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.

Lifestyle changes to control the symptoms of prostate enlargement

Neil Baum, MD

Conditions and Diseases

March 7, 2011

Prostate enlargement, or benign prostate hyperplasia (BPH), is a common, non-cancerous condition affecting nearly 14 million men over the age of 50.

The symptoms of prostate gland enlargement include a decrease in the force and caliber of the urinary stream, frequency of urination, urgency, a feeling of not emptying the bladder despite urination and nocturia, or the need to get up at night to urinate. Although lifestyle changes will not cure …

I see dead people, an excerpt from In Stitches

Anthony Youn, MD

Physician

March 7, 2011

An excerpt from In Stitches.

I see dead people.

Eighteen bodies covered with plastic, lying on gurneys. An occasional toe protrudes to verify that beneath the shiny black tarp, a dead person lies.

I smell dead people, too.

Or at least the thick chemical stench of formaldehyde, tearing at my eyes and packing my nose, enough liquid preservative in here to float a yacht. The smell rises from the bodies and from a dozen …

MKSAP: 64-year-old man with a new right-sided headache

mksap

Conditions and Diseases

March 4, 2011

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

A 64-year-old man is evaluated for a new right-sided headache that began 1 day ago. He awoke yesterday with a dull ache over his right forehead that has gradually increased in intensity. He also notes some right eye discomfort, sensitivity to light, and that his eye …

Welcome our new (doctor) computer overlords

angienadia, MD

Health Technology

March 4, 2011

In February, IBM supercomputer Watson won Jeopardy! against its two human opponents, Ken Jennings and Brad Rutter.

Watson’s victory rests on its power in speech recognition and the ability to understand colloquial human language used in game shows like Jeopardy!. The most interesting development of this story is that after Watson’s celebrated win on national television, IBM will partner with Nuance Communications to explore how Watson could help with medical diagnosis …

How to hire an IT director for your medical practice

Peter J. Polack, MD

Health Technology

March 4, 2011

About 8 years ago or so, our practice decided to move from paper records to electronic records. The decision was helped along by the fact that we were literally running out of space for our paper charts. I had been looking at electronic medical records systems (EMRs) for years prior to this but could not justify the cost to my partners – apart from the “gee-whiz” factor – until we …

Forever grateful to the doctors and nurses who saved my son

Kevin

Patient

March 3, 2011

by Kate Gray

I call William my spirited child. Like many 3 year-olds, he loves to run and jump, and does it without the slightest sense of fear. His boundless energy has always been one of his most endearing features, but in a split second, it also almost took him from us forever.

A few days before Christmas, my husband Mark and I had some last minute holiday …

Proton beam therapy and the medical arms race

Paul Levy

Physician

March 2, 2011

Proton beam therapy is an effective modality for killing certain types of cancer cells. New England and the Northeast are fortunate to have a proton beam machine at Massachusetts General Hospital, where it has been in use for some time effectively treating patients. This is a valuable resource, serving the entire region and beyond.

But what happens when everyone wants one? Well, we see the medical arms race at work again.

These …

Viewing physicians source of care, rather than a barrier to care

Sakina Shikari Bajowala, MD

Physician

March 2, 2011

Clinician. Diagnostician. Prognostician. Healer.

A physician has many jobs to perform, all critical to the appropriate management of what ails our patients. Without astute physical exam skills or a keen ability to sort through a medical history to uncover salient data, the physician is no better at diagnosing a patient than a Google search (and we’re quite a lot better, in case anyone was wondering). Without a proper understanding of physiology …

The physical exam of the head and neck is both simple and challenging

Bruce Campbell, MD

Physician

March 1, 2011

No great artist ever sees things as they are. If he did, he would cease to be an artist.
-Oscar Wilde

The physical exam of the head and neck is both simple and challenging. Simple, in that even children are familiar with the shape of the face, the sheen of the eye, the curve of the ear, and the texture of the tongue. Challenging, because when complicated, interlacing structures malfunction, they send …

Patients are not to blame for the miscommunication about cardiac stents

Carolyn Thomas

Patient

March 1, 2011

When I had a heart attack two years ago, I was taken immediately from the E.R. to the O.R. for emergency treatment, including cardiac catheterization and a stainless steel stent implanted in a major coronary artery that was 99% blocked. But, overwhelmed and terrified, I knew nothing about what was about to happen, even though I have a vague memory of the cardiologist explaining something to me before I was whisked …

Fewer physicians are taking call in rural emergency rooms

Edwin Leap, MD

Physician

February 28, 2011

My partners and I have long struggled with the lack of specialty back-up at our hospital. Semi-rural hospitals, out of the way facilities, just can’t always attract specialists. So, we’re happy to have cardiologists every night, but understand that we only have an ENT every third night. We’re thankful to have neurologists, even if they don’t admit anyone. We’re glad to have radiologists, even if they don’t read plain films …

Can I be a doctor with bipolar disorder?

