Every once in a while, there's a magazine piece that so encapsulates the key moral issues -- and irrationality -- of 21st Century medicine that it warrants designation as mandatory reading for anyone who interacts with patients. Atul Gawande has written some of these; so too has Slate medical columnist, Darshak Sangavi.The latest entry on the required reading list is Katy Butler's "My Father's Broken Heart," which appeared ...
September 2010
All Stories
Health blog posts of the week, ending September 10, 2010
Here are the top posts from this past week, based on the number of times they were viewed.1. Moments of internal struggle in the ER2. Stop eating before you become obese3. Why are most physicians writing their prescriptions by hand?4. Why are hearing aids so expensive, and reading glasses so cheap?5. Medical school is hard, and other medical student thoughts
KevinMD.com in the New York Times and New York Post and other recent media mentions
I’d like to thank various media outlets for recently citing KevinMD.com.In her New York Times diagnosis column, The heat of the night, Lisa Sanders discusses the case where a patient live-blogged his hospital stay, crowd sourcing his diagnosis:
[Physician blogger John] Schumann was worried, too. He lived nearly a thousand miles away — too far to come and see his friend. Besides, the patient was posting all his ...
Patients don’t believe the evidence, blame our healthcare system
Health Affairs reports on a study that finds Evidence That Consumers Are Skeptical About Evidence-Based Health Care.According to the abstract,
We found many of these consumers’ beliefs, values, and knowledge to be at odds with what policy makers prescribe as evidence-based health care. Few consumers understood terms such as “medical evidence” or “quality guidelines.” Most believed that more care meant higher-quality, better care. The ...
10 tips for troubleshooting complex EHR infrastructure problems
I recently joined my team while troubleshooting a complex infrastructure problem affecting our community EHR hosting private cloud.From years of experience doing this, here are my lessons learned.1. Once the problem is identified, the first step is to ascertain the scope. Call the users to determine what they are experiencing. Test the application or infrastructure yourself. Do not trust the monitoring tools if they indicate all is well but the ...
How physicians can endure the trauma of a malpractice lawsuit
Several clients have endured the trauma of malpractice law suits, Medicare audits and stinging accusations or criticisms from patients or colleagues that leave them reeling.These clients have shared feelings of:
- shame
- despair
- depression
- loss of self-worth
- disillusionment
- confusion
- hurt
- defeat
Diagnosing mental illness on Sesame Street
ZDoggMD, a hospitalist in California, gives us Diagnosis: Sesame Street, "a cluster of mental illness, all on one urban inner city avenue." Enjoy.width="430" height="340" classid="clsid:d27cdb6e-ae6d-11cf-96b8-444553540000" codebase="http://download.macromedia.com/pub/shockwave/cabs/flash/swflash.cab#version=6,0,40,0">
Primary care needs more than 15 minutes for patients
Psychotherapy appointments have traditionally lasted 50 minutes with 10 minutes for paperwork. This has lead to the expression, “the 50-minute hour”.
More recently there has been talk of incorporating psychotherapy techniques in brief visits in primary care. The provoking title “The Fifteen Minute Hour” is from a book about addressing the emotional aspects of disease in primary care during brief appointments. The title and the concept seem relevant to ...
How doctors can cope with stress
by Walter van den Broek, MD, PhDOften I ask my residents that if you can’t take care of yourself, how do you expect to take care of your patients?Or in another way: the only difference between God and a doctor is that God knows he’s not a doctor. These sound like cliches but there is some truth in them. In short, doctors are just ordinary people ...
Weekend video preview, September 10, 2010
A video preview of what's coming up this weekend on KevinMD.com.classid="clsid:D27CDB6E-AE6D-11cf-96B8-444553540000" width="430" height="288" id="viddler_kevinmd_3">
Contraceptive pill prices have a huge price range
Do you know that the price of a contraceptive pill in Chicago pharmacies varies from $9 (Trinessa, aka generic Tricyclen, at Target pharmacy) to $84 (Loestrin 24 at Kmart pharmacy) a month? That means, over the course of the year, depending on what pill you take and where you shop, you could drop as little as $84 or -- let me get my calculator here -- $1008! These prices are if you pay out ...
Beyond the final Medicare and Medicaid EHR incentive rules
by David C. Kibbe, MD, MBA and Brian Klepper, PhDFinally, we have a Final Rule on the Medicare and Medicaid EHR incentive programs.The rules and criteria are simpler and more flexible, and the measures easier to compute. But they are still an “all or nothing” proposition for physicians, who will have to meet all of the objectives and measures to receive any incentive payment. Doctors ...
What is an adequate trial of an antidepressant?
Since there are many antidepressants with varying dosage ranges, and many more degrees of variations between individual responses to particular antidepressants, psychiatrists have been unable to agree upon an operational definition of an "adequate trial" of an antidepressant.However, it's worth looking at some guidelines.A 2003 study from the Journal of American Medical Association found that only 21.7% of Americans diagnosed with depression received "minimally adequate treatment" in the past 12 ...
Chronic disease and using social media for health
Speaking to the senior staff of the National Library of Medicine recently was like going before the best kind of murder board.Picture it: 30 of the nation’s smartest health information mavens around a polished conference room table, asking me sharp questions, suggesting new lines of inquiry, and offering their own insights. In other words, heaven.Our jumping-off point was the Pew Internet Project’s latest research on internet penetration, mobile use, and ...
Bringing a friend or family member on doctor’s appointments
by Diana E. LeeMost of the resources I've read about how to prepare for a doctor's appointment recommend bringing a loved one with you so that person can help you remember what the doctor said and make sure you get your questions and concerns addressed. But when I read Paula Kamen's book All in My Head: An Epic Quest to Cure an Unrelenting, Totally Unreasonable and ...
Working with industry requires building a culture of trust
Howard Brody, a family physician, recently wrote an article in the Annals of Family Medicine discussing, “Professional Medical Organizations and Commercial Conflicts of Interest: Ethical Issues.”The article focused on how AAFP has “recently been criticized for accepting a large corporate donation from Coca-Cola to fund patient education and materials on obesity prevention,” and how this money has been called a “conflict of interest.” To that effect, Dr. Brody defines such ...
Physician resistance to EMR and why CPT should be replaced
After 5 successful years with electronic medical records (EMR), I am convinced that the promise of EMR to improve physician practices and to improve the health care system is real.If that is true, why is adoption of EMR currently limited to only 5-10% of medical practices? Why is there so much resistance? As folks who work in heath care IT so often ask, why don’t doctors “get it?” I don’t ...
How doctors can respond to report cards
by an anonymous physicianRecently, Danielle Ofri had a piece in the NEJM about medical report cards.You know, those computer generated reports that tell you how many of your patients have achieved normal blood pressures and normal cholesterols and so on. Dr. Ofri concluded her piece by shoving her most recent report card to the bottom of a stack of more important paper and heading ...
Why are most physicians writing their prescriptions by hand?
Is the pen mightier than the PC?When it comes to prescribing, it appears so. A new report from the Center for Studying Health System Change finds that most physicians write their RX scripts by hand, despite financial incentives for physicians to adopt electronic prescribing. Even those who have e-RX systems do not always use them, and when they do, they may not to use the features that were ...
Alzheimer’s disease needs better preventive strategies and treatments
The Alzheimer's Association sponsors a journal titled Alzheimer's & Dementia. In the March 2010 issue, they provide a report on facts and figures related to Alzheimer's disease (AD).I'm a sucker for data so I spent some time going through the manuscript and here are some of the things that stood out to me:Ninety (90) drugs are under investigation using human volunteers in the U.S. to slow or stop the ...
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....
