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
by Elizabeth Breuer, MDAs 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 ...
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 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....
