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.

Balancing a surgeon’s beliefs with the needs of the practice

Peter J. Polack, MD

Physician

August 20, 2010

Not long ago, we interviewed a physician for possible partnership in our practice. After showing him around our town, some of us partners had dinner with him to discuss business. He was a quite pleasant fellow, well trained, and seemed to be a good ‘fit’ for our practice. As dessert was being served, he said he needed to get one more thing off his chest: he prays aloud in the …

Gifts and money influence physician prescribing

Marya Zilberberg, MD, MPH

Medications

August 19, 2010

It is not a secret that large sums of money have passed from the pharmaceutical and device manufacturers into physicians’ hands.

This money has been paid not only for such socially beneficial pursuits as research and consulting, but also for lavish gifts and junkets. And interestingly, despite disingenuous assertions to the contrary by many a stake holder, these gifts generated a return on investment — surprise! It turns out that the …

Family doctors cannot be obsolete, for patients’ sake

Kevin

Physician

August 19, 2010

by Pepi Granat, MD

Yesterday, and every day, in my office we had one or two patients we call our “Oldie Goldies”.

People who have been with us since 1971 when I opened my practice, 39 years ago. People whose progress, medical and personal, I’ve shared, and who share mine. We know their parents, kids and cousins either because they call us in crisis, or they’re our ongoing …

Physicians should not be used for FDA ad enforcement

Michael Kirsch, MD

Medications

August 18, 2010

One of the advantages of marrying an immigrant is having intense exposure to another culture. My wife’s Russian heritage, and her family, have enriched my own life immeasurably. The trip that I took with her and my brother to Russia in 1990, where she served as our personal translator, was unforgettable.

During the early years of our relationship, I heard stories about her family that seemed incredible to an American like …

Why primary care is like air traffic control

angienadia, MD

Physician

August 18, 2010

Recently I had an interesting conversation with a few young doctors regarding the new health care reform that had been passed in the United States. One future specialist asked me why primary care doctors should receive more money than they have in the past.

And this is an important question that I think sheds light on the suboptimal state of our current health care system. It is important to specialists because …

Heart health depends on healthy behaviors

John Mandrola, MD

Conditions and Diseases

August 17, 2010

Everyone knows that the heart health of Americans is dismal. Obesity, diabetes, and high blood pressure are all on the rise.

For now, technological advances in cardiac care continue to maintain, or in some cases, lower the death rate from heart disease. Squishing blockages, ablating abnormal heart tissue, and installing cardiac devices have successfully kept the abysmal lifestyle habits of so many at bay. Despite all the fury of modern technology …

Why radiology should become more like McDonald’s

Paul Dorio, MD

Physician

August 16, 2010

For years, I have been progressively beating a louder and louder drum — one where my colleagues know that I liken radiology to McDonald’s.

Most of the bad press out there, it seems to me, has to do with poor customer service. Our health care system is often inefficient, and delivers limited, incomplete care. The root of the problem, in my opinion, is that there aren’t enough doctors or hours in …

Stop calling doctors fleas and teaching professionalism

Vineet Arora, MD

Physician

August 15, 2010

At the recent AAMC meeting on how to integrate quality into teaching hospitals, the question that kept popping up from speaker after speaker was how to address the fact that doctors in teaching hospitals don’t get along.

Unfortunately, all the specialty bashing that takes place prevents the adoption of a team based culture necessary to advance quality and safety. As one speaker highlighted, how can we really start to address this …

Being admitted to the ICU over the weekend increases risk of dying

MedPage Today

Physician

August 12, 2010

by Nancy Walsh

Patients admitted to an intensive care unit (ICU) over the weekend face a greater likelihood of dying compared with those admitted on a weekday, a meta-analysis suggested.

The meta-analysis, encompassing more than 180,000 weekend and weekday ICU admissions, found that even after adjusting for disease severity, the odds ratio for death among those admitted to an ICU over a weekend was 1.08 (95% CI 1.04 to 1.13, P<0.001), according …

Treating people with humility, and every patient like a V.I.P.

Anesthesioboist T., MD

Patient

August 8, 2010

People often seem to think that members of the medical world are excessively preoccupied with, defined according to, and ruled by a status-oriented system.

That may have been an accurate perception a generation ago, but I’ve seen enough surgeons sweeping O.R. floors, attending physicians socializing with interns, and doctors having deep conversations with custodians to believe that “medical people” have matured a little past the old caste systems that governed the …

Does surgery prevent knee osteoarthritis?

