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.

Rheumatologists debate whether fibromyalgia is really a disease

Kevin

Conditions and Diseases

November 2, 2009

Originally published in HCPLive.com

What defines a “disease?” At what point does a collection of symptoms and causes make the transition from “condition” to disease? Is it when a consensus forms around a concrete, observable, and repeatable set of biochemical and/or physiological processes and outcomes? Surely there is little doubt that diabetes or hypertension qualify as a disease under the standard paradigm. …

Is the impending physician shortage worse than we thought?

Kevin

Health Policy

October 31, 2009

Originally published in MedPage Today

by Charles Bankhead, MedPage Today Staff Writer

The physician workforce in the U.S. is growing smaller and younger, according to data from the Census Bureau, but conflicting estimates make it difficult to determine just how many doctors are out there — and how many the nation will need.

The census survey showed 67,000 fewer physicians than estimates based …

Implementing an EMR or health IT system is harder than it looks

Robert Wachter, MD

Health Technology

October 31, 2009

In 2001, when my colleagues and I ranked nearly 100 patient safety practices on the strength of their supporting evidence (for an AHRQ report), healthcare IT didn’t make the top 25. We took a lot of heat for, as one prominent patient safety advocate chided me, “slowing down the momentum.” Some called us Luddites.

Although we hated to be skunks at the IT party, we felt that the facts spoke for …

Are doctors getting enough skin cancer exam training?

Kevin

Conditions and Diseases

October 30, 2009

Originally published in MedPage Today

by Nancy Walsh, MedPage Today Contributing Writer

Opportunities to learn how to perform skin cancer examinations during medical training are inadequate, a survey of residents found.

More than half (55.3%) of residents said that they had never observed a skin cancer examination, 75.8% said they’d never been taught to perform one, and 57.4% had never practiced doing …

An obsession with making money can be a sign of physician burnout

Kevin

Physician

October 29, 2009

Originally published in HCPLive.com

by Jeff Brown, MD

Physician burnout has a tremendous effect on the financial bottom line and is far more common than docs want to talk about.

When I say the bottom line, I am referencing studies that have been done on “workaholics,” another softly defined term, that show in spite of increased hours and apparently focused activity, productivity in …

Have drug companies really curbed gifts to doctors at medical conferences?

Kevin

Medications

October 27, 2009

by Roberta Friedman, PhD

Banning pharmaceutical companies from handing out token items to doctors at conferences is so tip of the iceberg.

I have tales to tell of conferences past, where the excesses were beyond farcical. As a medical reporter covering such meetings, I have seen everything. When my kids were young, I enjoyed roaming the floor of the exhibit hall along with the docs, collecting such swag as bouncy balls that …

Is the newest, long-lasting insulin necessarily the best?

Kevin

Medications

October 27, 2009

Originally published in HCPLive.com

by Anita Ramsetty, MD

We are very fortunate to have a number of newer insulins available for our patients.

For years we had animal insulins only. NPH and Regular, then we had Ultralente. The development of analog insulins marked the upswing in technology that we would sustain for a period of time. The most recent big blip in the …

The high cost of hiring, and firing, a doctor

Kevin

Physician

October 26, 2009

Originally published in HCPLive.com

by Jeff Brown, MD

One area we need to look at is the surprisingly high costs of hiring and firing people who work with us. And as always, I rebuke our training programs for their ostrich-like attitudes, ignoring how important managerial and organizational competence is to the quality of medicine that we practice.

We know that recruiting a …

Discussing end-of-life care in the ICU and saving Medicare money

Marya Zilberberg, MD, MPH

Health Policy

October 25, 2009

I think by now there is not a person in the US who cannot quote at least approximately how much we spend annually on healthcare. Fewer people appreciate that nearly 1/3 of this $2.2 trillion bill is eaten by hospitalizations, amounting to about $680 billion. Although the data in the diagram below represent a single year, the overall distribution of expenses is remarkably constant over time.

When patients receive too much radiation from CT scans by mistake

Kevin

Conditions and Diseases

October 21, 2009

Originally published in MedPage Today

by Crystal Phend, MedPage Today Senior Staff Writer

Reports of stroke patients who were accidentally exposed to eight times the normal radiation dose during diagnostic CT scans at Cedars-Sinai Medical Center in Los Angeles are prompting safety warnings and soul searching among radiologists nationwide.

