One of my best friends in med school was an O.B. nurse. Though she has moved almost all the way across the country and I haven't seen her since I was in school, we're still in touch and expect to be seeing each other at last in a couple of months.By some coincidence one of my best friends now is also an O.B. nurse. I'll call her Ziva (yes, I ...
January 2011
All Stories
Should obesity be classified as a brain disease?
Many of our most popular stories are about diets and weight management.Did you know that some psychologists and psychiatrists would like to classify obesity as a brain disease? The reason for this is that there is mounting evidence that food, or certain types of food, can trigger the same addictive effects in the brain as drugs like heroin and cocaine. There is also substantial evidence that some people lose control over ...
KevinMD posts of the week, ending January 23, 2011
Here are the top posts from this past week, based on the number of times they were viewed.1. Why doctors should profit from dispensing medications. Hold onto your hats. I am about to enter dangerous territory. I am about to suggest maybe doctors should profit from dispensing medications from their office to offset declining reimbursements and rising expenses by using prescriptions as a source of ancillary revenues.2. Patients ...
How MD anesthesiologists have become victims of their own excellence
The New York Times has jumped all over a couple of recent scientific articles asserting that certified registered nurse anesthetists (CRNA's) provide equivalent care as MD anesthesiologists. Already, it is legal in 15 states for CRNA's to dispense anesthesia without the overarching supervision of a physician.Furthermore, a study from the Lewin Group in California has demonstrated that CRNA-only models of anesthesia provision are far more cost effective that ...
Problems with the connection between thimerosal and autism
An excerpt from Tabloid Medicine: How the Internet is Being Used to Hijack Medical Science for Fear and Profit.by Robert Goldberg, PhDFrom the beginning, there were two problems with the connection between thimerosal and autism. The first problem with was that thimerosal, while about half mercury, contains ethyl mercury, for which there were no exposure guidelines. So the scientists used the ones for methyl mercury. However, the ethyl mercury ...
Payment systems must take into account the art of medicine
You know that joke about the farmer whose cows are not producing enough milk? A university panel gathers under the leadership of a theoretical physicist. They analyze each aspect of the problem thoroughly and carefully, and after much deliberation produce a report, the first line of which is "First, assume a spherical cow in a vacuum."This joke has become short-hand for some of the reductionist thinking in theoretical physics, but ...
Malpractice fails when it comes to medical errors
Here’s your multiple choice question to set the stage: what percentage of all physicians do you think should be sued for malpractice?Would you say one-in-ten doctors ought to be sued? Or one-third? How about every single one of them? Let’s make it one claim per doctor, nationwide. Does that sound reasonable? Keep in mind that even defending yourself against a suit will cost on average $40,649 per claim, ranging from ...
Are parents to blame for childhood obesity?
Childhood obesity is a problem. It is a function of the foods children eat both at home and at school. The people responsible for feeding children are parents not advertisers. Running the line that it is all to do with advertising allows adults to run a "Johnny told me to" line, which would not be accepted as an excuse from a child.It is not about blaming parents. It is about ...
How effective will the physician payment national database be?
ProPublica.org did some interesting frontrunning on the physician payment national database that will become operable sometime around 2013 as part of health care reform.In the first of a series of stories that has been picked up by several mainstream media outlets, the New York-based investigative journalism non-profit culled all the physician payments that have been publicly posted by seven drug companies to date. It aggregated the dollars to ...
Menopause and cancer: What women should know
Menopause often brings more than physical changes. It also may bring uncertainty about cancer risks and cancer prevention.Below, I’ve compiled some of the questions I frequently hear from patients about menopause and cancer. I hope these answers will help other women start informed conversations with their doctors about menopause-related concerns.How does menopause affect a woman’s cancer risk? Menopause does not cause cancer. But your risk of developing cancer increases ...
Mental illness in the college student
Along with millions of Americans, I've tried to comprehend the tragic shootings in Tucson, reaching deep within myself to find compassion for a young man who has forever changed the world for himself and so many others through his actions.For those of us who assess, diagnose and treat college students struggling with mental illness while trying to succeed in their academic pursuits, the events leading up to his impulsive killings ...
