Primary Care

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.

Should doctors fire young patients if their parents refuse to vaccinate them?

Kevin

Conditions and Diseases

October 22, 2009

Originally published in MedPage Today

by Emily P. Walker, MedPage Today Washington Correspondent

If parents refuse to vaccinate their children, it’s ethical and legal to dismiss the child as a patient, a pediatrician told attendees of the American Academy of Pediatrics meeting here.

“In the middle of treatment, you can’t just say, I’m done,” Gary Marshall, MD, of the University of Louisville …

Google Android versus the iPhone for medical apps

Kevin

Health Technology

October 20, 2009

by Jeff Brandt

Verizon, Motorola, and Google, along with 9 other cell phone manufactures and countless world carriers, have teamed up to provide a smartphone with the power to deliver useful applications for medicine: the Verizon “Droid” smartphone, based on the Google Android operating system (OS).

The Droid’s processor is the same processor that powers the iPhone. The main reasons this …

Will co-sleeping with your infant increase the risk of SIDS?

Kevin

Conditions and Diseases

October 20, 2009

Originally published in MedPage Today

by Todd Neale, MedPage Today Staff Writer

Just over half — 54% — of sudden infant death syndrome (SIDS) cases in southwest England occurred when the baby was co-sleeping in the same bed as a parent, a case-control study showed.

That compares with 20% of infants among randomly selected families and controls deemed to be at high …

Doctors need to fix the health care system that they had a hand in breaking

Kevin

Health Policy

October 16, 2009

by Daniel A. Graubert, MD

Medicine has changed so dramatically since I graduated medical school in the 1980’s, that it is hardly recognizable.

Certainly, there has been an enormous growth in knowledge which is often beneficial, but has often led us down the wrong path. For example, when advanced imaging techniques such as CT scans and MRIs became available, we were able to see the inside of large numbers of patients …

Embracing the change coming to our health care system

Donald Tex Bryant

Health Policy

October 15, 2009

As Bob Dylan sang so long ago, The Times They Are A-Changin’. Some like change; some do not.

Consider these change scenarios:

* One of the important scenes of change for health care providers is the national debate on health care coverage currently playing out in Washington D.C. Some are very vocal in their support. The media covers many of the vocal opponents. Certainly some sort of change will come out of …

Should doctors be paid to e-mail their patients?

Michael Kirsch, MD

Physician

October 11, 2009

by Michael Kirsch, MD

This is a less controversial issue than patients ‘friending’ their doctors on Facebook, which I oppose. Although most physicians’ offices are not e-mailing with patients, perhaps they should. There are several obvious advantages.

* Decompress phone lines, which are suffocating nearly every medical practice in America.

* Relieve patients of the cruel and unusual punishment of languishing on ‘hold’ listening to elevator music or dead air.

* Allow office staff …

Will more primary care doctors keep patients out of the ER?

Edwin Leap, MD

Physician

October 9, 2009

One of the many questions asked in the health-care reform debate is ‘how do we keep people out of emergency departments in order to reduce costs?’ Simply put, we probably can’t. And 16 years into my emergency medicine practice, I think I know why.

Having taken my own children to the emergency department, even I have been surprised at the charges generated. But we should step back and remember that emergency …

Is a cocaine abuse vaccine coming soon?

Kevin

Conditions and Diseases

October 7, 2009

Originally published in MedPage Today

by Michael Smith, MedPage Today North American Correspondent

A vaccine against cocaine was effective in nearly 40% of users of the drug, researchers said.

In a randomized, placebo-controlled study, volunteers who reached a high level of antibodies after vaccination used less cocaine than those whose response was lower, according to Thomas Kosten, MD, of Baylor College …

Read more…

Is a cocaine abuse vaccine coming soon?

Does Chantix increase suicide risk?

Kevin

Medications

October 6, 2009

Originally published in MedPage Today

by Kristina Fiore, MedPage Today Staff Writer

Contrary to information that led the FDA and other regulatory agencies to release warnings about varenicline (Chantix), a new study has found “no clear evidence” of a relationship between the risk of suicide and the smoking-cessation drug.

Both varenicline and bupropion (Zyban), another drug used in smoking cessation programs, were …

Read more…

Does Chantix increase suicide risk?

