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.

December 1, 2009Dec 1, 200921

The following is part of a series of original guest columns by the American College of Physicians. by Steven Weinberger, MD, FACP It is difficult to find a medical guideline that has garnered so much press and controversy as the…

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

by Steven Weinberger, MD, FACP

It is difficult to find a medical guideline that has garnered so much press and controversy as the recent recommendations about breast cancer screening developed by the U.S. Preventive Services Task Force (USPSTF) and published in Annals …

Tech

The billions spent on electronic health records, and why there’s no way to know if EHRs will save money

Glenn Laffel, MD, PhD

November 30, 2009Nov 30, 20096

Barack Obama is certain that electronic health records (EHRs) can improve the quality of care and the efficiency with which it is delivered. How certain? Certain enough to have bet billions on a program that pays providers to adopt and…

Of course there are many ways to improve quality and efficiency. The Pennsylvania Health Care Cost Containment Council (PHC4) for example, publishes outcomes data for the states’ 172 …

Physicians

Baby boomers don’t receive enough preventive health

MedPage Today

November 25, 2009Nov 25, 20095

Originally published in MedPage Today by Kristina Fiore, MedPage Today Staff Writer Only a quarter of baby boomers take advantage of preventive services such as flu vaccines and cancer screenings, a new report from the government and two powerful interest…

Originally published in MedPage Today

by Kristina Fiore, MedPage Today Staff Writer

Only a quarter of baby boomers take advantage of preventive services such as flu vaccines and cancer screenings, a new report from the government and two powerful interest groups says.

At the same time, states are falling behind goals to increase certain screenings and reduce unhealthy behaviors, according to the …

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Conditions

How the mammogram and Pap smear debates ignore the uninsured

Jeoffry B. Gordon, MD, MPH

November 24, 2009Nov 24, 20093

by Jeoffry B.Gordon, MD, MPH The recent recommendation of the US Preventive Services Task Force against routine screening mammograms for healthy, low risk women under the age of fifty has demonstrated our broad consensus about the value of breast cancer…

by Jeoffry B.Gordon, MD, MPH

The recent recommendation of the US Preventive Services Task Force against routine screening mammograms for healthy, low risk women under the age of fifty has demonstrated our broad consensus about the value of breast cancer screening. The discussions about new guidance from the American Academy of Obstetrics and Gynecology on when to start and how often to do PAP smears illuminate the impact, effectiveness and support …

Conditions

Informed consent is missing from Pap smears and cervical cancer screening

Joel Sherman, MD

November 23, 2009Nov 23, 2009107

The American College of Obstetrics and Gynecology (ACOG) has just revised their guidelines for Pap smears under some pressure. This resulted from an Annals of Internal Medicine article which documented that only 16.4% of gynecologists followed the College’s prior guidelines.…

The American College of Obstetrics and Gynecology (ACOG) has just revised their guidelines for Pap smears under some pressure. This resulted from an Annals of Internal Medicine article which documented that only 16.4% of gynecologists followed the College’s prior guidelines. Most did more screenings than indicated, the worst record of the specialties tested. But the ACOG still recommends that nearly all women obtain regular screening at intervals of 1-3 years.

The …

Conditions

What is the death toll for the H1N1 flu pandemic?

MedPage Today

November 23, 2009Nov 23, 2009

Originally published in MedPage Today by Michael Smith, MedPage Today North American Correspondent In the first six months of the H1N1 flu pandemic, 22 million Americans fell ill from the virus, the CDC now estimates. Of those, about 98,000 needed…

Originally published in MedPage Today

by Michael Smith, MedPage Today North American Correspondent

In the first six months of the H1N1 flu pandemic, 22 million Americans fell ill from the virus, the CDC now estimates.

Of those, about 98,000 needed inpatient care, and 3,900 died, according to Anne Schuchat, MD, director of the CDC’s National Center for Immunization and Respiratory Diseases.

The estimates …

Op-ed: Humor can be healing for both doctors and patients

Kevin Pho, MD

November 21, 2009Nov 21, 20095

A version of this op-ed, co-written with Doug Farrago, was published on October 26th, 2009 in Medscape. It's tough to be a doctor these days. Whether it's listening to the difficulties of our medical colleagues as they try to best…

A version of this op-ed, co-written with Doug Farrago, was published on October 26th, 2009 in Medscape.

