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.

ProPublica’s Dollars for Docs: Strengths and weaknesses

Daniel J. Carlat, MD

Medications

February 6, 2011

The non-profit media organization ProPublica last year announced a new website/database called Dollars for Docs. It lists cash payments made to 17,000 U.S. doctors by seven large drug companies.

I’ve been browsing through the database and I have some thoughts about its strengths and weaknesses—and how it might be useful for patients.

First, here’s what these journalists did. Rather than waiting for the provisions of the Physician’s Payments Sunshine Act …

Kernels of humor in a tragic cancer story

Colleen Kelly Mellor

Conditions and Diseases

February 5, 2011

I didn’t always recognize its importance. I mean when I was younger, I thought that being attractive, slim, athletic, articulate were sure-fire antidotes to one’s suffering a life of mediocrity. I just never recognized the value of something I took for granted, my sense of humor. And then life happened.

When I was 36, my husband (who was older by 12 years) was diagnosed with lung cancer. Inoperable, incurable, his type …

Stressful life events in suicide attempts and completed suicides

William R. Yates, MD

Conditions and Diseases

February 5, 2011

The role of stressful life events in suicide attempts and completed suicides has been a key area of study in the epidemiology of mental disorders. Although suicidal behavior often occurs in the context of acute and chronic stressor, this does not prove a causal link. We all could probably report serious life stressors throughout out lives and these could be interpreted as a reason for suicidal behavior. So these associations …

Radiation treatment errors with Intensity-Modulated Radiation Therapy (IMRT)

Richard Leff, MD

Physician

February 4, 2011

In a recent series of articles in the New York Times, Walt Bogdanich uncovered an alarming series of radiation treatment errors associated with implementation of new computerized treatment technologies such as Intensity-Modulated Radiation Therapy (IMRT).

Based on this article, reporting hundreds of cases, some of them fatal, it appears that a variety of causes are associated with errors, including inadequate training of physicists and radiation therapists, difficulty physically validating computer-generated treatment …

A stent anecdote from a former FDA Associate Commissioner

Kevin

Physician

February 4, 2011

by Peter J. Pitts

As the saying goes, the plural of anecdote isn’t data. That is unless the anecdote supports your theory. Here’s a personal anecdote — a story of how the system works.

Being adopted, I have no family history, so when I suffered through some late night chest pains I figured I’d better act on the warning signals. I called my GP and got a same-day consultation, resulting in a next-day referral …

Why is there a gender gap in physician salaries?

Emily Lu

Physician

February 3, 2011

Some research studies just contain too many revelations to not share with the world. The Health Affairs study on the pay gap between newly-trained male and female physicians is just such a study, demonstrating conclusively that:

1. The gender gap in physician salaries is not related to specialty choice or work hours. No matter where women are choosing to work (solo practice vs. hospital, city vs. rural), which specialty they choose …

Mass shootings is a symptom of our nation’s broken health care system

Kevin

Patient

February 1, 2011

by Dora Calott Wang, MD

There will be more shooting rampages, like that which targeted Congresswoman Gabrielle Giffords in Tucson recently-as long as it is easier to get a gun than mental health care. Our current epidemic of mass shootings is but a symptom of our nation’s broken health care system. Poor access to medical care jeopardizes an individual’s health. But when the mentally ill or the seriously distressed can’t access …

Laryngopharyngeal reflux disease and a complex case or chronic cough

Steven Y. Park, MD

Conditions and Diseases

February 1, 2011

Chronic cough is a common condition that’s seen by many doctors, and in most cases, after a thorough history and exam, an answer can usually be found. However, just because a physician followed all the accepted guidelines and evidence based medicine principles to successfully address and treat a condition, it doesn’t mean that it was the right thing to do. Let me explain.

A 49 year old healthy woman presented to …

Marcus Welby and the relentless growth of specialization

Jan Henderson, PhD

Physician

January 31, 2011

In the very first episode of the TV series Marcus Welby, MD, our hero delivers an after dinner speech to a group of young interns. As he’s introduced, he hastily scribbles the title of his talk and hands it to the hospital director: “The future of the general practice of medicine, if any.” The year was 1969.

In his introduction, the director somewhat tactlessly remarks that many “eminent specialists” have addressed …

Patient advocacy is essential in health insurance appeals

Steven Reznick, MD

Patient

January 30, 2011

An active 61 year female, who has been in my practice for 30 years, developed strange aches and pains and abdominal symptoms. My evaluation turned up nothing.

