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.

Third world doctors are the real physician heroes

Dr. Martin Young

Patient

June 11, 2010

I recently was involved in a web discussion on elective choices with a group of medical students.

Financial considerations aside, I was surprised how few were interested in visiting third world countries to see how medicine is practiced outside the first world comfort zone of unlimited expertise, investigation and therapy — where “want” often exceeds “need.”

The third world however is completely different. It’s an environment where doctors and nurses are in …

Treating a child with fever and leukemia

StorytellERdoc, MD

Conditions and Diseases

June 10, 2010

I walked into Room 35 to find a three year-old lying on the hospital cot. Her father sat alongside her bed, whispering softly to her. The patient appeared quite tired, wiped-out even, and if it weren’t for her complacent eyes tracking my every move, I would have thought she might be sleeping.

She was visiting our ER because, after a few days of cough and congestion, she had developed a fever. …

Electronic medical records and detail obsessed doctors

Paul Sax, MD

Health Technology

June 10, 2010

When it comes to writing consult notes, it often seems as if we ID specialists have a blatant form of obsessive-compulsive disorder. Every detail is fair game — travel history, dietary habits, all sorts of seemingly trivial exposures, and of course microbiologic data stretching back to the Cretaceous period.

I’ll never forget receiving sign-out from the graduating first-year ID fellow when I started my fellowship. It included a photocopy of a …

What medicine was like in ancient Babylonian society

Jan Henderson, PhD

Potpourri

June 10, 2010

Each issue of the Journal of the American Medical Association includes an excerpt from an issue of exactly 100 years ago (JAMA has been published continuously since 1883).

The May 7, 1910 issue of JAMA included remarks on how much physicians were paid and, by implication, how they were regarded in 2250 B.C.

Ability to pay and malpractice

According to the famous Babylonian Code of Hammurabi (“an eye for an eye”), a physician’s …

Causes of stroke in young adults

MedPage Today

Conditions and Diseases

June 9, 2010

by Todd Neale

The recent stroke suffered by Delaware’s attorney general Beau Biden, who is 41, has highlighted the fact that people of all ages are vulnerable, despite seemingly good health.

A statement from Timothy Gardner, MD, medical director of the Center for Heart and Vascular Surgery at Christiana Care Health System in Newark, Del., where Biden was initially treated, said he had suffered a “mild stroke,” although it remains unknown whether …

Read more…

Causes of stroke in young adults

Peer review may require random over-reads

Larry Husten, PhD

Conditions and Diseases

June 9, 2010

“Let’s kill all the lawyers.” It’s every doctor’s favorite Shakespeare quote. And if you’re giving a talk to doctors there’s no better way to get the audience on your side than by starting with a lawyer joke.

But perhaps we shouldn’t be too hasty about killing all those lawyers. As recent commentary about the Mark Midei case makes clear, modern medicine doesn’t know how to police itself. And until medicine does …

Clinical judgment and when neurologists should order an MRI

Vernon Rowe, MD

Conditions and Diseases

June 8, 2010

With healthcare reform dominating the news recently, MRI and other imaging tests have become the (misguided) targets of many critics.

Although MRI makes up only one-half of one percent of total healthcare expenditures, it is easy to demonize since the average healthcare consumer can understand imaging much easier than the diagnosis related groups (DRGs), hospital facility fees or insurance contracts that have a much greater impact on the cost of health …

Choosing between Lasik and Lasek eye surgery

Kevin

Physician

June 5, 2010

by Tim Harwood

Hundreds of thousands of people each year are taking the plunge and choosing to have the life changing procedure that is laser eye surgery.

It is currently the most popular elective surgery in the world and the number of people having it done is likely to increase as the procedure becomes safer and more accurate. If you yourself are considering having laser eye surgery, then you will almost …

Can children really have bipolar disorder?

James Baker, MD

Conditions and Diseases

June 4, 2010

by James Baker, MD

Using the diagnosis “bipolar disorder” for children with problems in mood has been controversial ever since a surge in its use in the mid-1990’s.

A recent article in the Los Angeles Times gives the pros and cons on the use of “bipolar disorder” in children through the opinions of two psychiatrists on opposite sides of the controversy.

The problem with using “bipolar” is that it requires a too-loose interpretation …

MKSAP: A 50-year-old woman is evaluated for a rash on the back of her elbows and knees

mksap

Conditions and Diseases

June 3, 2010

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

A 50-year-old woman is evaluated for a rash on the back of her elbows and knees. A similar rash has occurred in the past, with her first episode as a young adult. She has used over-the-counter hydrocortisone cream without relief. She does not smoke or drink and is otherwise healthy.

