"Money talks. Mine just says goodbye." A physician client of mine once grumbled to me. He is in good company.Physicians by and large, are horrible wealth accumulators. Thomas Stanley, author of The Millionaire Next Door, found that among all high income groups, physicians have the lowest tendency to accumulate substantial wealth.This finding is not at all surprising to me. My wealth management practice focuses on physicians, so I’ve seen ...
June 2011
All Stories
Hospitalists should limit the number of patients they see
I was talking to a fellow physician and he inquired, "how many patients do you see in a day?" I said, "maybe around 20."He smirked and replied, "20 only! I can see around 40 in a day and still have time to hit some balls." There is something fishy here at Smallville.A few years ago I used to work for this company. I had no option but to see a ...
Explaining how an EKG works
What is an EKG?EKG stands for electrocardiogram. It should probably and sometimes is abreviated ECG, but EKG seems to have stuck as more popular.Scientists have known for over 120 years that the heart gives off electrical currents when it beats, but it was the Dutch scientist Willem Einthoven in the early 20th century who discovered the nature of this phenomenon and who developed the electrocardiogram as a tool to ...
Medical practice career choices commonly become medical business failures
by Curt Graham, MDNever in the history of medicine have doctors faced such a ruthless gauntlet of threats, financial debts, and practice restrictions than they do today. These factors, among others just as crucial, don’t begin to tell the story about why 40% of medical doctors readily admit to intense frustration in their practices, in addition to the percentage of doctors quitting medical practice completely.They’re not retiring. They’re adapting. Extended ...
How physicians should deal with angry patients
I highly recommend you take a look at "10 Dumb things you do at the doc’s office." Be sure to scan the article, but what you really need to look at is the comments, all 700+ of them.While by no means a representative sample of how we think about physicians, there is a clear pattern to the comments. A lot of people feel disrespected by ...
Shifting procedural work to midlevel providers
It is entirely clear that too few medical graduates go into primary care.Although the number of family physicians is increasing modestly, there are very few internal medicine residents becoming primary care doctors. This year there will be only about 200 new internal medicine doctors entering the workforce from training programs, which will not even begin to cover the attrition of older and more efficient physicians, and due to improvements ...
Why the AMA is in decline, and should doctors care?
The American Medical Association recently released its membership numbers, and they're declining.According to MedPage Today, the AMA "saw another steep drop in its membership in 2010 -- this time losing about 12,000 members or 5% of its total membership."It's been well publicized that the AMA only represents a minority percentage of physicians, depending on what you read, it's between 20 and 30%. But it seems many physicians have little ...
A good history is integral to practicing good medicine
Have you ever gone to the doctor’s office and forgotten what you were going to say or felt like you didn’t have the answers to any of the doc’s questions? Have you ever gone in to an appointment thinking, "I have pain and I am sure an MRI will show the cause," but your doctor seems to insist on asking you a million questions about your symptoms and doesn’t
A medical school dean plagiarized Atul Gawande in his commencement speech
Recently, Dr. Philip Baker, Dean of the University of Alberta's Faculty of Medicine, gave a speech to the graduating class at the convocation banquet held in Edmonton. Now, there are accusations that Dean Baker lifted much of his June 10 speech from a commencement address given by famed physician and essayist Dr. Atul Gawande at Stanford's School of Medicine in June 2010.As Baker gave his address last Friday, medical students ...
The official response to Mark Midei is not satisfactory
For more than a year now, as most CardioBrief readers undoubtedly know, a scandal in Maryland has raised troubling questions about hundreds of stent patients treated by Mark Midei -- previously considered one of the top interventional cardiologists in the state. In the wake of the scandal, some have questioned whether other interventional cardiologists, in Maryland and elsewhere, may also have routinely performed unnecessary procedures.Of course, ...
Hospitals that ban physicians from social media are long term losers
I've heard that a few academic medical centers, the identities which I will keep anonymous, are advising incoming medical residents to stay off social media. Meaning, they have to close their blogs, and shutter their Twitter or Facebook accounts.As hospitals and doctors try to best use social media, and prevent damage from its improper use, taking the extreme measure of forbidding doctors in training from utilizing social is ...
Evidence versus experience based medicine for patients
by Dennis GraceThe Internet’s been rife, lately, with discussions of evidence-based medicine (EBM) and its alternative, experience-based medicine (which, to avoid conclusion, I’ll call XBM).Look up either phrase on Google if you want more details, but be warned, it’s like trying to get a sip from Niagara Falls. Ideally, though, EBM is guided by information generated by studies conducted as rigorous, double-blind, randomized, ...
The best diagnostic medical device is right in your own home
What is the year 2011's best diagnostic and therapeutic medical device?Is it the PET scan with special bells and whistles to detect early Alzheimer's?Is it the robotic surgery that reams out the worst prostate cancers remotely?Is it the Total Genomic Analysis that predicts what your genetic future holds?Is it the GI endoscope that checks out your innards from stem to stern?Is it the latest drug-eluting stent that promises to ...
How Medicaid is under political attack
by Rishi Manchanda, MD, MPHMr. M walked into the community clinic where I work with a portable oxygen tank in tow. At 62, he's gaunt and winded, battling a disease that is progressively scarring his lungs. Every breath is a fight. Instead of the clear flow of air, I hear the sound of velcro ripping when I place my stethoscope on his chest. In medicine, his ...
Doctor Kevorkian dead, but not by suicide
Recently it was announced that Dr. Jack Kevorkian (also known as Dr. Death) died -- ironically, not by suicide.As a psychiatrist, one of the things I consider part of my job description is suicide prevention. Although many consider Dr. Kevorkian a civil rights activist for assisted suicide, I believe that there was a severe lack of ethics in his medical practice.From everything I've read in the media (and I ...
What to say if you suspect child abuse in the ER
I don’t know anyone that works in health care that does not dread suspected child abuse.On all levels it is horrible. Horrible that someone would do such a thing to a child, horrible for the logistical nightmares it can cause in treating the patient, horrible going though the whole mandated reporting process. It just sucks. Now, if it is obvious and you are totally sure it’s going on, you ...
The difference between an ambulatory and hospital EHR
What difference is there between an inpatient EHR and an ambulatory EHR?The difference is quite significant, actually. Let’s start by looking a little deeper into hospital IT issues, and the evolution of tools that try to address them.The hospital EHR environment Traditionally, from an IT perspective, a hospital is not really a single system – it is a collection of systems in various departments.Over the past few decades, each ...
KevinMD posts of the week, June 19, 2011
Here are the top posts from this past week, based on the number of times they were viewed.1. Physicians and their staff need to put on a consistent show. This past summer, I had a few parents complain to me about our staff. The parents wanted to let me know that they were treated nicely by the staff, but they had noticed things from the employees that they didn’t ...
A surgeon makes it a point to directly communicate with the patient
If nothing else, this post illustrates that surgeons are not that great with the whole bedside manner thing. I would like to think I'm an exception ... but I still am a surgeon.I make a point of communication with my patient. Obviously if he is a child, I use the same measure of effort in communicating with the parents. But few things irritate me more than some ...
MKSAP: 61-year-old man with progressive weakness
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 61-year-old man is evaluated in the office for a 6-month history of progressive weakness of the lower extremities. He says he has difficulty rising from a seated position and walking up stairs and also has episodes of dry eyes, dry mouth, and erectile dysfunction. ...
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....
