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.

Endocrinologists may improve surgical care in diabetic patients

Physician
May 15, 2010

by Kristina Fiore

Shorter hospital stays and lower costs were the result when surgical patients with diabetes and dysglycemia received endocrinology consults, researchers said.

Adding endocrinologists to surgical care teams for patients with abnormal blood glucose readings cut total length of stay among patients in a single center by 1,342 days and saved the hospital $1.15 million, according to Arthur Chernoff, MD, of Albert Einstein Medical Center in Philadelphia.

Chernoff presented his findings …

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Endocrinologists may improve surgical care in diabetic patients

Doctors are focusing on lifestyle when practicing medicine

Health Policy
May 14, 2010

An interview with Elizabeth Chase, MD, obstetrician-gynecologist in Dover, New Hampshire

Elizabeth Chase, better known as Betsy, is a close and enduring college friend of my son, Spencer. She is a solid, pragmatic, hard working obstetrician-gynecologist, with two sons, and an architect husband, who spends his time caring for their children and their house in Dover, New Hampshire. She represents many of changes that occur when women become full-time physicians. The …

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Doctors are focusing on lifestyle when practicing medicine

Medical practice success depends on a strong clinical team

Physician
May 13, 2010

Although every day can bring surprises in a medical practice, you can develop a clinical team that can optimize the efficiencies of your operation and make it easier for you to see your patients.

There are three key areas that lead to provider frustration in daily operations: preparation and anticipation; the daily dance; and being in the moment. Address these, and your days should go more smoothly.

Preparation and anticipation

Are your charts …

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Medical practice success depends on a strong clinical team

Declining autopsy rate, and how that impacts doctors

Conditions and Diseases
May 12, 2010

The role of autopsy in the medical profession is difficult to overestimate. Western medicine takes its roots from comparative studies between patient’s symptoms and the findings on autopsy.

Participation in an autopsy was one of the most valuable lessons from medical school and residency. If you participated in the patient’s care, there is no greater educational tool than witnessing the postmortem exam. It is especially true if the cause of death …

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Declining autopsy rate, and how that impacts doctors

C-section rates as a marker for obstetric care quality

Conditions and Diseases
May 12, 2010

by Michael Smith

When cesarean section rates are lower than expected, adverse maternal or neonatal outcomes are higher, researchers said.

But the converse isn’t true — higher-than-expected C-section rates aren’t associated with a protective effect, according to Sindhu Srinivas, MD, of the University of Pennsylvania, and colleagues.

The finding comes from an attempt to see if the risk-adjusted C-section rate can be used as a marker for the quality of obstetric care, Srinivas …

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C-section rates as a marker for obstetric care quality

Treating cancer needs to be an individual patient decision

Conditions and Diseases
May 11, 2010

The heresy of one age becomes the orthodoxy of the next.
-Helen Keller

The patient returned to my clinic several years after her original thyroid cancer surgery. “The cancer blood test never went completely back to zero,” she told me. “We knew there was cancer in there somewhere. Finally, the new ultrasound machine found it! I guess it is time for more surgery!”

I guess. In my patient’s situation, the latest high resolution diagnostic …

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Treating cancer needs to be an individual patient decision

Online dermatology visits for acne can be effective

Physician
May 9, 2010

by Chris Emery

Acne patients who received online treatment from dermatologists had similar outcomes to patients who were treated in the doctor’s office, a new study found.

Patients who participated in “e-visits” with dermatologists experienced similar reductions in inflammatory lesions as those who had office visits, Alice J. Watson, MBChB, MRCP, MPH, of the Center for Connected Health in Boston, and colleagues wrote in the report, published online April 19 in the …

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Online dermatology visits for acne can be effective

How PCOS can be diagnosed and treated in primary care

Conditions and Diseases
May 9, 2010

Hypothetical case scenario

27-year old female presents to the office with a complaint of irregular periods. Menarche was at age 15, and periods occur about 1-2 times a year. Breast development began at age 9, followed shortly by axillary & pubic hair. Growth spurt was at age 13. She’s been trying to get pregnant for the last one year now, and has never been seen before for her irregular periods.

On physical …

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How PCOS can be diagnosed and treated in primary care

Dying of old age in the era of modern medicine

Conditions and Diseases
May 8, 2010

He is 93 and has numerous medical problems, most of which involved aging blood vessels, as well as multiple orthopedic issues, including compression fractures and diffuse arthritis. The bony issues have resulted in a severely compromised mobility of late.

Despite ongoing treatment with both aspirin and clopidogrel, he presents after numerous hours of focal neurologic symptoms. A CT scan shows no evidence of bleeding and the diagnosis is a major stroke …

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Dying of old age in the era of modern medicine

Autistic enterocolitis may not be real

Conditions and Diseases
May 7, 2010

by Todd Neale

The status of a new inflammatory bowel condition identified in the retracted Lancet paper that linked the MMR vaccine and autism — autistic enterocolitis — appears to be in limbo.

