Dr. Kevin Kikta was one of two emergency physicians on duty at St. John’s Regional Medical Center in Joplin, MO on Sunday, May 22 when an EF-5 tornado struck the hospital.by Kevin J. Kikta, DOYou never know that it will be the most important day of your life until the day is over. The day started like any other day for me: waking up, eating, going ...
May 2011
All Stories
Why medical students should be closely observed with patients
I went off to medical school thirty-seven years ago.For the era, I went to what folks regarded as a very progressive place. It had a curriculum that was quite revolutionary for the time. Among other things, we started having interactions with actual patients during our first year, rather than the third year, as was traditional then.These days many, probably most, medical schools ...
What medical professionalism has to do with the federal debt
In recent weeks, headline news has been reporting on the battle to curb the federal debt. What does this have to do with medical professionalism?The federal government must borrow forty cents of every dollar it spends. In health care, it needs to borrow from China and other lenders to reimburse doctors, hospitals and other providers who bill federal programs.The government’s debt totals $14.3 trillion. It is ...
Questions to ask before moving from a paper chart to an EHR
The transition from paper to EHR is a major policy decision that can have repercussions on patient service, your operations and even your medical professional liability (MPL).Unfortunately, many practices are not taking the time to analyze their options and responsibilities from a patient care and compliance standpoint. In order to set the correct framework for your effort, you should think ...
Shared decision making in the golden years
by Mary McNaughton-Collins, MD, MPHAging does not have to be all about appointments, pills, tests, treatments and procedures - instead aging should be about celebrating life and rewarding those older individuals who are "living well" by encouraging pursuits outside of the medical realm.The current state of our health care system tends to revolve around the idea that "more is better," however, that is not always true -- especially when caring ...
In medicine, the greatest save is not having to make a save at all
In the real world of medicine, "great saves" are rare. Most patients that you expect to die will die, and those who experience a cardiac arrest or code rarely survive. Mr. GR is the closest I’ve seen to an exception to both of these rules, and his story illustrates the best but also the worst of what our health care system achieves.I first met Mr. GR in the emergency room. As ...
Guiding patients through fragmented health care
"The most important thing I learned was that different doctors know different things: I need to ask my internist different questions than I do my oncologist."This was not some sweet ingénue recounting the early lessons she learned from a recent encounter with health care. Nope. It was a 62-year-old woman whose husband has been struggling with multiple myeloma for ...
Would free medical school be enough to save primary care?
Medical school should be free.That's an argument made by physicians Peter B. Bach and Robert Kocher in the New York Times.This isn't a new concept. I've discussed whether medical school should be free for students who choose primary care. And, for some in the country, it's already happening. Like at Case Western Reserve University, for instance. The ...
Helping with the psychosocial needs of patients
The psychosocial needs of patients can feel overwhelming for a doctor.Our rite of passage as medical students, after all, is anatomy, not sociology. Even now, after a family medicine residency specializing in the biopsychosocial approach to medicine, I still brace myself for surprises before asking routine mental health screening questions of the patients in ...
Physicians should blame themselves for why they are unhappy in medicine
by Setu Mazumdar, MDEverywhere I go I see unhappy doctors.All everyone does is complain about rising malpractice premiums, more paperwork, declining pay, and 60 hour workweeks. This includes physicians just graduating from residency and physicians who’ve been practicing medicine for several decades.All of those complaints are legitimate, but one question I always have in ...
How the VA looks at population level data to analyze outcomes
The VA isn't perfect, but definitely is better than other health care systems I have worked in so far. It embraces the idea of patient-centered medical home, where a primary care physician coordinates and takes responsibility for a patient’s care ... the old-school definition of good medical care that has recently become popular again, ...
The evolution of hospitals and the present state of health policy
My first exposure to KevinMD.com is reading Healthcare costs can be reduced with emerging business models by Joe Flower.While I am not informed about the medical business models to which he refers, I am experienced in business. I hail from a family of doctors and hospital owners. While I did lose touch with the industry for several years, I have noted several changes which do not make sense. ...
Should doctors be addressed by their first name?
I was sitting next to a resident in the preceptor room yesterday. He was calling a patient to discuss lab results, and introduced himself on the phone by his first name and last name ... but not with "Doctor." (e.g., "Hi, this is John Smith from the Family Health Center.")I occasionally see the residents' patients for urgent visits. When I ask them who their regular PCP is at the office, ...
Compliance happens when it’s the patient’s treatment plan
Compliance. I really hate that word! The general impression given throughout the blogosphere is that patients:
- don’t take their medicine
- prevaricate
- Comp-LIE-ance: ”There are only 2 settings where compliance actually takes place; controlled substances and patients with high copays/no free ride.“
- On Your Own With Multiple Meds: “Even though people ‘know’ they should take their pills as directed, for the most part, they ...
KevinMD posts of the week, May 29, 2011
Here are the top posts from this past week, based on the number of times they were viewed.1. The tension between physicians and health policy experts. Health policy experts take subtle jibes against physicians in their analyses, with many feeling American doctors are overpaid, which exacerbates health costs. They tend to be politically progressive, and generally dismiss the issues that most doctors care deeply about.2. Transitions of ...
How PAs and NPs impact emergency room care
A recent survey in the American Journal of Bioethics, indicates that 80 percent of patients expect to see a physician when they come to the emergency department.Parents were more insistent about their child see a physician or resident for even a minor condition such as a sprained ankle.Patients indicated a preference for seeing a resident alone for non-urgent conditions (60%) and compared to a physician ...
