April 2010

All Stories

Psychiatric patients detained in the ER

by | in Physician | 12 responses

Our state of South Carolina is a delight. From wonderful people to beautiful landscapes, from a vibrant Southern culture to excellent food like shrimp and grits, it’s a place I’m thrilled to live. But we do lack a few things. And one of the most striking is adequate mental health care.The state budget, like so many state budgets, has been trimming anything and everything. And of course, mental health coverage ...

Dementia affects the entire family

in Conditions | no responses

by Emily P. WalkerMy grandfather recently died of pancreatic cancer.My grandpa was a WWII veteran, a nature enthusiast, an animal-lover, a chiropractor until the 1980s, and a firm believer in natural medicine. He helped my grandmother give birth to five children in her bed, and neither of them had ever taken any drugs except when both were hospitalized one winter with pneumonia.As someone with a major respect for medical doctors ...

Patient satisfaction scores improve when doctors sit

in Physician | 13 responses

Patient satisfaction, as I wrote previously, is being increasingly focused upon.Doctors are often pressed for time, and appear rushed -- which can potentially lead to unhappy patients.I saw this small study showing that the simple act of sitting down while talking to patients can have a profound effect. Many doctors I know already do this, but now there's some data to support sitting.According to the study, performed ...

High blood pressure treatment that patients need to know

by | in Conditions | 9 responses

When her gynecologist told her she had high blood pressure, Marie had a simple solution: switch doctors. After all, she had gone to him for a different problem, and this was the first time he had ever checked her blood pressure.“He said, ‘Oh my God, you’re like a bomb waiting to explode.’ I said, ‘I didn’t come here for that, I came here for something else,’” she explained.Two years later, ...

Top doctors may not always be the best physicians

by | in Patient | 17 responses

I’m sure you’ve read through top doctor rankings and online physician ratings. It is only human to seek perceived leaders. But as sometimes seen in politics, those who have reached the pinnacles are often motivated by ambition, charisma, and gamesmanship instead of altruism, sincerity, and merit.Beware the top doctors issues found in magazines and newspapers.Some of these doctors are excellent, but many are simply “notable.” They may be well-connected, in ...

Social networks affect alcohol drinking patterns

in Conditions | 3 responses

by Kristina FioreIf you're surrounded by heavy drinkers, you're more likely to become one, new research shows.An analysis of data on alcohol consumption and social networks found that people are 50% more likely to drink heavily if someone they're directly connected to does so, Nicholas Christakis, MD, PhD, of Harvard University, and colleagues reported in the Annals of Internal Medicine."We've found that the influence of your friends and people you ...

Politics shouldn’t be discussed in the exam room

in Policy | 40 responses

Jack Cassell is either Florida's most hated, or loved, urologist, depending on your point of view.He famously taped a sign outside his office, advising President Obama supporters to seek care elsewhere.Politics shouldnt be discussed in the exam roomSlate wrote a piece saying, from a civil rights perspective, Dr. Cassell is probably in the clear: "While the law bars physicians from excluding patients on the basis of traditionally protected ...

Sick friends could use your help

in Patient | 5 responses

by Duncan CrossIllness might be the most isolating and alienating experience a person can know. Lots of well people simply have no clue how to relate to someone with a chronic and catastrophic illness. That sort of thing is scary even just to witness. They hope (or assume) you’ll get better, and then they won’t have to deal with whatever you’re going through – but when that ...

Palliative care needs a simple and consistent message

by | in Physician | 6 responses

I was consulted recently about an elderly woman who refused surgery for a large bowel obstruction from a colonic mass, likely cancer. The inpatient team asked me to help with the transition to hospice and to help make her comfortable.I went to see her. She had a nasogastric tube sucking up brown material from her stomach. Her abdomen was swollen and uncomfortable. Her primary goal was to return to walking ...

MRSA control takes consistent time and effort

in Physician | 2 responses

by Michael SmithIt's possible to reduce the burden of drug-resistant pathogens in hard-hit hospitals -- all it takes is consistent effort over time, French researchers say.That's the conclusion after a 15-year, intensive program aimed at reducing the impact of methicillin-resistant Staphylococcus aureus (MRSA) on Parisian hospitals reported in the March 22 Archives of Internal Medicine.The program started in 1993 in the 38-hospital, 23,000-bed Assistance Publique-Hôpitaux de Paris, the largest ...

