Will medical school loan forgiveness be enough to convince prospective doctors to forsake specialty practice as a career?I've argued previously that it may help a little, but it's unlikely to change the overall trend away from primary care.A recent article from Health Affairs compares lifetime earnings from a cardiologist versus a primary care physician. The difference is stark:
Their calculations showed that cardiologists earn a career average of more ...
A guest column by the American Medical Association, exclusive to KevinMD.com.Physicians filing claims in $350M UnitedHealth Settlement can get help from new AMA guide by J. James Rohack, MD
In mid-April, the first of 18 million people around the country began receiving legal notices containing details of a record-breaking settlement reached last January in a historic court challenge ...
Added sugars hit a new low this week. A study published in JAMA found that people who consume higher quantities of added sugars have worse cholesterol profiles than those who consume less.First of, what are added sugars? Added sugars simply put are sugars that are added into foods (in contrast to naturally-occurring sugars that you find in fruits). The JAMA article writes that added sugars are “defined as caloric sweeteners ...
Although every day can bring surprises in a medical practice, you can develop a clinical team that can optimize the efficiencies of your operation and make it easier for you to see your patients.There are three key areas that lead to provider frustration in daily operations: preparation and anticipation; the daily dance; and being in the moment. Address these, and your days should go more smoothly.Preparation and anticipationAre your charts ...
Generally, I find my practice works best when I get paid in dollars. They're convenient. They can be transmitted electronically between bank accounts. Mary and Annie like them. I can spend them by swiping a credit card.But, in a remarkable effort to win the "Let's See How Stupid I Can Sound" award, a Nevada candidate for U.S. Senate has proposed ditching the idea of paying doctors in money, and going ...
There's little doubt that many doctors are frustrated, with some compelled to leave medicine altogether.And with the myriad of obstacles intruding on the doctor-patient relationship, combined with the factors contributing to burnout, that's certainly an understandable stance.So, why do so many continue the uphill climb to practice the best medicine they can?Emergency physician Edwin Leap gives his explanation, in a poignant column from Emergency Medicine News:
We may rail against ...
The role of autopsy in the medical profession is difficult to overestimate. Western medicine takes its roots from comparative studies between patient’s symptoms and the findings on autopsy.Participation in an autopsy was one of the most valuable lessons from medical school and residency. If you participated in the patient’s care, there is no greater educational tool than witnessing the postmortem exam. It is especially true if the cause of death ...
When I recently walked into my local Apple store to buy an iPad accessory, I saw a group of about 20 people huddled around a large LCD screen while an Apple employee was giving a workshop.When I saw the LCD screen full of medical applications, I was shocked. This wasn’t your run of the mill “how to use your iPhone” workshop.The people gathered for the workshop consisted of healthcare professionals ...
There is a lot of focus on what elders with dementia can't do. But what about more discussion of what they can do?When you see a patient with dementia, how do you help family members maintain meaningful interactions with their loved ones? I am sad to admit that I don't do this nearly as well as I should. After all, this is not the type of thing we are taught ...
by Michael SmithWhen cesarean section rates are lower than expected, adverse maternal or neonatal outcomes are higher, researchers said.But the converse isn't true -- higher-than-expected C-section rates aren't associated with a protective effect, according to Sindhu Srinivas, MD, of the University of Pennsylvania, and colleagues.The finding comes from an attempt to see if the risk-adjusted C-section rate can be used as a marker for the quality of obstetric care, Srinivas ...
I have spent most of the past 2 weeks on the road – first at ACP and this week at SGIM. I have talked with many internists, but several conversations have contributed to writing this post. Each of several leaders contributed to these ideas, but I will keep them anonymous so the innocent are protected.Here are the main assumptions:1. Internists by training excel in the care of complexity 2. Pursuing the ...
Physician burnout starts early in training.I wrote last year that medical residents faced burnout, helped in part by the culture they train in:
... residents “from seven different specialties and found that they set themselves up for burnout by accepting, even embracing, what they believed would be a temporary imbalance between the personal and professional aspects of their lives.”Recent studies have shed more light on the issue.According to a study ...
Beau Biden, son of Vice President Joe Biden, suffered a stroke today.
He is 41-years old, and is expected to make a full recovery according to the medical director of the Center for Heart and Vascular Surgery at Christiana Care Health System:
Biden has what the doctors "believe to be a mild stroke," according to Gardner. "[He is] "fully alert, ...
I have a patient in his 60s who is riddled with metastatic lung cancer. He isn't on hospice (oncology refuses to let him out of their clutches just yet; actually, the problem is that around here Hospice won't accept patients still on palliative chemo or radiation) but is aware of what they have to offer. He and his wife have assured me that they will let me know when they ...