The 1998 paper by Andrew Wakefield, MBBS, and colleagues was fully retracted by The Lancet in February, although the alleged and repeatedly disproven vaccine link was dropped in …

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Autistic enterocolitis may not be real

Social networking impact on patients, doctors, and non-profits

Social Media in Medicine
May 6, 2010

In its current listing of online social networks, Wikipedia presents 156 major, active websites. A neighboring link to view “now-defunct” sites accompanies the listing — a subtle reminder of the Internet’s competitive and volatile environment where promising endeavors rise and fall overnight.

But although the popularity of a specific website may fade with time, the practice of online social networking is here to stay.

In its simplest form, online social networking is …

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Social networking impact on patients, doctors, and non-profits

Avoiding the ER and arranging a direct admit is not easy

Physician
May 4, 2010

Are emergency departments solely responsible for the bulk of unnecessary tests?

Most would like to believe so, but emergency physician Edwin Leap says that’s not the case.

He cites an instance involving a primary care doctor and hospitalist:

Local physician, who does not admit to the hospital, sees patient in the office. Patient has uncontrolled hypertension and is having some chest pain and shortness of breath. Local physician contacts hospitalist. …

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Avoiding the ER and arranging a direct admit is not easy

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Medical device security may be vulnerable to hackers

Conditions and Diseases
May 2, 2010

by Kristina Fiore

Although no such attacks have yet been reported, medical devices could be susceptible to hackers, and a thorough security analysis should be done as part of FDA approval, researchers argue.

Premarket regulatory evaluation should include a risk-based security assessment depending on the nature of the device and the perceived threat of a security compromise, said William H. Maisel, MD, MPH, of Beth Israel Deaconess Medical Center, in Boston, and …

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Medical device security may be vulnerable to hackers

Physician supply trends for primary care doctors and specialists

Health Policy
April 30, 2010

Health care reform continues to be a key political topic of discussion in the U.S. Physician supply and specialty training are important elements in designing an efficient system that provides the highest quality of care.

To understand where U.S. physician supply and specialty training is headed, I examined the U.S. trends from 1990 to 2007 (latest year data is available).

Physician supply has been growing during this period. In 1990, there were …

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Physician supply trends for primary care doctors and specialists

Questions for doctors are powerful patient tools

Patient
April 27, 2010

by Toni Bigby

Our Federal Government is investing in a consumer education campaign called, “Questions are the Answer.” The idea is to encourage people to watch out for themselves a little better and be their own advocate by asking their doctors questions like, “Why do I need this surgery?” and “Are there any side effects from this drug?”

Why are we as health care consumers, who collectively spend trillions of dollars each …

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Questions for doctors are powerful patient tools

Sleep apnea increases stroke risk in men

Conditions and Diseases
April 27, 2010

by Charles Bankhead

Severe obstructive sleep apnea almost tripled stroke risk in men, data from a prospective cohort study showed.

Among men with mild or moderate apnea, each one-unit increase in the obstructive apnea hypopnea index (OAHI) raised stroke risk by 6%. Obstructive sleep apnea did not have a significant association with stroke risk in women, investigators reported online in the American Journal of Respiratory and Critical Care Medicine.

“This study provides compelling …

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Sleep apnea increases stroke risk in men

Aneurysm as a cause of the Bret Michaels brain hemorrhage

Conditions and Diseases
April 26, 2010

Bret Michaels continues to be monitored in the intensive care unit after suffering a subarachnoid hemorrhage.

bret michaels According to his road manager, “further testing this week will help locate the source of the bleeding.”

What exactly does that entail?

As I mentioned previously, aneurysms are responsible for the majority of brain bleeds. Finding that source is critical. Angiography, or …

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Aneurysm as a cause of the Bret Michaels brain hemorrhage

C-section rates and its association with lawsuits

Physician
April 25, 2010

The National Center for Health Statistics recently released a new report, Recent Trends in Cesarean Delivery in the United States. The report is most notable for a startling statistic; the C-section rate has reached the astronomical level of 32%, an increase of more than 50% since 1996. This is disturbing news.

Why is the C-section rate sky high?

The pervasive nature of the increase may hold some clues. The increase has …

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C-section rates and its association with lawsuits

Bret Michaels has a subarachnoid hemorrhage, and what that means

Conditions and Diseases
April 23, 2010

Bret Michaels is in critical condition from a subarachnoid hemorrhage.

bret michaelsI’ve been watching Celebrity Apprentice recently, and he comes across as a genuine person who, of course, has been raising awareness for Type 1 diabetes. As most people know, he has battled various diabetic complications on the show, and recently underwent an emergency appendectomy.

What’s his prognosis like?

Not good, I’m …

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Bret Michaels has a subarachnoid hemorrhage, and what that means

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