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 Priscilla Chan may become the country’s most influential doctor
Who has the potential to be the most influential physician of our generation? It's Priscilla Chan, who not only recently graduated from...
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Confused about prostate cancer screening? Make a shared decision
In a widely anticipated move, the USPSTF officially recommended against prostate cancer screening in healthy men. Case closed, right? Hardly. The prostate...
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When it comes to doctors and social media, hospitals fail miserably
When it comes to medicine and social media, much of the attention is negative. Doctors losing their hospital privileges because of Facebook....
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Warren Buffett’s prostate cancer choices aren’t right for every man
A version of this column was published on April 24, 2012 in USA Today. There has been a recent uptick of elderly men...
Physician
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Why test recalls should not be considered cheating
I was appalled recently by the coverage of radiology “test recalls” by CNN, amplified by Dr. Gary Becker of the American Board...
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Why physicians are susceptible to hardball tactics
I was invited to a medical staff leadership conference sponsored by our hospital. A company specializing in training physician leaders ran the...
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How we deliver bad news is critical to how families deal with grief
As a cardiac electrophysiologist, I have had to discuss bad news with patients and families more times than I would like during...
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His father’s suffering had already been too great
He looked dead. The paramedics brought him down the hall toward one of my critical care beds, and for a moment I...
Patient
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How death can be a beautiful experience
I was honored to be part of a beautiful experience in late January of 2011. It was the death of my mother-in-law...
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What meaningful encouragement can be given to someone who is dying?
Theirs is a lonely journey; to be moving towards the separation and end of all things known and loved. Being with a...
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Health care journalists have tendencies similar to those of doctors
As a patient who was asked to speak at the Association of Health Care Journalists 2012 conference, I felt a bit covert....
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Adaptation can be painful, but it can also be a gift
Nothing will force you to live life on your own terms faster than almost losing it. In 2008, I was on fire....
Policy
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What should America’s health care vision be?
America has this paradox of excellent biomedical science, innovative drug manufacturers and entrepreneurial device developers along with outstanding providers but at the...
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Hospitals around the world aim to remain relevant to patients
"It was the best of times, it was the worst of times ..." So begins a story called A Tale of Two...
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Repairing the tear in health care’s safety net with social media
The nation’s “safety net” hospitals are designed to ensure that uninsured, lower income and indigent populations receive adequate medical care – a...
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Look to technology to reduce health costs
Technology to lower costs rather than accelerate them. Smart phones to increase physician and other providers’ productivity. Fewer primary care physicians but...
Tech
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When patient care becomes secondary to filling out the medical record
The policeman was two cars in front of me. I meandered down the road cautiously adjusting my speed a few ticks above...
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Doctors, use Google to get more patients in less than 7 minutes
Every month, hundreds of thousands of people look for a doctor on Google. As an amazing practitioner, your site deserves to be...
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The user interface for EHRs should be uniform
The first thing I noticed when I walked into the physician’s office were the tall cabinets filled with manila folders, tabbed with...
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EMR liability needs to go further than just the physician
This example of a disaster waiting to happen, in the form of an error-promoting CPOE, is a poster example of why the...
Social Media
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We need to see the potential harm of social media
Prior to 1794, farms across the world could only pick cotton as fast as humanly possible. In the late 18th century, Eli Whitney...
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Why social media may not be worth it for doctors
Social media in healthcare is all the rage these days. You can’t visit even one physician-oriented website without someone breathlessly advising you...
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Transparency defines social media success for doctors
Want to understand social media? Physicians wanting to learn about social media must learn transparency. We must learn transparency on a personal...
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How Twitter was used in a potential mass casualty scenario
It was my first ER shift in charge of the resuscitation area. Needless to say, my adrenaline and nerves were firing like...