Over an 18-month period, 206 patients at the center received 3 to 4 …

Google Android versus the iPhone for medical apps

Kevin

Health Technology

October 20, 2009

by Jeff Brandt

Verizon, Motorola, and Google, along with 9 other cell phone manufactures and countless world carriers, have teamed up to provide a smartphone with the power to deliver useful applications for medicine: the Verizon “Droid” smartphone, based on the Google Android operating system (OS).

The Droid’s processor is the same processor that powers the iPhone. The main reasons this …

Does robotic surgery for prostate cancer help patients?

Kevin

Conditions and Diseases

October 19, 2009

Originally published in MedPage Today

by Peggy Peck, MedPage Today Executive Editor

Men who opt for minimally invasive prostate surgery — often with a helping hand from a robot — are twice as likely to have genitourinary complications as men who have a traditional prostatectomy.

That finding is especially troubling because the use of robotic-assisted minimally invasive prostatectomy has increased exponentially in …

Doctors need to fix the health care system that they had a hand in breaking

Kevin

Health Policy

October 16, 2009

by Daniel A. Graubert, MD

Medicine has changed so dramatically since I graduated medical school in the 1980’s, that it is hardly recognizable.

Certainly, there has been an enormous growth in knowledge which is often beneficial, but has often led us down the wrong path. For example, when advanced imaging techniques such as CT scans and MRIs became available, we were able to see the inside of large numbers of patients …

Texting young liver transplant patients to take their medications

Kevin

Conditions and Diseases

October 16, 2009

Originally published in MedPage Today

by Todd Neale, MedPage Today Staff Writer

Here’s a case where texting may actually improve a teenager’s health: Text message reminders appear to be effective in getting young liver transplant patients to take their immunosuppressive medications, a small study showed.

In 41 patients with a median age of 15, there was a significant improvement in medication compliance …

Embracing the change coming to our health care system

Donald Tex Bryant

Health Policy

October 15, 2009

As Bob Dylan sang so long ago, The Times They Are A-Changin’. Some like change; some do not.

Consider these change scenarios:

* One of the important scenes of change for health care providers is the national debate on health care coverage currently playing out in Washington D.C. Some are very vocal in their support. The media covers many of the vocal opponents. Certainly some sort of change will come out of …

One way to treat patients with severe H1N1 flu

Kevin

Conditions and Diseases

October 15, 2009

Originally published in MedPage Today

by Todd Neale, MedPage Today Staff Writer

Most patients who underwent extracorporeal membrane oxygenation (ECMO) for respiratory failure survived their struggle with pandemic H1N1 flu, according to a study by researchers from Australia and New Zealand.

Of the 68 patients treated with ECMO during the Southern Hemisphere’s winter, 54 were still alive as of Sept. 7, according to …

How H1N1 pandemic flu will affect intensive care units

Kevin

Conditions and Diseases

October 14, 2009

Originally published in MedPage Today

by Michael Smith, MedPage Today North American Correspondent

The winter wave of the pandemic H1N1 flu hit intensive care units in Australia and New Zealand hard, researchers said, and may offer lessons for doctors bracing for the pandemic’s return to the Northern Hemisphere.

All told, 722 people with confirmed pandemic flu were admitted to one of the …

Why rapid viral testing for kids with URIs may not help in the ER

Kevin

Physician

October 12, 2009

Originally published in MedPage Today

by Todd Neale, MedPage Today Staff Writer

Rapid viral diagnostic testing did not reduce the burden of treating children with respiratory symptoms and fever in the emergency department, according to a Cochrane Review meta-analysis.

Pooling the results of four trials, researchers found a significant reduction in the use of chest radiography (RR 0.77, 95% CI 0.65 to …

Will riding in a convertible harm your hearing?

Kevin

Conditions and Diseases

October 10, 2009

Originally published in MedPage Today

by Ed Susman, MedPage Today Contributing Writer

Cruising down the highway in a sleek convertible, with the wind blowing in your hair, may sound like the ideal road trip — but it could harm your hearing, British scientists said.

In a study conducted on the high-speed motorways of the U.K., doctors found that at highway speeds, …

Can ventilating patients spread H1N1 flu in hospitals?

Kevin

Conditions and Diseases

October 9, 2009

Originally published in MedPage Today

by Crystal Phend, MedPage Today Senior Staff Writer

Plumes of virus-laden air shooting out from the masks of patients undergoing noninvasive ventilation could put healthcare workers at increased risk for infectious diseases such as the pandemic H1N1 (swine) flu, researchers said.

A positive-pressure ventilation mask on a simulated patient yielded a jet of exhaled air extending …