If you have been at your nursing job for a while, you’ve probably almost forgotten.Forgotten what it was like to come in to the healthcare system you now work for and realize there are hundreds of new protocols for you to learn and adhere by as a nurse. After years of routine, you now go about your day as if you actually have some choice in the way you give ...
May 2011
All Stories
How stem cells will impact medical care
Stem cells will usher in the era of regenerative medicine, allowing the creation of cells, tissues and organs to treat or cure diseases and injuries. This will be a fundamental alteration in our approach to medical care and a transformational medical megatrend. And it will be very "personalized medicine" to provide the specific individual with custom tailored new cells and tissues for organ repair or ...
The patient is a partner in their illness management and health maintenance
Sixty five years ago my maternal grandmother, having experiencing months of fatigue, abdominal discomfort and weight loss, underwent exploratory abdominal surgery, the only truly diagnostic tool available at the time.One brief look by the surgeon told him everything he needed to know: her liver and omentum were riddled with tumor, clearly advanced, with the primary source unknown and ultimately unimportant. He quickly closed her up and went to speak with ...
Biting in children is a sign of normal social experimentation
I love to pick up my two year old from daycare. Her language is becoming increasingly complex with small sentences, lots of gesturing and expression. When I ask how school was, she says, "Miss you. I crying." Or, "I running fast with friends." Or sometimes a confident, "good," with a head nod.Yesterday, she said, "friend, bite me."Her very kind teacher confirmed the event, and asked my daughter to show me ...
Why doctors can’t screen patients for every disease
I had a patient once who wanted an exercise stress test even though he had neither symptoms nor risk factors to suggest the presence of coronary artery disease (such as chest pain with exertion). I argued vociferously against it. However, extenuating circumstances (not relevant here) prompted our mutual decision to go ahead with it anyway. To our surprise and dismay, it came ...
Poor health literacy linked with unnecessary health complications
An elderly woman sent home from the hospital develops a life-threatening infection because she doesn’t understand the warning signs listed in the discharge instructions.A man confused by an intake form in a doctor’s office reflexively writes "no" to every question because he doesn’t understand what is being asked.A young mother pours a drug that is supposed to be taken by mouth into her baby’s ear, perforating the eardrum.And a man in ...
Can ACOs reinvent the American health care system?
The cost curve of American medicine continues to bend up. That is unsustainable. It must begin to bend downward.Two recent headlines focus the problem: New York Times, May 14, 2011: Health Insurers Making Record Profits as Many Postpone CareAnd, CNN Money, May 11, 2011 reports "Your family's healthcare costs $19,393." That is for a family of four, which has a median income of $75,700 -- before taxes.Opportunity ...
Meaningful offline dialogue creates online inspiration
I’m all for the values of social media, as evidenced by my frequent use of Twitter, Facebook, Youtube and LinkedIn.Recently, I realized again the value of a telephone conversation. I was on the phone with someone who I consider a mentor, someone who has fiercely guided me through my journey into social media without knowing the power of what was being done. It was the best 20 minutes of ...
The three most useful words for a doctor
Here are the three most useful words for a doctor: "I don’t know."A close second would be "I’m not sure," another three that have got me out of trouble more times than I can remember. The older I get, and more experience I have, the more useful it becomes.Pattern recognition is essential in effective medical practice. So often patient complaints are vague and nondescript, and in the absence of physical ...
How doctors should professionally behave on Twitter
According to one of the the guidelines set forth by the AMA about professionalism in social media, "When physicians see content posted by colleagues that appears unprofessional they have a responsibility to bring that content to the attention of the individual, so that he or she can remove it and/or take other appropriate actions."With that in mind, Bryan ...
Doing the physical exam for the first time as a medical student
Armed with tools I have never used or seen before I entered a physical exam practice room for the first day of learning.Having finished history-taking practices last semester, we were now beginning a new chapter, learning to take a head-to-toe physical exam. Before class began, we were told to read a book and ...
Medical malpractice tort reform equals healthcare reform
I’m a big game theory guy.I think you can explain the actions of the participants in any structured activity or enterprise by looking at the rules of the game. When you look backwards in time you discover that the "players" almost always made choices that represented rational self-interest. This is especially true in games played using zero sum rules: someone wins only if someone else loses. How the game is ...
Cancer screening on autopilot in patients with advanced cancer
by Alex Smith, MDI used to get Sports Illustrated, and my favorite column was titled, "This week's sign that the apocalypse Is upon us." Well, JAMA recently published the medical equivalent.Sima and colleagues at Memorial Sloan Kettering used a population based dataset of patients with cancer to compare rates of cancer screening (mammography, PAP smears, PSA ...
