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.

Professionalism matters in correctional health care

Jeffrey Knuppel, MD

Physician

March 19, 2010

As correctional health care professionals, there may be times when we are tempted to conduct ourselves in a less than professional manner simply because we can.

We may be able to get away with speaking to our patients rudely, using profanity profusely, or wearing inappropriate clothing. After all, we work in jails and prisons. This culture is far from prim and proper. And, our patients are inmates. Many may tolerate misbehavior …

Homebirth does not protect against serious maternal infections

Amy Tuteur, MD

Conditions and Diseases

March 16, 2010

Homebirth advocates like to tout the many “advantages” of giving birth at home. High on the list is limiting exposure to hospital acquired infections, and since only your “own germs” are in your home, you are protected.

Yes, you are protected from hospital acquired infections, but the most dangerous infectious agents are actually those that live inside the mother, not the ones in the hospital. Consider that for newborns both Group …

Helping organ donation with donor advocate teams

John Schumann, MD

Physician

March 8, 2010

One of the joys of practicing at an academic center is that I get to do many different things in my job.

The foundation of my work is seeing my own patients in a large group (more than thirty doctors!) primary care practice.

Two months a year, I take my turn rotating on the hospital inpatient services, supervising teams of residents and students who are the primary caregivers for patients with illnesses …

Why physicians are working fewer hours

Kevin

Physician

March 8, 2010

Originally published in MedPage Today

by Michael Smith, MedPage Today North American Correspondent

Physicians are working fewer hours than they once did, the result of a decade-long decline that coincided with lower fees for their services, a study showed.

After two decades of stable hours, a steady decrease began in 1997, according to Douglas Staiger, PhD, of Dartmouth College, and colleagues.

The decline coincided …

Read more…

Why physicians are working fewer hours

Transgender patients face significant challenges in prison

Jeffrey Knuppel, MD

Patient

March 2, 2010

Imagine that as a child you thought you had been born in the body of the wrong gender. If you were biologically male, in your mind you really thought of yourself as female. Likewise, if you were born in a girl’s body, you thought that you were actually a boy.

Yes, you were probably more interested in children’s role-playing games more often associated with the opposite gender as well, but the …

How doctors can improve patient interactions

Kevin

Patient

February 24, 2010

by Lockup Doc

Physicians learn a lot about many different topics, both in medical training and in practice. However, there are some life lessons that we never learn as well as when we become patients ourselves.

When I was 13 or 14 years old, I regularly interacted with 2 different physicians with disparate interpersonal styles. Little did I know then that these seemingly meaningless encounters would indelibly shape my own beliefs about …

Atul Gawande’s The Checklist Manifesto reviewed

Robert Wachter, MD

Physician

February 24, 2010

Every now and then, I read and enjoy a book, but only later fully appreciate it as its lessons and insights slowly become apparent. Judging by the number of times I’ve said, “That reminds me of Gawande’s observations about ___” over the past month, The Checklist Manifesto is one such book.

In this short, deceptively simple volume, Atul (who I count as both friend and inspiration) discusses the …

What doctors do when they don’t know the answer

Alex Lickerman, MD

Conditions and Diseases

February 22, 2010

Part two of a series. See also part one.

Previously I’d discussed how most of the time diagnoses are relatively straightforward. But what do doctors do when a diagnosis isn’t immediately clear to them?

Likely one or more of the following:

1. Revert to “novice” thinking. Which, in fact, is completely appropriate. We’re taught in medical school that approximately 90% of all diagnoses are made from the history, so if we can’t …

Does your cardiologist deserve his salary?

John Mandrola, MD

Health Policy

February 20, 2010

Conflicted am I on reading of the strategy of a group of South Miami cardiologists who have written their patients complaining of the cuts to reimbursement, primarily cuts in imaging procedures. A tension emerges from within upon reading the following quote from a “healthcare expert.”

“I’m not at all sympathetic with the cardiologists,” said Robert Berenson, a doctor who was once in charge of Medicare payment policy and now is a …

Treating atrial fibrillation with catheter ablation on TV may not be ethical

Larry Husten, PhD

Conditions and Diseases

February 17, 2010

Mauricio Arruda performed a live atrial fibrillation ablation at University Hospitals in Cleveland on the Today Show recently.

The 6-minute segment was relentlessly upbeat. The TV producers pulled every trick in the book to overcome the inherent difficulty of portraying a hard-to-explain disease like atrial fibrillation and an even harder-to-explain procedure like catheter ablation. Instead of making any effort to truly educate their viewers, the producers took the easy …

Magnetic resonance imaging (fMRI) for persistent vegetative state

Kevin

Conditions and Diseases

February 17, 2010

Originally published in MedPage Today

by Michael Smith, MedPage Today North American Correspondent

Researchers in England are reporting they have been able to establish limited communication with a man in a persistent vegetative state by using functional magnetic resonance imaging (fMRI).

