It is insulting to think that doctors who are ostensibly smart enough to save one's life are in fact so stupid, or merely gullible enough, to be swept away by what is in actuality only a very weak potion of sales-presentation intermixed with and embedded within generally informative and pharmaceutical-balanced subject-focused medical lectures.Such lectures occur usually at a private function room at a restaurant or, in conjunction with a served ...
August 2010
All Stories
Notes in the chart are helping patients less
What is the purpose of the note in the patient chart?Depends who you’re asking.The best guidance I ever received on how to write a good note came from my residency program director, who told us that a note needn’t be encyclopedic to be excellent; in fact, he urged us to get away from the “second-year medical student” style, which typically includes absolutely everything.Instead, he urged us to write, as concisely ...
ABIM: Patient centered care is crucial in health reform
A guest column by the American Board of Internal Medicine, exclusive to KevinMD.com.by Christine Cassel, MD
The concept of patient-centered care was catapulted into the mainstream by the publication in 2001 of the seminal Institute of Medicine report Crossing the Quality Chasm: A New Health System for the 21st Century. This report ...
Bacterial resistance to chronic antibiotics, and why it’s a problem
Unlike climate change, where there’s a large contingent of denialists who spread doubt about the scientific evidence, no one denies that antibiotic resistance is a problem. There is controversy, however, on the question of just how much the widespread use of antibiotics contributes to the problem.The mechanism is not in dispute: If you expose bacteria to antibiotics, they will mutate to become resistant. But “overuse” of antibiotics is not the ...
Minimize patient waiting after a potential cancer diagnosis
I received a very troubling phone call from a close friend recently. He underwent a study, at the age of 40, and the physician came out of the procedure and said, "you have a large tumor, do you want me to call a surgeon for you."The purpose of this post is not to comment on the physician's behavior or delivery techniques, but to define this very precarious and anxiety producing ...
Obesity in American children and adults continues to grow
by Emily P. WalkerThe number of obese adults in the U.S. continues to rise, despite a growing number of federal anti-obesity initiatives in the past two years, according to a new report.The seventh annual "F as in Fat" report, released Tuesday by the nonprofit Trust for America's Health and the Robert Wood Johnson Foundation, found that obesity rates continued to rise in 28 states from 2007 through 2009.Nationally, two-thirds of ...
Breathe properly at night and learn to sleep better
Every time you see a depiction of someone sleeping on TV or in the movies, you'll see the person sleeping on his or her back, and oftentimes, snoring.The lay public, doctors, and even alternative and complementary practitioners naturally assume that you're able to breathe properly at night. This couldn't be further from the truth.Evolutionary biologists and comparative anatomists have stated that speech and language development was ultimately detrimental to humans. ...
Physician social networks and liability risk
I recently wrote about the hidden dangers of physician social networks, and how private posts can potentially become public at a later date.With the recent controversy surrounding former Washington Post blogger Dave Weigel and Journalist in mind, I commented that,
passionate, controversial debate is frequent on Sermo, along with discussion of patient cases. Part of what makes the site so provocative and insightful is the fact that the conversations ...
Android and iPhone pros and cons for healthcare
by Jeff BrandtI wrote an article for KevinMD.com several months ago discussing the benefits of Android for the healthcare market. I also compared Android with the iPhone. I listed the iPhone's technical shortcomings and really angered the “believers of all things Apple”. That was not my intent.Apple's latest release of iPhone 4.0 and their new operating system (OS) 4.0 corrects many of the ...
How to say goodbye to patients
OncRN is a wonderful blog written by an anonymous author sharing stories and insights in her line of work that many times speak to palliative themes. S/he says it best in her blog description,
my life gets intermittantly (sic) rocked by the wonders/horrors of being an oncology nurse. i just need to talk it all through sometimes.A recent post is about how to say good-bye to our patients, particularly ...
Unread echocardiogram fallout at Harlem Hospital Center
Recently, the New York Times reported that Harlem Hospital Center had finally completed its investigation into thousands of echocardiograms that after receiving an initial reading by a technician had never been read by a physician.It turns out that out of 7,000 tests that went unread, only 14 patients “might have been misdiagnosed because their tests had not been handled properly,” according to the hospital spokeswoman quoted in the story. ...
Create a family practice mystique in medical school
For at least the last 20 years, graduates of U.S. medical schools have resisted pleas from organized and disorganized medicine to become primary care physicians (PCPs). Since there is already a severe shortage of PCPs, pundits are wondering who is going to take care of the hordes of newly insured by 2014. Many have speculated about the possible reasons for this dilemma such as the relatively paltry earning potential of ...
Was JUPITER trial data influenced by AstraZeneca to favor Crestor?
by Charles BankheadReanalysis of a landmark cholesterol-lowering trial of people typically considered at low risk for heart attacks indicated that the results are flawed -- and do not support the primary-prevention benefits that made headlines, authors of the review asserted.The reanalysis of the massive JUPITER trial involving almost 18,000 people with low or normal cholesterol but elevated levels of the inflammatory biomarker C-reactive protein (CRP) -- turned up no evidence ...
