It had been a high-speed motor-vehicle accident. One car. A twenty-something male driver without passengers. No seat belt. And now, this same driver had no movement from his waist down and no sensations below his mid-abdomen.According to bystanders, he had been driving his sedan dangerously fast, some estimates of nearly 100 m.p.h., before losing control. The car veered off the roadway to the right, flipping mid-air before smacking head-on into ...
December 2010
All Stories
Sleep-breathing, your immune system, and colds
Have you ever wondered by some people never get colds? Why do other people get colds at the drop of a sneeze?An opinion piece recently published in the New York Times explains away a common myth—that you have to strengthen your immune system to fight a cold. His argument is that your symptoms of a cold are actually your immune system over-reacting to harmless viruses. This is similar ...
Why the Pre-Existing Condition Insurance Plan (PCIP) fails
by Ray CarlsonAs we all know, this past March Congress passed and the President signed The Affordable Care Act. One component of the new legislation was the creation of a program called the Pre-Existing Condition Insurance Plan (PCIP). This is a federally funded high risk pool for state residents who – having been denied individual insurance coverage within the past 12 months for a pre-existing condition – would now, theoretically, ...
Waste at hospitals in developing countries
Year: 1993Setting: Mendi Hospital, Southern Highlands province, Papua New Guinea Position: Chief medical officer for ChevronChevron is contributing to the budget of Mendi Hospital in the capital city of the Southern Highlands province. Each year, the hospital director sends a financial request to the company’s medical department, and this is my first time to review and approve it. Curious about how the money will be used, I phone the director to ...
Appendicitis in children and radiation exposure from CT scans
Recently, medical writer and pediatrician Perri Klass wrote in the New York Times about evolving issues regarding the diagnosis of appendicitis in children, which are also applicable to adults. There is well-documented concern regarding the excessive radiation exposure associated with CT scans.For example, a recent paper reported that a single abdominal CT scan with contrast delivers a radiation dose equal to undergoing more than 200 regular ...
How the pharmaceutical industry changed psychiatry
What’s happened to psychiatry over the last 15 to 20 years? That’s a big subject, discussed in many recent and excellent books. One of those books is by Daniel Carlat, author of Unhinged: The Trouble with Psychiatry – A Doctor’s Revelations about a Profession in Crisis
Should nurses become doctors to save primary care?
Do nurses want to be doctors? Of course many do.And I say, if you want to be a doctor, go to medical school. I say that as a red-blooded, licensed, board-certified, AMA card carrying, guild mentality, protectionist physician.But I am also a citizen, a patient, a taxpayer, a public health professional, and a member of the Institute of Medicine (IOM) of the National Academy of Sciences.The IOM has recently issued ...
Educate the patient about their disease and discharge plan
by Lyle Fettig, MDHave you ever discharged a patient from the hospital and had a gnawing feeling that maybe you could have done more to educate the patient about their disease, medications, and plan of care?Probably so. A recent survey published in the Archives of Internal Medicine tells us that this feeling is based in reality (I'm guessing that you already knew this) and that you ...
A better system is needed to migrate to electronic health records
Five years ago my associate and I invested sixty thousand dollars to purchase and set up an electronic health record system and eliminate extensive paper use.We researched all available systems and decided upon MediNotes because it was a large company with an excellent record of service and their system met all the national requirements for certification. We worked through our local computer vendor’s family ...
Learning from the Massachusetts experiment in universal coverage
We're learning a lot from Massachusetts' experiment in universal coverage - and some of the lessons are rather enlightening.According to Bestwire, Lora Pellegrini, president of the Massachusetts Association of Health Plans, said something along the lines of "That's the problem with the new U.S. health care reform law ... it offers millions of uninsured Americans access to health insurance but doesn't address underlying medical costs, which are contributing ...
Integration and virtual accountable care organizations in health reform
They are coming in fast under the radar, out of peripheral vision, in the magician’s other hand—and they will change everything. New ideas, surprising networks, stealth business models that may change health care profoundly, are bubbling up in pilot programs, experiments and full-on corporate transformations. There is something here that does not yet have a name, that no one is yet calling a movement, that no one is yet seeing ...
Lifestyle matters for specialties that want to survive
Medical students today consider lifestyle an essential criteria when choosing a specialty.It's become a cliche that most are looking towards the ROAD (radiology, ophthalmology, anesthesiology and dermatology) to happiness.There's been some recent media attention at how women are lured to specialties that offer a greater balance between their family lifestyle and professional demands.Claudia Golden, a Harvard economics professor, recently noted that,
high-paying careers that offer more help in balancing work ...
Creativity and ADHD may share some common genetic vulnerabilities
by Shelley Carson, PhD
Both highly creative individuals and ADHD-diagnosed individuals often report feeling out of place, like a square peg in a round hole.(In fact, in my creativity research questionnaires I actually ask the question “Do you often feel like a square peg in a round hole?” Participants who score high on the Creative ...
MKSAP: 70-year-old woman with hypothyroidism and a fractured hip
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 70-year-old woman with hypothyroidism fell and fractured her hip. During preoperative evaluation for hip fracture repair, she mentions recent mild fatigue, which has not significantly limited performance of her daily activities, and ongoing right upper-quadrant abdominal pain after eating. She takes levothyroxine, ...
Medical students need mentors
by Berry PierreAs I was browsing one of my favorite sites, Student Doctor, it hit me that a lot of the pre-medical students have no clue how to go about removing the prefix from their title.This is a problem that I know of very well because I was in their same position when I was an undergraduate. Growing up I knew that I wanted to be ...
A neurosurgical resident’s typical day
I’ve made some fairly outrageous claims about the workload of a neurosurgical resident recently. Seems like a reasonable time to lay out exactly what a day on call can be like for me and my fellow residents.To be fair an average experience may be hard to articulate. Different rotations and different days yield different … adventures. Right now I’m on a service that could hardly be called grueling, but I ...
Conspiracies against vaccines: Blame the media
How did the idea that vaccines are dangerous, toxin-filled CDC experiments metastasize so quickly from the fringe to the mainstream?Keep in mind that not only have vaccines been scientifically proven to be safe, but that some of the arguments against vaccines are so scientifically incredulous they are the equivalent of saying there is a UFO sitting in Central Park right now.So let’s begin at the beginning. In 1998 Andrew Wakefield ...
KevinMD.com recent media mentions, December 2010
I’d like to thank various media outlets for recently citing KevinMD.com.KIRO Radio: What should doctors tweet about?
But what should doctors tweet about, and how can it help you, the patient? Dr. Kevin Pho has been blogging at KevinMD.com since 2004. "60 plus percent of patients use the web to research health information," he said. "Having a reputable organization guide patients and point them to reputable information is one of ...
A community of healthy seniors inspires this physician
I have been genuinely blessed by my career in medicine.When I started medical school, I was living through a very rocky time, dealing with severe, at times suicidal depression. I was working through an outpatient alcohol and drug rehabilitation program, and I was about 40 pounds overweight. I had grown up with a very negative and fatalistic attitude toward life which resulted in chronic misery and a number of personal ...
Fruits and veggies for everyone, including doctors
Doctor, did you eat your fruits and veggies today?Two servings of fruit and three servings of vegetables each and every day?If you did not, how can you expect your patients, for whom you are supposed to set an example, to do so?The Healthy People 2010 program of the Department of Health and Human Services set as a goal that 75% of Americans would consume two or more servings a day ...
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....
