There’s been a lot of talk in the past year about how we need to re-think the role and profile of the pharmaceutical/biotech sales rep.This dialogue needs to happen, given the trends that are rapidly shrinking the size of sales forces. Of course, when you poll the doctors, they are going to focus on the need for greater depth of clinical knowledge. ...
May 2011
All Stories
How podcasts can help patients with health literacy
by Robert Rodvien, MDWhen a person is told that they have a serious illness, they are similar to Alice falling down the rabbit hole.They enter a bewildering new world of discussions, tests and treatment programs that must be navigated while maintaining a job, life obligations, and relationships with friends and family. Just when ...
Paying physicians for medication adherence
by George Van AntwerpShould you pay physicians for medication adherence?I’d love to hear some physician perspectives on this. It’s a question that comes up every once in a while.Let’s start with a few facts:
- Adherence is estimated to be a $290B problem
- Poor adherence limits the effectiveness of the healthcare system
- Interventions do impact adherence
- There are lots of reasons for non-adherence
- Medication adherence leads to
One in four children in the United States are on chronic medications
The Wall Street Journal reported that a study of prescription patterns in 2009, conducted by IMS Health, showed that 25% of children in the US were on regular medication.IMS Health is a firm that provides "marketing intelligence" to pharmaceutical companies. The firm’s job is to keep the $800 billion per year global pharmaceutical industry on a continued pattern of growth. Hopefully these consultants accomplished something quite different this week. Hopefully they ...
Why the ophthalmologist and optometrist conflict should concern patients
If you need laser eye surgery in the state of Kentucky, or a little cosmetic work around the eyelids, it now behooves you to ask your prospective surgeon the following question before signing the operative consent form:"Say doc, did you go to medical school?"Kentucky joined the company of Oklahoma earlier this year as the second state to conflate optometrists and ophthalmologists. Only ophthalmologists are the sort of doctors who graduated ...
How to escape the prison of social anxiety
Your current thought patterns are likely what keep you trapped in the prison of social anxiety.To unlock yourself from this prison, you will likely need to have to rewire your brain with new thoughts that take time to cement in the brain, but if you try this as a start, it will lead you up the correct path.1. The change cannot happen ...
Treatment for stage 0 breast cancer is definitely real
I had never heard of ductal carcinoma in situ before I was diagnosed with it. Nor did I have a clue that breast cancer could be classified as stage 0; I only thought it came in stages 1 through 4. And I’m far from alone; most people I talked to had never heard of it either, including a ...
Physicians coping after a medical error
A failed treatment, a surgical complication, a medical error, a patient death. When the going gets tough, even the toughest clinicians should get help.Physicians and nurses who feel personally responsible for a medical error or a patient’s injury face an immediate quandary—their next patient. In the midst of your angst and guilt, do you suck it up and soldier ...
Health related anxiety in patients with complex problems
As an academic gastroenterologist at a tertiary care university medical center, I often see patients who have failed traditional therapies that many of my colleagues in the community have tried.Over the past several years my practice has evolved, from dealing with predominantly the medical aspects of my patients’ diseases to embracing the biopsychosocial model of illness. One of my colleagues has been the world leader in patient care and research in the ...
Excited about the future of healthcare in the emergency department
by William Schumacher, MDAm I the only one excited about the future of healthcare?With all the prevailing pessimism about America’s "dysfunctional" health" system, optimists (and I am one) sometimes feel stranded on our own lonely islands.It’s not that we don’t know what the challenges are. I have been practicing emergency medicine for over 30 years, and there ...
How to use an iPad in the OR during surgery
by Felasfa Wodajo, MDThe iPad has received a significant amount of attention in the health care arena since its introduction last year.The attraction is fairly obvious; it is a portable, lightweight, powerful computing device with an intui-tive interface and a large library of built-in applications. In fact, major medical schools such as
ASA: Drug shortages continue to impact anesthesiologists and patients
A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com.by Mark A. Warner, MD
Drug shortages of a number of drugs, including anesthetics, continue to impact anesthesiologists and patients each day. Throughout the shortages, anesthesiologists will be committed to ensuring patients remain safe and receive ...
Implementation of a rational system of medical care
The patient entered her private solo physician’s office and handed her medical ID card to the doctor. He put the card in his desktop reader and reviewed her medical history. All of her visits, vaccinations, medications, tests, x-rays etc from all providers were inscribed on the data chip in the card. The card also included insurance and billing information. At the end of the visit, he updated her information on ...
Our personal commitment and social engagement as physicians
by Synphen H. Wu, PhDMr. C is a 46-year-old Chinese immigrant restaurant worker who came to Bellevue Hospital after two weeks of fatigue, malaise, right upper quandrant (RUQ) abdominal pain, and progressive jaundice.He was referred from a Chinatown clinic, where his blood tests showed hepatitis B surface antigen, a hepatitis B viral load of 133 million copies, and elevated liver transaminases and bilirubin levels, ...
Doctor bashing and confronting physicians in the media
It's certainly been fascinating monitoring the response to Theresa Brown's New York Times' op-ed on physician bullying.Predictably, most physicians were outraged, while the rest of the population generally supported Brown. As alluded to in a comment, whenever you have an aggrieved party accusing another one in a national forum, controversy is what you're going to get. The piece was ...
Health care coordination under the rules of an ACO
On March 31, 2011 CMS issued its proposed rules for Accountable Care Organizations (over 400 pages).There is now a 60-day comment period. Shortly thereafter, the final rules will be issued. I am sure there will be changes in the proposed rules as there were changes in the “meaningful use” rules for electronic health records (EHR’s). Yet, much of the intent of ...
Why medical students should go through a psychiatry rotation
"Psychiatry consult, returning a page,” she said, cradling the phone between her left ear and left shoulder. Digging around in her pockets, she eventually pulled out a half-sheet of paper that wasn’t already covered in barely legible writing and boxes marked with Xs. Her right hand clicked the pen and prepared to write.
“Hi, this is Cardiology,” the male voice on the phone said. Doctors tend to lose their names when they ...
Honored to care for many priests and nuns in my practice
Our society thrives on tension and competition.
- GOP vs Democrats
- Civil Libertarians vs Eavesdroppers
- Ohio State vs Michigan
- Creationists vs Darwinists
Bereavement related depression and consoling a new widow
I am really enjoying my geriatrics rotation.Although my attending preceptor is primarily a geriatrician, and practices deep in the heart of retiree central in southeast Florida, he also sees some patients who are younger. I took a history on a patient who was younger than me today, in her early thirties.She started off complaining about insomnia and headaches, and then said ...
KevinMD posts of the week, ending May 8, 2011
Here are the top posts from this past week, based on the number of times they were viewed.1. Why do people decide to become doctors anyway? So basically, from the moment you start into medical school to the moment you finish your training, you’re looking at a minimum of seven years—for most people it’s closer to ten—before you’re even close to being considered a "real" doctor.2. Should nurses ...
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....
