by Aroop Mangalik, MDA man has lung cancer that has spread to the brain. The cancer in the brain has been growing despite full dose radiation. His lungs have failed and he has been on a respirator for 10 days with progressive worsening of lung function.Despite multiple discussions between the doctors and the Intensive Care Unit’s team ...
June 2011
All Stories
A doctor’s letter to a patient with newly diagnosed cancer
Dear "Robin,"Nothing in my career in medicine has prepared me for being a friend to someone with such a terrible disease. As a doctor I dispense advice on a daily basis, but those interactions remain strangely impersonal. With you, cancer has invaded our inner circle, and we all share your shock and despair.No one can know exactly what it feels like ...
Prices should be readily available to save hospitals money
Hospital costs are out of control. We have an aging population living longer with more complicated presentation of disease. We have an insurance driven platform instead of a health driven accountability. The long term sustainability of that architecture is one of guaranteed insolvency.One way or another hospitals are going to find their lifeline cut off. Medicaid is bankrupt.
Budget cuts to NICU admissions will have a ripple effect
What is wrong with the state of Texas? Have they no heart? Why is it that at the time of fiscal crisis, it’s always the “little” people whose services are eliminated first?The “little” people in this case would be babies who are either born sick or premature. The New York Times article, In Search of Cuts, Health Officials Question NICU Overuse, was shocking. The Texas state officials have ...
What it means to be sick as a medical student
For the first time since I have been in medical training, I got sick.Not just the kind of sick where its a cold, or you know that its stress, but the kind of sick that does not go away and randomly comes up just to make you mad when you just want to have fun (like ...
Market demands determine whether to add physicians to a medical practice
Regardless of the method of reimbursement, the importance and relevance of increases in local market demand for health care services, such demand being the major economic factor that creates opportunities for business growth, is often under-appreciated by busy physician practices.The trigger for adding a physician to a practice is typically either a response to being unable to sustain the current workload with existing personnel or a desire to proactively add ...
Adult ADHD and academic performance in college
‘Twas the week before finals and all through the dorm, few students were sleeping, since Adderall is the norm …What is the state of academic performance and achievement in the age of adult ADHD?Recent media publications feature "neuro-enhancement" sought by college students and stressed professionals through the use of prescribed and non-prescribed medications, particularly stimulants, to guarantee focus, concentration ...
Discussing social media with physicians on Sermo
I was recently asked by Adam Sharp, MD the Chief Medical Officer of Sermo, the physician-only online community at Sermo.com, to write a guest post of my choosing and facilitate a discussion about it for a few days. My choice? Social media, (based on the recent article colleagues and I co-published in The Permanente Journal). This post is about my experience and what I learned.I know that only ...
Cultural attitudes influence the benefit from stem cell therapy
Embryonic stem cells are present after a fertilized egg divides for two or three days. They have the seemingly miraculous ability to turn into any of the tissue types in the body—whether brain neurons, beating heart cells, bone, or pancreatic islet cells. It is important to understand just where these cells come from.Those used in science are ...
The nightmare of medical research in the lay press
The World Health Organization recently announced that cell phones "may possibly" cause cancer.Now, I'm neither a researcher or statistician, and personally think the jury is still out on this one. I'm not going to take sides.But here is what I am pissed off about. Notice that the story said "may possibly" cause cancer. But the way we think, it somehow becomes "does cause cancer," and so we panic, and hold ...
USA Today op-ed: Patients need to be involved with team based care
My most recent column was published this morning in USA Today: As health reform unfolds, involve the patients.
Regular readers of KevinMD.com are up to date with Accountable Care Organizations and Patient Centered Medical Homes, both of which are ...
Tips for medical students entering intern year
As intern year winds down and all of the giddy 4th year medical students are shelling out 200 dollars to rent that a robe for one day of pomp and circumstance, all of us interns are impatiently waiting for the fresh meat to arrive.Having just experienced every single emotion under the psychological rainbow this year, I am going to give a ...
Students interested in primary care must survive hazing
by Kimberly Every one of us who practices family medicine has had to defend our chosen profession against a myriad of antagonists.As mentioned in the post, Family Medicine is a Waste of Your Talent, we are sometimes told that we are too smart to pursue family medicine. Other topics range from salary comparisons between specialties to scope of practice. I’ve been told on many occasions ...
5 important cancer prevention updates
Most people agree — the best way to beat cancer is to prevent it. What can we do as a nation to help people live healthier lives today so they can avoid cancer tomorrow?Major research findings and policy changes are steps in the right direction. Here are some important cancer prevention milestones we’ve reached in the past year.1. Lung cancer screening is now a reality for selected patientsSmoking causes ...
The growing disconnect between hospitals and post-acute providers
An interview by Curaspan Health Group with Mark Lachs, MDMark Lachs, MD, MPH, geriatrics physician, professor, researcher and author of the new book, Treat Me, Not My Age, says one of the hottest new areas of research is care transitions. He warns that there’s a growing disconnect between hospitals and post-acute providers.Curaspan: ...
Patients could use more group hugs from their doctors
Today, healthcare is criticized by the public as too high on technology and too low in touch. Computers take patients histories, provide differential diagnoses, and even supply educational materials to patients. A new specialty, tele-medicine, offers healthcare services to rural areas that were previously underserved or couldn't afford the latest diagnostic technology.A humorous story about technology occurred when a patient’s secretary called to say that her boss was too ...
