October is breast cancer awareness month. There are pink ribbons and wristbands to wear, pink products to buy, and pink races to run -- all to improve awareness about screening and raise money for a cure. And rightly so, because breast cancer affects 250,000 American women every year.Fewer people know that October is also intimate partner violence awareness month. Purple is the color representing the more than 1.3 million women ...
October 2010
All Stories
Deal with your triggers when trying to lose weight
One of the most common complaints that I hear from people attempting to lose weight is, “I don’t know how to deal with my triggers.” Most of us have had the experience of eating just one bite of something and suddenly wanting to devour the entire thing. Sometimes we do, even though we know we won’t be happy with ourselves when we finish.I am familiar with the experience of insisting ...
Using a white board as a patient tool
There is a white board in every patient's room. This is used to keep patient oriented and provide them with basic information. You would see some data on it, most of the time there is a date scrolled on it, name of the nurse and maybe physician’s name.I recently read an article "Getting the most out the humble white board" by Deborrah Gesenway. This is an excellent read ...
Avandia aftermath: winners and losers
Responses to the Avandia panel have been all over the map, as cleverly noted on the Wall Street Journal's Health Blog. Avandia is “dead” (Forbes), or, perhaps worse, “now a Zombie” (BNET). By contrast, others thought the panel granted Avandia a “reprieve” (Wall Street Journal and that Avandia would now probably be allowed to stay on the market (Los Angeles Times, Pharmalot).All these ...
If physician decisions were based strictly on Cochrane
First, a disclosure. I am President and Board Chair of the not-for-profit Lundberg Institute in California, which is dedicated to Archie Cochrane.What would happen if we in American healthcare actually followed the teachings of the revered Archie Cochrane? I'm sorry. You don't know what those teachings are? ... and you don't even know who Archie Cochrane was? Oh my ...Click www.lundberginstitute.org, no registration required, and then click to ...
Medicare needs to be more like a credit card
I live in New York. Last week my daughter in Chicago called to say that a five dollar charge had been refused at a local coffee shop. My credit card company had identified an unusual pattern of purchases, and had put a hold on the card.No similar process exists for the Medicare system, where cost savings could be realized by systems that identify unusual patterns of charges and outright abuse ...
How time can be used as a diagnostic tool
I can’t remember which lecture it was, or even just when in my first two years of medical school the lecture was given, but I do remember how the concept struck me as really important.The gist of the message was that the timing of onset of a patient’s symptoms is a key part of understanding the nature of the patient’s diagnosis. Symptoms from a neoplasm come on gradually, tend to ...
Trust your doctor but review your medical bills
by Dennis GraceThe last time I visited my physician for an epidural injection, as the doctor’s assistant was situating me under the fluoroscope, the doctor was feverishly dictating notes on his previous patient’s procedure. No doubt your physician has a similar work schedule: when not dashing off notes from one patient or burrowing through medical research to diagnose another, he’s performing delicate medical procedures ...
How observation admissions affect Medicare patients
A revealing article in Bloomberg recently described the latest way in which elderly patients are getting screwed by the system.Medicare reviews all admissions and if the patients don’t meet indications for admission, the hospital doesn’t get paid by Medicare. Medicare has also recently implemented a mercenary system called Recovery Audit Contractors (or RAC for short) in which third parties audit hospital charts to see whether Medicare “overpaid” for a patient’s ...
Health blog posts of the week, ending October 8, 2010
Here are the top posts from this past week, based on the number of times they were viewed.1. Catherine Zeta-Jones blames doctors for Michael Douglas’ throat cancer. Why is Catherine Zeta-Jones so mad? It’s a facetious question. Her husband, Michael Douglas, was recently diagnosed with throat cancer he described at “stage 4.”2. The day that medicine broke her and destroyed her innocence. I was a third-year medical student ...
Quality programs have social and medical consequences
Like it or not, “garbage in, garbage out” is the rule rather than the exception for the vast majority of bureaucratically dictated “quality control” programs that we’re ever likely to launch. There are three primary reasons for this.First and foremost, there’s Goodhart’s Law:
“Originally, an economic theory stating that if a particular definition of the money supply were to be used as the basis for ...
