Call it the McVictim syndrome. Too many pundits, public health experts and politicians are working overtime to find scapegoats for America's obesity epidemic.In his latest book, former FDA Commissioner David A. Kessler argues that modern food is addictive. In it, he recounts how he was once helpless to stop himself from eating a cookie. In a paper in this month's Journal ...
December 2010
All Stories
Accountable care organization (ACO) and medical home differences
by Kevin Fickenscher, MDIn the great healthcare alphabet soup, it’s easy to lose sight of the differences between proposed solutions for making healthcare more efficient and effective.Rather than tackling payment reform in isolation of care delivery, Accountable Care Organizations (ACOs) and Medical Homes offer a consolidated approach to both issues. While the models are still developing, various pilot programs are being implemented around the ...
Favorite ER superstitions
by 911Doc, MDER docs and nurses (and paramedics) are a superstitious lot. I thought it might be interesting for those not in the business to read about some of our superstitions. In no particular order, here are my favorites.1. The "Q" word. "Quiet." it's truly the kiss of death. The "S" word, "slow" carries the same jinx. Usually some newbie nurse or clerk who is "not ...
How to find and treat lice in children
“Dr. Roy, you’ve got to help me!”The most heartfelt pleas I ever hear from parents are for three things:
- The three year old who won’t use the potty—so can’t register for school.
- The 15 month old who still isn’t sleeping through the night.
- The school-aged girl(s) with recurrent lice.
Physicians need to compare themselves with their peers
Imagine that an innovative health plan - aware that half or more of health care cost is waste and that physician costs to obtain the identical outcome can vary by as much as eight fold - hopes to sweep market share by producing better quality health care for a dramatically lower cost.So it begins to evaluate its vast data stores. It’s goal is to identify the specialists, outpatient services and ...
Health blog posts of the week, ending December 12, 2010
Here are the top posts from this past week, based on the number of times they were viewed.1. $11,000 hospital bill from the emergency department. “What am I going to do now Doc?” asked Mike, a down on his luck, 29 year–old recently unemployed truck driver, as he handed me his hospital bill.2. 10 most expensive errors in healthcare settings. In the US, avoidable medical errors added ...
Check for skin cancer and melanoma, even with dark skin
The mole on Ivis Febus-Sampayo's face looked odd. But it wasn't until her son needed treatment for acne that she went to a dermatologist."As mothers, we're working, we're busy," she said. "I forgot about me and called the dermatologist to make sure my son was getting taken care of."The doctor removed a sliver of the mole, and reassured Ivis that it was probably nothing to worry about. Two weeks later, ...
Good patient communication by managing expectations
My father suffered a mild heart attack last year. In his 80+ years, he has never had any indication he had a problem with his heart! A variety of other health issues have arisen over time, but Dad’s heart was always thought to be as strong as could be.In fact, despite protestations (“I don’t really think these chest pains are a big deal… let me just ...
What meaningful use stage 1 will mean to patients
As State Health Information Exchanges and Federal efforts (NHIN Connect/NHIN Direct) implement the data sharing technology that will enable all providers in the country to achieve Meaningful Use Stage 1, I'm often asked "but when will this healthcare information exchange technology be able to retrieve all my records from everywhere when I'm lying unconscious in the Emergency Department and cannot give a history?"Here are ...
The secret to better healthcare is the primary care physician’s brain
When I first stared hearing about the Patient-Centered Medical Home (PCMH) concept, I perceived it to be a euphemism.For whatever reason, the concept of primary care or family medicine hasn’t resonated with politicians, corporate benefits managers, or the general public. To me "medical home" was just a warm fuzzy term that at least gave an unknowing listener a sense of the benefits of a strong relationship with a competent primary ...
Facebook Page or Facebook Profile, what doctors need to know
Now I am going to confess my bias – I am fast becoming a Facebook junkie! As an entrepreneurial physician who has to keep feeding and nurturing a business, I sense Facebook's huge potential and I'm eager to learn how to participate effectively in this brave new world.Both Twitter (an instantaneous but fleeting stream of chatter mixed in with pointers to valuable resources) and LinkedIn (a searchable Rolodex on steroids) ...
