Physicians writing on KevinMD about the primary care shortage, the fifteen-minute visit, panel size, what primary care is paid against procedural specialties, continuity, and the administrative load that has grown around the work. Four maintained records draw on this archive: Primary care: what physicians say, in their own words, Direct primary care: what physicians say, in their own words, Prior authorization: what physicians say, in their own words, and Scope of practice: what physicians, nurse practitioners, and PAs say, in their own words.
Raising children in a world full of accessible opinion is a funny thing.
Everyone seems to have an idea about how to do this right. Stay home, work full time, work part time, return to work, cry to sleep, not cry to sleep, pacifier, no pacifier … the recipe for each of us is different, of course. Often we’re all right in what we’re doing from picking out baby food to …
Read more…
Competitive parenting and raising children in an opinionated world
A couple of months before my son was born 2 1/2 years ago, we were notified that my husband, an active duty member of the Navy, was getting deployed to Iraq.
His date of departure was exactly one week after my due date. To any wife or family member of a service member, this would be difficult news — a loved one going into a war zone. But, to me, 8-months …
Read more…
Practicing medicine as a single parent requires finding balance
I often find, when I talk with patients and families about hospice care, there is a palpable sense of relief; relief that there is another option when facing a terminal diagnosis or end stage disease process.
Families who have participated in caring for their loved one at the end of life are grateful for the guidance provided in hospice care. Patients in turn are grateful to spend their last days at …
Read more…
Hospice care and what patients and their families can expect
by John Gever
Elderly people who are depressed may be at twice the risk of developing dementia or Alzheimer’s disease over time — but it’s unclear whether depression causes dementia or vice versa, researchers said.
Among more than 900 participants in the original Framingham Heart Study, almost 22% of those who were depressed when screened between 1990 to 1994 were diagnosed with dementia over 17 years of follow-up, compared with 16.6% of …
Read more…
Depressed elderly at risk for dementia or Alzheimer’s disease
I was in a room full of Family Doctors – who call themselves everything but Family Docs: Family Physicians (FPs) Primary Care Physicians (PCPs) General Practitioners (GPs). It was the Society of Teachers of Family Medicine (STFM) Spring Conference, at a session entitled: “Language Matters: Women-centered talk during pelvic exams.”
Two men amongst 20 women, all interested in learning more about being Politically Correct (PC) whilst conducting a pelvic exam. Session leaders Drs …
Read more…
Pelvic exam etiquette that doctors need to know
by Leonard R. Friedman, MD
In diagnosing areas of chronic pain for adult pain management, I have come across a helpful test which I have unable to peer review.
It is the Draw a Person test. Pain management physicians have not used this easily identifiable test to evaluate the subconscious of the patient. This is done by asking the patient to draw a male and a female, with …
Read more…
Draw a Person test to help with pain management diagnosis
Summer has already begun, and LeeAnn has already had enough of mosquitoes. She wants to know, “Does taking Vitamin B1 really help keep mosquitoes from biting? How much is safe for children?”
I remember a trip to the Florida Everglades as a child with school—surrounded by mosquitoes, alligators, and miles of swamp, our teachers told us that mosquitoes are a vital part of the food chain, and essential to the ecosystem.
I …
Read more…
How to prevent and treat mosquito bites in children
by Todd Neale
Postmenopausal women of any age with a 10-year fracture risk equal to or greater than that of a 65-year-old woman and no other osteoporosis risk factors should be screened for the disease, according to draft guidelines from the U.S. Preventive Services Task Force (USPSTF).
The 2002 USPSTF guidelines recommended routine screening only for women ages 65 and older, as well as women ages 60 to 64 with an increased …
Read more…
New osteoporosis screening guidelines from the USPSTF
It’s exceedingly uncommon for a healthy middle-aged man to walk into his doctor’s office and demand a colonoscopy. But even though he lacked a family history, Stanley Thornton, an African-American engineer who was then in his mid-40’s, wouldn’t take no for an answer.