MKSAP: Healthy 68-year-old man with a cigarette smoking history
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 68-year-old man is evaluated during a routine examination. He has a 5 pack-year cigarette smoking history but stopped 12 years ago. He has no history of hypertension, diabetes mellitus, stroke, or transient ischemic attack. He has no claudication. He is being treated for hyperlipidemia. ...
Benefits of chance meetings with other cancer patients
My wife had just finished meeting with her medical oncologist for her bi-annual check-up at MD Anderson’s Thoracic Clinic.We were sitting in an area called "the Park" rehashing what her doctor had said when a mother and her daughter sat down at our table. There were lots of empty seats in area but for some reason they decided to sit with us. Call it serendipity. ...
FoxNews column: Solving hospital bullying requires everyone to share the blame
My latest column, discussing hospital bullying, has been published on FoxNews.com: Bullies In Hospitals?Recently, Theresa Brown wrote a New York Times op-ed on the issue, which generated some controversial feedback, including how I thought it was unfair to single out physicians, and how the piece perpetuated doctor bashing in the media.I aim for a more balanced take, where I discuss how hospital bullying starts at the genesis ...
Why cookbook medicine detracts from compassionate care
by Greg Smith, MDAs a psychiatrist, part of my job is to listen as you tell me about symptoms that bother you every day.If I can help you put these symptoms into a framework such as a syndrome or a disease, then we can work together on trying to figure out how to treat them. Often times in
Kevin Pho, MD
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Why Priscilla Chan may become the country’s most influential doctor
Who has the potential to be the most influential physician of our generation? It's Priscilla Chan, who not only recently graduated from...
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Confused about prostate cancer screening? Make a shared decision
In a widely anticipated move, the USPSTF officially recommended against prostate cancer screening in healthy men. Case closed, right? Hardly. The prostate...
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When it comes to doctors and social media, hospitals fail miserably
When it comes to medicine and social media, much of the attention is negative. Doctors losing their hospital privileges because of Facebook....
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Warren Buffett’s prostate cancer choices aren’t right for every man
A version of this column was published on April 24, 2012 in USA Today. There has been a recent uptick of elderly men...
Physician
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Why test recalls should not be considered cheating
I was appalled recently by the coverage of radiology “test recalls” by CNN, amplified by Dr. Gary Becker of the American Board...
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Why physicians are susceptible to hardball tactics
I was invited to a medical staff leadership conference sponsored by our hospital. A company specializing in training physician leaders ran the...
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How we deliver bad news is critical to how families deal with grief
As a cardiac electrophysiologist, I have had to discuss bad news with patients and families more times than I would like during...
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His father’s suffering had already been too great
He looked dead. The paramedics brought him down the hall toward one of my critical care beds, and for a moment I...
Patient
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How death can be a beautiful experience
I was honored to be part of a beautiful experience in late January of 2011. It was the death of my mother-in-law...
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What meaningful encouragement can be given to someone who is dying?
Theirs is a lonely journey; to be moving towards the separation and end of all things known and loved. Being with a...
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Health care journalists have tendencies similar to those of doctors
As a patient who was asked to speak at the Association of Health Care Journalists 2012 conference, I felt a bit covert....
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Adaptation can be painful, but it can also be a gift
Nothing will force you to live life on your own terms faster than almost losing it. In 2008, I was on fire....
Policy
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What should America’s health care vision be?
America has this paradox of excellent biomedical science, innovative drug manufacturers and entrepreneurial device developers along with outstanding providers but at the...
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Hospitals around the world aim to remain relevant to patients
"It was the best of times, it was the worst of times ..." So begins a story called A Tale of Two...
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Repairing the tear in health care’s safety net with social media
The nation’s “safety net” hospitals are designed to ensure that uninsured, lower income and indigent populations receive adequate medical care – a...
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Look to technology to reduce health costs
Technology to lower costs rather than accelerate them. Smart phones to increase physician and other providers’ productivity. Fewer primary care physicians but...
Tech
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Mobile health apps don’t always follow conventional wisdom
Propaganda and non-truths abound all around the Internet saying that mobile health apps are everything from a threat to Big Pharma to...
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When patient care becomes secondary to filling out the medical record
The policeman was two cars in front of me. I meandered down the road cautiously adjusting my speed a few ticks above...
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Doctors, use Google to get more patients in less than 7 minutes
Every month, hundreds of thousands of people look for a doctor on Google. As an amazing practitioner, your site deserves to be...
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The user interface for EHRs should be uniform
The first thing I noticed when I walked into the physician’s office were the tall cabinets filled with manila folders, tabbed with...
Social Media
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We need to see the potential harm of social media
Prior to 1794, farms across the world could only pick cotton as fast as humanly possible. In the late 18th century, Eli Whitney...
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Why social media may not be worth it for doctors
Social media in healthcare is all the rage these days. You can’t visit even one physician-oriented website without someone breathlessly advising you...
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Transparency defines social media success for doctors
Want to understand social media? Physicians wanting to learn about social media must learn transparency. We must learn transparency on a personal...
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How Twitter was used in a potential mass casualty scenario
It was my first ER shift in charge of the resuscitation area. Needless to say, my adrenaline and nerves were firing like...