Loss of an empathic connection between doctors and their patients
It has been reported that up to 60% of doctors suffer from symptoms of psychological job-exhaustion, or physician burnout, leading to diminished career satisfaction, substance abuse, divorce, quitting the profession, and suicide.An article in a recent Journal of the American Medical Association by Helen Riess, a Harvard psychiatrist, attributes much of this psychosocial carnage to the loss of an empathic connection between doctors and their patients.The author summarizes a ...
Tobacco and alcohol kill large numbers of Americans every day
Ethyl alcohol kills large numbers of Americans every day (about 200), almost all legally.Tobacco kills large numbers of Americans every day (about 1,200), almost all legally.Americans also use many illegal psychoactive drugs and some of these also kill, but the numbers are much smaller. We don't know what the effect on American mortality figures would be if these illegal psychoactive drugs were legalized or decriminalized, but it is a topic ...
Mortality risk associated with lack of social relationships
PLoS Medicine recently published an article commenting on an earlier study exploring the link between social networking and mortality.The result speaks for itself: "the degree of mortality risk associated with lack of social relationships is similar to that which exists for more widely publicized risk factors, such as smoking." You read that right, according to this study which examined over 300,000 participants in a meta-analysis, social relationships are ...
Social prejudices may limit the accuracy of patient information
Raghav Govindarajan, ACP Associate Member, a neurology resident at the Cleveland Clinic Florida, told us about a case he saw in India that has important lessons for clinicians everywhere. The patient was a 65-year-old man who presented with chronic symptoms of burning discomfort and weakness in his left leg.His symptoms had started about seven years prior and he had been told that he had “neuritis.” He reported that he had ...
AMA helps physicians care for patients
A guest column by the American Medical Association, exclusive to KevinMD.com.As the nation’s largest physician organization, the American Medical Association (AMA) is uniquely positioned to help physicians thrive in medical practice throughout the stages of their careers.Because the AMA is led by physicians, we understand the many demands and rigors physicians face as they work to provide high-quality patient care, and we are proud to support physicians in their ...
Health IT and doctors need to bridge the cultural gap
The recent financial incentives offered by the government (HITECH) for EMR implementation are somewhat helpful but are also misleading.Most fail to recognize that the biggest obstacles to EMR implementation are not financial, but are cultural. EMR adoption will require cooperation between two disparate cultures: the Health IT (HIT) culture and the medical culture. One needs only to read a few of the EMR debates in any health care blog to ...
Evaluating a new drug is difficult for the pharmaceutical community
New medicines are like new fashions in clothing. They are introduced with great fanfare. Most turn out to seem fairly ordinary after a few years. Some are quickly forgotten or discarded and make us say: “What was I thinking?”Evaluating a new drug is difficult, for the pharmaceutical and scientific communities as well as for us clinicians. It often takes years of general use before a drug can really prove its ...
Stercoral perforation as a deadly cause of colon rupture
I got the call from the ER because I was the "no-doc" surgeon, meaning I was the guy to call when a patient showed up needing a surgeon, and who had no primary care doc to direct the referral. Usually it meant trouble. A drunk who smashed his car and himself, possibly others. Stab-wound, gun-shot. People who don't have their own doctors include more than those down on their luck; ...
Intuitive and algorithmic decision making and The Simpsons
by Tim Richardson, PTOne of the most popular Simpsons episodes ever - MoneyBART - succinctly describes the struggle between intuitive and algorithmic decision making in physical therapy.This struggle, catapulted to prominence in 2002 with the publication of Flynn's manipulation rule, is not unique to physical therapists.Physicians, too, resist the influence of decision rules and adhere poorly to clinical practice guidelines.Physical therapists share some commonalities with physicians ...
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....
