Kevin Pho, MD

A practicing, board-certified internal medicine physician and the founder and editor of KevinMD.

385 articles on KevinMD

About Kevin Pho, MD

Articles, page 13

Health technology

Why Watson makes board certification exams obsolete in medicine

Kevin Pho, MD

February 17, 2011Feb 17, 201134

Like most everyone else, I took a break from my evening chores the past few nights, and watched Jeopardy! IBM's super-computer, Watson, was taking on Jeopardy! phenoms Ken Jennings and Brad Rutter. The computer won handily. After watching, I began…

Like most everyone else, I took a break from my evening chores the past few nights, and watched Jeopardy!

IBM’s super-computer, Watson, was taking on Jeopardy! phenoms Ken Jennings and Brad Rutter. [SPOILER] The computer won handily.

After watching, I began to study for my upcoming board re-certification exam.

But, then, I wondered. Why?

In the New York Times, applications for Watson are …

Medical education

Money prevents medical students from choosing primary care as a career

Kevin Pho, MD

February 16, 2011Feb 16, 20119

There are plenty of reasons why medical students aren't choosing primary care as careers. Lack of role models. Perception of professional dissatisfaction. High burnout rate among generalist doctors. Long, uncontrollable hours. But what about salary? Until now, the wage disparity…

There are plenty of reasons why medical students aren’t choosing primary care as careers.

Lack of role models. Perception of professional dissatisfaction. High burnout rate among generalist doctors. Long, uncontrollable hours.

But what about salary? Until now, the wage disparity between primary care doctors and specialists has only been an assumed reason; the evidence was largely circumstantial. After all, the …

Physician voices

When more aggressive care is better for patients

Kevin Pho, MD

February 16, 2011Feb 16, 20115

The recurring narrative among health reformers is that hospitals that provide more care raise health costs, but don't necessarily improve quality. This has lead to a backlash against so-called "aggressive" hospitals and doctors, with upcoming financial penalties to match. But…

The recurring narrative among health reformers is that hospitals that provide more care raise health costs, but don’t necessarily improve quality.

This has lead to a backlash against so-called “aggressive” hospitals and doctors, with upcoming financial penalties to match.

But the situation, as always, appears to be more nuanced than that.

In her column in the New York Times, Pauline Chen looks at …

Patient voices

When in the ER with abdominal pain, adjust your expectations

Kevin Pho, MD

February 14, 2011Feb 14, 20118

Abdominal pain is the bane of many emergency physicians. Recently, I wrote how CT scans are on the rise in the ER. Much of those scans look for potential causes of abdominal pain. In an essay from TIME, Zachary Meisel…

Abdominal pain is the bane of many emergency physicians.

Recently, I wrote how CT scans are on the rise in the ER. Much of those scans look for potential causes of abdominal pain.

In an essay from TIME, Zachary Meisel discusses why abdominal pain, in his words, is the doctor’s “booby prize.” And when you consider that there are 7 million visits annually by people who report abdominal pain, that’s a …

Health policy

Integrating doctors and hospitals may worsen cost control in health reform

Kevin Pho, MD

February 8, 2011Feb 8, 201135

Health reformers propose the proliferation of integrated health systems, like the Mayo Clinic or Kaiser Permanente, which, according to the Dartmouth Atlas, lead to better patient care and improved cost control. To that end, Accountable Care Organizations have been a…

To that end, Accountable Care Organizations have been a major part of health reform, changing the way health care is delivered.

Never mind that patients may not be receptive to the new model, but the creation of these large, integrated physician-hospital …

Physician finance

Female physicians make less money than male doctors, here’s why

Kevin Pho, MD

February 5, 2011Feb 5, 201124

Female doctors make less than male physicians. That conclusion gained major media traction recently. A recent post on KevinMD.com by medical student Emily Lu had some great conversation discussing some reasons why women make less money in medicine. To recap,…

Female doctors make less than male physicians.

That conclusion gained major media traction recently. A recent post on KevinMD.com by medical student Emily Lu had some great conversation discussing some reasons why women make less money in medicine.

