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.

Are malpractice lawsuits really responsible for the rise in C-sections?

Kevin

Physician

January 16, 2011

by Louise Marie Roth, PhD

About one third of all births in the contemporary United States occur via c-section. Physicians and the public at large often attribute this to a “malpractice crisis,” whereby obstetricians perform c-sections routinely to avoid malpractice litigation. Over the last couple of years, I have been conducting research on obstetric practices and malpractice.

One of the things that I have learned …

How cocaine can be used in sinus surgery

Christopher Chang, MD

Medications

January 16, 2011

Many people are already aware that marijuana is now legal in some states in the US with a medical prescription.

What many people may not realize is that cocaine is also used in medical care, especially in the ENT world.

Cocaine is one of the most potent anesthetic and vasoconstrictor. These two characteristics make it an ideal medication for use during sinus surgery as well as any nasal procedure where bleeding and …

Intubating the combative patient

Ralph Gordon, MD

Conditions and Diseases

January 11, 2011

How many times have I been asked by the trauma surgeons to see a trauma patient for respiratory failure? The reason for intubation and ventilatory support – being combative and non-cooperative.

Intubating, sedating and sometimes even paralyzing a combative patient is an established practice. Combative patients are dangerous to themselves and to the medical staff. Clinical and radiological evaluation of these patients is difficult as well. Asking “What is hurting, Sir” …

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Intubating the combative patient

Common things are common, except when the diagnosis is rare

Michael Aaronson, MD

Conditions and Diseases

January 7, 2011

During my training at Hennepin County Medical Center (HCMC) in Minneapolis, MN, my mentor would use the following teaching pearl during rounds: “When you hear hoofbeats, think of horses not zebras!” He would also frequently use: “If it looks like a duck, swims like a duck, and quacks like a duck, then it probably is a duck.” What did my mentor, the Sage of HCMC, mean by this?

From Wikipedia: “Zebra …

Little Patient Big Doctor: One Mother’s Journey, an excerpt

Kevin

Patient

January 7, 2011

An excerpt from Little Patient Big Doctor: One Mother’s Journey.

by Haleh Rabizadeh Resnick

Dear Doctor,

I want to share with you my experiences with two of my children . . . . I share the hecticness our lives with you for a reason. We are all the same. We are all busy. We all face adversity. And while we want most to trust the opinions of professionals, …

MKSAP: 74-year-old man with gradually progressive dyspnea

mksap

Conditions and Diseases

January 6, 2011

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

A 74-year-old man is evaluated for a 5-year history of gradually progressive dyspnea and dry cough without wheezing or hemoptysis. For the past 2 years he has had pain and occasional swelling in both knees. He has not had fever or lost weight. He smoked one pack …

Patients will choose their medicine, based on their doctor’s advice

Dave deBronkart

Patient

January 4, 2011

TEDMED is a truly extraordinary conference in San Diego, a fall sibling of TED talks focused on medicine. TED talks are just 18 minutes long, chosen and designed to blow your mind. They don’t all hit that level, but many do.

True to form, the opening session was a mind-blower. 26 year old Charity Tillemann-Dick stepped out on stage and belted out a soprano aria. I thought that was it – an opening …

Protecting health care professionals who act based on their conscience

Kevin

Patient

January 4, 2011

by Child of the Ocean

I recently came across an interesting article titled “Conscientious Objection Gone Awry — Restoring Selfless Professionalism in Medicine” by Julie D. Cantor, M.D., J.D., in the New England Journal of Medicine.

This article argues against a rule, the Provider Refusal Rule, from the United States Department of Health and Human Services (DHHS) that legally protects health care professionals who act based on …

Permanent makeup risks and dangers

Orly Avitzur, MD

Conditions and Diseases

January 2, 2011

“She just got permanent eye liner and eyebrow augmentation—looks fab,” emailed one of my closest friends last month, about her coworker. “I am seriously considering permanent liner/eyelash augmentation. Do you have any interest in doing this with me?”

I understood the appeal … I’d never have to reapply makeup after showering at the gym, save time on my morning routine and enhance features like thinning lashes and brows. Although we had …

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Permanent makeup risks and dangers

Discussing cancer treatment with the terminal patient

Bruce Campbell, MD

Conditions and Diseases

January 1, 2011

For everything, there is a season…
– Ecclesiastes

“Are you giving up on me?” My patient looks at me severely. “There must be other treatment options! Aren’t there some experimental drugs out there? I have beaten this cancer twice before. Are you saying that I can’t beat it again?”