“I was concerned that African-Americans do get colorectal cancer earlier, and I said, ‘hey, let me lead by example,’” he said recently. “We argued about it for a …
Read more…
Colonoscopy and other screening options for colon cancer
“Avoiding those twin traps of overtreatment and therapeutic nihilism”
Recognize this phrase? It’s from our Hippocratic Oath, the one I took, standing beside my newly assigned cadaver, in my second year of medical school.
“What Broke My Father’s Heart“, recently in the New York Times Magazine, is an exquisitely painful story of medicine and our Oath gone awry in the United States. I urge you to read it.
End-of-life care is a …
Read more…
Doctors need to confront end of life care
by John Gever
So-called cyberbullies share many of the psychosocial features as their victims — and in fact many bullies were also victims themselves, researchers from Finland said.
A population-based cross-sectional study surveyed more than 2,000 seventh- and ninth-graders in two Finnish communities and found that cyberbullies had higher than average rates of self-perceived difficulties in life, headache, feeling unsafe at school, and perceiving teachers as uncaring, among other problems, reported Andre …
Read more…
What cyberbullies have in common with their victims
One of my medical school professors was an internationally renowned subspecialist, whose ward occupied the entire top floor of the medical tower at Academy Hospital in Uppsala.
He had cadres of residents working for him, and for two glorious months I rotated through his ward as part of my internal medicine training in medical school.
One thing that stands out in my memory, to this day, from those two months is how …
Read more…
Male hormone treatment and testosterone replacement concerns
by Michael Smith
It’s not just TV — video games are also associated with an increased risk of attention problems in children, researchers said.
A large study found that children who spent more than three hours in front of a computer or television screen — whether playing video games or watching TV — were significantly more likely to have attention problems, according to Edward Swing, MS, of Iowa State University in Ames, …
Read more…
Video games are linked with attention problems in children
I’ve been interested in the role of testosterone in physical performance, depression and aging for many years. While at the University of Iowa, I was involved in research to detect testosterone doping, the psychological effects of testosterone and the potential for testosterone to alleviate depression in older men.
One of the difficult questions facing clinicians is when is testosterone too low in older men.
One problem with answering this question is the …
Read more…
Testosterone and when should low levels be treated in older men
The Wall Street Journal reported that overall medical use fell as patients had fewer doctor office visits, lab testing, and maintenance medications possibly due to the recession or as a result of consumer driven healthcare in the way of higher deductibles and copays.
This is very worrisome. Certainly patients should have some financial responsibility for their care, but skimping on care will only result in Americans not becoming healthier, but sicker. …
Read more…
Patients will skip care with higher deductibles and copays
For years, physicians have argued that the specter of annual cuts in Medicare will cause many of them to leave the program, or at the very least, to limit how many new Medicare patients they will accept in their practices. Yet, for the most part, measures of seniors’ access show that the vast majority enjoy good access to care.
For instance, in May of this year, the Medicare Payment Advisory Commission …
Read more…
Will Medicare really lose physicians because of the SGR?
by Emily P. Walker
The number of obese adults in the U.S. continues to rise, despite a growing number of federal anti-obesity initiatives in the past two years, according to a new report.
The seventh annual “F as in Fat” report, released Tuesday by the nonprofit Trust for America’s Health and the Robert Wood Johnson Foundation, found that obesity rates continued to rise in 28 states from 2007 through 2009.
Nationally, two-thirds of …
Read more…
Obesity in American children and adults continues to grow
OncRN is a wonderful blog written by an anonymous author sharing stories and insights in her line of work that many times speak to palliative themes. S/he says it best in her blog description,
my life gets intermittantly (sic) rocked by the wonders/horrors of being an oncology nurse. i just need to talk it all through sometimes.
A recent post is about how to say good-bye to our patients, particularly …
Read more…
How to say goodbye to patients
For at least the last 20 years, graduates of U.S. medical schools have resisted pleas from organized and disorganized medicine to become primary care physicians (PCPs). Since there is already a severe shortage of PCPs, pundits are wondering who is going to take care of the hordes of newly insured by 2014. Many have speculated about the possible reasons for this dilemma such as the relatively paltry earning potential of …
Read more…
Create a family practice mystique in medical school