I then asked for help at the University of Miami rheumatology and gastroenterology divisions. With the help of a brilliant local gastroenterologist and rheumatologist, and after a trip to Johns Hopkins Medical Center and the Mayo Clinic, collagenous …

Where an extremely premature baby immediately receives care matters

Jennifer Gunter, MD

Conditions and Diseases

January 28, 2011

When you think about giving a premature baby the best possible start in life, it is important to consider the hospital where they are born. The care an extremely premature baby receives immediately after birth makes a big difference in outcomes.

A premature baby who is less than 32 weeks gestation or weighs less than 1500 g at birth should be cared for in a level III NICU. These babies also …

Dabigatran (Pradaxa) questions in atrial fibrillation

Larry Husten, PhD

Patient

January 27, 2011

The approval of dabigatran (Pradaxa) has been long awaited in the cardiology community. Although just about everyone agrees that a good alternative to warfarin is highly desirable, there are many remaining questions about the drug as it prepares to enter the marketplace.

Here are a few questions raised by electrophysiologist John Mandrola on his blog:

In the RE-LY trial, dabigatran was used twice daily. When not symptomatic, patients often …
Read more…

Dabigatran (Pradaxa) questions in atrial fibrillation

What your medical office can learn from Norman Rockwell

Brandon Betancourt

Physician

January 24, 2011

This past summer I got a chance to visit Washington DC. While I was there, I saw a Norman Rockwell exhibition at the Smithsonian American Art Museum. As it turned out, the exhibition was the private collection of George Lucas and Steven Spielberg. The exhibition highlighted Rockwell’s masterful storytelling.

I didn’t know much about Norman Rockwell before that day. I knew he was a famous American painter and I had seen …

Adherence to HIV treatment in Africa

Paul Sax, MD

Patient

January 24, 2011

There has been an irresistible urge for people — doctors, public health officers, politicians, journalists, the usual pundits — to compare adherence to HIV treatment in resource-rich vs. resource-limited setting.

I suspect this is because the whole issue got off to a famously bad start in 2001, when then-head of the U.S. Agency for International Development (USAID) Andrew Natsios said in an interview with the Boston Globe that Africans,

don’t know what Western time …

Read more…

Adherence to HIV treatment in Africa

How MD anesthesiologists have become victims of their own excellence

Jeffrey Parks, MD

Physician

January 22, 2011

The New York Times has jumped all over a couple of recent scientific articles asserting that certified registered nurse anesthetists (CRNA’s) provide equivalent care as MD anesthesiologists. Already, it is legal in 15 states for CRNA’s to dispense anesthesia without the overarching supervision of a physician.

Furthermore, a study from the Lewin Group in California has demonstrated that CRNA-only models of anesthesia provision are far more cost effective that …

A laryngectomy shakes this physician to the core

Itzhak Brook, MD

Conditions and Diseases

January 19, 2011

As an infectious diseases physician with a special interest in head and neck infections, I had extensive experience in otolaryngological illnesses. However, when I was exposed to new, different, and challenging experiences as a neck cancer patient, I had to deal with these as a patient — not as a physician. I endured the consequences of radiation, repeated surgeries, and prolonged hospitalizations. I confronted medical errors in my care, discrimination …

Your doctor isn’t superhuman and is allowed to call in sick

Doctor Grumpy, MD

Patient

January 18, 2011

I mentioned having a migraine this past weekend, and was somewhat surprised by how many people commented and wrote to me, surprised that a doctor, let alone a neurologist, would actually get migraines.

What’s up with that?

I know this may be hard to believe, but we get health problems too.

I see this odd view surprisingly often. People who somehow expect us to be beyond the health concerns of non-doctors.

We may be …

Is red wine really good for your heart and your brain?

Kevin

Patient

January 18, 2011

by Marie Pasinski, MD

Although much has been written about how red wine in moderation can be good for your heart and your brain, I would like you to reconsider. It’s important to understand that the studies supporting this claim are “observational.” This means they were conducted through self-reported questionnaires inquiring into the drinking habits of a large group of …

How often to see your doctor when feeling well

Eric Van De Graaff, MD

Patient

January 17, 2011

How often do you see your doctor? Once a year? Every 6 months? Never? Most of you are pretty healthy and only show up for screening physical exams or aches and pains. Some of you may have more health problems and come more frequently.

What if you had diabetes, coronary disease, hypertension, high cholesterol, and sleep apnea, but no symptoms to indicate any …

Fetal ultrasound and our image oriented society

Randi Hutter Epstein, MD, MPH

Patient

January 17, 2011

An excerpt from Get Me Out: A History of Childbirth from the Garden of Eden to the Sperm Bank published by W. W. Norton & Company, 2010 (paperback January 2011).

On eBay, you can buy a fetal ultrasound scrapbook that has a poem on the first page that begins, “I loved you from the start.” It comes with Care Bear stickers. One of them is a pregnant rabbit eating …

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