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.

Alzheimer’s disease needs better preventive strategies and treatments

William R. Yates, MD

Conditions and Diseases

September 8, 2010

The Alzheimer’s Association sponsors a journal titled Alzheimer’s & Dementia. In the March 2010 issue, they provide a report on facts and figures related to Alzheimer’s disease (AD).

I’m a sucker for data so I spent some time going through the manuscript and here are some of the things that stood out to me:

Ninety (90) drugs are under investigation using human volunteers in the U.S. to slow or stop …

Why are hearing aids so expensive, and reading glasses so cheap?

Randall S. Bock, MD

Conditions and Diseases

September 7, 2010

I am currently 53 years old, but I recently found an imperfection in my near-vision. I was probably laboring for a year or so before caving in: purchasing reading glasses. I am using them right now and they have made all the difference.

In the space of a few months, I went from no reading glasses to seven pairs. I bought all seven online together as a package recently, for the …

Some MRI places have good quality machines, others are obsolete

Doctor Grumpy, MD

Conditions and Diseases

September 7, 2010

“Dave” showed up at my office last week with neck pain, worsening weakness in his arms and legs, and changes in his bladder control. All signs pointed to something gone bad in his neck.

His internist had already thought of this, because he’d ordered the appropriate MRIs. And they’d all been read as normal, leaving me without a cause.

Here is where the problem began. Everything about Dave’s exam and story pointed …

Cosmetic foot surgery can have serious downsides

Howard Luks, MD

Physician

September 7, 2010

How far will some women go to fit into high heels? The menu of services at Beverly Hills Aesthetic Foot Surgery in Studio City, Calif., provides a clue.

There’s the trademarked “Cinderella Procedure”—a preventive bunion correction that makes feet narrower. The clinic also offers the “Perfect 10! Aesthetic Toe Shortening” that invisibly trims toes that hang over the end of sandals or have to be crushed into tight shoes. There’s also …

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Cosmetic foot surgery can have serious downsides

How to use your CPAP machine when traveling

Steven Y. Park, MD

Conditions and Diseases

September 6, 2010

One of the most common excuses for not wanting to use CPAP is that “I travel a lot.” Even after I explain that many people travel just fine with their CPAP machines, some people are stll reluctant.

With advances in technology and increased awareness by the lay public, government officials and medical professionals about the importance of using CPAP for obstructive sleep apnea, traveling with CPAP, although initially a challenge, can be …

Multiple assessments are needed in the face of repeated testing

Jerome Groopman, MD and Pamela Hartzband, MD

Conditions and Diseases

September 6, 2010

At a recent weekly case conference at our hospital, we heard about a young woman with an elevated testosterone level. The patient was evaluated by James Hennessey, FACP, prior ACP governor from Rhode Island and currently director of clinical endocrinology at Beth Israel Deaconess Medical Center, along with an endocrine fellow, Laura Sweeney, MD.

Case study: Polycystic ovarian syndrome suspected

The patient was a 19-year-old art student at a local university. She …

Wound infections and the Surgical Care Improvement Project (SCIP)

Skeptical Scalpel, MD

Physician

September 5, 2010

The Surgical Care Improvement Project (SCIP) and its antecedent, the Surgical Infection Prevention project, have been around for several years.

In short, these consist of several rules issued by various self-appointed agencies with important-sounding names and the Centers for Medicare and Medicaid Services (CMS), a federal agency. The main rules are 1) administer the correct prophylactic antibiotic before surgery, 2) give the antibiotic within one hour before the skin is incised …

Are physicians today active in the arts?

Jan Henderson, PhD

Physician

September 4, 2010

Physician/poets such as William Carlos Williams are an honorable tradition in the history of medicine, following in the footsteps of Keats, Schiller, and Oliver Wendell Holmes (of “Chambered Nautilus” fame). Physicians have also been writers, painters, musicians, philosophers, and – at least in more recent times –photographers.

Yet in 1980 the historian G.S. Rousseau expressed concern that modern physicians no longer embodied the humanist tradition of their predecessors. Now that medicine …

The primary care specialist pay gap shouldn’t be squeezed too hard

Colin Son, MD

Physician

September 3, 2010

The primary care-specialist pay gap is a popular target for those eager for reform. The gap is hailed independently as an example of and a cause of the lack of focus on primary care and prevention in the United States.

There is no doubt that the United States treats primary care, preventative care and triage much differently than most of the rest of the developed world. The distribution of primary care …

The TPA time limit for acute stroke causes mass chaos in the ER

ER Stories, MD

Conditions and Diseases

September 1, 2010

I hate acute strokes. There are several reasons for it. Most of them are logistical. First, everyone gets into a tizzy because of the 3 (or 4.5) hour time limit after the onset of symptoms that which TPA can be given and hopefully improve the patient’s outcome. Unfortunately, this time limit (and the data for TPA’s efficacy is only OK at best) causes mass chaos and annoyance.

