Call it the McVictim syndrome. Too many pundits, public health experts and politicians are working overtime to find scapegoats for America’s obesity epidemic.
In his latest book, former FDA Commissioner David A. Kessler argues that modern food is addictive. In it, he recounts how he was once helpless to stop himself from eating a cookie. In a paper in this month’s Journal …
Obesity patients are not victims
My father suffered a mild heart attack last year. In his 80+ years, he has never had any indication he had a problem with his heart! A variety of other health issues have arisen over time, but Dad’s heart was always thought to be as strong as could be.
In fact, despite protestations (“I don’t really think these chest pains are a big deal… let me just …
Good patient communication by managing expectations
As State Health Information Exchanges and Federal efforts (NHIN Connect/NHIN Direct) implement the data sharing technology that will enable all providers in the country to achieve Meaningful Use Stage 1, I’m often asked “but when will this healthcare information exchange technology be able to retrieve all my records from everywhere when I’m lying unconscious in the Emergency Department and cannot give a history?”
Here are …
What meaningful use stage 1 will mean to patients
It has been reported that up to 60% of doctors suffer from symptoms of psychological job-exhaustion, or physician burnout, leading to diminished career satisfaction, substance abuse, divorce, quitting the profession, and suicide.
An article in a recent Journal of the American Medical Association by Helen Riess, a Harvard psychiatrist, attributes much of this psychosocial carnage to the loss of an empathic connection between doctors and their patients.
The author summarizes a …
Loss of an empathic connection between doctors and their patients
PLoS Medicine recently published an article commenting on an earlier study exploring the link between social networking and mortality.
The result speaks for itself: “the degree of mortality risk associated with lack of social relationships is similar to that which exists for more widely publicized risk factors, such as smoking.” You read that right, according to this study which examined over 300,000 participants in a meta-analysis, social relationships are as important …
Mortality risk associated with lack of social relationships
Raghav Govindarajan, ACP Associate Member, a neurology resident at the Cleveland Clinic Florida, told us about a case he saw in India that has important lessons for clinicians everywhere. The patient was a 65-year-old man who presented with chronic symptoms of burning discomfort and weakness in his left leg.
His symptoms had started about seven years prior and he had been told that he had “neuritis.” He reported that he had …
Social prejudices may limit the accuracy of patient information
A guest column by the American Medical Association, exclusive to KevinMD.com.
As the nation’s largest physician organization, the American Medical Association (AMA) is uniquely positioned to help physicians thrive in medical practice throughout the stages of their careers.
Because the AMA is led by physicians, we understand the many demands and rigors physicians face as they work to provide high-quality patient care, and we are proud to support physicians in their …
AMA helps physicians care for patients
The recent financial incentives offered by the government (HITECH) for EMR implementation are somewhat helpful but are also misleading.
Most fail to recognize that the biggest obstacles to EMR implementation are not financial, but are cultural. EMR adoption will require cooperation between two disparate cultures: the Health IT (HIT) culture and the medical culture. One needs only to read a few of the EMR debates in any health care blog to …
Health IT and doctors need to bridge the cultural gap
One of the most popular Simpsons episodes ever – MoneyBART – succinctly describes the struggle between intuitive and algorithmic decision making in physical therapy.
This struggle, catapulted to prominence in 2002 with the publication of Flynn’s manipulation rule, is not unique to physical therapists.
Physicians, too, resist the influence of decision rules and adhere poorly to clinical practice guidelines.
Physical therapists share some commonalities with physicians in that we overestimate …
Intuitive and algorithmic decision making and The Simpsons
Ten years ago, I wrote the Pew Internet Project’s first report on the impact of the internet on health care, calling it “The Online Health Care Revolution.”
Back then, the idea that people were searching online for health information was revolutionary. All of a sudden, regular people had access to medical information that had always been locked up and out of reach.
