An ER doc strikes back.
September 2007
All Stories
Who’s the patient?
Getting hooked at WhiteCoat Rants. Worth a chuckle.
Don’t alter prescriptions
Especially if you have Parkinson's.
Medgadget vs Sermo
Turning up the heat?
Neurosurgeon: "People think we make millions of dollars, but that’s not true"
More on critical physician shortages due in part to rising malpractice rates.
Pelvic exams in the ER
How useful are they really?
For such a useless procedure, there is an unreasonable amount of emphasis placed on its performance by our consultants, probably a vestigial remnant from the olden days when CT scans, ultrasounds, and antibiotics were not as powerful or widely available.
A typical ER shift
You'd be surprised at how little time is spent on actual medical emergencies.
The 5-hour CT scan
A woman was forgotten in a CT scanner. Scary thing is, this wasn't the first time this happened:
A physician who works at the practice and knew of the incident said it's not the first time such a thing has happened. "People have been left in the office after hours, when something like that happens "” it's the same sort of thing," said Dr. Steven Ketchel. "My guess ...
Leaving your mark
Sid Schwab on naming anatomy:
When it takes some effort -- maybe a microscope or some really careful dissection -- to discover something, it seems reasonable that your name gets attached. Islets of Langerhans. Ampulla of Vater. Sphincter of Oddi. Valves of Heister. Crypts of Morgani (he got "columns," too.) But where's the cutoff? I don't get why Gabriele Falloppio got to name something as obvious and macroscopic as ...
Cover your ass, defensive medicine
Chris Rangel on how defensive medicine has changed the practice of medicine:
The practice of emergency medicine (among other high risk specialties) has become so regimented and infused with defensive medicine tactics that many ER docs are not even aware of how this has changed the way they think. It seemed as if this ER physician could not fathom the concept that we would send home a patient who could ...
Chantix: Pfizer’s golden goose?
With the miserable failures of Exubera and torcetrapib, Pfizer is throwing some marketing muscle behind Chantix - an anti-smoking medication that actually works and is quite useful. A look at the recent DTC ad for the product.
"I order a lot of CT scans"
An ER doc confesses:
I shouldn't let this kind of thing bother me. Why should I care what the techs and nurses think? Let them walk a mile in my shoes. They're not held accountable if they miss a head bleed or PE or small bowel obstruction or neck fracture. I am.
A for-profit DO school is about to open
Bizarre and could be start of a disturbing trend. What kind of corners will be cut in the name of profit?
Critics say a for-profit school will be beholden to investors and will scrimp on educational mission. Supporters assert that Rocky Vista must meet the same accreditation standards of other osteopathic schools. They also say the school's educational outcomes will be the same as nonprofit schools.
Mmm . . . purple urine
What a fascinating cause of this phenomenon:
Purple discoloration can occur in alkaline urine as a result of the degradation of indoxyl sulfate (indican), a metabolite of dietary tryptophan, into indigo (which is blue) and indirubin (which is red) by bacteria such as Providencia stuartii, Klebsiella pneumoniae, P. aeruginosa, Escherichia coli, and enterococcus species.
The patient-hitting cardiologist
He has resigned from the hospital, but gives his side of the story:
He said the patient was "a drug addict coming off of opiates, completely in withdrawal (and was) restrained as he should have been by protocol by five technicians. I was only the sixth person, never hitting anybody."
Why does American medicine do so many tests?
Megan McArdle wonders:
You can't blame it all on lawsuits; my doctor didn't test me for hyperthyroidism because she was afraid of the malpractice suit that would result from my losing too much weight and getting heart palpitations. Nor can you blame it on money; my doctor doesn't profit from giving me blood tests that all come back normal. And I don't think the lack of rational rationing can ...
Malpractice: Fight or settle?
This physician was pressured to settle, to his regret:
I spoke to some of my senior colleagues and they all advised me to settle. I relented, and what followed was a nightmare of the worst kind.
My insurance carrier increased my premium from $4,000 to $30,000, terminated my liability coverage, and then cornered me to buy a tail for $30,000 or retire. With retirement as no option, I ...