Much like many other news items, I came upon the one about the proposed name change for Physician Assistants quite by accident: it came to me as an e-mail notification of a new topic being discussed on one of the physician only discussion boards that I am a part of. Apparently, after 40+ years of the profession's existence, there is a grassroots effort afoot to upgrade the name, and presumably ...
An audiobook except from Intern: A Doctor's Initiation, now available for download on iTunes.Intern: A Doctor's Initiation -- Click to play audioclipby Sandeep Jauhar, MDChapter one
I had been an intern less than an hour, and already I was running late. The sloping footpath leading up to the hospital was paved with gray cobblestones. My feet ached ...
by Joyce FriedenIn one of those “important but little noticed” announcements that government officials are prone to put out, the Department of Health and Human Services recently let the world know – via the Federal Register -- that it has created an Office of Consumer Information and Insurance Oversight to assist with implementation of the newly passed health insurance reform law.This new office has four divisions. Here are a ...
The heresy of one age becomes the orthodoxy of the next. -Helen KellerThe patient returned to my clinic several years after her original thyroid cancer surgery. “The cancer blood test never went completely back to zero,” she told me. “We knew there was cancer in there somewhere. Finally, the new ultrasound machine found it! I guess it is time for more surgery!” I guess. In my patient’s situation, the latest high resolution diagnostic ...
There's been a lot of commentary on a recent article from the New England Journal of Medicine, detailing the undocumented tasks that a typical primary care physician performs.For those who haven't read the piece, entitled, What's Keeping Us So Busy in Primary Care? A Snapshot from One Practice, it's available free at the NEJM website. I highly recommend it.To summarize, primary care doctors are responsible for much more ...
A guest column by the American Board of Internal Medicine, exclusive to KevinMD.com.by Christine Cassel, MD, MACP
Imagine a sub-par doctor at a vibrant health system with care delivered and coordinated by skilled teams, using robust EHRs and other vital supports for physicians and patients. Now imagine an extremely talented, knowledgeable doctor at an underfunded community clinic. This ...
According to a recent study from the Archives of Internal Medicine, primary care physicians are referring more patients to specialists than ever...
One of the reasons there is such a movement against vaccines is the democratization of information, perpetuated by search engines like Google....
In a widely circulated CNN article, many radiologists have been found to cheat on their board exams: "Doctors around the country taking an...
Are doctors really going broke? According to this piece from CNN Money, some are: "Doctors list shrinking insurance reimbursements, changing regulations, rising...
It was 1976 and I was a junior resident in urology at Baylor College of Medicine in Houston, Texas. I was assigned...
Diagnosis is the foundation on which all care and treatments rest. If the diagnosis is wrong, most probably so is the treatment. ...
As physicians, we are often called upon to be advocates for our patients. Sometimes they have no other person to turn to....
Mike was a runner, outdoors-man, and fitness nut. This was not so much as for health reasons as for "feeling good", but...
I love listening to life stories. As a hospice chaplain, I loved sitting with our patients and their loved ones engaging in...
For health care professionals, patient engagement is the holy grail of health care. It is the key to patient adherence – a...
This is a response to Deb Discenza's article requesting a one page informational sheet informing a patient about hospice or palliative care. This would...
So, Megen at Not Nurse Ratched wrote post recently about therapeutic presence. The following passage really caught my attention: "Question is: are...
A social media movement is happening before our eyes with action starting to take shape. The #occupyhealthcare movement has begun within to...
The triple aim of health care, as defined by the Center for Medicare and Medicaid Services (CMS) is: improving the experience of care, bettering...
The storyline is familiar. An organization is challenged to achieve better results without spending more money. An executive is committed to obtaining...
Why are cancer organizations waiting until it starts to rain before they suggest buying an umbrella? “Join my Medicare Advantage plan and...
How many times as a doctor do you ask the same questions over and over again as part of the routine process...
Many clinical decisions in older persons are dependent on life expectancy. For example, as life expectancy declines, cancer screening is likely to...
“To Err Is Human” is the title of the now famous book from the Institute of Medicine on patient safety published about...
Professor Gunter Dueck, is a calm and eloquent german mathematician who’s also the CTO of IBM Germany. He studied mathematics and philosophy...
As a physician, technology cannot replace you, but it can make you more efficient and effective. This was the message from Richard...
Looking ahead to the next several months, I’ve found myself frequently wondering how many physicians will make this their year to take...
The physician’s decision to first dive into social media can be stress-inducing. Issues of time management, maintaining professionalism, and determining a return...
The impact of social media on medicine could arguably be compared to the impact of the industrial revolution on the human condition....
