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.

7 procedures that can affect the way you breathe and sleep

Steven Y. Park, MD

Conditions and Diseases

April 9, 2011

Millions of surgical operations are performed every year to improve your health, beauty, and even your smile, but there’s a hidden danger in some of the most common procedures that can aggravate if not actually cause obstructive sleep apnea.

Sleep apnea happens when your jaws are too narrow, which constricts the internal soft tissue layer that lines your upper breathing passageways, from …

16 and Pregnant is increasing the awareness of teen pregnancy

Jeff Livingston, MD

Patient

April 7, 2011

Recently, I had the honor of moderating a discussion for the Sex::Tech 2011 Conference with the producers of MTVs 16 and Pregnant Morgan Freeman, Dia Sokol Savage and The National Campaign to Prevent Teen Pregnancy.

I was fascinated by the responses of members in the audience as well as the reactions I read while monitoring the online live stream via Twitter. So what did I conclude?

I concluded that the issue of teen pregnancy …

Why does society frown on doctors earning a reasonable living?

Steven Reznick, MD

Physician

April 6, 2011

Recently, while jogging through my community, I had the pleasure of bumping into a former colleague and his brother who were out for their daily five mile walk.

Dr. G. had attended a local medical school, finished near the top of his class, and had gone on to do his internship and residency at the premier private hospital in Miami Beach, Florida. After completing his residency …

Overuse of heart stents and the response of Abbott Labs

Joe Flower

Health Policy

April 5, 2011

“Someone needs to take this writer out and kick his ass.”

The quote leaped out at me from a New York Times article.

Now, maybe I’m a little sensitive about using physical threats to try to silence writers, since I am a writer. Maybe I am especially sensitive about threatening to kick someone’s ass for writing about healthcare. To my eyes, the quote stood out as emblematic of the tumor …

The Relative Value Scale Update Committee (or RUC) impact on health care

Brian Klepper, PhD

Health Policy

April 5, 2011

On Kaiser Health News, Barbara Levy MD, the Chair of the AMA’s Relative Value Scale Update Committee (or RUC), published a glowing defense of the RUC’s activities.

Her article extols the work of the 29 physician volunteers who, “at no cost to taxpayers … generously volunteer their time, supported by advisers and staff from more than 100 national medical specialty societies and health care professional organizations.”

She fails to mention that the …

MKSAP: 28 year old woman with easy bruising and bleeding gums

mksap

Conditions and Diseases

April 2, 2011

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

A 28-year-old woman has a 3-month history of easy bruising and bleeding gums. She feels otherwise well. Medical and family histories are unremarkable, and she takes no medications.

On physical examination, temperature is normal, blood pressure is 110/70 mm Hg, pulse rate is 64/min, and respiration rate …

Dangers of strict adherence to clinical guidelines

Douglas Perednia, MD

Physician

April 1, 2011

Medical guidelines are well on their way to becoming the Law of the Land. Dr. Rich over at The Covert Rationing Blog featured a recent post that highlighted this point.

When a study published in the Journal of the American Medical Association showed that nearly 23% of patients receiving implantable cardioverter-defibrillators (ICDs) received them under circumstances that did not match up with the recommended “guidelines” for doing so, this breach of …

Calling in sick serves as a reminder for compassion for this doctor

Anesthesioboist T., MD

Physician

March 28, 2011

One of my Facebook updates on my private account was that I “have a love-hate relationship with interleukin-6. Yes, macrophages and T cells, I know you are doing your job, but how many proinflammatory cytokines does it really take to fight this thing? What’s that? Be grateful you guys are even working? Oh, all right. I’ll shut up and eat my soup now.”

Yes, I’ve been sick this week. It started …

Expand health care systems in a way that is professionally satisfying

Michael D. Shapiro, MD, MBA

Health Policy

March 24, 2011

You try to do the right things to sustain your business. You set high standards for delivery of quality care, follow the basic tenets of marketing, align your organization so that everyone in your firm “gets it,” avoid unnecessary expenses but identify important growth opportunities and prudently invest so that you remain competitive and serve your patients well. But can you afford investing in the assets you require to become or …

Restricting nuclear cardiac stress testing in favor of stress echocardiography

Adam Rothschild, MD

Conditions and Diseases

March 24, 2011

Dr. William Follansbee is the chairman of the American College of Cardiology/American Society of Nuclear Cardiology (ACC/ASNC) task force on non-invasive cardiac imaging and the director of nuclear cardiology at the University of Pittsburgh Medical Center Cardiovascular Institute.