Specialist shortages in the emergency room
One of the best medical blog writers is ED physician Edwin Leap. With all the talk about emergency room specialist shortages, he implores his specialist-colleagues to step up to the plate:
And here's one last reality. This is America. It isn't the Communist block with bizarre borders and border guards. If a patient needs your care, but isn't from you community, why does it matter? ...
Talking Health 2.0
Joshua Schwimmer gives a talk on the subject. Thanks for the mention!
"Why aren’t administrators more concerned with cleanliness?"
Can it be because of the money?
Kevin Pho, MD
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How I approach ovarian cancer screening with patients
Ovarian cancer screening clearly touches a nerve. No one doubts that ovarian cancer is a devastating diagnosis, often found when the disease...
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Why more primary care doctors are referring patients to specialists
According to a recent study from the Archives of Internal Medicine, primary care physicians are referring more patients to specialists than ever...
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Should Google censor anti-vaccine claims?
One of the reasons there is such a movement against vaccines is the democratization of information, perpetuated by search engines like Google....
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Radiologists who cheat on their board exams: Who’s to blame?
In a widely circulated CNN article, many radiologists have been found to cheat on their board exams: "Doctors around the country taking an...
Physician
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Why an anesthesiologist would be needed for organ donation
I've only had to declare death a couple of times. Once in a three-year-old and once in an adult. In each case...
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5 ways to avoid a misdiagnosis
Billionaire Teddy Forstmann had been diagnosed with a serious form of brain cancer. There’s a tragic twist to the story: according to...
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Benefits of the Medicare Adult Wellness Visit
One of the things I love about family medicine is that I get to care for people of all ages. I almost...
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Cancer has a way of teaching us poignant life lessons
I just finished reading George’s recent post on Evelyn Lauder, who recently passed away from ovarian cancer, and am still stirred by...
Patient
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In love there is a life giving force
Here is a toast to the miracle of love. Not to the romantic, chocolate, dance club nightlife type of love. Not warm...
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How to get ready for death
No one wants to die. Even people who want to go to heaven don't want to die to get there. And yet...
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The long term cost of a pain in the neck
One morning this May, I woke up with a stiff neck. I applied hot and cold therapy all day and took an...
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Preparing for your visit with someone in hospice care
Visiting someone who is dying or critically ill is an experience many of us will have in the course of our lives....
Policy
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AMA: Advocating for Medicare, military and fiscal responsibility
A guest column by the American Medical Association, exclusive to KevinMD.com. This week, I’m joining hundreds of physicians and medical students in Washington, DC...
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A critical look at value driven health care
Everyone in the world is talking about “value-driven health care.” Or so it might seem if you pick up a medical journal...
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Surviving the new landscape of physician reimbursement
CNN recently posted an article titled "Doctors Going Broke." It described several cases of independent physicians who are near bankruptcy although they once...
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Doctors lobby Congress to repeal the SGR
One of the things that I like most about my job is engaging with ACP’s physician leadership—the internal medicine doctors who dedicate...
Tech
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There is a patient attached to that implantable defibrillator
As a follow-up to my post on why patients with implantable defibrillators should have access to their device’s data, I am going...
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The pitfalls of email communication with patients
A recent article in the Wall Street Journal reviewed the emerging role of email in healthcare, arguing that doctors should more aggressively...
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Why adoption of EHRs is a transformational event for physicians
Paul Conslato, MD, director of clinical affairs for Lancaster General Medical Group, recently was quoted in the PAMED Better Health Network eZine...
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Why EMR is a dirty word to many doctors
Don’t get me wrong, EMRs (electronic medical records) are inevitable. Over the long-run they are almost certainly good for physicians, patients and...
Social Media
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Using Twitter to deliver health improvement messages
I have decided to spam for public health. Phone calls, text messaging, and even apps have been shown to help improve health...
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Addressing comments on your medical practice’s Facebook page
Does your medical practice allow anybody to post links and comments on your Facebook page? The short answer is yes. We do....
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The Internet is where patients go for pre-visit consultations
As a physician, technology cannot replace you, but it can make you more efficient and effective. This was the message from Richard...
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5 ways doctors can benefit from professional connections
Looking ahead to the next several months, I’ve found myself frequently wondering how many physicians will make this their year to take...
