Specialty Care

Specialists writing on KevinMD about their practices: what private equity does when it buys a specialty group, from dermatology roll-ups to staffing companies, and whether nurse practitioners and physician assistants belong in every specialty and on what terms. Two maintained records draw on this archive: Private equity and corporate medicine: what physicians say, in their own words and Scope of practice: what physicians, nurse practitioners, and PAs say, in their own words.

Physicians should embrace patient engagement

Kent Bottles, MD

Patient

October 20, 2011

The doctor/patient relationship is certainly changing and evolving. A term I hear a lot today is: “patient engagement/activation.” Why is this concept so important and what does it mean? What can physician executives do to make it easier for our patients to become engaged and activated?

Judith Hibbard has pioneered the study of patient engagement, and she noted that one needs knowledge, skills, and emotional support to actively engage in one’s …

It’s time for a VBAC court

Amy Tuteur, MD

Physician

October 18, 2011

We understand the problem: the VBAC (vaginal birth after cesarean) rate is too low. It’s time for a bold solution. We need a “VBAC Court.”

VBAC is a safe option for most women, and almost 3/4 of women who opt a VBAC will deliver vaginally and avoid another C-section. But we also know that approximately 0.8% of women attempting VBAC will end up with a ruptured uterus, a catastrophic complication …

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It’s time for a VBAC court

Science makes me a better doctor, faith makes me a better person

Anees Chagpar, MD

Physician

October 17, 2011

Some have argued that there is an innate conflict between faith and science. I am not sure that is so. Not only do the two seem to co-exist; but to my mind, they may even be synergistic.

A few months ago, at Schwartz rounds, a case of a pregnant patient who was being given chemotherapy was presented. When the nurse …

tPA is the standard of care for stroke but with significant risks

Charles A. Pilcher, MD

Conditions and Diseases

October 17, 2011

Under current guidelines from the American Stroke Association, tissue plasminogen activator (tPA, commonly known as a “clot buster” drug) should be administered within 3-4.5 hours of “last seen normal” – and 1 hour of patient arrival – to potentially ameliorate a new onset stroke. (“Last seen normal” means exactly what it says. A patient who went to bet at 10 PM and awoke with slurred speech at 6 AM was …

Is Groupon legal for doctors?

Deniza Gertsberg, Esq

Physician

October 16, 2011

Groupon and other similar social sites, like Living Social and CoupTessa, are all the rage now. But is it legal for doctors and dentists to advertise their services on these websites?

Groupon is a deal-of-the-day website that features discounted gift certificates usable at local or national companies. If a certain number of people sign up for the offer, then the deal becomes available to all; if the predetermined minimum is not met, no one …

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Is Groupon legal for doctors?

The rewards of medicine can be overwhelming

Dr. Martin Young

Physician

October 16, 2011

As I greeted my next patient of the morning, I knew from the early folder number that I had seen him six or seven years before. I no longer expect to remember everyone I have ever met professionally. The man before me was tall, fit and well built. There is usually some inkling of recognition, but nothing about him was familiar to me at all.

We made small talk for some …

Cardiac surgery is a team sport

Norman Silverman, MD

Physician

October 16, 2011

It is my strong contention that patients facing cardiac surgery should choose an institution, not a particular heart surgeon. Although individual judgement and technical dexterity are obviously important, best surgical outcomes reflect the performance of many medical providers before, during and after the operation. Professionalism and a competitive business environment both stimulate open heart centers to continuously focus on quality assurance programs to improve patient safety. Also, continuing medical …

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Cardiac surgery is a team sport

A urologist responds to the new prostate cancer screening guidelines

Neil Baum, MD

Conditions and Diseases

October 15, 2011

“U.S. Panel Says No to Prostate Screening for Healthy Men” was the title of an article on the front page of the New York Times on October 6, 2011. The article goes on to suggest that healthy men should no longer receive a PSA blood test to screen for prostate cancer because the test does not save lives over all and often leads to more tests and treatments that needlessly cause pain, impotence and incontinence …

The decision not to become a surgeon

Jim deMaine, MD

Physician

October 12, 2011

Every medical student goes though a process of elimination when deciding what kind of doctor they want to become. We hear the old saying, “Internists know everything and do nothing; Surgeons know nothing and do everything; Psychiatrists know nothing and do nothing; Pathologists know everything and do everything but it’s too late.” We hear that pediatricians wear bow ties, are short, and love to laugh and play; that surgeons …

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The decision not to become a surgeon

Knowing the true name of a medical condition

Christopher Johnson, MD

Conditions and Diseases

October 11, 2011

There is a long tradition in folklore, one shared by shamans and occultists, that knowing the true name of something gives you power over it.