Medications that increase the risk of photosensitivity
by Marianna Rakovitsky, RPhOh, Summer! The weather is warm, the sun is shining and it is the time when we try to get outside as much as possible. Summer is my favorite time of the year. I love the beach, days that are filled with light and sunshine, trips to the orchards and hanging out in the backyard. The sunshine that makes the summer such a ...
Is patient adherence responsible for health quality and safety?
A while back I did in a post where I asked the question, What can patients really expect from their physicians today? In that post, I wondered at the fact that many patients still have a high degree of trust in their physician in spite of the quality and safety problems attributed to physicians in the press.For example:
- On average, US adults receive only 50% of recommended ...
Every patient deserves a death with dignity and without pain
Death is not the enemy. We all die.The enemies of patients and physicians are premature death, disease, disability, pain, human suffering.I believe that all people deserve a death with dignity and without pain. Palliative care is the right mode for as many as 80% of all Americans who will die of chronic progressive incurable diseases. Eighty percent of those state that they do not want to die in a hospital ...
Pay specialists less to save primary care
Since 1997 the number of US medical students choosing to go into primary care has decreased by more than 50%.It seems that sources as diverse as the Obama Administration and the Wall Street Journal think that we should find a way to encourage medical students to choose primary care specialties in order to allow Americans to have the best and most cost effective care. This is very problematic when primary ...
The difficulty of regulating x-ray radiation in the ER
A recent article in the New England Journal of Medicine touched off another salvo about how non-clinicians have no problems judging the abilities of clinicians in the world of medicine.The article begins by presenting the case of a woman who awoke with facial paralysis and then went to the emergency department. On arrival, she received CT scans and MRI scans of her brain. When those were normal, she was diagnosed ...
Why health plans who rate physicians should be supported
Some physicians and physician groups are quite upset about insurers' recent moves to offer employer customers tight, small networks of providers based on quality and cost criteria. In an effort to block these new plans, the AMA and other groups are focusing on the few problems with ratings and avoiding the larger issue - some physicians are just bad actors.What they should be doing is working closely with health plans ...
Caring for dying patients needs better physician communication
by Michael SmithClinicians treating dying patients did well in managing pain but fell short on communicating with patients and their loved ones, researchers said.The findings, from a single-institution study, suggest that those who care for terminal patients also often failed to assess shortness of breath in a dying patient whose mechanical ventilation was withdrawn, according to Anne Walling, MD, of the University of California Los Angeles, and colleagues.But overall those ...
Kevin Pho, MD
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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...
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Doctors: Don’t be ashamed about going bankrupt
Are doctors really going broke? According to this piece from CNN Money, some are: "Doctors list shrinking insurance reimbursements, changing regulations, rising...
Physician
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Patients will understand an honest mistake if the doctor tells the truth
It was 1976 and I was a junior resident in urology at Baylor College of Medicine in Houston, Texas. I was assigned...
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Diagnosing an illness is an art
Diagnosis is the foundation on which all care and treatments rest. If the diagnosis is wrong, most probably so is the treatment. ...
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Physicians have a natural role as advocates
As physicians, we are often called upon to be advocates for our patients. Sometimes they have no other person to turn to....
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Our society expends huge sums on futile care
Mike was a runner, outdoors-man, and fitness nut. This was not so much as for health reasons as for "feeling good", but...
Patient
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How will the Baby Boomers age and die?
I love listening to life stories. As a hospice chaplain, I loved sitting with our patients and their loved ones engaging in...
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Patient engagement is the holy grail of health care
For health care professionals, patient engagement is the holy grail of health care. It is the key to patient adherence – a...
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Why do doctors delay hospice referrals?
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...
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How touch can calm patients
So, Megen at Not Nurse Ratched wrote post recently about therapeutic presence. The following passage really caught my attention: "Question is: are...
Policy
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A lack of incentive for medical schools to train primary care doctors
A social media movement is happening before our eyes with action starting to take shape. The #occupyhealthcare movement has begun within to...
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What should be the stated aim of health care in America?
The triple aim of health care, as defined by the Center for Medicare and Medicaid Services (CMS) is: improving the experience of care, bettering...
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How Moneyball applies to healthcare
The storyline is familiar. An organization is challenged to achieve better results without spending more money. An executive is committed to obtaining...
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The problem of insurance gaps in cancer patients
Why are cancer organizations waiting until it starts to rain before they suggest buying an umbrella? “Join my Medicare Advantage plan and...
Tech
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Repetition is the curse of the doctor-patient engagement
How many times as a doctor do you ask the same questions over and over again as part of the routine process...
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Why the prognosis of patients is difficult
Many clinical decisions in older persons are dependent on life expectancy. For example, as life expectancy declines, cancer screening is likely to...
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Innovative technologies can markedly enhance safety
“To Err Is Human” is the title of the now famous book from the Institute of Medicine on patient safety published about...
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Google knows more about certain diseases than physicians ever will
Professor Gunter Dueck, is a calm and eloquent german mathematician who’s also the CTO of IBM Germany. He studied mathematics and philosophy...
Social Media
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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...
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Twitter Is my third office location
The physician’s decision to first dive into social media can be stress-inducing. Issues of time management, maintaining professionalism, and determining a return...
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The impact of social media on a physician assistant
The impact of social media on medicine could arguably be compared to the impact of the industrial revolution on the human condition....
