I’m thankful that I don’t have to research symptoms on the internet, diagnose myself, and come up with my own treatment. All I have to do is go to my doctor and describe my symptoms. My doctor can listen to my symptoms, match them up to what he knows, ask questions to pinpoint what might be going on, order appropriate tests, and recommend a treatment plan.Odds are, when people get ...
January 2011
All Stories
HPV test: Doctors are still not following testing guidelines
by Brian Jackson, MD and Brian Shirts, MD, PhDWe’ve heard a lot of talk lately about personalized medicine (i.e., using advanced diagnostics to guide customized therapy).A great deal of research is going into creating new molecular and genetic tests. But whether the health care system is prepared to actually generate value from these advanced diagnostics remains an open question. Our group’s research, presented in ...
Primary care doctors and specialists need to better communicate
Whenever I refer a patient to a specialist, a copy of the patient's recent notes, labs and diagnostic tests is faxed to the specialist -- in many cases, prior to their visit.And most of the time, after they see the specialist, I receive a fax back describing what happened.You'd think this is standard procedure, but it doesn't happen as often as it should.A study from the Archives of Internal Medicine ...
5 reasons doctors should love the Healthy, Hunger-Free Kids Act
The Healthy, Hunger-Free Kids Act provides increased funding beyond inflation for school meals for the first time in 30 years and addresses both food insecurity and obesity in children. Here are the details:1. Growing bodies and brains need good nutrition, the best medicine for our patients. Children at or below 185% of the poverty level qualify for free or reduced cost meals. Although children compose only 25% of ...
Alzheimer’s disease diagnosis criteria: A critical review
Generally, Alzheimer’s disease is diagnosed only after patients have progressed to major levels of cognitive impairment that results in substantial problems in daily functioning. But the brain changes that result in cognitive impairment start years, if not decades, before patients become symptomatic. So, wouldn’t it make sense to try to diagnose Alzheimer’s Disease in patients who have the brain changes, before they have clinical symptoms?The answer would be yes if ...
How public health and MPHs are influencing medicine
Way back in the mid 20th century when I graduated from George Washington University with an MD degree I imagined that I had arrived.I remember my classmates selecting different specialties and eventually going off to clinical training. I could not imagine doing anything other than clinical work, and perhaps dabbling in some clinical research. Some of my friends were studying ‘epidemiology’ and a new field ‘public health’. At that time, ...
How patients can advocate for themselves
Advocacy is an important and vital skill for any young adult, but young adults with cerebral palsy and other disabilities have a bit of a unique need for developing the skills. I would argue that the skills needed for self advocacy need to have the opportunity to develop in small ways when a child becomes a toddler.For me, the roots of my advocacy were planted in the years prior to ...
The safety of biosimilars and FDA regulation
by John HortonWhen the FDA was created in 1906, not even Nostradamus could have predicted the medical advances that would come to extend and improve our lives: childhood vaccines, insulin, and the use of lasers in surgery were all unimaginable a century ago.While many future advances are beyond our imaginations’ reach, it seems certain that the advances in biologics -- medicines made from living organisms -- will stand out as ...
A culture of fear worsens the nursing shortage and medical errors
There has been a lot talk about changing how we reimburse providers for healthcare from one that pays for services performed, to another that reimburses providers depending on what happens to the patient.I think we must take a couple of steps back and first tackle the public health crises we are facing that is putting our healthcare in danger, namely, medical errors and the growing nursing shortage. Despite identifying work ...
Are physicians motivated by virtue or are they passive victims?
An interesting article in JAMA by Drs. Jain and Cassel referred to the British economist Julian Le Grand who suggested that public policy “is grounded in a conception of humans as knights, knaves or pawns.”Basically, are we motivated by virtue, by self interest or are we just passive victims? The authors suggest that this is a good question not only for physicians to contemplate but ...
Disconnect between knowledge of STIs and behaviors to reduce risk
In my opinion, people are often too embarrassed to see their doctor about sexually transmitted infections (STIs)—in my opinion.“In my opinion” is one of the most dangerous phrases in science. But when in comes to attitudes toward STIs, the data are scarce. STI’s are very much a “behavior”-based disease, so knowing what attitudes prevail can help us design effective prevention strategies. Attitudes toward HIV have been ...
KevinMD posts of the week, ending January 9, 2011
Here are the top posts from this past week, based on the number of times they were viewed.1. Is more primary care really better? Proponents of health reform have long claimed that one of the biggest problems with our health care system is an overemphasis on expensive specialists and an underemphasis on primary care physicians.2. Permanent makeup risks and dangers. Permanent makeup—aka micropigmentation, dermal pigmentation, permanent cosmetics, cosmetic ...
Can a doctor dodging a question help the patient?
Doctor D has dodged some questions in his career, but he has also been on the receiving end of some non-answers and can attest to their usefulness on the patient's side of things.How can a doctor dodging a question help the patient?Let me tell you a story:Doctor D’s son Little D was born with a very rare genetic condition which required he see an expert at a big university. As ...
Lotteries in life may have to do with suffering, disability and death
Winning the lottery -- yes, I've heard the horror stories of how people's lives have taken a turn for the worse after it's happened. But, like many others, I still wonder what it would be like. I'd be willing to take my chances with the win!But this post is not about money. Not at all. Actually it's about gratitude.It's about the many 'lotteries' in life that have nothing to do ...
Employing a virtual assistant in your medical practice
by Daniel McKennitt, MDThe many benefits of utilizing virtual assistant in the physician’s office have become clear to many. Physicians report greater job satisfaction, patient retention and cost-efficiency as some of the most obvious areas impacted by the use of virtual assistants in their practices.Physicians preparing to shift some of their staffing needs to a virtual assistant or virtual assistance company have many questions and concerns that will be addressed ...
A cartoon guide to learning in medical school, residency and fellowship
(via A modest proposal for a truly useful EMR
I love computers. Really, I do. Despite my oft-repeated claims about the shortcomings of electronic medical records in their current form, I do believe that information technology has the potential to be of great help to me and other physicians in providing quality care to Americans.Stop laughing. I really mean it.I do not believe, however, that IT best serves the medical needs of our patients when ...
Explore information technology and safely digitize medicine
We have an intuitive sense of what is meant by those urging medicine to "go digital." It seems to refer to modernizing, becoming more flexible, and basically following the path of modern computing and information technology.Is it useful to think more rigorously than this hazy conception, without necessarily reading a special report from The Economist?Digital information is special because it can be transmitted to and instantiated within any number of ...
Common things are common, except when the diagnosis is rare
During my training at Hennepin County Medical Center (HCMC) in Minneapolis, MN, my mentor would use the following teaching pearl during rounds: "When you hear hoofbeats, think of horses not zebras!" He would also frequently use: "If it looks like a duck, swims like a duck, and quacks like a duck, then it probably is a duck." What did my mentor, the Sage of HCMC, mean by this?From Wikipedia: "Zebra ...
Little Patient Big Doctor: One Mother’s Journey, an excerpt
An excerpt from Little Patient Big Doctor: One Mother's Journey.by Haleh Rabizadeh ResnickDear Doctor,I want to share with you my experiences with two of my children . . . . I share the hecticness our lives with you for a reason. We are all the same. We are all busy. We all face adversity. And while we want most to trust the opinions of professionals, ...
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....
