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.

When a biopsy cannot completely rule out cancer

Jeffrey Parks, MD

Conditions and Diseases

July 30, 2010

Pathologists and radiologists don’t have the luxury of spending time with actual patients so they have to render professional judgments and determinations based on indirect data (radiographs, a mashed up slice of breast tissue, etc.).

I don’t envy them; the utter detachment from patient care would make me miserable. But they do have a tough job. They get one shot at getting it right. There’s no patient follow up. They never …

How industry money continues to influence orthopedics

Ford Vox, MD

Physician

July 30, 2010

Three years ago, the Department of Justice took stock of the orthopedic medical device industry–represented by the five big makers of orthopedic implants–and concluded that it was rampantly violating federal anti-kickback laws with the bribes and favors it was offering to surgeons. Such bribes often came in the form of training grants for those just starting out in the profession, or as lucrative consulting contracts for influential academic orthopedists.

The …

Obesity should not require specialists to manage

Arya M. Sharma, MD

Conditions and Diseases

July 28, 2010

Medical school trains us to deal with a wide range of medical problems.

No matter what our current practice or specialty, at some point during medical school we will have had to study and demonstrate our knowledge and competency in dealing with common disorders like diabetes, hypertension, depression, chronic pain and countless other ailments. In addition, we will have spent hours poring over much rarer disorders, conditions that many of us …

Certified stroke centers and ischemic stroke treatment realities

Kevin

Conditions and Diseases

July 28, 2010

by John Fauber

Time is brain. Every minute wasted seeking treatment is measured in neuronal death, which is why stroke specialists were early supporters of certified stroke centers. Getting a stroke patient to the right center — a center that could administer clot-busting therapy quickly, and safely — was considered the surest way to “save brain.”

That was the concept behind the certified …

The art of medicine and whether computers can replace doctors

Eric Van De Graaff, MD

Conditions and Diseases

July 27, 2010

My medical school at the University of Utah developed a clever computer program in the late 80s that was meant to both educate medical students and assist in the treatment of patients.

For several years the tech geeks at the school had collected an immense database of information from all the patient admissions at the hospital—presenting symptoms, exam findings, tests, and final diagnoses. They took all this data and crunched …

Preventing postop infections need to be implemented as a package

Kristina Fiore

Physician

July 27, 2010

by Kristina Fiore

Measures designed to prevent postoperative infections work if measured as a package, but looked at individually they provide no improvement, researchers found.

When analyzing the six components of the Surgical Care Improvement Project (SCIP) on an all-or-nothing basis, there was a 15% reduced risk of infection, according to Jonah J. Stulberg, MD, PhD, MPH, of Case Medical Center in Cleveland, and colleagues.

But the three core infection prevention measures taken …

Best Doc in a magazine, the inside story

Doctor Grumpy, MD

Physician

July 25, 2010

You’ve seen it, somewhere.

Every city in America, and likely the world, has a local magazine. And once a year, that magazine publishes a “Best Docs” issue, usually listing 10 doctors from each specialty who they consider the best of the best.

Dr. Grumpy, for the record, is not biased against this. I’ve been named a “Best Doc” in my field several times.

And I know most of the other neurologists on the …

Hearing loss from iPods and other MP3 players

Crystal Phend

Patient

July 24, 2010

by Crystal Phend

iPod users beware. Listening to an MP3 player for even an hour can induce short-term hearing loss, researchers affirmed.

Compared with controls, hearing deterioration among MP3 users was 3.97 to 4.40 times more likely when listening to pop/rock music through earbud headphones at different output levels, found Hannah Keppler, MS, of Ghent University in Ghent, Belgium, and colleagues.

Listening to an iPod with over-the-ear headphones also boosted the odds of …

Good medicine sometimes makes patients unhappy

Ralph Gordon, MD

Physician

July 24, 2010

As physicians, we all strive to practice good medicine. Good medicine means evidence based medicine in the patient’s best interests. In the ideal world this will make patients happy and satisfied. If you are getting the best treatment for your condition you should be happy, right?

In the real world, though, keeping patients or their families’ happy and practicing good medicine might not be possible at the same time. This is …

Viagra for muscular dystrophy and publicity for accidental insight

Jeoffry B. Gordon, MD, MPH

Conditions and Diseases

July 22, 2010

by Jeoffry B. Gordon, MD, MPH

As a family doc in practice for over 30 years I have been always tried to conceptualize disease states beyond the standard text book parameters.

Thus I was elated by the prospect of discovering a new beneficial treatment for muscular dystrophy when 5 years ago I gave some Viagra to a 57-year old patient of mine with limb girdle muscular dystrophy for the usual purpose. In …

How can doctors minimize unnecessary testing?

Robert Centor, MD

Physician

July 21, 2010

A recent comment raised a minor controversy about the strategy of minimizing tests. I actually do not think that the disagreement is that great, but I feel like exploring the issue.