To recap, the study from Health Affairs concluded that,

newly trained physicians who are women are being paid significantly lower salaries than their male counterparts according to a new study. The authors identify

…

Health policy

Health reform repeal will lead to single payer, Medicare for all

Kevin Pho, MD

February 1, 2011Feb 1, 201186

In a guest post last year, physician-author Richard Reece commented that the individual mandate may collapse health reform. Those words came to mind as Judge Vinson not only ruled the individual mandate unconstitutional, but the entire Affordable Care Act, as…

In a guest post last year, physician-author Richard Reece commented that the individual mandate may collapse health reform.

Those words came to mind as Judge Vinson not only ruled the individual mandate unconstitutional, but the entire Affordable Care Act, as well.

Nobody likes to be mandated to do anything, least of all purchase health insurance, and this was always the sticking point with the current iteration of health reform.

So, what …

Health policy

What’s next for doctors if pay for performance fails?

Kevin Pho, MD

January 28, 2011Jan 28, 201121

I recently pointed to a BMJ study concluding that pay for performance doesn't seem to motivate doctors. It has been picking up steam in major media with TIME, for instance, saying, "Money isn't everything, even to doctors." So much is…

I recently pointed to a BMJ study concluding that pay for performance doesn’t seem to motivate doctors. It has been picking up steam in major media with TIME, for instance, saying, “Money isn’t everything, even to doctors.”

So much is riding on the concept of pay for performance, that it’s hard to fathom what other options there are should it fail. And there’s mounting evidence that it will.

Aaron Carroll, a …

Health technology

Electronic medical records and pay for performance don’t improve care

Kevin Pho, MD

January 27, 2011Jan 27, 201113

Electronic medical records and pay for performance are among the ways health reformers are going to improve patient care. It's a fundamental shift in how doctors practice, with more practices adopting expensive EMRs. And with the advent of Accountable Care…

Electronic medical records and pay for performance are among the ways health reformers are going to improve patient care.

It’s a fundamental shift in how doctors practice, with more practices adopting expensive EMRs. And with the advent of Accountable Care Organizations, doctors will soon be compensated in part by quality measures.

But will they work? Well, the jury’s still out.

Two articles caught my eye recently.

The first, from the WSJ’s Health Blog, reports …

Physician voices

Old doctors who continue to treat patients

Kevin Pho, MD

January 25, 2011Jan 25, 201116

Did you know that one-third of the country's physicians are over the age of 65? That's right, there's a good chance that your doctor is on Medicare. That's a concern, because physicians aren't immune to the ails of aging, and…

Did you know that one-third of the country’s physicians are over the age of 65?

That’s right, there’s a good chance that your doctor is on Medicare. That’s a concern, because physicians aren’t immune to the ails of aging, and are just as prone as patients to succumb to the effects of Parkinson’s or various types of dementias.

Not comforting if you’re about to undergo an operation, for instance. And absolutely frightening when …

Physician voices

Your surgeon may be contemplating suicide

Kevin Pho, MD

January 18, 2011Jan 18, 20114

I wrote last year in USA Today about the impact of physician burnout. Not only do doctors suffer, but so do their patients. Burnout starts early in residency, with entering interns having a depression rate of 4%, similar to the…

I wrote last year in USA Today about the impact of physician burnout. Not only do doctors suffer, but so do their patients.

Burnout starts early in residency, with entering interns having a depression rate of 4%, similar to the general public. But after the first year of residency, that number balloons to 25%.

Now, another study adds fuel to this disturbing trend.

A paper published in the Archives of General Surgery …

Physician voices

Primary care doctors and specialists need to better communicate

Kevin Pho, MD

January 11, 2011Jan 11, 20119

Whenever I refer a patient to a specialist, a copy of the patient's recent notes, labs and diagnostic tests is faxed to the specialist -- in many cases, prior to their visit. And most of the time, after they see…

Whenever I refer a patient to a specialist, a copy of the patient’s recent notes, labs and diagnostic tests is faxed to the specialist — in many cases, prior to their visit.

And most of the time, after they see the specialist, I receive a fax back describing what happened.

You’d think this is standard procedure, but it doesn’t happen as often as it should.

