Diagnosis is the foundation on which all care and treatments rest. If the diagnosis is wrong, most probably so is the treatment. Diagnosing an illness is an art. A diagnostician needs to be one part scholar, one part detective, and four parts artist. He has to be a good listener, open minded, and capable of assimilating a large amount of sometimes confusing data into an accurate picture of a disease …
Diagnosing an illness is an art
As physicians, we are often called upon to be advocates for our patients. Sometimes they have no other person to turn to. At those times, in particular, we evaluate their health in the context of relationship, family, and workplace. Having practiced family medicine for so many years, and now in counseling medicine, I have had the responsibility of advocating for my patients with their health insurance companies, within their families, …
Physicians have a natural role as advocates
According to a recent study from the Archives of Internal Medicine, primary care physicians are referring more patients to specialists than ever before. In fact, the rate almost doubled in the 10-year period between 1999 and 2009.
This drives up the cost of care, as specialist consults tend to be more expensive than primary care visits. Furthermore, specialists tend to …
Why more primary care doctors are referring patients to specialists
As the world speeds up we tend to assume that newer must be better. In some instances it is but when it comes to health, less so than one might expect. The other tendency is to overlook simple solutions and go to complicated, and often expensive ones.
In medical practice there is one step even before considering what to do with a given problem and that is whether there is a …
There is scope for harm when ordering tests
A social media movement is happening before our eyes with action starting to take shape. The #occupyhealthcare movement has begun within to the blogosphere and through various areas of social media by storm.
What does the #occupyhealthcare movement mean to me? My main focus in advocacy for family medicine is the production of an adequate primary care workforce distributed adequately to best serve our country. Those close to me also …
A lack of incentive for medical schools to train primary care doctors
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 …
Stories help the public make sense of evidence
When Dr. Timothy Malia of Fairport, New York, runs behind schedule, he passes out five-dollar bills to everyone in the waiting room. And when Dr. Cyrus Peikari of Dallas, Texas canceled his appointments for a family emergency, he gave each patient 50 bucks for the inconvenience.
Most doctors apologize. Few offer cash. Others get creative: Dr. Gwen Hanson of Bellevue, Washington gives out Starbucks cards; Dr. Sharon McCoy George of Irvine, …
Doctors who give cash to patients for running late
A guest column by the American Medical Association, exclusive to KevinMD.com.
Let me start by wishing you and your families a very happy and healthy new year. This is my first column of 2012 for this blog, and I am excited to talk about a new initiative that is beginning this year. Medicare accountable care organizations (ACOs) have been discussed at length …
AMA: A new model of patient care
It is obvious to those who know me that I am an avid anti-smoker and work hard to help those afflicted with a tobacco addiction break their habit.
Knowing your shortcomings is an important part of being successful. One of my short comings is not knowing when to quit. When it comes to helping smokers stop smoking, I am a zealot. Today, I went to work on one of my smokers, …
When it comes to smoking, I am a militant
You know Mr. Miller?
I adjusted the phone on my ear as I slipped out of bed and snuck into the bathroom. I tiptoed across the floor and winced as the old hardwood started to creek beneath my feet. I craned my head and listened for signs of stirring children.
Remembering the resident holding on the line, I whispered into the cell.
Yeah. What about him? He had a cholecystectomy this morning.
I waited …
The covenant between doctor and patient is sacred
To just what age do you expect to live? You haven’t thought about it? I bet you have. Would you like to live as long as Methuselah?
Television’s “Today Show” antes up centenarians to celebrate from time to time. There are about 70,000 American outliers past the age of 100. But that’s out of a population of some 311,000,000 people.
The most sensible place I know to read about this conundrum of …
How long do you expect to live?
As the new year starts, I’m eager for a fresh start and working on improving myself both physically and emotionally. I’m also eager for the NFL playoffs and seeing how my favorite team, the New England Patriots, fares under the leadership of Coach Bill Belichick and quarterback Tom Brady. Doctors and health care can learn much from their examples.
Over the past decade, the New England Patriots have been dominant …
What health care can learn from the New England Patriots
Boston tops The Daily Beast’s 2011 list of the 25 tipsiest towns in America, moving up from the eighth position last year. The Beast credits its click-ready rankings to a mixture of market research surveys and CDC statistics. I don’t know about the scientific accuracy, but from my perspective in its trenches, ranking Boston the booziest rings true.
You see, I spent 2011 seeing most of the traumatic brain injury …
The cost of being America’s drunkest city
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Last night was clear with full moonshine and the owls were busy hunting on our farm, calling back and forth to each other, comparing notes on where to find prey.
Thankfully they were not calling my name. At least I don’t think so, nevertheless their hoots haunted me.
A coastal tribal legend has it that if you hear an owl call your name, your death is imminent. I’ve had no recent brushes …
Considering the preciousness of life and preservation of health
A couple of months ago, I was dragging a large suitcase that got hung up on a curb, giving my arm and shoulder a good yank. Over the next few days, my shoulder began to ache a bit. Applying the very reasonable ‘tincture of time’ principle, I rested it a bit, hoping that with time the symptoms would resolve. Two months later, I was getting an MRI and anticipating surgery …
Health care is in crisis. Reimbursements from insurance companies continue to dwindle, while the expenses of running an office continue to rise. Looming cuts in Medicare are only weeks away, and many physicians may stop taking Medicare. If these cuts go into affect, it is possible that primary care physicians could lose up to 50% of their salary. Just recently CNN reported that some doctors are going bankrupt.
How …
A concierge or boutique label is discredits retainer medicine
In the modern medical environment of unpaid insurance claims, malpractice lawsuits and rushed patient encounters, many doctors feel unmotivated and unhappy.
Could the use of improved healthcare technology make doctors feel motivated and fulfilled again?
The hierarchy of needs
Motivating others is always difficult task. But according to Dan Heath, author of Made to Stick, all employers need to do to effectively motivate employees is get out of the basement – Maslow’s basement …
Motivate physicians through technology
In 2003, authors Warshaw and Bragg published a paper that reported on three decades of progress in creating a workforce to care for our aging population.
They noted that, as of academic year 2001-2002, 120 geriatric medicine fellowships were training 338 fellows. U.S. medical schools had 869 full-time equivalent (FTE) geriatrics faculty members teaching in IM residency programs and FP residency programs. From 1988-2002, more than ten thousand Certificates of …
How can we train more geriatricians?
Based on a survey conducted by the largest cosmetic surgery provider in the U.K., 76% of British women feel “depressed” about their appearance in January, related to an average weight gain of 11 pounds during December. Inquiries about cosmetic procedures peak on the third Monday in January, dubbed “Fat Day” in the U.K.
Most people will, of course, try various diet and exercise programs before resorting to cosmetic or Read more…
Which celebrity diet will you recommend to patients?
Mammograms, pap smears and P.S.A. levels, what’s a patient to think?
Each of these procedures has been widely accepted as a means of detecting cancer early and thereby improve ones chances of survival. The tests themselves are simple to perform and have become an accepted standard of care. Patients are now being told that the United States Preventative Services Task Force (USPSTF) an independent panel of non-Federal experts in prevention and …
Educate patients when it comes to cancer screening tests
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