E-prescribe now, or risk a Medicare penalty
Doctors who do not successfully e-prescribe 10 times for Medicare patients in the first six months of 2011 using claims-based reporting may be hit with a 1% penalty on their Medicare Part B payments for covered professional services in 2012.The penalty will increase to 1.5% in 2013 for those who don't e-prescribe for 25 Medicare patients during 2011.Not yet e-prescribing?Maybe your Omega-3 fatty acids (more properly called “n-3 fatty acids”) are a group of naturally occurring fat molecules.They are found mainly in fish and other marine-derived oils, but some can also be extracted from plants. Omega-3′s are currently very popular, but the evidence for their usefulness isn’t so clear. A recent study failed to show any benefit in preventing dementia. A new study out ...Omega 3 fatty acids and the prevention of heart disease
Almost everyone over the age of 60 should receive the zoster vaccine
Herpes zoster (or shingles) is caused by the same virus that causes chicken pox.Zoster increases in incidence with advancing age. It is estimated that over 1 million Americans get shingles annually with the resulting acute discomfort and often chronic pain thereafter. A vaccine was introduced by Merck in 2006; the initial studies of 38,546 patients indicated ...
ACP: How accountable care is a team sport
A guest column by the American College of Physicians, exclusive to KevinMD.com.by John Tooker, MD, MBA, MACP
On March 31, 2011, CMS issued a proposed rule to implement a section of the Patient Protection and Affordable Care Act (ACA) that requires the HHS Secretary to establish a Medicare Shared Savings Program. Under the proposed rule, eligible providers and hospitals ...
Cut hospitalizations to reduce hospital related medical errors
by David Cundiff, MDTo address the huge problem of errors by health professionals causing injuries and deaths to hospitalized patients, the U.S. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius unveiled the Partnership for Patients initiative.Secretary Sebelius referred to a recent study showing that adverse events in hospitalized patients, including those caused ...
A psychiatrist on the compulsion behind running and exercise
I love running.I typically run 3-4 miles a day 5 to 6 days per week. It's only about a half hour of time, and it's well worth it. I get 'in the zone' when I run, and I can tune out the rest of the world and enjoy just being. It feels great physically and mentally each time. It's helped me immensely to stave off the obesity issues that have ...
How basing physician pay on popularity marginalizes some patients
Part one of the three-part series, Let's Pay Popular People More!My patient only had 20 minutes to wait for the van headed to detox. The people who had worked to get him into a detox program already numbered in the double digits. Sam (not his real name) was the classic public inebriate — he woke on sidewalks with the shakes, vomited blood on a regular basis, had lost most of ...
Kevin Pho, MD
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How patient satisfaction can kill
Patient satisfaction is all the rage. Medicare is beginning to tie patient satisfaction scores with hospital reimbursement, and doctors across the country...
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How I approach ovarian cancer screening with patients
Ovarian cancer screening clearly touches a nerve. No one doubts that ovarian cancer is a devastating diagnosis, often found when the disease...
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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....
Physician
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The analogy between baseball hierarchy and medical systems
From age six through high school, I played baseball. Playing baseball ended, rather abruptly it seemed, when I went to college, but...
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Saving patients from Internet health information
Lately, I get the feeling that I’m doing something wrong. I’m supposed to form a partnership with my patients. My patients are...
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Understanding what patient centered care really means
There was nothing the professor despised more then the syrup that oozed out of his partner's lips when dealing with patients. He...
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A letter of thanks to my organ donor
I have tried to write a letter of thanks but don't know what to say or even how to begin. I don't...
Patient
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Why patient engagement is reciprocal
It is said that "turn around is fair play." So if providers (physicians, hospitals and other health care professionals) expect patients to...
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Question the price of drugs and medical procedures
Hypertension was the trigger that forced medical cost awareness to the forefront. My doctor decided that with my rise in blood pressure...
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In love there is a life giving force
Here is a toast to the miracle of love. Not to the romantic, chocolate, dance club nightlife type of love. Not warm...
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How to get ready for death
No one wants to die. Even people who want to go to heaven don't want to die to get there. And yet...
Policy
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America has a medical care system not a health care system
As Americans we believe we have the best healthcare system in the world. But think again, it’s really not the truth. We...
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Reading between the lines of breast cancer treatment studies
Between the Susan G. Komen-Planned Parenthood debate and the study on treatments released by the Journal of the American Medical Association recently,...
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Why are labor and deliveries closing?
Labor and deliveries are slowly closing across the United States: California, Pennsylvania, and Ohio. In regional areas where there have been no...
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America has a health care paradox
We have a real paradox in American healthcare. On the one hand we have exceptionally well educated and well trained providers who...
Tech
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Why physicians don’t want patients to have their cardiac device data
There is a groundswell of discussion concerning patients demanding to have direct access to data derived from their implantable defibrillators and pacemakers....
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Impersonal communication on the Internet fuels cyberbullying
In the old days, bullying used to consist of name calling or physical aggression from someone in a position of power over...
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Health IT and doctors: A framework for successful partnerships
We are on the front lines of the healthcare revolution along side our patients and our colleagues in technology. We have firsthand...
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Break out of the prison of the American health care delivery system
Speaker after speaker at the recent Care Innovations Summit in Washington, DC concluded that increasing the quality and decreasing the per-capita cost...
Social Media
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Why doctors should embrace Google+
Lots of pressure out there for you to be on Facebook and Twitter, right? The ultimate question, though, is how are you...
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Using Twitter to deliver health improvement messages
I have decided to spam for public health. Phone calls, text messaging, and even apps have been shown to help improve health...
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Addressing comments on your medical practice’s Facebook page
Does your medical practice allow anybody to post links and comments on your Facebook page? The short answer is yes. We do....
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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...