Compassion and decency overwhelmed by fear
by Eileen M.K. Bobek, MDThe year after I finished my emergency medicine residency, I had all four of my wisdom teeth pulled.Afterwards, I looked as if I had taken several punches to my face. My jaw was swollen, my skin a cornucopia of muddied blues, purples, greens, yellows and reds. If people didn't know better, I told my husband with a laugh, they might think that I'd ...
Personal responsibility and societal structure changes that reduce obesity
I visited my parents this past week. The are both in their 80s and in relatively good health although my mother received a diagnosis of diabetes while having a medical exam for an unrelated problem. I spent some time educating her about Type 2 Diabetes, the causes (genetics and weight gain) and the options (medication and/or weight loss and exercise). I stayed with my brother-in-law and sister and the conversation ...
EHR data is currently ill suited for clinical research
One of the most promising uses of Electronic Health Records (EHR) is research.As EHRs become more and more widespread and the clinical data previously held in silos of paper charts becomes fluid, exchangeable and duly collected, large clinical repositories should emerge and be made available to those engaged in research, presumably medical research. The results of such research are expected to help us identify cost effective therapies, health care trends ...
5 ways to improve your medical practice in 2011
Here are five things that you should have on your 2011 To-Do list.1. Start electronic prescribing. What have you been waiting for? The EMR/EHR? (See number 4 below.) Electronic prescribing can work in a stand-alone (no EMR/EHR) environment. Work flow can be modified, and you will benefit tremendously with additional nurse time available to you after the nurses realize how much phone time they save each day.Ask your current practice ...
Patients Google their symptoms, doctors need to deal with it
Many doctors roll their eyes whenever patients bring in a stack of research they printed out, stemming from a Google search of their symptoms.A piece by Zachary Meisel in TIME.com describes a familiar scenario:
The medical intern started her presentation with an eye roll. "The patient in Room 3 had some blood in the toilet bowl this morning and ...
How Millennial physicians will impact disease management
Oh, those Millennials.Also called "Generation Y," this is the American demographic group born during and after the '70s, that was vicariously raised by "learning is fun" Sesame Street and became accustomed to getting awarded for any effort. They don't know about bomb shelters, walking to school, tape decks or having to get up to change a TV channel. Well, they're now entering the workplace and their informality, disregard for rank, ...
Maternity leave and infant brain development
It is not until about eight weeks of age that an infant has a fully developed capacity for mutual gaze.Then a baby looks directly into his mother’s eyes, while she, in turn, reflects back this loving gaze, cooing softly in response to her baby’s earliest communication. When a mother looks at a baby in a way that communicates with him, not with words but with feelings, “I understand you,” he ...
Superior customer service to grow your practice
Can you succinctly state what your company does, where it’s headed and how you plan for it to get there?In the April 2008 edition of Harvard Business Review, Collis and Rukstad ask an important question: "Can you say what your strategy is?"Of course, they ask this because their research found that many firms’ CEOs cannot succinctly summarize their organization’s strategy. And if the CEO cannot do this, then it’s a ...
Worsen the nursing shortage with more nurse practitioners?
by mdstudent31One of the hot topics occurring in the health care debate deals with figuring out appropriate leaders of the Patient Centered Medical Home (PCMH). With the recent report by the IOM advocating for independent practice by nurse practitioners, many physician groups, including the AAFP and AMA, have come forth with strong statements advocating against the IOM report and independent practice ...
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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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...
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I learned the value of listening to the patient
William Osler famously said (among other things): “Listen to the patient. He is telling you the diagnosis.” I was doing my obstetrical...
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Repeated experiences of shaming are not good for a young child
The little boy, who looked to be about two, darted away in a fit of giggles. His young mother, who seemed thoroughly...
Patient
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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...
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How I became a hospice volunteer
People often ask me how I became a hospice volunteer. For the record, nobody is more surprised than I am. You know...
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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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...
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Robotics can revolutionize the delivery of medical care
Robotics has the potential to revolutionize the delivery of healthcare. It can help extend the delivery of information, expertise and clinical care...
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....
