Physicians hate acid. But, hey, who doesn’t hate acid? It burns things. It corrodes. It’s that after-pizza punishment.We prescribe antacid medications by the ton in this country, not because people’s stomachs have developed increased acidity, but because people in our modern society are generally overweight, like to eat large meals, and prefer fatty foods and things like alcohol, chocolate, and tobacco, all of which tend to worsen acid reflux.Physicians like ...
November 2010
All Stories
Should patients be charged for no shows?
No shows. It seems that no matter what we do, we always have them.Despite the fact that we call every single person on the schedule to remind them of their appointment the day before (the staff personally makes the call. We don’t use an automated system) we found that in 2009, we had 389 no-shows.Slicing the dataIs 389 a high number of no-shows? I guess it depends on the size ...
How small private practices can still thrive
Health care is changing at lighting speed. If you don’t know this, or worse, don’t accept it you’re doomed. No. Really. It’s change or close shop. Whether you like it or not, health care reform is going to change the way we practice from now on.Many physicians are choosing to work for large group practices to buffer themselves from directly dealing with change. Mental health providers could do the same, ...
Talk with your family about their end of life wishes
by Alexandra Drane and the Engage With Grace teamFor three years running now, many of us bloggers have participated in what we’ve called a “blog rally” to promote Engage With Grace – a movement aimed at making sure all of us understand, communicate, and have honored our end-of-life wishes.The rally is timed to coincide with a weekend when most of us are with the very people with whom we ...
Pregabalin for HIV related distal sensory peripheral neuropathy
Published earlier this year in the journal Neurology – not typically on my radar screen — is this remarkable study comparing pregabalin to placebo for HIV-related distal sensory peripheral neuropathy.Here are the results:
At endpoint, pregabalin and placebo showed substantial reductions in mean Numeric Pain Rating Scale (NPRS) score from baseline: -2.88 vs -2.63, p = 0.3941 ...... Individuals with HIV-associated neuropathy achieved NPRS treatment effect size similar to those in ...
Bedbug rashes, and how to prevent and get rid of bedbugs
There’s a new bunch of bloodsuckers running rampant in cities all over the country.No, they’re not on a new vampire TV show or in a Twilight sequel. They’re bedbugs, and they’ve been showing up in droves in more and more cities across America. And despite what is commonly thought about them, bedbugs do not exist only in the poorest sections of town, they are showing up at 5-star hotels.That means ...
Never forget to advocate for your patient
There are some lessons we learn and keep re-learning in medicine. For me some of these recurring lessons are,
- Listen to your "gut."
- Pay attention to the clues.
- Listen to your team.
- Don't be afraid to call for help.
- Stick to your guns when advocating for your patient.
Penicillin and the Cocoanut Grove fire in Boston
by Nancy WalshThe recent report of the deliberate infection of Guatemalans with syphilis in the 1940s to see if penicillin could cure and prevent transmission of the disease was a reminder of just how short the time has been since most infectious diseases were untreatable. Penicillin -- discovered by Scottish biologist Alexander Fleming in 1928 but not available for clinical use until the 1940s -- ...
Drug reps know what doctors are prescribing
An excerpt from White Coat, Black Hat.by Carl Elliott[Michael] Oldani worked as a rep in the late 1980s and the 1990s, a period when the drug industry was undergoing key transformations. Its ethos was changing from that of the country-club establishment to the aggressive, new-money entrepreneur.Impressed by the success of AIDS activists in pushing for faster drug approvals, the drug industry increased pressure ...
Why comparing healthcare access to food is a false analogy
When I was in training as a resident and a fellow, I remember taking only a couple of sick days over the entire 6-year period.And I had to stay home because I could not stop praying to the porcelain Goddess during a bout of a particularly nasty flu, despite a vaccination. I actually took pride in my health record, and attributed it directly to being rather sickly as a child. ...
There is no routine procedure in general surgery
The life of a general surgeon is one fraught with contingency, soul-crushing doubt, unexpected disaster, and overwhelming stress. I wouldn't wish it upon my worst enemy. Fortunately, I was brainwashed to a sufficient degree during residency such that I actually don't mind my job.One of the reasons general surgery is so tough is that it is nearly impossible to map out your week according to a strict schedule. Maybe at ...
Diabetes and leg amputations in McAllen, Texas
The Dartmouth Atlas of Health is once again throwing a harsh spotlight on McAllen, Texas.This time the Mexican border town has the highest rate of leg amputations in the nation, a new report released recently showed. McAllen's rate was ten times the rate of Provo, Utah, which had the lowest rate of leg amputations among the Medicare eligible population. The national average was one-third of McAllen's rate.McAllen became ...
ACP: Health care innovation in the Affordable Care Act
A guest column by the American College of Physicians, exclusive to KevinMD.com.by John Tooker, MD, MBA, MACP
The Patient Protection and Affordable Care Act (PPACA) has important provisions – improved access, safety and quality among them – that have the real potential to improve health and health care and, lower costs.Two recent reports remind us of the urgent ...
Noninvasive fat removal in plastic surgery
One of the hottest things in plastic surgery is noninvasive fat removal.I’ve mentioned on Rachael Ray Showthat fat removal without any invasiveness is the ‘holy grail’ of plastic surgery, and I still stand by it. I’ve gone over the Zerona a few times, but what about Zeltiq, a.k.a. Cryolipolysis? Does this device actually remove fat without surgery or needles?Well, let’s review the different fat removing technologies:1. Diet and exercise. The ...