First, one has to …

Empiric antibiotics in the ICU

Paul Sax, MD

Medications

August 31, 2010

Last year, I commented on the ironic sameness of ICU infectious diseases — that incredibly sick, complex patients entered the ICU with vastly different problems, then over time, seemed to converge, presenting similar kinds of clinical issues and management challenges for the ID doc.

Or, as a visiting medical student said to me, “My ICU attending said that every patient in the ICU should be on vancomycin and Zosyn.”

Which brings up …

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Empiric antibiotics in the ICU

What is Glenn Beck’s macular dystrophy?

Michele R. Berman, MD

Conditions and Diseases

August 31, 2010

During a recent speech from his American Revival tour, Glenn Beck, 46, announced that he has an eye condition called macular dystrophy that could cause him to go blind. Speaking in front of a large group at his “Revival America” tour, the Fox News pundit told the crowd:

“A couple of weeks ago I went to the doctor because of my eyes, I can’t focus my eyes…he did all kinds of …

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What is Glenn Beck’s macular dystrophy?

How JetBlue can improve your medical practice

Brandon Betancourt

Physician

August 31, 2010

I got a chance to fly JetBlue for the first time recently. Since I had heard so many good things about the airline, I was looking forward to experiencing the JetBlue, well, experience.

I took four flights in total with them. While outbound, they lost my bag. While inbound to Chicago, my last leg was delayed about 2 hours. I then I had to wait another 80 minutes for my bag …

Should physicians undergo random drug testing?

Jeffrey Parks, MD

Physician

August 30, 2010

Lucian Leape MD, a public health professor at Harvard, wants to subject doctors in America to strict random and periodic drug testing to help identify those physicians who are impaired. All in the name of patient safety, of course:

“I’m very much in favor of random testing,” Dr. Leape says. “We have a responsibility to identify problem doctors and bring them into treatment.” And to protect patients in the process.

Ok, I …

Watchful waiting pays off for a torn ACL

Merrill Goozner

Conditions and Diseases

August 30, 2010

“Why golf,” my friends often ask. They, like too many Americans, assume it is a sport for the country club set, and have a hard time fathoming why someone like me — liberal, somewhat intellectual, decidedly anti-elitist — would passionately embrace the game.

My answer is always brief and direct. When I was 35, I tore my right knee’s anterior cruciate ligament during one of my twice-weekly pick-up basketball games in …

Root beer bonds a chemotherapy patient with his oncologist

Kevin

Conditions and Diseases

August 30, 2010

by Krupali Tejura, MD

I am treating a patient for head and neck cancer — which can be one of the most harrowing therapies.

To receive chemotherapy and radiation concurrently can be pretty debilitating. Swallowing foods can be next to impossible, and the taste changes and saliva changes are brutal. It’s one of the harshest areas to treat … and I warn the patients beforehand: …

For women with endometriosis, motherhood is elusive

Kevin

Conditions and Diseases

August 27, 2010

by Lone Hummelshoj

Earlier this year, we finished a month dedicated to women and mothers. In the U.S., we celebrated “National Women’s Health Week” and before it Mother’s Day. One study suggested Americans would spend a total of $14.6 billion in May alone to honor our mothers. And we should honor our mothers!

However, for millions of women with endometriosis, motherhood is elusive. In fact, an estimated …

Applying the minimally invasive concept to patient management

Ralph Gordon, MD

Patient

August 24, 2010

Every time you subject the patient to an invasive procedure you take the risk of causing complication. I have done hundreds if not thousands of procedures which makes me even more aware of the risk I take every time I stick a needle or cut into the patient. We can do everything possible to enhance the safety, yet we cannot completely eradicate the risk of adverse events.

With the recent progress …

Is placebo a therapy, like surgery or medication?

PalMD

Conditions and Diseases

August 23, 2010

The New England Journal of Medicine recently published a troubling article on acupuncture, which was ably deconstructed by Dr. Mark Crislip. This incident has reignited a discussion of what, exactly, “placebo” is.

A common argument is that placebo is like any other intervention, something that can be intentionally harnessed for the benefit of patients. This is both true and overly simplistic.

First, we must review what “placebo” …

Fetal heart rate monitoring is given too much importance

Nicholas Fogelson, MD

Conditions and Diseases

August 23, 2010

Continuous fetal heart rate monitoring is at its core an almost laughable idea.

We are checking a single vital sign and using that vital sign to extrapolate a host of ideas and meanings. OBs that have read strips for years can make some sense of them, but would we give so much meaning to any other single vital sign? Would we do it with an adult? Of course not, but there …

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