Dinah Miller, MD

Physician

February 25, 2011

“I have bipolar disorder. Can I be a doctor?”

It’s one of those questions to which there is no real answer. Being a doctor takes a long time, it requires reliability, diligence, and a willingness to learn things you may not want to learn and do things you may not want to do. It requires endurance and passion. You need to be tolerant of many things: arrogant supervisors, irritable colleagues, sick …

The torture and emptiness of psychological hoarding

Srini Pillay, MD

Conditions and Diseases

February 25, 2011

Humans are imbued with a competitive spirit. And as a result, we like to count our victories.

There are an infinite number of possibilities in human experience. And when the possibility of death looms over us, the sudden fear that we might not have done everything we might have creates immense distress. This “range” or “number” idea rarely has the effect it is supposed to have. Every kind of sex, every …

Sharing information about your health with specialists is difficult

Jessie Gruman, PhD

Patient

February 25, 2011

As far as my chemo nurse Olga (not her real name) is concerned, I can do nothing right.

She scolded me for sending an e-mail when she thought I should have called and vice versa. She scolded me for going home before my next appointment was scheduled. She scolded me for asking to speak to her personally instead of whichever nurse was available. She scolded me for calling my oncologist directly. …

When your privacy is violated in the doctor’s office

Joel Sherman, MD

Patient

February 25, 2011

Few patients enter our health care system prepared for the unexpected and embarrassing circumstances that can routinely happen.

Most can accept it when we’re treated with modesty and respect. But not many are prepared for those times when you might be unnecessarily exposed or treated rudely. The possibilities for embarrassment are endless and it is usually unexpected. When avoidable incidents do happen, most patients are not prepared to speak up. Many …

Gastric bypass is not a short cut to treat obesity

Michael Kirsch, MD

Conditions and Diseases

February 24, 2011

Recently, a female patient saw me in the office for the first time to discuss her chronic digestive issues. Luckily for her, my recommendations did not include probing into her alimentary canal with the endoscopic serpents that we gastroenterologists rely upon.

As the visit concluded, she advised me that she intended to have a gastric bypass (GIB) procedure performed, and even used the medical term of bariatric surgery. I suppose that …

How two different attending physicians approach similar conditions

MomTFH, DO

Physician

February 24, 2011

I recently finished my second month of internal medicine. I had a different attending physician for each month. It is interesting to see how two different attending physicians will approach similar conditions. There is a lot of flexibility in the standard of care. Neither of them is wrong by any stretch of the imagination. Just different.

It is also amazing how much of a difference a good, well informed resident can …

How important is a doctor’s skill in the physical exam of a patient?

John Mandrola, MD

Patient

February 23, 2011

How important is a doctor’s skill in the physical examination of a patient?

To the lay person, a doctor’s examination might seem really important. “Of course it is, Dr M … Come on.”

But is it so? Or, perhaps, is the examination a charade, a show, a necessity to complete the medical record.

It turns out that many in the profession think doctors may be losing the skill of palpating and listening. At …

Revenue cycle management for your physician practice

Rosemarie Nelson

Physician

February 23, 2011

Revenue Cycle Management. What does it mean? In a nutshell, it means taking steps to assure that you get paid for what you do and that you get paid in a timely fashion.

The revenue cycle starts when the patient calls your office for an appointment and your staff captures the patient’s name, phone number, and maybe the name of their insurance company.

The cycle ends when the balance on their account …

When should psychiatrists give advice to patients?

Jeffrey Knuppel, MD

Patient

February 23, 2011

This post was inspired by Dinah, a psychiatrist over at Shrink Rap.

She recently described how a psychiatrist friend of hers has been going through some phase-of-life changes. Recently he has regretted some of the advice that he previously had given to patients who were going through the same life changes he’s now going through himself. He realizes that he was not nearly so qualified to give the advice …

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