Ten years later, I am ready to declare the access …
The internet and online health information trends
Are patients better off than they were ten years ago?
Just over a decade ago the Institute of Medicine (IOM) released its celebrated report on patient safety, To Err is Human. Many credit that report, which was released with great fanfare, with launching the patient safety movement. So it’s appropriate to assess the movement’s impact eleven years later. How did we do?
On November 25 the New England Journal of Medicine published …
A postmortem on the patient safety movement
by Diana E. Lee
It sounds like NFL Wide Receiver Percy Harvin (Minnesota Vikings) is one of the luckier chronic migraine patients out there.
He was actually able to identify a specific reason for his drastically increased number of migraine attacks (sleep apnea) and implement a treatment that seems to be helping (CPAP). He is performing solidly and confidently and taking contact without any issues.
I know a …
Percy Harvin and how sleep apnea affected his migraine headaches
In 1905 William Osler gave his farewell address as he prepared to leave Johns Hopkins for Oxford and England. After speaking to the assembled medical students about the tragic side of medicine he said:
The comedy, too, of life will be spread before you, and nobody laughs more often than the doctor at the pranks Puck plays upon the Titanias and the Bottoms among his patients. The humorous side is really …
William Osler’s humor, and finding fun in medicine
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A response to my recent post, The malpractice system doesn’t improve patient safety.
by Brian Nash
In his blog, Dr. Kevin acknowledges that in the “world of medical error, truth is often clouded in secrecy.” He then points out that “… taking the bold step of publicly describing your mistake is a brave one. Some would say it’s long overdue.”
Well so far, Dr. K, we’re …
Open dialogue on medical malpractice and patient safety
The September issue of Journal Watch General Medicine included an article from the American Academy of Pediatrics about new criteria for diagnosis and management of concussions in children and adolescents.
Shortly after this issue was published, a segment aired on ESPN regarding a confrontation between the head football coach at Texas Christian University and its team physician over holding a player out of the game due to a concussion.
As a sports …
Playing hurt and when to return to football after a concussion
by Steve Sanders, DO
“What am I going to do now Doc?” asked Mike, a down on his luck, 29 year–old recently unemployed truck driver, as he handed me his hospital bill.
Mike was seen at our local emergency department on a Friday evening with complaints of indigestion. Earlier that day he and his wife Susan celebrated their second anniversary by splitting a store bought pepperoni pizza. …
$11,000 hospital bill from the emergency department
I told a friend what I did recently to get in to see a dermatologist and she was shocked.
“You wrote a letter asking her to take you as patient?” “Wow!” “Yes,” I admitted. “I’d called her office for an appointment; she wasn’t taking new patients; I needed to resort to an over-the-top approach.”
You see, I’d researched her (ok, I Googled her) and after reading her background, schooling, and patient reviews, …
Choose your primary care physician with particular care
Recently, medical writer and pediatrician Perri Klass wrote in the New York Times about evolving issues regarding the diagnosis of appendicitis in children, which are also applicable to adults. There is well-documented concern regarding the excessive radiation exposure associated with CT scans.
For example, a recent paper reported that a single abdominal CT scan with contrast delivers a radiation dose equal to undergoing more than 200 regular …
Appendicitis in children and radiation exposure from CT scans
Have you ever discharged a patient from the hospital and had a gnawing feeling that maybe you could have done more to educate the patient about their disease, medications, and plan of care?
Probably so. A recent survey published in the Archives of Internal Medicine tells us that this feeling is based in reality (I’m guessing that you already knew this) and that you are not alone.
The …
Educate the patient about their disease and discharge plan
by Shelley Carson, PhD
Both highly creative individuals and ADHD-diagnosed individuals often report feeling out of place, like a square peg in a round hole.
(In fact, in my creativity research questionnaires I actually ask the question “Do you often feel like a square peg in a round hole?” Participants who score high on the Creative …
Creativity and ADHD may share some common genetic vulnerabilities
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