Many years ago I had a very sick patient in the PICU who one morning, totally out of the blue, broke out in a bright, red rash all over his body. The boy had many critical problems already and, although the rash didn’t seem to be causing …

Are physician services to blame for high health costs?

Cedric Dark, MD, MPH

Health Policy

October 9, 2011

Why does health care cost so much more in the United States than in other countries? The answer is exceedingly complex; pharmaceuticals, hospitals, and physician services (among others) comprise the multiple slices of the health care pie that in the United States is about twice the size of the next largest spender for health care services.

A new study from one of President Obama’s appointees (note: this study was written prior …

Three major cognitive errors physicians make

Jerome Groopman, MD and Pamela Hartzband, MD

Physician

October 9, 2011

As physicians, we all dread missing a diagnosis: indigestion that turns out to be angina, back pain that signals an aortic aneurysm, migraine that proves to be a brain tumor. Although it is only an estimate, several studies in the medical literature indicate that misdiagnosis occurs in 15% to 20% of all cases, and in half of these, there is serious harm to the patient.

Researchers have found that the vast …

Transparency in health care preserves our ability to innovate and grow

Michael Tarnoff, MD

Physician

October 9, 2011

Collaboration between medical professionals and the healthcare products industry has long been vital to advancing patient care and safety. Healthcare professionals help companies better understand unmet clinical needs, while companies invest in innovative research and product development that are squarely focused on improving patient care and enhancing patient safety.

As a society, we should acknowledge the value of these bona fide relationships. Balanced provider input into corporate decision-making has broad …

Observing the Primatene Mist controversy as an asthma specialist

Paul M. Ehrlich, MD

Medications

October 8, 2011

As the clock ticks away on Primatene Mist, the only over-the-counter asthma inhaler left on the market, it is being ginned up as an argument against regulatory overreach by the Obama administration. I have been observing the Primatene controversy for decades as an asthma specialist. I have to say that there’s blame enough on many sides of this discussion, not just pro and con government regulation, but both the pharmaceutical …

MKSAP: 72-year-old woman with fatigue and decreased exercise capacity

mksap

Conditions and Diseases

October 8, 2011

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 72-year-old woman is evaluated for fatigue and decreased exercise capacity. The patient has severe chronic obstructive pulmonary disease, which was first diagnosed 10 years ago, and was hospitalized for her second exacerbation 1 month ago. She is a former smoker, having stopped smoking 5 years …

Psychiatry should not be a tool for social justice

Steve Balt, MD

Physician

October 7, 2011

A doctor’s primary responsibility is to heal, and all of our efforts and resources should be devoted to that goal. At times, it is impossible to restore a patient to perfect health and he or she must unfortunately deal with some degree of chronic disability. Still other times, though, the line between “perfect health” and “disability” is blurred, and nowhere is this more problematic than in psychiatry.

To illustrate, consider …

USPSTF prostate cancer screening guidelines need emotion to resonate

Kevin Pho, MD

KevinMD

October 7, 2011

Prostate cancer screening has always been controversial.

Now, with the USPSTF is recommending against screening for prostate cancer, gas is about to be poured on the proverbial fire.

Recently, the New York Times Magazine published a lengthy piece on the issue, perhaps not coincidentally, perfectly timed with the Task Force’s announcement.

In 2009, advocates for breast cancer screening were up …

Healthcare professionals need to get an annual flu shot

Norman H. Edelman, MD

Conditions and Diseases

October 6, 2011

Whether you are a physician, nurse, physician assistant, pharmacist, or someone else who cares for sick or disabled people, your job as a healthcare professional is an important one. Healthcare professionals are expected to provide services to individuals in need and to do so with quality and care.

One way we can help ensure that we are doing our job the best way possible is to get our annual flu …

The use of a signing bonus as tool for physician recruitment

Bo Claypool

Physician

October 5, 2011

As someone whose livelihood is dependent upon successfully recruiting physicians to various practice opportunities, whenever possible I use the tool of a “signing bonus” and it may not be for the reason you think.

If you have found yourself in the role of recruiter for your practice, you should be open to use of this valuable tool within the physician recruiting process.

Now, I must say, that whenever this is brought …

Patients and families must be tireless in expressing any frustrations

Norman Silverman, MD

Patient

October 4, 2011

I was reading the other day in a magazine the personal account of a woman who had a “perfect example of a mitral valve click” (a type of heart murmur) that was so textbook in sound that she was asked to be a listening post for a class of medical students. She was pleased to help, but was disappointed in how of the 15 examiners no one treated her like …

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