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.

Doctors need to take care of themselves, for their patients’ sake

Patient
December 11, 2009

by Nancy Rappaport, MD

In order to be truly effective in our work, we physicians need to conduct our own personal exploration, take time for introspection, and replenish our personal reserves. Part of our job is to balance the demands of our work (be they finding a cure for cancer, caring for terminally ill patients, solving the problems of healthcare or delivering twins—whatever our calling may be) with caring for ourselves. …

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Doctors need to take care of themselves, for their patients’ sake

Is constipation a sign of early Parkinson’s disease?

Conditions and Diseases
December 11, 2009

Originally published in MedPage Today

by Charles Bankhead, MedPage Today Staff Writer

Constipation may represent one of the earliest signs of Parkinson’s disease, preceding the onset of motor symptoms by two decades or more, data from a case-control study suggest.

Patients with Parkinson’s disease were more than twice as likely to report a history of constipation compared with a control population. The …

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Is constipation a sign of early Parkinson’s disease?

NFL football players with concussions may need independent neurologists to clear them

Conditions and Diseases
December 8, 2009

Originally published in MedPage Today

by John Gever, MedPage Today Senior Editor

Responding to growing concern over concussions suffered by professional football players, the National Football League may soon require teams to seek opinions from independent neurologists before allowing head-injured players back on the field.

League officials have not confirmed the plan, but reports in The New York Times, the Associated Press, FOXSports.com, …

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NFL football players with concussions may need independent neurologists to clear them

Why it’s important to brand your medical practice

Physician
December 7, 2009

Originally published in HCPLive.com

by Jeff Brown, MD

You might be thinking, “Why should I consider branding or marketing?” And your reasoning might go something like this:

1. As a doctor, I already have a powerful, built-in identity;
2. My practice is full;
3. Even if my practice isn’t full, Congress is in the process of putting 40 million more insured people into the available patient pool over the next few years.

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Why it’s important to brand your medical practice

Radiologists don’t agree with the USPSTF breast cancer mammogram screening guidelines

Conditions and Diseases
December 7, 2009

Originally published in MedPage Today

by Kristina Fiore, MedPage Today Staff Writer

Radiologists have rejected revised mammography guidelines from the U.S. Preventive Services Task Force (USPSTF), arguing that they are not backed by scientific evidence and will lead to unnecessary deaths.

Under the revised guidelines, “screening will begin too late and its effects will be too little,” said Stephen A. Feig, MD, of …

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Radiologists don’t agree with the USPSTF breast cancer mammogram screening guidelines

Do chest x-rays and mammograms increase the risk of breast cancer in young women?

Conditions and Diseases
December 5, 2009

Originally published in MedPage Today

by Kristina Fiore, MedPage Today Staff Writer

Some women already at high risk of breast cancer should be cautious about having mammography or chest x-rays before the age of 30 because the imaging may increase the risk of developing the disease, researchers here said.

Five or more x-rays, or any exposure to ionizing radiation before age 20, …

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Do chest x-rays and mammograms increase the risk of breast cancer in young women?

An oncologist takes on the recent breast and cervical cancer screening controversy

Conditions and Diseases
December 4, 2009

Recently, two groups released new guidelines that may affect breast cancer and cervical screening in women.

The US Preventive Services Task Force (USPSTF) recommended against screening women in their 40s and to screen women every other year starting at age 50. The USPSTF left room for individualized screening, particularly in the presence of risk factors such as family history. Still, it is …

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An oncologist takes on the recent breast and cervical cancer screening controversy

Low pay for diabetes care harms patients

Conditions and Diseases
December 4, 2009

Originally posted in MedPage Today

by John Gever, MedPage Today Senior Editor

Almost one-third of doctors in an industry-sponsored survey said they didn’t spend enough time with their diabetic patients and blamed low reimbursement rates for diabetes care, researchers said.

In a survey of 200 primary care physicians and 100 endocrinologists, 32% reported an inability to provide comprehensive diabetes care, Alyssa Pozniak, …

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Low pay for diabetes care harms patients

iPhone medical apps can be improved by Google Android

Health Technology
December 3, 2009

by Felasfa Wodajo, MD

In a recent post, entitled, Why doctors should choose Google Android over the iPhone for medical apps, the author seems to have gone out of his way to make a series of increasingly hyperbolic arguments declaring Motorola Droid superior to the iPhone.

The long trail of negative comments on the site demonstrate that perhaps not all readers were swayed …

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iPhone medical apps can be improved by Google Android

Specialists should staff the patient centered medical homes, not primary care doctors

Health Policy
December 3, 2009

Originally published in HCPLive.com

by Alan Berkenwald, MD

The approaching fire storm over the “patient-centered medical home” model reminds me of the destructive powers seen before in HMOs. Once seemingly destined to revolutionize organized medicine, the HMO model nearly destroyed it.

We can learn from past failures. We need to promote best-practice models and make physicians accountable for their actions, both physiologically and …

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Specialists should staff the patient centered medical homes, not primary care doctors

Pharma, evidence, and trust

Medications
December 2, 2009

by David Rind, MD

A number of the other blogs that have noted the existence of this blog seem to have “Pharma” in their titles in one way or another, and the implication is not that the blogger likes much about Big Pharma.