This is the sentence that triggered the comment, courtesy of primary care physician Rob Lamberts:

Order as few tests as possible. No test should be ordered for informational purposes only; the question, “What will I do with these results?” should always …

Read more…

How can doctors minimize unnecessary testing?

Participatory medicine and evidence from medical journals

Dave deBronkart

Patient

July 20, 2010

I’ve only been studying healthcare for two years and I hesitate to be overly assertive.

But I have, finally, reached the point where I feel confident in citing cases where people are simply being unscientific: ignoring evidence. That’s always hazardous, and it becomes insidious when it’s caused by a blind, unquestioning belief in our institutions.

Case in point:

Julie Thoren is an active practitioner of Participatory Medicine who’s seen first-hand the tremendous value …

Watchful waiting may be appropriate for most prostate cancer cases

Crystal Phend

Conditions and Diseases

July 19, 2010

by Crystal Phend

Deferring curative treatment for low-risk prostate cancer may be a good option for many men ages 70 and younger, a population-based observational study affirmed.

In the national Swedish prostate cancer registry, the cumulative 10-year prostate cancer-specific mortality rate was only 2.4% for men at low risk who opted for watchful waiting or active surveillance, according to Pär Stattin, MD, PhD, of Umeå University Hospital in Umeå, Sweden, and colleagues.

This …

Cancer patients need compassion and balanced information

Bruce Campbell, MD

Patient

July 18, 2010

If you have to ask what jazz is, you will never know.
– Louis Armstrong

The stillness in the meeting room was electric.

First, one panelist addressed the audience members who have never experienced a malignancy. She described the unique and powerful bond that exists between cancer survivors. She described how the brush with mortality forces each survivor to renegotiate terms with Life itself. She reminded everyone that the cancer care system too often lets …

Unnecessary testing needs more than tort reform to cure

Michael Kirsch, MD

Conditions and Diseases

July 17, 2010

Recently, while covering for one of my partners on a weekend, I was consulted by a physician to do a procedure.

The doctor wanted his patient to undergo an EGD, which is a scope test that examines the esophagus, stomach and first portion of the small intestine called the duodenum. We gastroenterologists do this test routinely to search for an explanation for a patient’s symptoms, or to determine if these organs …

Stents to treat blocked heart arteries are not an easy fix

John Mandrola, MD

Conditions and Diseases

July 15, 2010

Cardiologist Richard Fogoros — aka DrRich — has put out an incredibly timely and pertinent piece of advice concerning the common practice of stenting blockages in the coronary arteries.

He succinctly summarizes a small retrospective study that showed an increased risk of cardiac events after non-cardiac surgery in patients who have recently undergone either a bare metal or drug-eluting coronary stent.

On a website clearly designed to educate patients, DrRich rightly points …

Why this doctor felt compelled to go to Haiti

Kevin

Physician

July 15, 2010

by David Chong, MD

As the world watched the greatest athletes gather to compete in Vancouver, I was on a plane to Haiti. Just getting on the plane was quite a feat.

After I received an urgent e-mail for volunteer doctors from the University of Miami’s Project Medishare field hospital in Port-au-Prince, Haiti during an overnight shift at New York’s Presbyterian hospital, I began to send frantic requests for coverage for …

Treating intellectual disabilities in patients who can’t talk

Jeffrey Knuppel, MD

Conditions and Diseases

July 14, 2010

Psychiatrists treating patients who can’t talk. Sounds fishy, doesn’t it?

Well, I do it 2-3 days per week, and as strange as it may sound, it makes perfect sense.

Let me explain.

I provide psychiatric consultation services in a facility for people with intellectual and developmental disabilities. (Intellectual disability is the newer term for mental retardation). Some of my patients are short-term admissions from the community, and others are long-term residents of the …

Pregnant with triplets, and a premature delivery

Jennifer Gunter, MD

Conditions and Diseases

July 14, 2010

An excerpt from The Preemie Primer.

There’s a well-entrenched theory that OB/GYNs have the most complicated pregnancies.

In reality most of us probably do not, but doctors remember complications most vividly when they happen to people they know and love. My pregnancy was, unfortunately, a good example of that old adage. Many of my colleagues who looked after me during that time have said, “It was the worst night of my life.” …

Cancer in a transplant kidney, is it the doctor’s fault?

Amy Tuteur, MD

Physician

July 13, 2010

May you never be an interesting case.

That’s a cautionary proverb familiar to medical professionals. While it’s bad to get sick, it’s much worse to get sick with something uncommon or unusual. The more fascinating a case is for doctors, the more difficult it is for patients. Difficult to diagnose, difficult to treat, and often difficult to survive.

Kenneth Liew was doubly unfortunate. He was an interesting medical case and an interesting …