I think that I am missing a gene from one of my X chromosomes.I attended my sister-in-law's baby shower recently. I love my sister-in-law dearly and was happy to be there to support her. If only I could have supported her in another way.I detest showers. Once I was engaged, I stated clearly to everyone I knew that I did not, under any circumstances, want a bridal shower. Naturally, everyone ...
March 2011
All Stories
Should doctors be like workers on factory assembly lines?
fatigue |fəˈtēg|noun 1 extreme tiredness, typically resulting from mental or physical exertion or illness : he was nearly dead with fatigue. • a reduction in the efficiency of a muscle or organ after prolonged activity.No, this post is not a part of my twenty six installment Psychiatry A to Z series.You'll have to wait for the next one in that group, which by the way will be looking at a "T" word. ...
Gratitude from patients and their families
It is hard to imagine that someone can emerge from intern year – 12 months of chaos, little sleep, and hours upon hours spent responding to pages and putting orders in a computer – and know something, anything, about medicine. I did not believe in this training system until now, after my first night as a supervising resident. The knowledge I have absorbed over the ...
Physician reputation management in the age of social media
What is the physician's most precious possession? Some might answer that it is his patients.Others might respond it is the training and education that the physician has obtained to practice his (or her's) craft.But the real answer is that it's the physician's reputation.Doctors live and die by their reputations. Reputations take years to build but are so fragile that they can ...
Will iodine and potassium iodide protect against radiation from Japan?
People in the United States are rushing out to take iodine pills, specifically in the form of potassium iodide, to combat the threat of radiation spreading from the nuclear events stemming from the Japan earthquake and tsunami.There are numerous reports that pharmacies in California have run out of the drug.Potassium iodide works when the thyroid takes it up, instead of the potentially dangerous radioactive iodine that comes from a ...
Doctors receive no training on coding, which makes them prone to fraud
How much attention do you pay to your Evaluation and Management (E&M) Coding practices?E&M codes represent the type, setting, and complexity of services provided and the patient status, such as new or established. Providers are responsible for ensuring that the codes they submit accurately reflect the services they provide.According to the Office of the Inspector General (OIG), Medicare paid $25 ...
Health costs need to be addressed by doctors, patients, and lawyers
It's no secret that our health system encourages doctors to order too many tests. Compounded with the widespread belief that more tests equates to better medicine, the reasons why health costs are spiraling out of control aren't a secret.In a perspective piece from the New England Journal of Medicine, physician Sean Palfrey notes our dire situation:
Recent advances ...
Do Not Resuscitate and the need for a central line
Just the other day I was called to see a patient coming up to the Intensive Care Unit with a diagnosis of pneumonia. Upon my arrival the patient is "hanging in there" with the blood pressure in the 60’ and 70’s systolic.This is a no-brainer situation - the patient is in sepsis and septic shock.Early intravenous antibiotics and aggressive resuscitation is what this gentleman needs right now. Per the ER ...
Why this medical student found primary care awesome, and boring
I recently finished another 5-week clinical rotation. This one was primary care (outpatient internal medicine +/- family medicine).First a few words about primary care as a field: I found it to be both awesome and boring.It was awesome because I was the "doctor." I had essentially full responsibility for my each patient. From calling him in from the ...
Why this patient recommends her family physician
"Do you know a good doctor?" is a question tossed around in conversation sometimes. If the person is reasonably nice/intelligent, I’m happy to hand out my doctor’s name and phone number.Recently, I referred more friends to my all-time favorite doctor. Instead of just taking his name and phone number, the couple wanted to know why I like him. That’s a fair enough ...
How to prevent suicide in physicians
by Zakari Tata, MDMany articles have been written on physician suicides. Yet nothing practical has been implemented. The problem is probably much larger than reported, as families will try to avoid publicity where possible.In medicine, just as in the rest of society, people diagnosed with depression are wrongly labeled as weak, and discrimination, especially the subtle passive ...
Empathy and the physician patient relationship
Is anyone else tired of hearing about how important empathy is in the physician-patient relationship? Every other day it seems a new study is talking about the therapeutic value of empathy. Enough already!It’s not that I don’t believe that empathy is important, I do. I also believe the data that links physician empathy with improved patient outcomes, ...
Alternative medicine problems patients need to know about
Americans spend an astounding 34 billion dollars on alternative medicine annually. Given that so many of us put our faith in alternative care, I wanted to clear up some common misconceptions about it to help people make wiser choices when and if they turn to it.What is alternative medicine? In general, alternative medicine is used to describe practices outside the bounds of conventional medicine. ...
ASA addresses drug shortages to ensure patient safety
A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com.by Arnold J. Berry, MD, MPH
Drug shortages continue to impact patients across the nation. Over the past year, anesthesiologists have been faced with the challenge of finding alternatives for several unique drugs needed to safely provide anesthesia for patients having surgical, diagnostic or therapeutic procedures.Anesthesiologists have ...
How to help autistic or delayed children behave and learn
Here are ways doctors can help autistic or delayed children behave and learn.I certainly do not mean to trivialize the behavior issues that erupt as typical children develop, but the problems of atypical kids are more difficult and less likely to be fully addressed by general pediatricians and society at large.1. Understand the ABCs of behavior. Antecedent = What happened immediately before the behavior? Behavior = A description of the ...
Should hospital beds be kept full or empty?
Should physicians strive to keep hospital beds full or empty?Obviously, in an economically optimal situation, just like in the hotel business, the hospital beds that are "needed" and available should be kept pretty close to full, in order to cover fixed costs and balance the hospital budget.A recent discussion board on another physician website has called attention to an alleged practice of both emergency physicians and hospital administrators being paid ...
TMA: Vaccines, autism, and Andrew Wakefield’s wake
by Steve Levine
The sad story of the fraud Dr. Andrew Wakefield perpetrated on the world’s autism community lies at the intersection of my personal and professional lives. Could these latest revelations be the final chapter?As chief of communications at Texas Medical Association, I promote the ...
Bullying among nurses needs to stop
I do not wish simply to use the buzz word of the hour. Nor do I wish to assert that I have all the answers.I genuinely desire to bring to light an interesting conflict that has plagued the nursing profession for decades.Bullying.Why in a profession centered around the concepts of compassion, caring, and healing has a mindset of bullying permeated the culture. Even more confusing is that most often, this ...
Danger of multiple emergency room visits to different hospitals
If you are one of the more than 100 million Americans who visit emergency rooms (ER) at least once a year, you’re not alone.Americans, insured and not, make ample use of hospital emergency rooms. One out of every five visited an ER at least once in 2007, the latest year for which the National Center for Health Statistics ...
The differences between comparative and clinical effectiveness
by Peter J. Pitts"Newspeak," the language of Big Brother, was designed "not to extend but to diminish the range of thought."Some well-known examples of Newspeak are Bellyfeel (a blind, enthusiastic acceptance of an idea), Duckspeak (meaning literally to quack like a duck or to speak without thinking), Crimethink (the Newspeak word for thought crime) and Goodthink (or "political orthodoxy").Which brings us from the nightmare fantasy of "1984" to the health ...
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....