In the late 1990s, when I was spending much of my clinical time providing HIV care, I was a defender of Pharma on Usenet, at least as it related …

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Pharma, evidence, and trust

Seeing floaters or flashing lights can be caused by posterior vitreous or retinal detachment

Conditions and Diseases
December 2, 2009

Originally posted in Insidermedicine

The eye is very similar to a camera. Both are optical systems that have lenses in the front to focus light rays onto a film. The retina is the eye’s film. It is a tissue that consists of 10 layers and is about 500 microns thick—or, half a millimeter. The main function of the retina is to trap light rays, convert them into electrical impulses, and send …

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Seeing floaters or flashing lights can be caused by posterior vitreous or retinal detachment

ACP: Teasing out science, politics, and emotion about the mammography guidelines

Conditions and Diseases
December 1, 2009

The following is part of a series of original guest columns by the American College of Physicians.

by Steven Weinberger, MD, FACP

It is difficult to find a medical guideline that has garnered so much press and controversy as the recent recommendations about breast cancer screening developed by the U.S. Preventive Services Task Force (USPSTF) and published in Annals …

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ACP: Teasing out science, politics, and emotion about the mammography guidelines

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The billions spent on electronic health records, and why there’s no way to know if EHRs will save money

Health Technology
November 30, 2009

Barack Obama is certain that electronic health records (EHRs) can improve the quality of care and the efficiency with which it is delivered. How certain? Certain enough to have bet billions on a program that pays providers to adopt and meaningfully use EHRs.

Of course there are many ways to improve quality and efficiency. The Pennsylvania Health Care Cost Containment Council (PHC4) for example, publishes outcomes data for the states’ 172 …

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The billions spent on electronic health records, and why there’s no way to know if EHRs will save money

Will the H1N1 flu virus mutate?

Conditions and Diseases
November 30, 2009

Originally published in MedPage Today

by Michael Smith, MedPage Today North American Correspondent

The CDC is keeping a careful eye on a mutation in some strains of the pandemic H1N1 flu that Norwegian researchers isolated from three patients with severe disease.

The mutation has been seen “sporadically” in the U.S., according to Anne Schuchat, MD, director of the CDC’s National Center for Immunization …

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Will the H1N1 flu virus mutate?

The joys of practicing rural emergency medicine

Physician
November 25, 2009

I practice in the rural, northwest corner of South Carolina, also known as “The Upstate.” It is a place of expansive lakes, white-water rivers and the mist covered foothills of the Blue Ridge Mountains. The area includes thousands of acres of Sumter National Forest. The natural beauty is breathtaking. Sumter National Forest and our various parks are laced with hiking trails, which are lined with unique plants and trees, some …

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The joys of practicing rural emergency medicine

How does Zetia and niacin affect the carotid intima-media thickness (CIMT)?

Medications
November 22, 2009

Originally published in MedPage Today

by Peggy Peck, MedPage Today Executive Editor

By a margin of 0.014 mm in carotid intima-media thickness (CIMT), extended-release niacin (Niaspan) demonstrated superiority over ezetimibe (Zetia) as an add-on for high risk patients on long term statin therapy.

But is a difference of 0.014 mm clinically significant?

The niacin versus ezetimibe findings come from the ARBITER 6-HALTS trial, …

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How does Zetia and niacin affect the carotid intima-media thickness (CIMT)?

Op-ed: Humor can be healing for both doctors and patients

Physician
November 21, 2009

A version of this op-ed, co-written with Doug Farrago, was published on October 26th, 2009 in Medscape.

It’s tough to be a doctor these days. Whether it’s listening to the difficulties of our medical colleagues as they try to best care for their patients, or engaging other health professionals about the uncertainties surrounding health reform, we’ve noticed a tense, sometimes gloomy, atmosphere among physicians.

A recent survey from the Annals of Internal …

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Op-ed: Humor can be healing for both doctors and patients

Can less aggressive cancer screening recommendations be better for patients?

Conditions and Diseases
November 19, 2009

Doctors have understood for some time that it was inevitable. The American Cancer Society has acknowledged that cancer screening has been oversold.

It seems like every day you read in the newspaper that what was standard medical care yesterday is now no longer recommended. Don’t doctors know anything? Well, actually they do. And what seems like paradoxical behavior, no longer recommending aggressive screening for certain cancers, actually represents a more sophisticated …

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Can less aggressive cancer screening recommendations be better for patients?

How to choose the right electronic health record (EHR) consultant

Health Technology
November 19, 2009

Originally published in HCPLive.com

by Jonathan Bertman, MD

You may have seen advertisements, or may already have been contacted by people who’ve promised to help you figure it all out so you can get your share of the stimulus money. Be wary. The truth is that the Obama administration is still defining many essential elements of the Health Information Technology for Economic and Clinical Health Act (HITECH), and full details about the …

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How to choose the right electronic health record (EHR) consultant

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