He recently published an editorial in the Pittsburgh Post Gazette in which he criticized the local Blue Cross/Blue Shield carrier, Highmark, for restricting the use of nuclear cardiac stress testing in …

Patient volume and money instead of quality patient care

Linda Burke, MD

Patient

March 24, 2011

To everything there is a season and mine comes to an end today. For 720 weeks I attempted to give quality care to my patients. The task was not always easy especially when most of my patients held the unenviable position of having a high risk pregnancy and receiving Medicaid or being uninsured. Babies have a right to be born healthy …

Engage employees in healthcare to enhance patient outcomes

Donald Tex Bryant

Physician

March 24, 2011

It is an axiom of business that employee engagement produces many positive results, no matter what the setting—manufacturing or service. This is true for healthcare as well.

Employee engagement produces a better product or service. In healthcare, engaged employees produce enhanced patient outcomes. When employees are engaged there is less turnover, which reduces training costs. Engaged employees are problem solvers.

How …

A surgeon on those who understand murderers, rapists and child molesters

bongi, MD

Physician

March 21, 2011

(Editor’s note: reader discretion advised)

Recently I was involved in a discussion with a guy that was explaining how we should understand criminals. The emphasis was on farm murders but we touched on murderers in general, rapists and child molesters. My point of view was that I did not understand them and felt that he was justifying their actions. In the end I was informed that I was smug. Apparently that …

How obesity is like alcoholism

Arya M. Sharma, MD

Conditions and Diseases

March 21, 2011

Recently, I attended a scientific symposium on addictions.

One of the books I picked up at that conference, and read on my flight to Montreal, is A. J. Adams’ Undrunk: A Skeptic’s Guide to AA.

While this book is a very quick and highly readable introduction to AA (Alcoholics Anonymous), about which I knew very little, today’s post is not about this book.

The definition reads as follows:

Alcoholism is a primary chronic disease …

Read more…

How obesity is like alcoholism

Evaluating dizziness in the cardiologist’s office

Eric Van De Graaff, MD

Conditions and Diseases

March 20, 2011

I see a lot of patients who are sent to me for evaluation of dizziness. On the surface you wouldn’t think a cardiologist would have much to do with a symptom that relates more to the head than the heart, but there is some logic to it—poor blood flow to the brain could lead to dizziness and, since blood flow starts in …

Uncertainty in the diagnostic methods of the obstetrician

Kevin

Physician

March 20, 2011

by Henry Dorn, MD

In 1974, the noted obstetrician Marcus Filshie published a review of the relatively new electronic fetal monitoring in the British Journal of Hospital Medicine. He stated, somewhat fatefully:

Now that the appropriate technology is available, the obstetrician may virtually eliminate intrapartum stillbirths and reduce morbidity to a minimum.

Similar statements were made in the United States by leaders in the obstetrical …

Supportive physicians and management to implement an EHR

Ron Sterling

Health Technology

March 18, 2011

From Medicare/Medicaid incentives to EHR industry ads, it is hard to cut through the hype and determine if your practice is even ready to try to select and implement an EHR.

Implementing an EHR is a transformational exercise for any practice that requires redesigning every aspect of charting, clinical workflow and interaction with patients. However, in too many cases, practices approach EHR …

Cancer patients get better care than patients in primary care

Shantanu Nundy, MD

Physician

March 17, 2011

Why do my patients with cancer get better care than my patients in primary care? As the senior resident on my hospital’s inpatient leukemia service recently, this question troubled and intrigued me daily.

Despite the sheer complexity of treating leukemia (administration of chemotherapy, bone marrow biopsies, stem cell transplantation), the resources required (transplantation routinely costs $1 million), and the severity of the illness …

Label the interaction as difficult, not the patient

Maria Yang, MD

Patient

March 17, 2011

Kevin Pho, at KevinMD.com, posted a commentary about encounters with “difficult patients.” He correctly notes that physicians themselves contribute to these interactions. To reduce the likelihood of these encounters, he suggests that physicians would benefit from more training in “psychosocial skills.”

Kudos to Kevin for adjusting his own language by the second sentence of his post: He makes the distinction between difficult patient and difficult encounter.

A vital step in decreasing …