Flu and H1N1 influenza vaccine recommendations for doctors and health care workers

American College of Physicians

Conditions and Diseases

October 5, 2009

The following is part of a series of original guest columns by the American College of Physicians.

by Steven Weinberger, MD, FACP

In the Fall of 2009, we physicians should perhaps change the Biblical phrase, “Physician, heal thyself” to “Physician, immunize thyself” and then follow the phrase twice – once for seasonal influenza and once for H1N1. To date, physicians and other health care workers have too often been lax …

Analysis of the Senate Finance Committee health care reform bill

Kevin

Health Policy

October 3, 2009

Originally posted in MedPage Today

by Emily P. Walker, MedPage Today Washington Correspondent

The Senate Finance Committee finished work on its healthcare reform bill in the wee hours of Friday morning, paving the way for a committee vote next week.

After considering hundreds of amendments, the committee is now waiting for a cost-estimate from the Congressional Budget Office (CBO) before it …

Health care reform analysis from a former insurance and hospital executive

Kevin

Health Policy

October 3, 2009

by Marie Cooper

I have been in senior executive management in both managed care and a major hospital system. I find the hysteria over “reform” bitterly amusing because it is so misdirected.

The real problem with health care in America? Greed, indifference and incompetence, pure and simple. But not in the places everyone is pointing.

Insurer side

Insurance companies have to maximize their revenue because they answer to their boards. They …

What the United States health care system can learn from Mexico

Kevin

Health Policy

October 2, 2009

by Esther Buddenhagen, MSW

I write as a lay person concerned about the gap between what many people should receive and what they actually receive. The question of good medical care for ordinary people is being buried not only by insurance issues but by failure to come to terms with what primary care should be about.

Even Atul Gawande, who is particularly good at making distinctions between good and …

Not all doctors discuss the risks and benefits of prostate cancer screening to patients

Kevin

Conditions and Diseases

October 2, 2009

Originally published in MedPage Today

by Todd Neale, MedPage Today Staff Writer

Men might not be getting the information they need to make an educated decision about prostate cancer screening, two new studies suggest.

Among 375 men surveyed by telephone, only 69.9% had discussed a prostate-specific antigen (PSA) test with their physician before making a decision about screening, according to the …

Informed consent is central to the doctor-patient relationship

Dr. Martin Young

Conditions and Diseases

October 1, 2009

The doctor-patient relationship must remain the central focus of good health care. Diminish or hinder that relationship, and no technological advance, funding system, or government intervention in the world will be able to compensate. Many complaints about present health care systems can be seen as evidence of relationship dysfunction, not in the least due to the interference of third parties, administrators, payers and insurers, who wield the financial clout. Transparency …

Medical ghost-writing influences doctors to prescribe more drugs

Daniel J. Carlat, MD

Medications

October 1, 2009

Recently, a former staff medical writer at a MECC (Medical Education Communication Company) anonymously alerted me to a particularly sleazy advertising tactic used by a medical writing company. This person had worked as a pharma-supported medical writer for several years, but recently quit because, “I really couldn’t stomach the ethical problems associated with writing for the pharma industry.” Recently, looking for medical writing jobs, this writer came across a company …

What doctors can learn from patients in the health care reform debate

Wendy S. Harpham, MD

Health Policy

September 30, 2009

Two things are missing from the bustling conversations on health care reform jamming the Internet highway. First, where among the finger-pointing anecdotes and critical analyses of our “broken” American medical system are the stories and discussions of all that is right? Second, where is our sense of hope?

I’ve experienced American health care from an unusual, yet useful, vantage: that of a physician with chronically recurring cancer. From both sides of …

What’s the latest on prostate cancer and the PSA screening test?

Kevin

Conditions and Diseases

September 28, 2009

Originally published in MedPage Today

by Chris Emery, MedPage Today Contributing Writer

Prostate specific antigen (PSA) tests may lead to unnecessary treatment of healthy men for prostate cancer, and there is little evidence supporting the common but controversial test for routine cancer screening, two new studies found.

Measurements of blood concentrations of PSA failed to predict cancer with the accuracy generally …

Is the seasonal flu vaccine associated with H1N1 pandemic influenza?

Kevin

Conditions and Diseases

September 26, 2009

Originally published in MedPage Today

by Michael Smith, MedPage Today North American Correspondent

In unpublished data, Canadian researchers have suggested that seasonal flu vaccination may increase the risk of catching the H1N1 pandemic strain, but such a pattern has not been found in the U.S., the CDC said.

The Canadian data appear to suggest that people who had been vaccinated against …

Should soft drinks be taxed and be called a public health hazard?

Kevin

Health Policy

September 24, 2009

Originally published in MedPage Today

by Kristina Fiore, MedPage Today Staff Writer

Soft drinks and other beverages loaded with sugar should be taxed as a public health hazard, much as cigarettes are, a group of prominent medical researchers says.

Since extensive evidence ties sugary drinks to an epidemic of obesity and related health problems, such as heart disease and diabetes, they …