent less likely to die from lung cancer compared to a similar group that was screened with chest x-rays (a “placebo” intervention that another study found to be ineffective). My own institution, Georgetown University Hospital, was one of the …

View medical apps with caution, just like any new medical device

Kenneth Lin, MD

Tech

September 4, 2012

Doctors of my generation have experienced dramatic changes in the way we access the information we need to care for patients. As a medical student 15 years ago, my “peripheral brain” consisted of fat textbooks sitting on office bookshelves or smaller, spiral-bound references stuffed into the bulging pockets of my lab coat. As a doctor-in-training, I replaced those bulky references with programs loaded onto PDAs. Today, smartphone apps allow health …

Stop paying McDonald’s wages if you want Cheesecake Factory medicine

Kenneth Lin, MD

Physician

August 30, 2012

In “Big Med,” his latest article on health care in The New Yorker, surgeon-writer Atul Gawande added the Cheesecake Factory to his running list of health care analogies (which have included, among others, farming, pit crews, and airline safety). Observing that the Cheescake Factory and other upscale restaurant chains successfully lower costs and improve quality by “studying what the best people are doing, …

Reaching the end of PSA screening

Kenneth Lin, MD

Conditions

July 24, 2012

In the summer of 2007, then-U.S. Preventive Services Task Force member Russ Harris, MD, MPH approached me about taking on what he suggested would be a fairly quick and straightfoward project: summarizing the small amount of medical literature on the benefits and harms of the prostate-specific antigen (PSA) test that is commonly used to screen asymptomatic men for prostate cancer.

Little did I know that this research and its implications would …

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Reaching the end of PSA screening

What’s needed for an EHR to transform primary care

Kenneth Lin, MD

Tech

July 10, 2012

The family medicine residency program where I serve as a faculty preceptor “went live” with their new electronic health record. They posted a sign at the front desk that read in part: “Pardon Our Progress,” as if we were starting a major construction project — which in a way, we were.

Instead of wading through stacks of unruly paper charts, my colleagues and I logged on to a sleek online portal …

Stories help the public make sense of evidence

Kenneth Lin, MD

Physician

January 20, 2012

Recently, I presented Family Medicine Grand Rounds at Georgetown University School of Medicine on resolving conflicts between screening guidelines. During the question and answer session, Department Chair James Welsh, MD asked how evidence from carefully conducted clinical trials can possibly overcome powerful emotional stories of “saved lives.”

I answered that evidence-based medicine’s supporters must fight anecdotes with anecdotes. For every person who believes his or her life was extended by a …

Coronary CT screening is low value health care

Kenneth Lin, MD

Physician

August 30, 2011

Like many states, Texas is facing a fiscal crisis caused by decreased revenue from the economic recession and skyrocketing health care costs. Even without the expansion of publicly financed health insurance mandated by last year’s health reform law, the percentage of the state budget devoted to Medicaid expenses is projected to rise from 28 percent to 46 percent by 2020, even faster if the law withstands current constitutional …

How politics have weakened the USPSTF

Kenneth Lin, MD

Policy

August 23, 2011

Health reform was supposed to have been good news for the U.S. Preventive Services Task Force. Until 2009, this independent panel of federally-appointed experts in primary care and preventive health was not particularly well known, and its evaluations of the effectiveness of clinical preventive services had no binding authority on public or private insurance plans. Within the small circle of physicians and policymakers who were aware of the their …

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How politics have weakened the USPSTF

Examining the evidence behind a community health screening

Kenneth Lin, MD

Physician

June 3, 2011

The following deceptive advertisement appeared in my church’s bulletin yesterday:

Life Line Screening, the nation’s leading provider of preventive health screenings, will offer their affordable, non-invasive, painless health screenings [in the church cafeteria] on April 9th. Five screenings will be offered that scan for potential health problems related to: blocked arteries, which is a leading cause of stroke; abdominal aortic aneurysms, which can lead to a ruptured aorta; hardening of the …

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Examining the evidence behind a community health screening

Family physicians who care for underserved patients

Kenneth Lin, MD

Physician

March 21, 2011

One of the ugliest incidents in my career occurred during my faculty development fellowship year, when I spent two days each week seeing patients at several federally qualified community health centers in inner city Washington, DC. Midway through the year, I was transferred from a health center that served an African-American population to one serving a mostly Spanish-speaking clientele.

Nearly all of the permanent Read more…

Family physicians who care for underserved patients

Individual health beliefs play a role in medical decisions

Kenneth Lin, MD

Patient

January 17, 2011

As a family physician, I’ve found that patients’ individual health beliefs often play a big role in important decisions such as starting a new medication or undergoing an invasive test or procedure.

Some patients were more willing to endure potentially risky procedures in order to learn their diagnosis quicker, for example, while others preferred “watchful waiting,” or monitoring symptoms that were unlikely to be a sign of anything serious. Unfortunately, in …

Kenneth Lin, MD

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