MedPage Today

Physician

August 7, 2010

by John Gever

Surgery for torn knee ligaments and meniscal cartilage may have improved patients’ short-term outcomes, but it did not seem to prevent the eventual development of osteoarthritis, researchers said.

A study that followed 326 patients for a mean of 10 years found that radiographic findings shortly after the initial knee injury strongly predicted the long-term clinical course, with no significant difference seen between those who did and did not have …

MKSAP: A 35-year-old man with red eye and acute eye pain

mksap

Conditions and Diseases

August 6, 2010

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

A 35-year-old man is evaluated for red eye and acute onset of right eye pain. He wears contact lenses daily. Fluorescein staining is positive for corneal abrasion without a dendritic, or branching, pattern. He is instructed to stop wearing the contact …

Attribution error in a patient with colon cancer

Jerome Groopman, MD and Pamela Hartzband, MD

Conditions and Diseases

August 5, 2010

Zahia Esber, ACP Associate Member, who practices at McKenzie-Willamette Medical Center in Eugene, Ore., told us about a case of a 71-year-old obese woman whose mental status deteriorated rapidly while in the hospital.

The patient had undergone a sigmoid resection in December 2009 for colon cancer. At that time, her mental status was intact. Three weeks after surgery, she returned to the hospital because of nausea and anorexia. She told the …

Notes in the chart are helping patients less

Paul Sax, MD

Physician

August 4, 2010

What is the purpose of the note in the patient chart?

Depends who you’re asking.

The best guidance I ever received on how to write a good note came from my residency program director, who told us that a note needn’t be encyclopedic to be excellent; in fact, he urged us to get away from the “second-year medical student” style, which typically includes absolutely everything.

Instead, he urged us to write, as concisely …

Breathe properly at night and learn to sleep better

Steven Y. Park, MD

Conditions and Diseases

August 4, 2010

Every time you see a depiction of someone sleeping on TV or in the movies, you’ll see the person sleeping on his or her back, and oftentimes, snoring.

The lay public, doctors, and even alternative and complementary practitioners naturally assume that you’re able to breathe properly at night. This couldn’t be further from the truth.

Evolutionary biologists and comparative anatomists have stated that speech and language development was ultimately detrimental to humans. …

How to say goodbye to patients

Christian Sinclair, MD

Patient

August 3, 2010

OncRN is a wonderful blog written by an anonymous author sharing stories and insights in her line of work that many times speak to palliative themes. S/he says it best in her blog description,

my life gets intermittantly (sic) rocked by the wonders/horrors of being an oncology nurse. i just need to talk it all through sometimes.

A recent post is about how to say good-bye to our patients, particularly …

Read more…

How to say goodbye to patients

Is patient adherence responsible for health quality and safety?

Steve Wilkins, MPH

Patient

August 3, 2010

A while back I did in a post where I asked the question, What can patients really expect from their physicians today? In that post, I wondered at the fact that many patients still have a high degree of trust in their physician in spite of the quality and safety problems attributed to physicians in the press.

For example:

On average, US adults receive only 50% of recommended …
Read more…

Is patient adherence responsible for health quality and safety?

Pay specialists less to save primary care

Edward Pullen, MD

Health Policy

August 2, 2010

Since 1997 the number of US medical students choosing to go into primary care has decreased by more than 50%.

It seems that sources as diverse as the Obama Administration and the Wall Street Journal think that we should find a way to encourage medical students to choose primary care specialties in order to allow Americans to have the best and most cost effective care. This is very problematic when primary …

What does a TIA feel like? A Stroke Diaries excerpt

Kevin

Patient

August 2, 2010

An excerpt from Stroke Diaries.

by Olajide Williams, MD

The man who did not take his medicine

Pedro was lying on the bathroom floor next to the toilet bowl. Water was still running from rusty faucet, overflowing the sink, and pooling around his body as he lay limp on wet porcelain tiles. Lucy was standing over him and whining. The young black Labrador retriever had not left …

Early dialysis may not improve kidney failure outcomes

MedPage Today

Conditions and Diseases

July 31, 2010

by Nancy Walsh

Planned early initiation of dialysis in patients with chronic kidney disease did not improve survival or other clinical outcomes, a multicenter randomized trial conducted in Australia and New Zealand found.

The hazard ratio for death among patients who had an early start of dialysis, when the estimated glomerular filtration rate (GFR) was 10 to 14 mL/min, was 1.04 (95% CI 0.83 to 1.30, P=0.75), according to Bruce A. Cooper, …

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