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.

How to improve doctor patient communication

Paul Dorio, MD

Patient

February 22, 2011

When I was a medical student on my first clinical rotation, obstetrics, I was criticized for not using enough medical jargon when I spoke to the patients.

I took that criticism as a compliment and have always attempted to speak clearly and without too much “inflation” of my terms. In my opinion, the more clearly we physicians communicate, the better will be our patients’ understanding of their ailments.

The important topic of doctor-patient communication led a …

ACP: High value, cost conscious care

American College of Physicians

Physician

February 22, 2011

A guest column by the American College of Physicians, exclusive to KevinMD.com.

by John Tooker, MD, MBA, MACP

There were two reports from the recent 2011 International Stroke Conference that got my attention.

One report noted the sharp increase in the incidence of strokes in children and young adults. The second, in the Los Angeles Times (“Mild strokes may …

Read more…

ACP: High value, cost conscious care

The biggest problem faced by pilots and obstetricians alike is nature

Amy Tuteur, MD

Physician

February 21, 2011

It’s a bit ironic that pilots, the people who spend the most time traveling above the magnificent landscape that is our planet earth, spend very little time appreciating the scenery.

That’s because they are trained to always be on guard for unexpected emergencies. While the passenger in a jumbo jet traversing the continent can admire the majesty of the Rocky Mountains, the desolation of the Great Salt Lake or the endless …

Tragedy of cancer in a small child

gcs15, MD

Conditions and Diseases

February 18, 2011

The OR was hushed on Friday.

Normally, it is a loud, busy place. The staff and surgeons are almost like a big family; we chat with each other and banter cheerfully with patients to help get their minds off the imminent ordeal of surgery. Chaplains pray with patients and families. Sometimes there are disagreements, as in any workplace. But everyone cares about everyone else.

Because of that caring, it was hushed. Instead …

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Tragedy of cancer in a small child

The care was futile, and the patient’s wishes

Jim deMaine, MD

Physician

February 18, 2011

“We have a patient on a ventilator here who is stable enough to transfer to your ICU, if that’s OK with you.”

This call, coming from the transfer coordinator, is emblematic of an insurance generated “medical care” coverage issue. I am salaried under the patient’s insurance carrier so the insurer wants this patient back under its wing as soon as possible.

The community hospital has been keeping Stella Norris (not her real …

Let Me Down Easy and facing illness and death

Danielle Ofri, MD, PhD

Physician

February 17, 2011

Every illness is unique, and every person faces illness in his or her own way.

Anna Deveare Smith, in her one-woman Broadway show “Let Me Down Easy,” slips into the persona of twenty individuals who have faced an aspect of illness or death. In ninety minutes, Deveare Smith takes the audience on an existential scavenger hunt, allowing us to observe, and occasionally pluck, insights from this gathering of individuals.

These individuals do …

Requiring an ultrasound and counselling before an abortion

Robert Luedecke, MD

Health Policy

February 17, 2011

A bill given emergency status by Texas Governor Rick Perry is the largest invasion of the patient-physician relationship that I am aware of. Proposed by Senator Dan Patrick (R-Houston) and supported by Lt. Gov. David Dewhurst, the bill as originally written would require physicians to perform a ultrasound and explain the physical characteristics of the fetus to anyone contemplating an abortion.

Physicians would be required to inform women about alternatives to …

Time with your patients in the hospital and time with your children

Felicity Billings, MD

Physician

February 16, 2011

As part of the routine scut of the overnight call team, I was sent up to the floor to preop an add-on for the next day’s OR schedule.

The Preoperative Anesthesia Assessment form has tidy little boxes for cardiac, pulmonary, renal, hematologic and an assortment of other complaints, and spaces for height, weight, allergies and personal or family history of untoward reactions to anesthesia. I put a single slash through the …

What makes a good, competent psychiatrist?

Dheeraj Raina, MD

Physician

February 16, 2011

A reader recently asked, how does someone find a good psychiatrist?

Stated another way, the questions are:

What qualities make a good, competent psychiatrist?
How do I find a good, competent psychiatrist?
How do I get my concerns heard about the direction of my treatment?

I typed the question “How do I find a good psychiatrist?” in Google and got almost half a million results from around the world. I find it hard to believe …

Difference between proactive and reactive medicine

Dr. Martin Young

Physician

February 16, 2011

Looking back, some of my biggest medical mistakes have been times when I was reactive rather than proactive when faced with a clinical problem. A doctor may have to be one or the other depending on the circumstances, but knowing when and which approach to take is one of the harder skills of medicine, taking time and experience to master.

