It happened again. I was talking to a particularly sick patient recently who related another bad experience with a specialist.
“He came in and started spouting that he was busy saving someone’s life in the ER, and then he didn’t listen to what I had to say,” she told me. ”I know that he’s a good doctor and all, but he was a real jerk!”
This was a specialist that I hold …
10 reasons for physician burnout
A guest column by the American College of Physicians, exclusive to KevinMD.com.
Fall is the time of year when the CDC, CMS, insurance companies, and professional societies bombard physicians with reminders to vaccinate their patients against influenza. I will do these groups one better and not only remind you, but also share a couple of ideas for improving …
ACP: Make flu vaccination a team effort
It’s National Primary Care Week, an annual celebration when members of the primary care community come together across the country in events largely organized by trainees to celebrate, promote and advance primary care. So what makes this year different?
Put simply, the momentum for advancing primary care in the US has never been stronger. Those of us who believe that a robust foundation of primary care is essential to the health …
National Primary Care Week 2012: What makes this year different?
For some of my patients, going to college is especially nerve-wracking because it will be their first time living away from home with a chronic disease.
I deal with teen health daily. I care for a lot of adolescents and young adults with chronic disease, everything from asthma to diabetes to congenital heart defects. As my patients grow up they have a lot to deal with because of medical issues: taking …
10 tips for new college students with chronic disease
After all the hullabaloo generated by my passing on the accurate but controversial information that exercise will not help you lose weight, I thought I should give equal time to the other side, and discuss several things that appear to help enhance efforts at weight loss.
Sleep
Although I’m not aware of any formal studies documenting this, I can report from personal and professional experience that the value of sufficient …
3 unexpected ways to help you lose weight
When Apple launched the App Store, Epocrates had a front seat at the table, and collaborated with Apple to make sure its software would be one of the first available for iPhone users.
As medical professionals, this didn’t come as a surprise. We expected Epocrates to be “the first”. It had been the undisputed king of medical and mobile before the word “apps” became everyday vernacular. Epocrates was dominating the …
Will Epocrates slowly become irrelevant in the iPad era?
“Health care costs are sky-rocketing!”
“The percentage of the U.S. GDP devoted to heath care costs is the highest in the world.”
“The cost of Medicare is unsustainable.”
For most of us, the cost of health care (i.e., the dollars required by the system to produce and deliver care) isn’t what brings us the most anxiety.
It’s when we’re patients or helping a loved one find care that so many of us are deeply …
The cost of health care is different from its price
When I walked into the exam room, the mom was almost crying because her son’s fever wouldn’t go down. I already knew that this was a simple virus – the kind that gives a high fever for a few days and then a rash. This mom was from Brazil, however, where this sort of infection is barely seen. In Brazil, a high fever that won’t go down equals a good chance …
Watch team based primary care in action
My mother is stubborn. She occasionally approaches me for medical advice and, since I owe her more than words can adequately describe, I am happy to do what I can. Unfortunately, she is a stoic. She is also no fan of pharmaceuticals. She believes in baptism by fire, that pain purifies the soul, and what doesn’t kill you makes you stronger. So while she sometimes wants my medical advice, she …
What if the patient’s choice is frustratingly ill advised?
Have you ever worried about how you’re going to get healthy these days? Has your doctor recommended diet and exercise? Well, if you’re like millions who are struggling to find health, you’re going to need a lot more than just diet and exercise. You’re going to have to fight like crazy against a mind-set of disease that’s paradoxically disguised as health care.
America’s healthcare system – health insurance companies, government health …
How America’s healthcare system will keep you sick
Recently a neighbor backed into my car while I was leaving a food store. The damage was minimal, but she offered to have her insurance company pay for the repair. After contacting the company, I was offered several body shops, and chose the one closest to my home. The work was completed in only two days, and while it was in the shop, I decided to also have some dents …
Why health insurance is the problem and not the solution
The American Academy of Family Physicians (AAFP) recently issued a new report describing its vision of primary care’s future. Not surprisingly, the report talks about medical homes, with patient-centered, team-based care.
More surprisingly, though, it makes a point to insist that physicians, not nurse practitioners, should lead primary care practices. The important questions are whether nurse practitioners are qualified to …
The AAFP picks a fight with nurse practitioners
1. A 40-year-old female sees her family physician for burning chest pain after she eats hot peppers. She had it only once while exercising. Her family physician sends her to the emergency department and she gets admitted for chest pain. Rather than going home with treatment for her GERD, she ends up dead. This never should have happened, but the family never learns what really killed her.
2. A 33-year-old father of …
Cause of death: Defensive medicine
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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 …
The CDC recommends hepatitis C screening: Should they be followed?
It’s a uniquely modern problem. We have the most obese impoverished population in the history of the planet and its been called the “hunger-obesity paradox.” Even the homeless are now more than likely to be overweight with over 32% being officially obese. Think about that.
Then think about every single picture you have ever seen from the Great Depression when 1 of every 4 Americans were out of …
The hunger-obesity paradox: Why it’s a modern problem
As a longtime consumer reporter, I’ve always thought the best way to see how the marketplace works is to put yourself in the shoes of someone buying the product or service you’re investigating. After learning recently that I may need cataract surgery, it was time for me to check out the hospitals where that procedure might take place.
To begin my quest for the best, I searched for ratings for four …
Even when using rankings, differences among hospitals may be subtle
Outside a patient’s room in the cardiac intensive care unit (CICU), a senior doctor, a nurse, and several residents in various stages of wakefulness cluster for morning rounds. Each resident mans a computer-on-wheels (once called a C.O.W., the acronym was formally abandoned at MGH, legend has it, after a patient thought it was directed at her and took offense).
One of the residents reads off laboratory test results from the patient’s …
Should medical students learn how to use an EHR in medical school?
Trying to figure out whether Medicare vouchers are a good idea for patients and their physicians? Then consider these two basic questions:
1. How much will the federal government contribute?
2. Who is at risk for health care cost increases?
How much will the government contribute? The traditional Medicare program has no set limit on how much the federal government will contribute to a beneficiary’s health care, although there are limits on how …
Are Medicare vouchers a good idea for patients and their physicians?
The Center for Disease Control and Prevention (CDC) has requested that all individuals born between 1945 and 1965 be tested for the presence of the hepatitis C virus. This is a clear cut change in their policy which had previously asked that only high risk patients be tested.
Hepatitis C is a viral infection usually transmitted by blood to blood transmission. High risk patients include intravenous drug users who share needles, …
Talk about hepatitis C screening at your next scheduled visit
I am guilty of neglect.
I’ll admit it. I’ll own it. I’ll embrace it.
When I am doing a consult now for one of many hospital emergency rooms, I am sent a pretty standard package of history, nurses notes, doctor’s assessment, physical exam report, lab results and other information that I review prior to actually seeing the patient on the screen and doing my own assessment. Now, on a day like today, …
When patient histories start to blur
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