Physical activity level in patients with osteoarthritis
When we think of osteoarthritis (OA), we think of chronic "wear and tear" on a joint that has just plain worn out. Many patients with arthritis become less and less active and that is actually the worst thing for an arthritic joint.A study published in Arthritis and Rheumatism looked at the functional performance in 2589 adults with knee OA and found that ...
Organizing DSM-5: The new framework of mental disorders
by David J. Kupfer, MDIt will not be an ordinary table of contents. But then, the DSM-5 will not be an ordinary book.When the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders comes out in 2013, it will reflect the advances over the past two decades that have helped illuminate connections between the brain and behavior.Functional MRI studies, for example, have provided insight into obsessive-compulsive disorder. ...
Do American medical specialists really make too much money?
Whether specialists make too much money depends on whom you ask.Policy expertsIf you ask policy experts, most of whom are progressives, they will say "yes, of course, specialists make too much money." Too many specialists making too much money spoil the national health care broth.Just look at any other country, especially countries with government-run systems.Specialists there make one-half of what our specialists bring home. Look at their total ...
Online physician professionalism, a medical student opinion
Recently we saw a flurry of discussions about online physician professionalism, the merits of being anonymous, and teachable moments. As a newbie I'm trying to figure this out. But I need to be more mindful of the filter bubble - a self-imposed bias by preferentially linking to people and things we agree with, thus unwittingly trivializing reasonable alternatives.I've just had 3 "Uh-oh" moments:
- Right after the #hcsm Twitter ...
Kevin Pho, MD
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Why Priscilla Chan may become the country’s most influential doctor
Who has the potential to be the most influential physician of our generation? It's Priscilla Chan, who not only recently graduated from...
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Confused about prostate cancer screening? Make a shared decision
In a widely anticipated move, the USPSTF officially recommended against prostate cancer screening in healthy men. Case closed, right? Hardly. The prostate...
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When it comes to doctors and social media, hospitals fail miserably
When it comes to medicine and social media, much of the attention is negative. Doctors losing their hospital privileges because of Facebook....
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Warren Buffett’s prostate cancer choices aren’t right for every man
A version of this column was published on April 24, 2012 in USA Today. There has been a recent uptick of elderly men...
Physician
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Why test recalls should not be considered cheating
I was appalled recently by the coverage of radiology “test recalls” by CNN, amplified by Dr. Gary Becker of the American Board...
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Why physicians are susceptible to hardball tactics
I was invited to a medical staff leadership conference sponsored by our hospital. A company specializing in training physician leaders ran the...
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How we deliver bad news is critical to how families deal with grief
As a cardiac electrophysiologist, I have had to discuss bad news with patients and families more times than I would like during...
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His father’s suffering had already been too great
He looked dead. The paramedics brought him down the hall toward one of my critical care beds, and for a moment I...
Patient
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How death can be a beautiful experience
I was honored to be part of a beautiful experience in late January of 2011. It was the death of my mother-in-law...
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What meaningful encouragement can be given to someone who is dying?
Theirs is a lonely journey; to be moving towards the separation and end of all things known and loved. Being with a...
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Health care journalists have tendencies similar to those of doctors
As a patient who was asked to speak at the Association of Health Care Journalists 2012 conference, I felt a bit covert....
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Adaptation can be painful, but it can also be a gift
Nothing will force you to live life on your own terms faster than almost losing it. In 2008, I was on fire....
Policy
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What should America’s health care vision be?
America has this paradox of excellent biomedical science, innovative drug manufacturers and entrepreneurial device developers along with outstanding providers but at the...
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Hospitals around the world aim to remain relevant to patients
"It was the best of times, it was the worst of times ..." So begins a story called A Tale of Two...
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Repairing the tear in health care’s safety net with social media
The nation’s “safety net” hospitals are designed to ensure that uninsured, lower income and indigent populations receive adequate medical care – a...
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Look to technology to reduce health costs
Technology to lower costs rather than accelerate them. Smart phones to increase physician and other providers’ productivity. Fewer primary care physicians but...
Tech
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Mobile health apps don’t always follow conventional wisdom
Propaganda and non-truths abound all around the Internet saying that mobile health apps are everything from a threat to Big Pharma to...
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When patient care becomes secondary to filling out the medical record
The policeman was two cars in front of me. I meandered down the road cautiously adjusting my speed a few ticks above...
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Doctors, use Google to get more patients in less than 7 minutes
Every month, hundreds of thousands of people look for a doctor on Google. As an amazing practitioner, your site deserves to be...
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The user interface for EHRs should be uniform
The first thing I noticed when I walked into the physician’s office were the tall cabinets filled with manila folders, tabbed with...
Social Media
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We need to see the potential harm of social media
Prior to 1794, farms across the world could only pick cotton as fast as humanly possible. In the late 18th century, Eli Whitney...
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Why social media may not be worth it for doctors
Social media in healthcare is all the rage these days. You can’t visit even one physician-oriented website without someone breathlessly advising you...
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Transparency defines social media success for doctors
Want to understand social media? Physicians wanting to learn about social media must learn transparency. We must learn transparency on a personal...
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How Twitter was used in a potential mass casualty scenario
It was my first ER shift in charge of the resuscitation area. Needless to say, my adrenaline and nerves were firing like...
