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 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....