It’s tough to be a doctor these days. Whether it’s listening to the difficulties of our medical colleagues as they try to best care for their patients, or engaging other health professionals about the uncertainties surrounding health reform, we’ve noticed a tense, sometimes gloomy, atmosphere among physicians.

A recent survey from the Annals of Internal …

Conditions

When women should have their first Pap smear; the new cervical cancer screening guidelines

MedPage Today

November 20, 2009Nov 20, 2009

Originally published in MedPage Today by Charles Bankhead, MedPage Today Staff Writer Women can wait longer for their first Pap smear and then repeat the test less frequently, according to recommendations from the American College of Obstetricians and Gynecologists (ACOG).…

Originally published in MedPage Today

by Charles Bankhead, MedPage Today Staff Writer

Women can wait longer for their first Pap smear and then repeat the test less frequently, according to recommendations from the American College of Obstetricians and Gynecologists (ACOG).

The organization now says women should begin cervical cancer screening with a Pap test at age 21. Subsequent tests should occur at …

Conditions

Can less aggressive cancer screening recommendations be better for patients?

Amy Tuteur, MD

November 19, 2009Nov 19, 200911

Doctors have understood for some time that it was inevitable. The American Cancer Society has acknowledged that cancer screening has been oversold. It seems like every day you read in the newspaper that what was standard medical care yesterday is…

Doctors have understood for some time that it was inevitable. The American Cancer Society has acknowledged that cancer screening has been oversold.

It seems like every day you read in the newspaper that what was standard medical care yesterday is now no longer recommended. Don’t doctors know anything? Well, actually they do. And what seems like paradoxical behavior, no longer recommending aggressive screening for certain cancers, actually represents a more sophisticated …

Tech

How to choose the right electronic health record (EHR) consultant

Kevin

November 19, 2009Nov 19, 20092

Originally published in HCPLive.com by Jonathan Bertman, MD You may have seen advertisements, or may already have been contacted by people who’ve promised to help you figure it all out so you can get your share of the stimulus money.…

Originally published in HCPLive.com

by Jonathan Bertman, MD

You may have seen advertisements, or may already have been contacted by people who’ve promised to help you figure it all out so you can get your share of the stimulus money. Be wary. The truth is that the Obama administration is still defining many essential elements of the Health Information Technology for Economic and Clinical Health Act (HITECH), and full details about the …

Conditions

Why health reformers should be worried about the breast cancer screening backlash

Kevin

November 19, 2009Nov 19, 200972

What if a non-partisan, authoritative entity wrote a robust, evidence-based guideline, but nobody followed it? That is precisely what's happening with the USPSTF's recent revision of their breast cancer screening recommendations. The change most find problematic is their recommendation that…

What if a non-partisan, authoritative entity wrote a robust, evidence-based guideline, but nobody followed it?

That is precisely what’s happening with the USPSTF’s recent revision of their breast cancer screening recommendations. The change most find problematic is their recommendation that women younger than 50 not undergo any breast cancer screening, such as with a mammogram.

Here are their reasons explaining why:

The harms resulting from screening for breast cancer include psychological harms,

…

Conditions

Can family doctors do safe first trimester abortions?

MedPage Today

November 18, 2009Nov 18, 2009

Originally published in MedPage Today by Chris Emery, MedPage Today Contributing Writer Complications from first trimester abortions performed by family practitioners are rare, and family doctors could help address abortion provider shortages across the U.S., a new study found. Among…

Originally published in MedPage Today

by Chris Emery, MedPage Today Contributing Writer

Complications from first trimester abortions performed by family practitioners are rare, and family doctors could help address abortion provider shortages across the U.S., a new study found.