No one can ever know with absolute certainty whether my patient’s newly recurrent cancer might miraculously disappear with one more treatment. His recurrence, however, has …

Lessons learned from asthma therapy

Juliet K. Mavromatis, MD

Conditions and Diseases

December 31, 2010

As a kid I had allergies and asthma.

Because of this, for several years, my mother wrote a note excusing me from the 600 meter run in elementary school. My father took me to weekly allergy shots. At times I had eczema on my forearms and eyes, and according to my allergist, whose notes I later read, I had moderate allergic shiners (also known as dark circles under my eyes). My …

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Lessons learned from asthma therapy

Your attention deficit disorder may be an anxiety disorder

Srini Pillay, MD

Conditions and Diseases

December 29, 2010

Are you one of those people who simply cannot concentrate for long enough? Do you find that no sooner than you start doing something, that your attention is scattered all over the place? Do you find that you log onto your computer and within minutes are surfing every possible tangential site that you find?

Your problem may not be a problem with your attention. In fact, it may be that the …

How American physicians should be paid

George Lundberg, MD

Health Policy

December 29, 2010

How do you think American physicians should be paid?

I think many of the current methods are insane. Case in point:

In the 1980s, during a meeting of the board of trustees of the American Medical Association, I experienced sudden unexpected unilateral loss of hearing. You might say that was lucky. But I was scared and went right to my ENT’s office.

He looked in my ear and extracted a large wad of …

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How American physicians should be paid

Tips to find a good psychiatrist

Dinah Miller, MD

Physician

December 29, 2010

Seems like a simple enough question: How do you find a psychiatrist?

It’s not that easy to answer. There are all sorts of psychiatrists who do all sorts of things (therapy, not therapy, specific forms of therapy like psychoanalysis or CBT), and then there’s the overriding insurance question. Not to mention location, location, location.

We’ve talked before about insurance, and if you haven’t read Why Shrinks Don’t Take Your …

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Tips to find a good psychiatrist

Physicians need to take responsibility for their actions

Jeffrey Knuppel, MD

Physician

December 21, 2010

As the saying goes, when you’ve got a hammer, everything looks like a nail. Send a patient to a surgeon, and he very well might get surgery. Send a patient to a psychiatrist, and he very well may end up on psychotropic medication.

As physicians, we need to take responsibility for our own actions. We should not prescribe or perform procedures unnecessarily. However, even if we are responsible for our own …

Pay close attention to what doctors say to patients

Paul Dorio, MD

Patient

December 20, 2010

In a report from the Archives of Internal Medicine, it was reported that most hospitalized patients (82%) could not accurately name the physician responsible for their care and almost half of the patients did not even know their diagnosis or why they were admitted. Of the physicians, 67% thought the patients knew their name and 77% of doctors thought the patients “understood their diagnoses at least somewhat …

A physician story of addiction and recovery

Kevin

Physician

December 16, 2010

by an anonymous physician

I am a physician now in recovery.

I don’t like that term. The correct thing to say is, I am sober. I am going on a year sober without any problems. Recovery suggests some disease state and I don’t think it is that simple. It also suggests an ongoing daily struggle or effort to remain sober, and I don’t find that the case, either. I know this …

How to intubate: Teaching a medical student during anesthesia residency

Felicity Billings, MD

Medical Education

December 16, 2010

The first time I let a medical student try to intubate was in August. Now in my final year of anesthesia residency, I had volunteered to mentor a third-year medical student for a week. A few weeks in advance I got an email with the form she had filled out. Anesthesia experience: none. Excited to learn: yes.

I met her on Monday morning after she navigated through the preoperative holding area …

Why physicians ignore fatigue

Robert Wachter, MD

Patient

December 15, 2010

Several years ago, I spoke at Baylor College of Medicine in Houston, where Michael DeBakey, the legendary heart surgeon, was master of the universe for nearly half a century.

I heard lots of DeBakey stories during my visit, but one in particular really stuck with me. “A few years back,” someone told me in a voice of hushed reverence usually reserved for descriptions of flawless beach days and single …

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Why physicians ignore fatigue

A poetry reading at Bellevue Hospital

Danielle Ofri, MD, PhD

Physician

December 14, 2010

The waiting area in Bellevue Hospital was full. Every chair was taken. But the people kept streaming in. More chairs had to be brought in. It wasn’t clear if the room could accommodate everyone.

This wasn’t the emergency room or the clinic waiting area, however. It was the scene of the Bellevue Literary Review poetry and prose reading. More than 100 people poured into Bellevue Hospital on a Sunday evening to …

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A poetry reading at Bellevue Hospital