As in anyone’s life, the hardest thing to achieve in life is a balance. Whether it’s work, school, home, or play, it’s just plain tough. For those of us with challenges such as cerebral palsy, it brings a new set of challenges. Here’s why.Task execution takes longer. Where it might take my sister thirty minutes to get herself ready and out the door in the mornings, it will take me ...
March 2011
All Stories
KevinMD posts of the week, ending March 13, 2011
Here are the top posts from this past week, based on the number of times they were viewed.1. Primary care physicians are rebelling against the system. The system has made primary care physicians suffer emotionally and financially.2. What is a difficult patient, and how doctors may be responsible. Doctors can tell many tales of what they term as a difficult encounter. Just as many patients can recall ...
Withholding liver transplants for Medicaid recipients in Arizona
Governor Brewer’s decision to withhold liver transplants for Medicaid recipients in Arizona should serve as a loud warning to the electorate regarding governmental intrusions into health care financing and health care operations.The decision was ill advised on the basis of multiple factors. The survival rates differ from one facility to another.What is the liver transplant survival rate and what information needs to be considered when looking at such numbers?For example, ...
Smart biosimilars approval pathway key for patient safety
by Earlexia M. Norwood, MDThe Department of Health and Human Services (HHS) is second only to the Department of Defense in its total budget, but first in the Federal government in terms of its influence on most American’s daily lives.The most important agency within HHS is the Food and Drug Administration (FDA), which protects our food supply and keeps tabs on new pharmaceuticals to ensure they are ...
Humility in medicine and our academic training environments
I sometimes wonder if we spend too much time talking about professionalism.It is not that I don't think we should promote professionalism. Of course we should. But many discussions of professionalism descend into overly academic and scholarly treatises that end up obscuring rather than clarifying the values such discussions hope to promote. It may be a mistake to overly ...
Why team based primary care won’t help evidence based medicine soon
Despite the advances in evidence-based medicine, not every patient benefits.In a recent column from the New York Times, Pauline Chen looks at a study showing exploring the issue:
For many patients, evidence-based medicine isn’t working. Two-thirds of patients with diabetes, a disease with some of the strongest evidence-based guidelines available, continue to have trouble controlling their blood sugar levels; and only half of all ...
Prevention of disease and monitoring of chronic diseases in a yearly physical
When I go to the doctor for my yearly physical (OK, not quite yearly, but…) he puts me through the ringer. He asks me dozens of questions, follows up with more questions, and does a (thorough!) physical exam. Then he takes some blood, and sometimes runs some other tests. The big question is "why"? What are ...
What should we expect of a physician leader today?
What should we expect of a physician leader today? I believe it should be something much different than what leaders do now.Today, a hospital physician CEO might be expected to develop new or improved clinical programs, in part by recruiting the best and the brightest, by building new wings, and by purchasing new technologies. The measure of success would be improved finances as a result of added ...
Japan earthquake and tsunami first hand physician account
An international ACEP member has been giving real-time updates to the ACEP Disaster Section about the developing situation in Japan. He agreed to share the information with the emergency medicine community and will try to continue to provide updates when he can.
by Dr. Takashi NagataFriday, March 11, 2011 1:13 AM CSTHello. I am Dr. Takashi Nagata, ...
Challenge the constitutionality of EMTALA
Here is a letter to the editor in a recent Philadelphia Inquirer:
… In 1986, Congress passed and President Ronald Reagan signed the Emergency Medical Treatment and Active Labor law, which requires hospitals to admit all who arrive at the emergency room and treat them without regard for their ability to pay.In essence, we had federally mandated national health care – ...
Making sense of colorectal cancer headlines
by Robert Bresalier, MDDid you hear the one about the cancer-sniffing dogs?Sounds crazy, right? This is just one of many recent headlines that may leave you scratching your head.Not every study you read in the news is the final word. But recent research can provide interesting new insight on colorectal cancer — the second leading cause of cancer death in the United States.Here’s some insight to help you make sense ...
What will prevent the iPad from dominating health care IT?
iMedicalApps reviewed some recent news articles regarding business/enterprise adoption of the iPad as a legitimate alternative to Windows machines in the workplace, taking it as a sign that healthcare IT is poised to adopt it, too: "All in all, these developments bode well for the adoption of the iPhone and iPad as a mainstream, IT-blessed mobile ...
Aspects of psychiatry this doctor appreciates
Working as a psychiatrist is very rewarding. It’s stressful in a unique way, and some people may look at me strangely for having an unusual job. But overall I really enjoy it. Here are some of the aspects of psychiatry that I really appreciate.1. Being trusted. Psychiatrists meet people when they are at their most vulnerable points, and we are entrusted with extremely ...
AMA push against Medicare recovery audit overreach
A guest column by the American Medical Association, exclusive to KevinMD.com.The Centers for Medicare and Medicaid Services (CMS) has pushed back the April 1 deadline for states to implement their Medicaid recovery audit contractor (RAC) programs until an unspecified time later this year. The implementation delay was welcomed by the American Medical Association (AMA) and other national physician organizations who have vocally urged CMS to improve its proposed Medicaid RAC ...
Using Facebook, Twitter and other social media to change health care
Ten years on, Ian Morrison’s "Hamster Health Care: Time to Stop Running Faster and Redesign Health Care" is still eminently applicable.In his words:
Across the globe doctors are miserable because they feel like hamsters on a treadmill. They must run faster just to stand still. In … the managed care systems in the United States doctors feel that they have to see more patients to maintain their incomes. But systems ...
Taking Chantix to help smokers quit may be worth the risk
I decided to dedicate a medical blog on smoking cessation after realizing that too many people in Douglas County (Omaha, Nebraska) smoke. Did you know that despite a smoking ban in restaurants and bars, 18.3% of people in Nebraska are smokers? That's one in five people. And this number contributes to Omaha's health ranking of 142 out of 182 cities in ...
High rate of surgical site infections (SSIs) in our nation’s hospitals
By now, most healthcare professionals -- and many well-read consumers -- are aware of the disturbingly high rate of surgical site infections (SSIs) in our nation's hospitals.Each year, approximately 500,000 surgical patients develop SSIs. In some types of operations, such as colorectal surgery, the rate is close to 10%.Many hospitals submit information about SSIs in their institutions through the ...
Gout is a common cause for episodic joint pain and swelling
For Christmas Eve dinner, our family congregated at Café Opera, in the Intercontinental Hotel for a scrumptious seafood buffet. Going to a buffet is a little bit evil, as you know that you’re about to commit the sin of gluttony.I usually tell my patients who suffer with gout to avoid buffets. That 3rd mountain of prawns may precipitate an acute episode of gout. Christmas party season is a dangerous time.Overindulgence ...
What is a difficult patient, and how doctors may be responsible
What, exactly, is a difficult patient?Doctors can tell many tales of what they term as a difficult encounter. Just as many patients can recall doctors whom they would say are difficult to work with as well.According to a study from the Journal of General Internal Medicine, here's a definition:Patients deemed difficult included those with more than five symptoms, severe symptoms or an underlying mental disorder or were less functional. These ...
Signs that your practice is ready for EMR
My current practice is getting ready to go live on Electronic Medical Records (EMR), but it’s taken us over a year to get here. When I first started this job, we were supposed to go live with EMR in two months. After I’d had a chance to speak with everyone, I just knew the timing wasn’t right for the EMR. We would need to be able to run, and at ...
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....