Should the public participate in preparing cadavers for students?
The Wall Street Journal's Health Blog carries an interesting piece about a program at Indiana University–Northwest that allows volunteers from the general public to participate in preparing cadavers for first year medical students.This is a brilliant idea for several reasons:
- One persistent problem facing physicians is the extremely low health literacy of most patients. Simply put, “health literacy” refers to how well patients can comprehend what their ...
When a chief complaint doesn’t match the ultimate diagnosis
Most times a patient that is triaged with a specific chief complaint ultimately have a diagnosis that appears to relate to that complaint. Such as “chest pain” often results in a diagnosis of “unstable angina” or “pulmonary embolus."
Occasionally, something will be a little different like "back pain” turns out to be “biliary colic” or “myocardial infarction." Still, those are not surprising.However, once and a while you have a chief complaint ...
Server upgraded, apologies for lost overnight comments
Last night was the first of several technical upgrades to scale KevinMD.com for future traffic growth.The site was migrated to a dedicated server (dual Intel Xeon 5430 2.66GHz quad cores with a 12M cache for those technically interested).As a result, comments posted overnight were lost. Apologies for that.In the coming weeks, you'll see a variety of tweaks to further improve site speed and the user experience. Please let ...
Watchful waiting is underutilized for most men with prostate cancer
NPR has a great blog on their website called Shots about current events in health care. Recently, Scott Hensley, the main blogger there, posted a recent article on treatment of prostate cancer from the Archives of Internal Medicine.If you look at the article, you may notice a very small subheading above the article’s title. It reads “Less is More.”Very telling.The thrust of the article and the ...
When parents should be concerned about a lump on their child
I was recently scanning an online forum about pediatric health concerns. (What can I say? I sometimes need inspiration.) There was one thread within the forum that was significantly longer than any other. Parent after parent posted about how they had noticed a knot on their infant or toddler. This concern parallels what I see in practice. An unexplained knot on the head is a common reason parents bring their ...
How open medical charts help Healthy Survivorship
[Editor's note: Please visit part 1 of Dr. Harpham's take on OpenNotes.] "Our" ChartDoes the opportunity for patients to read their medical charts help or hurt patients' ability to become Healthy Survivors?Open notes can facilitate Healthy Survivorship for some patients.Unfortunately, other patients may learn something about their condition that makes it more difficult to get good care or live as fully as possible. Or they may experience feelings that threaten the physician-patient bond. ...
Why doctors should care about Regional Extension Centers (RECs)
Over the past year, states across the country have begun to develop Regional Extension Centers (RECs) to help support the broad electronic health record (EHR) initiative passed as part of the economic stimulus package in 2009.Why should physicians care? With benefit of a little background information, the answer is pretty clear.The evidence suggests -- and it is generally believed -- that adoption of EHRs by physicians and other healthcare providers ...
How to foster a cycle of excellence in medicine
“What does it take to be good at something in which failure is so easy, so effortless?” asks Atul Gawande in his book, Better. For medical students who will soon have responsibility over people’s lives, it’s a daunting question. It draws out our fears of messing up and making mistakes. Of getting a lower grade than our peers on a Structure Function exam. Of answering a question incorrectly and embarrassing ...
Medical malpractice and how legal waste increases overall costs
Dr. Kirsch at MD Whistleblower has written about his recent unpleasant experience with malpractice litigation. Despite having full access to the patient’s chart and medical records, the plaintiffs attorney chose to include Dr. Kirsch in the suit ... apparently ... just because ... he had seen the patient.In Ohio – where this case was filed – a plaintiff in a medical malpractice case is required to obtain an ...
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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Improve patient safety to improve healthcare quality
It has taken 13 years for us to revisit the issues in To Err Is Human, the 1999 landmark government report that...
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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...
Tech
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New classes of devices to diet and exercise
For many celebrities, their livelihoods depend on their physical appearance and they rely on armies of personal assistants, schedulers, stylists, trainers and...
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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...
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....