A study from the Archives of Internal Medicine …

Conditions and diseases

Radiation risks from CT scans are underestimated by patients

Kevin Pho, MD

January 6, 2011Jan 6, 20112

Radiation from CT scans needs to be better taught to patients, as their risks are real. It's the best way to help curb the rampant ordering of these tests. Unfortunately, we aren't doing a very good job. In a study…

Radiation from CT scans needs to be better taught to patients, as their risks are real.

It’s the best way to help curb the rampant ordering of these tests. Unfortunately, we aren’t doing a very good job.

In a study from the Annals of Emergency Medicine, most patients underestimate their risk from radiation.

When asked to compare the amount of radiation from a CT scan to the amount that Hiroshima …

Physician voices

Pain contracts threaten the doctor-patient relationship

Kevin Pho, MD

January 4, 2011Jan 4, 201128

Doctors today are wary about treating chronic pain. One of the main worries is precipitating fatal opioid overdoses. Indeed, according to the CDC, and reported by American Medical News, "fatal opioid overdoses tripled to nearly 14,000 from 1999 to 2006…

Doctors today are wary about treating chronic pain.

One of the main worries is precipitating fatal opioid overdoses. Indeed, according to the CDC, and reported by American Medical News, “fatal opioid overdoses tripled to nearly 14,000 from 1999 to 2006 … [and] emergency department visits involving opioids more than doubled to nearly 306,000 between 2004 and 2008.”

Requiring chronic pain patients to sign pain contracts is a way to mitigate this …

Physician voices

Should surgeons tell patients how much sleep they had?

Kevin Pho, MD

December 30, 2010Dec 30, 201010

In a recent New England Journal of Medicine, a perspective piece on what to do with fatigued surgeons is generating debate. The issue of work-hour restrictions has been a controversial issue when it comes to doctors in training, something that…

In a recent New England Journal of Medicine, a perspective piece on what to do with fatigued surgeons is generating debate.

The issue of work-hour restrictions has been a controversial issue when it comes to doctors in training, something that I wrote about earlier in the year in USA Today. But once doctors graduate and practice in the real world, there are no rules.

As summarized in the WSJ’s Health Blog, …

Health technology

Why an EMR doesn’t necessarily deliver better patient care

Kevin Pho, MD

December 29, 2010Dec 29, 201021

Regular readers of this blog know that the mere introduction of an electronic medical record doesn't necessarily guarantee better patient care. There are multiple reasons for that, including the fact that many systems are archaic in nature, counter-intuitive, and doctors…

Regular readers of this blog know that the mere introduction of an electronic medical record doesn’t necessarily guarantee better patient care.

There are multiple reasons for that, including the fact that many systems are archaic in nature, counter-intuitive, and doctors are forced to learn multiple systems.

Yesterday, the WSJ’s Health Blog posted a study showing that hospitals with an EMR don’t necessarily have better quality measures.

Shocker.

According Rand Corp.,

trying to

…

Conditions and diseases

How false positives can kill patients

Kevin Pho, MD

December 28, 2010Dec 28, 20106

I've written in the past that more medicine and tests do not necessarily reflect better care. There is no test that is 100% specific or sensitive. That means tests may be positive, when, in fact, there is no disease ("false…

I’ve written in the past that more medicine and tests do not necessarily reflect better care.

There is no test that is 100% specific or sensitive. That means tests may be positive, when, in fact, there is no disease (“false positive”), or tests may be negative in the presence of disease (“false negative”).

It’s the latter that often gets the most media attention, often trumpeted as missed diagnoses, but false positives …

Read more…

How false positives can kill patients

Physician voices

Patient complaints do not fit the primary care office visit

Kevin Pho, MD

December 28, 2010Dec 28, 201050

Primary care physicians often have to see patients with a litany of issues. Often within a span of a 15-minute office visit. This places the doctor in the middle of a tension -- spend more time with the patient to…

Primary care physicians often have to see patients with a litany of issues. Often within a span of a 15-minute office visit.

This places the doctor in the middle of a tension — spend more time with the patient to address all of the concerns, but risk the wrath of patients scheduled afterwards, who are then forced to wait.

And, in some cases, it’s simply impossible to adequately address every patient question …