Colchicine is now a branded gout drug, and why patients lose

in Meds | 11 responses

Colchicine is a commonly used drug to treat gout. It used to cost pennies a pill, but now its price has since soared to $5 or more a pill.What happened?It's an unintended consequence of FDA regulation. Colchicine had been used for centuries, but was caught up with the FDA's zeal to regulate unapproved drugs.A profit-driven pharmaceutical company swooped in at the opportunity, and performed the studies showing ...

ACP: Challenges for a competency-based framework for residency training

in Education | one response

A guest column by the American College of Physicians, exclusive to KevinMD.com.by Steven Weinberger, MD, FACPACP: Challenges for a competency based framework for residency trainingSince the Accreditation Council for Graduate Medical Education (ACGME) instituted its Outcome Project approximately 10 years ago, residency training programs have progressively focused on how well their residents have acquired knowledge, skills and attitudes in six broad domains. These “general competencies” include medical knowledge, patient ...

President Obama should have had colonoscopy without sedation

in Conditions | 8 responses

by Michael Kirsch, MDDoes anyone out there know why President Obama underwent a virtual  ‘colonscopy’ (VC) instead of a conventional colonoscopy earlier this year?In my gastroenterology practice, we do not offer colon cancer screening to 48-year-old individuals, unless special risk factors are present. Of course, maintaining the president’s health is in the national interest, so I understand why professional screening guidelines might not apply to him. For ...

Primary care needs better physical exam skills

in Physician | 17 responses

by Joseph Biundo, MDNot long ago, primary care physician Rob Lamberts did a blog post about the economics of seeing Medicare and Medicaid patients, stating that doing so was bad business. While I agree with most of his points, I have a quarrel with his statement that primary care physicians keep down the cost of care by keeping people healthy, away from specialists, and out of the hospital.That may be ...

Health reform winners and losers, and how it affects doctors

by | in Policy | 12 responses

I congratulate President Obama and the Democrats on their historic health reform achievement.Will this bill be able to win approval as it runs the parliamentary gauntlet? Is it an act of political suicide that will become manifest in November? Will it bankrupt the country because of lack of cost controls?Regardless of where one stands, the bill is a political act of vast ambition and colossal risk.Now may be a good ...

Health reform needed a moderate third party

in Policy | 3 responses

Partisan rancor was one of the signatures of the recent health reform debate.Can middle ground actually be sought?That's a question that Eric Segall asks in a recent AOL News op-ed. As is the case in Washington, both sides are to blame:

Contrary to what Democrats suggest, there are few examples (if any) where the federal government, or for that matter any government, has required individuals to purchase something from ...

Dabigatran is superior to warfarin, but at what cost?

by | in Meds | 8 responses

Dysrhythmias like atrial fibrillation (AF), more often than not, require medical therapy.The dreaded blood thinner, warfarin (Coumadin) comes to the fore often. In aggregate, I have likely spent months of my life discussing the risks and benefits of this much maligned drug. Common rat poison is made from the same ingredients as warfarin -- only rats keep eating it and die days later of bleeding, while humans have the blood ...

Patient appointment scheduling needs flexibility

by | in Physician | 6 responses

The daily appointment schedule is often a sore spot in everyone's day:* Patients aren't completely satisfied because they can't get an appointment when they want one. * Physicians feel they've lost control of their day when the flow is not running smoothly and they fall behind and patients complain. * Nurses and medical assistants are frustrated at the hodgepodge of types of appointments that get scheduled seemingly without any consideration for timing ...

Prison affects how children relate to their parents

by | in Conditions | one response

It’s an unfortunate scenario I’ve seen time and time again:* Parent goes to prison. * Child, who already felt neglected by parent, becomes more upset when parent ends up behind bars. Child either blames the parent for misbehavior that results in parent being taken away from child and/or blames him or herself (as children often do). * Parent tries to have contact with child via phone calls, letters, or visits. * Child decides ...

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