Why you should care about prison healthcare
It was kind of amazing how little coverage the recent report on healthcare in our prison systems got. Heck, you may be thinking, I don’t think that’s amazing – why waste airtime on that topic – why should I fret and worry about the healthcare that prisoners get when my child is burning up with fever and coughing up a lung and I can’t even afford to take ...
Breast cancer transforms a doctor in training to patient in an instant
by Jessica Tekla Les, MDDuring my third year of medical school I was performing a routine breast exam, more for practice than anything else. I was trying the concentric-circles-around-the-nipple technique, one of several I'd been taught. About halfway through the right breast I found a lima-bean-sized lump, not far from the breastbone. I took liberties with this particular exam. I poked the lump, tried to ...
Will primary care be saved by the community health center?
As I have written before, the Teaching Health Center is seen as a way to move education into the community (using Community Health Centers as a training resource) and out of the Academic Health Center.Currently, 20 million Americans receive care in a CHC. They serve Americans who are unable to obtain access through more traditional means, either because of location (the community will not support traditional healthcare) or socioeconomic ...
Do online physician rating sites help patients to choose a good doctor?
The following op-ed was published on October 27th, 2010 in USA Today.When I ask new patients how they found me, frequently they say on the Internet through search engines such as Google.Out of curiosity, I recently Googled myself. Numerous ads appeared, promising readers a "detailed background report" or a "profile" of me. Among the search results was information about my practice, whether I was board certified, had any lawsuits against ...
Depression and whether a behavioral problem is mental illness
It has been said that depression is the epidemic of the 21st century. Certainly the rates of diagnosis have increased over the last 10-15 years. Some claim that this is due to better recognition of the issue and that actual rates are unchanged. Others feel that we are collectively more depressed than in years gone by.The number of Americans prescribed an antidepressant doubled between 1996 and 2005 and those being ...
Trust your life records to an unnamed chain of software vendors
Every day millions of Americans and billions of people around the globe are routinely accepting colorful pieces of paper in return for their labor and placing those hard earned possessions in modern glass buildings whose owners they do not know.It took a few hundred years to change how business transactions are conducted, but today, there is very little apprehension about depositing one’s wealth in a bank. Public trust in both ...
Kevin Pho, MD
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How patient satisfaction can kill
Patient satisfaction is all the rage. Medicare is beginning to tie patient satisfaction scores with hospital reimbursement, and doctors across the country...
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How I approach ovarian cancer screening with patients
Ovarian cancer screening clearly touches a nerve. No one doubts that ovarian cancer is a devastating diagnosis, often found when the disease...
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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....
Physician
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The analogy between baseball hierarchy and medical systems
From age six through high school, I played baseball. Playing baseball ended, rather abruptly it seemed, when I went to college, but...
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Saving patients from Internet health information
Lately, I get the feeling that I’m doing something wrong. I’m supposed to form a partnership with my patients. My patients are...
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Understanding what patient centered care really means
There was nothing the professor despised more then the syrup that oozed out of his partner's lips when dealing with patients. He...
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A letter of thanks to my organ donor
I have tried to write a letter of thanks but don't know what to say or even how to begin. I don't...
Patient
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Why patient engagement is reciprocal
It is said that "turn around is fair play." So if providers (physicians, hospitals and other health care professionals) expect patients to...
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Question the price of drugs and medical procedures
Hypertension was the trigger that forced medical cost awareness to the forefront. My doctor decided that with my rise in blood pressure...
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In love there is a life giving force
Here is a toast to the miracle of love. Not to the romantic, chocolate, dance club nightlife type of love. Not warm...
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How to get ready for death
No one wants to die. Even people who want to go to heaven don't want to die to get there. And yet...
Policy
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America has a medical care system not a health care system
As Americans we believe we have the best healthcare system in the world. But think again, it’s really not the truth. We...
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Reading between the lines of breast cancer treatment studies
Between the Susan G. Komen-Planned Parenthood debate and the study on treatments released by the Journal of the American Medical Association recently,...
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Why are labor and deliveries closing?
Labor and deliveries are slowly closing across the United States: California, Pennsylvania, and Ohio. In regional areas where there have been no...
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America has a health care paradox
We have a real paradox in American healthcare. On the one hand we have exceptionally well educated and well trained providers who...
Tech
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Why physicians don’t want patients to have their cardiac device data
There is a groundswell of discussion concerning patients demanding to have direct access to data derived from their implantable defibrillators and pacemakers....
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Impersonal communication on the Internet fuels cyberbullying
In the old days, bullying used to consist of name calling or physical aggression from someone in a position of power over...
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Health IT and doctors: A framework for successful partnerships
We are on the front lines of the healthcare revolution along side our patients and our colleagues in technology. We have firsthand...
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Break out of the prison of the American health care delivery system
Speaker after speaker at the recent Care Innovations Summit in Washington, DC concluded that increasing the quality and decreasing the per-capita cost...
Social Media
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Why doctors should embrace Google+
Lots of pressure out there for you to be on Facebook and Twitter, right? The ultimate question, though, is how are you...
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Using Twitter to deliver health improvement messages
I have decided to spam for public health. Phone calls, text messaging, and even apps have been shown to help improve health...
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Addressing comments on your medical practice’s Facebook page
Does your medical practice allow anybody to post links and comments on your Facebook page? The short answer is yes. We do....
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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...
