April 2010

All Stories

Preventive medicine may not always help patients

by | in Physician | 14 responses

If there's one thing everyone agrees on, it's that preventive care is always a good thing. Well, I'm a doctor and I'm afraid of preventive medicine.The theory behind preventive medicine is sound. It is better to treat prevent disease than to treat it. It is better to refrain from smoking and never get lung cancer than it is to treat lung cancer. It is better to refrain from alcohol abuse ...

Twitter can spread inaccurate medical information

in Social media | 4 responses

As more patients find themselves on Twitter, it's concerning the amount of medical misinformation that they can be exposed to.Now, in a study from the American Journal of Infection Control, we have some data to back up that assertion.Over a 4-month period in 2009, hundreds of Twitter users posted inaccurate antibiotic information, which, in turn, was re-tweeted to millions.According to the study's author, ""When we looked at tweets... we ...

Psychiatry benefits when psychologists prescribe drugs

by | in Meds | 30 responses

I want to touch on what is probably the hottest topic in psychiatry: whether psychologists should obtain prescription privileges. This is topical because Oregon just overwhelmingly passed a law authorizing prescriptive privileges for psychologists, although it is unclear whether the governor will sign the bill.I endorse psychologists prescribing, and here’s why: it would be the single best thing that could happen to psychiatry.Yes, I know it sounds ridiculous, but ...

Epidemiology and how confounding statistics can confuse

by | in Conditions | no responses

Now, as you know, I am a big fan of epidemiology. I do not believe that a randomized controlled trial is the be-all-and-end-all in evidence generation, and a well done observational study can add to our reservoir of knowledge much more efficiently. Of course, I, as many others, acknowledge certain limitations of epidemiologic design. However, many of them can be overcome with careful design and analysis.I have to confess, though, ...

Chronic pain patients may have been disobedient children

in Meds | 18 responses

by Nancy WalshChildren who are irritable or disobedient, or who steal or bully others, are at risk for chronic pain in middle age, a large prospective study found.Youngsters who had persistent behavior problems at ages seven, 11, and 16 years had more than twice the risk of of widespread chronic pain at age 45 as other children (RR 2.14, 95% CI 1.43 to 3.21), according to Dong Pang, PhD, of ...

Patient attacks on doctors and nurses are more frequent

in Physician | 12 responses

With the attention focused, rightly, on patient safety, what about health care workers?It's somewhat of a hidden phenomenon, but attacks on doctors and nurses are on the rise.Rahul Parikh writes about this in a recent Slate piece. He cites data from the Bureau of Labor Statistics, which found "health care workers are twice as likely as those in other fields to experience an injury from a violent act at ...

Patient advance directives are critical in the ICU

by | in Physician | 3 responses

When someone dies at home we call it ‘going to a better place.’ When someone dies in the hospital we call it a ‘code.’Recently, working in the cardiac ICU, I have been thinking a lot about code status. Code status is the medical term that describes what a patient’s wishes are should his or her heart stop or lungs fail. While code status is not a topic that typically ...

Hospital admissions may require watching and waiting

by | in Physician | 7 responses

A sweet little lady came to the emergency department recently. She said she felt short of breath and sweaty at home. In the department, she looked like a rose! Normal oxygen levels, normal labs. Her chest x-ray had a faint area that ‘one might possibly imagine could perhaps be’ a pneumonia. It looked remarkably like her previous film.But her history was concerning to me, and it was concerning to ...

iPad in the ER, a hands on physician review

by | in Tech | 7 responses

I had been anxiously awaiting the arrival of my iPad. This is the form factor I have been asking (begging) of all the vendors for years. I'm very happy to say that it appears to be living up to my high expectations.The screen is gorgeous. It's very clear and bright, I had no trouble seeing the screen in bright outdoor light. The machine seems extremely responsive -- it ...

Don Berwick to lead Medicare and Medicaid

by | in Policy | 2 responses

While the health reform bill will have many effects, one of its most profound will be to unshackle the Centers for Medicare & Medicaid Services (CMS).Under the legislation, CMS is now far freer to undertake a variety of pilot programs and demonstration projects designed to improve quality, safety and efficiency, and to convert the successful ones into policy. And, if that wasn't enough for those who have long been praying ...