The 34-year-old man was able to answer simple Yes or No questions by imagining different types of activity, which caused changes …

Don’t fall into the dementia trap when treating a developmental disability

Kevin

Conditions and Diseases

February 16, 2010

by Lockup Doc

In addition to correctional psychiatry, I spend about half of my professional time treating patients with developmental and intellectual disabilities (mental retardation). The majority of my patients have severe or profound mental retardation and are completely nonverbal.

Over the years I have observed that when many of them are admitted to the hospital for acute medical or surgical problems, because they are severely cognitively and functionally impaired, they are …

Neuroscience explains why changing addictive behavior is so difficult

Kevin

Conditions and Diseases

February 12, 2010

Originally published in MedPage Today

by Kristina Fiore, MedPage Today Staff Writer

By the end of January, many New Year’s resolutions have been tossed out with the leftover holiday cookies. That’s because change is hard — and neuroscientists are learning why.

Advances in neuroimaging have enabled researchers to peer inside the brains of addicts and patients with addictive behaviors. They can see in …

Doctors are responsible for a minority of medical mistakes in radiation therapy

Amy Tuteur, MD

Physician

February 11, 2010

The New York Times recently featured a disturbing expose of serious medical errors associated with the newest forms of high tech radiation treatment, entitled, Radiation Offers New Cures, and Ways to Do Harm. The piece is an example of excellent medical journalism, compelling stories of two individuals who sustained truly horrifying injuries as the result of treatment errors framed a detailed investigation of similar errors that have occurred in New …

Doctors have an ethical obligation to treat complications from a transplant operation performed abroad

Kevin

Conditions and Diseases

February 11, 2010

Originally published in MedPage Today

by Kristina Fiore, MedPage Today Staff Writer

Patients who travel to foreign countries for organ transplants may return with more problems than they left with — and physicians here have a moral responsibility to treat them, researchers asserted in a transplant journal.

“Medical tourism” has been on the rise as demand for organs outpaces supply and U.S. …

The power of a doctor’s choice of words in explaining CPR

Alex Smith, MD

Conditions and Diseases

February 8, 2010

Words have power. Language has power.

The words we use may comfort or shock, allay or provoke, sooth or batter. Words often imply layers of meaning that are not explicitly articulated, yet rest beneath the surface:

“I worry that time is short for you” (You are dying) (I care about you)

“I wish we could have done more” (Nothing would have changed her death) (I am on your side)

“I hope with you that …

An anesthesiologist accused of making up trial data pleads guilty to federal charges

Kevin

Medications

February 8, 2010

Originally published in MedPage Today

by John Gever, MedPage Today Senior Editor

A Massachusetts anesthesiologist accused of fabricating data in studies of pain drugs will plead guilty to federal criminal charges under an agreement with prosecutors.

Scott Reuben, MD, a well-known pain researcher at Baystate Medical Center in Springfield, Mass., was charged with one count of healthcare fraud.

Early last year, the hospital …

How hypertension increases the risk of dementia

Kevin

Conditions and Diseases

February 7, 2010

Originally published in MedPage Today

by John Gever, MedPage Today Senior Editor

Another study has found that hypertension may contribute to increased risk of dementia, this time with evidence of actual brain abnormalities.

Data from an offshoot of the Women’s Health Initiative found that participants’ baseline blood pressure was strongly correlated with volume of lesions in their brains’ white matter, according to Lewis …

The specialty of underwater medicine, and an interview with a dive physician

Kevin

Conditions and Diseases

February 5, 2010

Originally published in MedPage Today

by Kristina Fiore

Physicians tend to prefer intellectual hobbies — chess, reading, writing. Dr. Alfred Bove is no exception. His hobby often requires application of his expertise in physiology. You know him as the president of the American College of Cardiology. But you may not know that his heart belongs to the sea.

Bove’s interest in scuba diving …

Leg and buttock pain can be signs of peripheral arterial disease, especially in patients with diabetes

Kevin

Conditions and Diseases

February 4, 2010

by Michael Jaff, MD

Peripheral Arterial Disease (PAD), a condition commonly correlated with diabetes, also known as a “silent killer,” affects at least one in every three diabetics over the age of 50 and approximately eight million Americans in total over the age of 40. Although PAD is prolific among diabetic and senior populations, current data show that public and physician knowledge of the disease is startlingly low, with only 25 …

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