Every year, it is estimated that more than 126,000 hospitalizations and nearly 17,000 deaths in this country are linked to overuse of over-the-counter (OTC) pain medicine ingredients -- specifically acetaminophen and NSAIDs (nonsteroidal anti-inflammatory drugs). In my own practice, it’s not uncommon to find patients who are taking two to four times the recommended doses. This can have tragic results. Recently, we had a young woman with liver failure. She had been ...

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You won’t read about the International Classification of Disease (ICD) on TMZ or hear it discussed on The View, but it has the potential to be an unpleasant October surprise in the healthcare world. It is a list of codes that physicians and hospitals use when billing insurance companies. These codes cover all manner of medical diagnoses for diseases, conditions, and injuries. The first version of ICD appeared in 1946 with ...

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Postmodern cultural values have seriously impacted medical care and the patient-physician relationship. Corporate control of medical care, computerization of medical information and consumerism in the clinical encounter, plus the destruction of the myth of the physician are all embodiments of postmodern values. Postmodern thinkers such as Foucault, Lyotard, Levinas, and Bauman offer powerful insights  that can be applied to understand how current values have changed medical practice, including issues such as ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 76-year-old woman is evaluated for a 3-month history of left knee pain of moderate intensity that worsens with ambulation. She reports minimal pain at rest and no nocturnal pain. There are no clicking or locking symptoms. She has tried naproxen and ibuprofen but developed dyspepsia; acetaminophen provides mild to moderate relief. ...

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A new study asks orthopedic surgeons to guess the price of the devices they implant: “the amount your institution currently pays the vendor for the implant.” Despite a lenient grading system, in which the researchers counted as correct any guess within 20% of the actual price, surgeons estimated costs correctly only 1 in 5 times. When I first glanced at this study, I wasn’t sure of its importance. But then I learned ...

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Obesity and obesity related illness accounts for an enormous health care expenditure in the US today: approaching 150 billion dollars annually.  In an era of health care reform and cost containment, preventative medicine is essential to success.  Rather than rearranging networks, separating doctors from patients and limiting choice, our government may be more effective in reducing health care costs by focusing on slimming waistlines throughout the US. According to a recent ...

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Imagine you want health care. You go to your doctor who recommends a medication. Your doctor tells you that the medication used to be prescribed one way 14 years ago, but very rigorous, more recent studies indicate a lower dose is just as effective. And has fewer side effects. And is less expensive. You are pleased because a) your doctor is up on the latest medical therapies, and b) the least ...

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Confidence is contagious. So is lack of confidence. -Vince Lombardi “So, can you leave this here with us?" I was part of a group of U.S. surgeons traveling to Eldoret, Kenya, seeing patients and helping the Kenyan ENT surgeons learn surgical techniques. Our two week mission allowed us to work across-the-table from Kenyan colleagues, discussing surgical approaches, demonstrating techniques, and reviewing all aspects of surgical care. “I have never seen such a thing!” my ...

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It’s a strange business we are in. I can freeze a couple of warts in less than a minute and send a bill to a patient’s commercial insurance for much more money than for a fifteen minute visit to change their blood pressure medication. I can see a Medicaid or Medicare patient for five minutes or forty-five, and up until now, because I work for a federally qualified health center, the payment ...

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After a relaxing weekend with my daughter, son-in-law and 2-year-old grandson, my wife and I made our way to the Atlanta airport to begin our trip home. The end of a trip -- even a short weekend -- is always sad. I never look forward to the travel home and usually want to snap my fingers and skip the travel. My wife and I have trouble packing light and so, when ...

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From MedPage Today:

  1. Small Practices: Down but Not Out. Emily Briggs, MD, MPH, is all too familiar with the decline in small physician practices.
  2. IV Ketamine Rapidly Effective in PTSD. Patients with moderate to severe post-traumatic stress disorder (PTSD) symptoms showed rapid and substantial relief with a single intravenous dose of ketamine in a pilot randomized trial.
  3. Missed Doses Cripple Postop DVT ...

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I heard this on the radio recently: Mom takes her new baby to the emergency department on a weekend because she thinks her daughter might have a urinary tract infection. She's right, but regulations say the baby has to stay in the hospital for two days to ensure the infection clears. Afterwards, the mom is surprised by and concerned about a $7,000 hospital bill for the baby's care. The reporter says ...

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Readers know that I went to the University of Virginia as an undergraduate. Since graduating in 1971 I have remained a huge sports fan and academic fan of the university. Those who follow my Twitter account have seen me tweet often about the basketball team. Our coach, Tony Bennett, took his 5 pillars of success from his father, the famous coach Dick Bennett. While these pillars have a Christian origin, I ...

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I covered one of the chief residents in our hospital for two days recently, seeing more than 40 patients in total. My off-the-cuff remarks on Facebook still apply: “Twenty-two inpatients later, it is time once again to declare my awe and admiration for all who do this work daily: hospitalists, housestaff, nurses, techs, custodial staff (et al., et al.). And, of course, the patients who are -- on the other side ...

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The debate over e-cigarettes has been heating up. Are the smokeless, battery-powered, nicotine-dispensing devices a gateway to smoking for young people or a helpful way for smokers to quit? Public health experts can be found on both sides of the debate. An article in the New York Times cited two leading figures, Dr. Michael Siegler from Boston University and Dr. Stanton A. Glantz from the University of California, San Francisco. Dr. ...

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I recently spoke to a class of undergraduates about the benefits, harms and politics of screening smokers for lung cancer using low-dose CT scans. Afterwards, a student asked how I felt about the Affordable Care Act's requirement that Medicare and private insurers cover U.S. Preventive Services Task Force "A" and "B" recommended screening tests and other preventive services without co-payments or deductibles, making them free at the point of care. I ...

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People suffering from chronic pain are often angry. They are trapped not only by an unpleasant sensation, but also by their limited treatment options. The experience can lead to feeling not only like there is no end in sight, but also as through there is no hope. So strong are the associated emotions that I often call this state of mind “the abyss.” All too often, when that frustration becomes too ...

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From MedPage Today:

  1. Striking a Nerve: Bungling the Cannabis Story. Correlation does not equal causation, and a single exam cannot show a trend over time. Basic stuff, right?
  2. 'Choosing Wisely' Lists Don't List Big Moneymakers. When America's joint surgeons were challenged to come up with a list of unnecessary procedures in their field, their selections shared one thing: none significantly impacted their incomes.

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Earlier this year, I completed a medical rotation in Africa. It was an amazing, eye-opening experience. While I expected it might be difficult to acquire newer, more expensive medications and procedures, I had anticipated that, given limited resources, there would be some rationale in deciding which medications and procedures would be available. I was deeply mistaken in this assumption. During my time abroad, I watched several patients with heart attacks pass ...

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Going to the doctor starts as a disconcerting experience: Getting naked, physically and emotionally; talking about your weight, your smoking, your divorce. You count on your doctor’s ear and her discretion. Often enough, a patient will apologize for taking my time or for crying or whatever. I remind them that this is what the exam room is for, this is what they pay me for. How far does this special relationship ...

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