Medicare cuts are forcing doctors to charge an annual fee

in Policy | 12 responses

Here's a novel way some physician groups are countering Medicare cuts.Charge everybody an annual fee.As reported on NPR's health blog, Shots, a cardiology group in California will resort to annual fees ranging from $500 to $7,500 -- which seems like a pretty big range to me. Of course, specialties like cardiology are panicking more than others, since reimbursement cuts for heart studies is scheduled to be approximately 40% ...

Twitter for doctors, a guide for health care professionals

by | in Social media | 4 responses

With the explosion of social media, I am amazed at how many doctors I encounter who know little to nothing about blogs, Twitter, Facebook, Google Buzz and the like. "I'm too busy." "Who has time for that stuff?" "I wouldn't have time for anything else." "How can I possibly keep up?"And yet today, as more and more patients reach out to the web to find medical information or, more importantly, ...

Social work is key to quality patient care

by | in Physician | 5 responses

In 1927, Francis Peabody remarked that, "The secret of the care of the patient is in caring for the patient."Medicine has made much progress since those days, but some might argue that some of the humanitarian cornerstones of caring that concerned Peabody have been lost. Of course, there are many health professionals that still embody this caring ethic. And in today's era, perhaps the group that best personifies this central ...

Medicare denies a brain tumor drug after a patient moves

in Policy | 10 responses

by John FauberFor nearly a decade, Paula Oertel's brain tumor was kept at bay by a drug that was not approved to treat her condition. Then Oertel did something she never imagined would jeopardize her health.She moved -- less than 30 miles -- from one county in Wisconsin to another.That move triggered a review of her health insurance from Medicare, which eventually led to a loss of coverage, including ...

KevinMD has joined forces with MedPage Today

in Social media | no responses

I am pleased to announce a partnership with MedPage Today.MedPage Today has supported my blog since its inception, and today's announcement is a logical progression forward.What this mean to you, the valued reader?I continue to maintain complete editorial independence, with zero outside influence on what I write and which articles I choose to republish. Guest authors retain all rights to their articles.I am now able to better share MedPage ...

Patient safety requires changing the culture of medicine

in Education | 2 responses

Patient safety has become more pronounced in hospitals today. But for the movement to have its full impact, doctors have to buy into it wholeheartedly.And that's where the progress is slower.In her recent New York Times column, surgeon Pauline Chen discusses the "culture of fear" that pervades medical training. She cites a report from the Lucian Leape Institute of the National Patient Safety Foundation, which concluded that ...

Aortic dissection symptoms and current treatment options

in Physician | no responses

by Joseph Lombardi, MDYou probably remember the tragic death of actor John Ritter in 2003.Recently, his family partnered with the Thoracic Aortic Disease (TAD) Coalition to shed light on the condition that took his life: aortic dissection.In addition to TAD Coalition’s “Ritter Rules,” which focus on recognizing, treating and preventing the condition, the American Heart Association and American College of Cardiology also released new guidelines designed to ...

Grey’s Anatomy and other TV doctors skirt bioethical issues

in Social media | 4 responses

by John GeverAs portrayed on popular television shows, physicians frequently deal with vexing ethical dilemmas -- perhaps more often than occurs in real life, researchers said.Doctors on TV also sleep around a great deal, with each other and with patients, and behave unprofessionally in a host of other ways, reported researchers at Johns Hopkins University in Baltimore who analyzed the content of a full season of "House M.D." and "Grey's ...

Pain management depends too heavily on narcotics

in Meds | 15 responses

by Michael Kirsch, MDFirst, let me state unequivocally that I am against all varieties of pain, foreign and domestic. Indeed, I wish that we could snuff the varmint out every time and place it surfaces. Pain is a wily opponent that can be difficult to vanquish. In recent years, physicians have been resorting to a ‘shock and awe’ strategy of using excessive force against it.While this may be sound military ...

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