Among more than 2,500 abortions performed by family physicians, abortion was successful without complications in 96.5% of patients using medications (95% CI 95.5% …

Conditions

Why doctors are doing so many unnecessary Pap smears

Matthew Mintz, MD

November 17, 2009Nov 17, 200912

The Wall Street Journal and other sources reported on a study from the Annals of Internal Medicine that showed that most US doctors don't know the guidelines of how often women should get a pap smear. More importantly, doctors were…

The Wall Street Journal and other sources reported on a study from the Annals of Internal Medicine that showed that most US doctors don’t know the guidelines of how often women should get a pap smear. More importantly, doctors were doing a lot of pap smears on women who didn’t need them. In all the talk about health care reform, reducing costs by eliminating unnecessary testing has been mentioned multiple …

Patients

Learn how to conduct a family meeting by using a structured approach

Alex Smith, MD

November 16, 2009Nov 16, 2009

On my last day of ward attending, I handed out an EKG that resembled the Dow Jones industrial average over the last 10 years (not pictured). The normal pattern of an EKG was completely disrupted: ST segments were markedly elevated, P waves were hidden, and beats were grouped in odd patterns. My medical team laughed and shook their heads.

I asked why.

A brave intern responded that he was completely at a …

Meds

Why you should stop taking Vytorin for high cholesterol

Matthew Mintz, MD

November 16, 2009Nov 16, 2009

At the American Heart Association meeting in Orlando, the results of the ARBITER 6-HALTS study were released. No Vytorin was used in the study, but I am sure that all the headlines will mention Vytorin. The actual study published ahead…

The actual study published ahead of press online in the New England Journal of Medicine. Essentially, they enrolled over 200 patients from Walter Reed and Washington Adventist who had known heart disease or were at …

Conditions

Who’s dying from the H1N1 flu pandemic?

MedPage Today

November 15, 2009Nov 15, 20093

Originally published in MedPage Today by Michael Smith, MedPage Today North American Correspondent Although the pandemic H1N1 flu tends to strike younger people, it can be life-threatening when older people are infected, California researchers said. In the first four months…

Originally published in MedPage Today

by Michael Smith, MedPage Today North American Correspondent

Although the pandemic H1N1 flu tends to strike younger people, it can be life-threatening when older people are infected, California researchers said.

In the first four months of the pandemic, 1,088 people in the state needed inpatient care or died of the pandemic flu strain, according to Janice Louie, …

Read more…

Who’s dying from the H1N1 flu pandemic?

Social media

Saying no to a re-tweet request, and whether Twitter as a legitimate news source

Marya Zilberberg, MD, MPH

November 15, 2009Nov 15, 20092

The other day I re-tweeted a tweet from someone whose Twitter activity I enjoy very much. I like where his links take me, and I appreciate the intellectual and emotional honesty of his own writing. The message I re-tweeted was…

Diane Harper of the University of Missouri is a prominent researcher who was heavily involved in the Gardasil development program. Over the …

Conditions

Medicine needs to get back to hands-on basics, rather than focusing on technology

Rahul K. Parikh, MD

November 14, 2009Nov 14, 200915

There is plenty to criticize in our bungling trek toward health reform. Leaders on the right, left and at 1600 Pennsylvania Avenue have sidestepped the crucial conversation of controlling the cost of care, in favor of partisan rhetoric about “death panels” and “rationing care.” Worse, the entire focus of reform has centered on spending billions of dollars on technology solutions that will only make marginal changes in the cost and …

Meds

Patients who want the H1N1 vaccine need to be triaged

Kairol Rosenthal

November 11, 2009Nov 11, 200915

I am a young adult cancer patient who waited five and a half hours for the H1N1 vaccination along with 1200 other Chicagoans in a city college hallway. I do not have the trained eye of a public health analyst, yet it was easy to spy the glaring flaws that occurred in the whimsical distribution of this short supply vaccine. One of these oversights was the absence of trained …

Conditions

How do people with dementia die?

Victor G. Dostrow, MD

November 11, 2009Nov 11, 20093

Originally published in HCPLive.com by Victor G. Dostrow, MD Dementia is a terminal illness. However, people with advanced dementias often languish in skilled nursing facilities, far from the ministrations of specialists. And, with reasonable luck, they have directives that specify…

Originally published in HCPLive.com

by Victor G. Dostrow, MD

Dementia is a terminal illness. However, people with advanced dementias often languish in skilled nursing facilities, far from the ministrations of specialists. And, with reasonable luck, they have directives that specify that they are not to be taken to the hospital in the event of a respiratory arrest. Consequently, most of us are not privy to the mechanisms of demise in such situations. …

Read more…

How do people with dementia die?

Primary Care

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