There are many more individuals with end stage kidney failure, heart failure, chronic lung disease, or liver failure who would benefit from a transplanted kidney, heart, lung or liver than are available. Similarly, there are many people with unstable, difficult to control diabetes that could benefit from a ready source of pancreatic insulin-producing islet cells.Today the only option for more organs available for transplant ...
June 2011
All Stories
How technology intersects with medicine and its impact on patients
by Alison McKnightWe are surrounded by technology. No matter where you go, you will find technology rearing its face, whether ugly and ungodly or tempting and beautiful. These advances have brought both good and evil to many professions, especially healthcare.Twenty years ago, you would not have found signs instructing people to turn off their cell phones in physician offices. Now these signs litter both ...
Should academic physicians have the final word on acceptable practice?
The New York Times recently published an opinion editorial entitled "Squandering Medicare’s Money"in which Dr. Rita Redberg, professor of cardiology at UCSF, proposes that much of Medicare’s financial deficit could be reduced if the government did not spend "a fortune each year on procedures that have no proven benefit."To support her contention, Redberg cites several studies which indicate that many routinely performed tests and treatments ...
Medication reconciliation brings the ER back to 1960
What a blessing and a curse it must have been to practice medicine fifty years ago.Most internists had only about twenty or so medications that they used regularly. It was a curse not to have effective medications to treat many common ailments but somewhat of a blessing not to have the modern medical nightmare of having patients on 15-20 chronic medications with all the logistical problems of keeping track of ...
Why the word “drug” promotes a public bias in chronic pain treatment
by Jack CainIn the United States, there is a heated debate at all levels over the increased use of narcotic pain relievers, especially as part of a long-term treatment regimen for chronic pain. Part of that debate is fueled by the pejorative use of the term “drug” instead of “medication” in conjunction with the legal prescribing, dispensing and consumption of these substances.Bias is ...
Pain needs to be better treated in cancer survivors
After people have a heart attack, stroke or joint replacement, rehab is a routine part of their recovery plan. Cancer survivors, too, can have significant musculoskeletal issues during and after the acute illness. Yet cancer rehab programs are few and far between. Why is that?For no good reason, rehab has not yet made it to the culture of survivorship. It's time to do something about this.Cure Magazine published an important article by physician-survivor ...
A history of smallpox in America
This past Presidents’ Day, I thought it would be a good idea to talk briefly about the role that smallpox played in the life of our first president and it’s important role in the American Revolution. For those who would like to learn about this in greater detail, I would highly recommend the book, Pox Americana: The Great Smallpox Epidemic of 1775-82, written by Elizabeth A. Fenn.In 1751, when George ...
Insurance companies cutting corners puts patients at risk
My patient, whom I’ll call Jane, had a neurologic disorder that prevented her from emptying her bladder properly.She required a permanent urinary foley catheter to help her urinate. Jane landed back at the hospital with yet another urinary tract infection – her third in one month. She had pus draining from her catheter and was infected with a multi-drug resistant strain of the bacteria Proteus. Our lab ran tests (sensitivities) ...
Balanced living for medical students
As a third-year medical student, I sometimes felt like a hypocrite.I spent much of my time advising my patients on how to take care of themselves, discussing in depth the best ways to care for our bodies and relationships. And yet, the schedule and intensity of my work often prevented me from following my own advice. I was not getting recommended levels of exercise or sleep and I was substituting ...
Hospital inefficiencies observed during a surgery rotation
by Anar MikailovI recently finished my surgery rotation at a Level 1 Trauma Hospital in Philadelphia and amidst the ephemeral eight weeks I quickly realized the immense demands of a surgical residency. So, as an avid technology enthusiast and a team member, I took note of inefficient workflows with potential for technology driven solutions. By discussing the observed inefficiencies and potential solutions I hope ...
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 appreciate. They mentioned that the staff seemed annoyed and irritated, even bored at times and a bit disingenuous.I wanted to investigate the issue before I reprimanded the staff. Things ...
Letting the states decide healthcare reform
by Terry O’KeefeThe State of Vermont just passed the nation’s first single-payer universal healthcare system. While there are still some bureaucratic hurdles to cross, Vermont will soon install the kind of system that healthcare progressives have been drooling about for decades.And whether you think that puts Vermont on the high road to healthcare nirvana, or the low road to socialized medicine, I think we ...
MRI overuse is widespread, and dangerous to patients
MRI overuse and misuse really make me angry.Did you know that a growing number of doctors don’t even read the tests themselves? Another shocking aspect of this industry is that some doctors will order an MRI because it’s quicker than doing a full examination. Rushing to an MRI can oftentimes erase clinical correlation, that is, connecting the dots between pain and what the MRI shows.MRI is unnecessarily overused. In ...
ASA: The multidimensional practice of pain medicine
A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com.by Richard W. Rosenquist, MD
Pain affects an estimated 75 million Americans, according to the American Pain Foundation. Pain management by unqualified providers can present serious risks to patients due to the complexities involved in diagnosing and treating pain. The American Society of Anesthesiologists (ASA) recently ...
How physicians derive evidence for their practices needs to change
I like to poke fun at real estate agents (please, forgive me if you are one, it is all in good fun).My experience has been that, despite what I describe as my preferences, they always end up showing me what they have, even if it does not bear the remotest resemblance to what I need. This holds true for politicians, with this cardinal rule: always answer the question you want ...
Social media ROI for one practicing physician
This is a message that should resonate loud and clear with providers, institutions or members of the healthcare enterprise world who are ruminating over the upsides -- and potential downsides -- of a wide reaching, multiple digital property: social media presence.As Ted Eytan found out when he questioned the (anonymous) physicians on Sermo, many physicians are simply not interested in establishing an online presence."Risk” is the overwhelming variable they’re ...
More healthy eating tips to add to the USDA food plate
The USDA has recently released it’s new concept, the food plate, to replace the iconic food pyramid it introduced in 1992 (and modified in 2005).At its release, Agriculture Secretary Tom Vilsack criticized the food pyramid for being "too complex to serve as a quick and easy guide for American families" – I completely agree, and have always felt this way. The food pyramid ...
The last exam of a first year medical student
Recently, the Harvard class of 2014 took its last exam of the year.We filled our usual amphitheater, took a 60 multiple choice question test on viruses, parasites and fungi, and went to go see X-men in the afternoon. I told my mom last night that I expected people to exit the lecture hall in hysterics, falling to their knees on our marble floors and weeping at being 25% closer to ...
Why doctors shouldn’t have to choose between medicine and family
For the past few Sundays, the New York Times has published provocative op-eds involving physicians.
The first tackled physician bullying. Next was the cost of medical education. And, most recently, the phenomenon of part-time, mostly female, physicians.This is obviously a live-wire topic, sure to generate passionate commentary.In the piece, anesthesiologist Karen S. Sibert goes over ramifications of part-time ...
Hospital bullying requires everyone to share in the blame and solution
The following column was published on May 28, 2011 in FoxNews.com.Theresa Brown’s New York Times op-ed, Physician, Heel Thyself, recently introduced hospital bullying into the national health care conversation.In it, she recounted a hospital vignette while working as an oncology nurse. A patient asked a doctor who should he blame for a late test result. ...
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....