Patients who attempt suicide and withdrawal of medical care

Ralph Gordon, MD

Conditions and Diseases

June 2, 2010

If a person tries to commit suicide, could that be considered as a statement that this person wishes to die and does not want aggressive treatment to save his or her life?

Not from a legal standpoint, and not if you are living in the United States.

A middle-aged man with a long standing history of depression decides to end his life. He puts a large caliber gun straight to his forehead …

Your asthma or COPD inhaler is not available, and what to do

Matthew Mintz, MD

Medications

May 28, 2010

As reported in MedPage Today, the FDA announced the end for CFC-propelled inhalers. Of the seven inhalers with deadlines for removal, only three are still being made:

Flunisolide (Aerobid Inhaler System) on June 30, 2011
Albuterol and ipratropium combination (Combivent Inhalation Aerosol) on Dec. 31, 2013
Pirbuterol (Maxair Autohaler) on Dec. 31, 2013

The reason for this is because CFC’s are harmful for the environment, and the newer inhalers have to be replaced with …

How doctors choose which specialists they refer to

Michael Kirsch, MD

Physician

May 28, 2010

There is an aspect of professional sports that I greatly admire. This transcends the athleticism and skill of the athletes, the work ethic, coaching expertise, teamwork and the thrill of the game. This is one of the only institutions that is a pure meritocracy. The philosophy is simple and not blurred by arguments for diversity or massaging the qualifications for admission to serve another agenda. Coaches, managers and owners want …

How primary care should manage chronic pain patients

Juliet K. Mavromatis, MD

Medications

May 28, 2010

In April 2010 the American Society of Anesthesiologists (ASA) published updated guidelines for the management of chronic pain. The guidelines were based on a review of recent scientific evidence as well as a survey of expert opinion. As I read through the guidelines, summarizing the efficacy of various therapies for chronic pain ranging from epidural injection to medication management, some of my most challenging clinical cases involving pain management …

Healthcare needs to be simpler and more like real economics

John Mandrola, MD

Health Policy

May 27, 2010

A middle aged patient whom I have seen in the past for benign palpitations called today because of atypical chest pain. Although I have criticized the overuse of nuclear imaging studies, and probably order the fewest of any cardiologist in the city, there are times when they are appropriate –this was one of those occasions. Symptoms did not rise to the level of an invasive angiogram, but could not be …

Treating patients in prison for murder

Jeffrey Knuppel, MD

Patient

May 26, 2010

Correctional psychiatrists inevitably treat patients who have been convicted of a broad array of crimes. There is a correlation between the security level of the institutions in which one works and the severity of the crimes of the inmates being housed there.

Since I’ve treated inmates of minimum, medium, and maximum custody levels, I’ve had the opportunity to work with people who have been convicted of everything from drug possession to …

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Treating patients in prison for murder

Waterbirth dangers to newly born babies

Amy Tuteur, MD

Conditions and Diseases

May 26, 2010

Waterbirth has become a central component of “natural” childbirth dogma, despite the fact that for primates giving birth underwater is entirely unnatural. You don’t need a medical degree to appreciate the idiocy of birth in water. The most critical task for the newborn is to take its first breath.

Inhaling a mouthful of fecally contaminated water instead of air is profoundly dangerous. Not surprisingly, as the popularity of waterbirth has grown, …

Read more…

Waterbirth dangers to newly born babies

A medical student chooses dermatology because of family

Kevin

Medical Education

May 25, 2010

by an anonymous medical student

As of today, I am one month from adding those long sought-after and hard-earned initials to my name, M.D. I matched at my number one choice in a very competitive “lifestyle specialty,” have a fabulous husband who has helped me through the emotional turmoil that is medical school, and two young boys who make me laugh and smile every day. I sit here, where …

Medical imaging is increasing in cancer patients

Kristina Fiore

Conditions and Diseases

May 22, 2010

by Kristina Fiore

Medical imaging for cancer patients and resulting costs have increased over the last decade, particularly in positron emission tomography (PET), researchers have found.

Annually, use of the diagnostic screen rose significantly between 1999 and 2006 — ranging from 36% in lung cancer to 54% in breast cancer, Kevin A. Schulman, MD, of Duke University, and colleagues reported in the April 29 Journal of the American Medical Association.

Imaging costs also …

Father of a patient with a sudden brain hemorrhage

StorytellERdoc, MD

Conditions and Diseases

May 20, 2010

She was 50. Prior to being transported to our ER, her only complaint had been for non-traumatic elbow pain over the past two weeks. She was on no medications and had no significant medical history.

She was at home, preparing to visit her doctor for a scheduled visit, when she collapsed. Because she didn’t drive, her elderly father had planned on swinging by to pick her up. He had just called …

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