What do I mean? Here are some examples from my field.

Treating …

Top 5 NICU tips from a preemie parent

Deb Discenza

Patient

February 15, 2011

Heads up folks in the Neonatal Intensive Care Unit (NICU), parents of premature babies want you to succeed more than you may realize. It is just hard for them to communicate this through the fog of stress and exhaustion that has consumed them for countless hours, days and even months.

So here is a little insight into the parent mind and what they want you to know about what it is …

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Top 5 NICU tips from a preemie parent

Why physicians should sell their practice

Kevin

Physician

February 15, 2011

There are many reasons to sell your practice. Physicians attempt to sell their practices for various reasons. Some physicians are reaching the age of retirement, while others are looking to add a partner, who, in time will take over the practice as a whole. Whatever the reason, attempting to get a quality price for the practice can, at times, be a challenge in this current …

Shared decision making to determine implantable defibrillator need

Shannon Brownlee

Physician

February 15, 2011

Implantable defibrillators are truly life saving devices that have prevented sudden death in thousands of patients. No bigger than an iPod nano, the device can sense when the heart is beating irregularly and deliver an electrical jolt that kicks it back into proper rhythm. But like so many of medicine’s miracles, defibrillators are not always used on the right patients. According to a study published recently in the …

Your physician may be thinking about suicide

Heather Fork, MD

Physician

February 15, 2011

Very few of us are untouched by the tragedy of suicide. Whether in our own family, through friends, or one of our colleagues, most of us have been affected by suicide. We are often left alone, with the painful questions,

“Why?”

“What could we have done differently?”

Now we learn from a study by Shanafelt et. al, in the Achieves of Surgery, that one in 16 surgeons had suicidal ideations in the …

When in the ER with abdominal pain, adjust your expectations

Kevin Pho, MD

KevinMD

February 14, 2011

Abdominal pain is the bane of many emergency physicians.

Recently, I wrote how CT scans are on the rise in the ER. Much of those scans look for potential causes of abdominal pain.

In an essay from TIME, Zachary Meisel discusses why abdominal pain, in his words, is the doctor’s “booby prize.” And when you consider that there are 7 million visits annually by people who report abdominal pain, that’s a …

How to become a licensed, board certified doctor

Roy Benaroch, MD

Physician

February 12, 2011

I am licensed to practice medicine and surgery in Georgia. But that doesn’t mean I should, or that you ought to let me—at least not the surgery part. I’m actually pretty good at carving a turkey, but that’s pretty much the only kind of surgery that I’m qualified to do.

Don’t let the license fool ya, I’m no surgeon. So what, exactly, does a doctor have …

What is job satisfaction for physicians?

Philippa Kennealy, MD, MPH

Physician

February 10, 2011

“I can’t get no satisfaction,” sang the Rolling Stones. And so it goes for many of the physicians who contact me.

I was struck by the fact that the word “satisfaction” in connection with work was used in two separate conversations with physicians recently.

It got me curious. Just what is job satisfaction?

How is it defined by the folks who study this kind of stuff?

And why is it so hard to come …

A person’s attitude toward their illness has a huge impact

Richard Barager, MD

Patient

February 10, 2011

In classic Aristotelian drama, there comes a moment when the main character is presented with an insurmountable obstacle, be it physical, psychological, spiritual, or otherwise. The nature of the obstacle forces the character to make a choice: a critical choice, an act of free will that determines the glide path of the rest of the story, irrevocably altering its arc.

So it is with the arc of illness, a medical drama …

How anchoring leads to misdiagnosis

Jerome Groopman, MD and Pamela Hartzband, MD

Conditions and Diseases

February 10, 2011

Anchoring refers to the tendency to latch on, or anchor, to the first symptom or bit of data and fail to consider the full spectrum of information, leading to misdiagnosis. Recently, we have received several cases where an anchoring error was triggered by a mistake in translating the patient’s words into clinical terms.

Case study #1

Henry Solomon, FACP, currently the medical director of Pfizer Global Pharmaceuticals, was for many years a …

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How anchoring leads to misdiagnosis

Do stroke centers improve patient outcomes?

Harlan M. Krumholz, MD

Conditions and Diseases

February 8, 2011

Another good paper for a journal club recently appeared in JAMA. What makes this one worth discussing is the research question the investigators posed and how they addressed it. Although this is not focused on cardiac care, the issues are germane to literature in our field and cardiac care certification is also spreading.

The article, titled “Association Between Stroke Center Hospitalization for Acute Ischemic Stroke and Mortality,” focuses on the New …