There was news of yet another high profile death from an uncertain cause in a star with addiction history. Media accounts included reference to the "27 club" -- a lengthy list of famous artists who have perished by their own hand, often unintentionally, at the age of twenty seven.The reality is that too many fatal overdoses responsible for the deaths of the famous and not-so-famous are from medications ...
July 2011
All Stories
How prevalent are false diagnoses of disease?
Recently, we expressed concern about the effects on the accuracy of the diagnostic process of the increasing numbers of well and worried well entering the medical care system.One of the consequences of this influx of well people (and the concomitant reduction in disease prevalence) is the generation of more false positive test results and false diagnoses of nonexistent diseases.The medical literature is filled with studies on the accuracy of ...
Advances in cancer treatment are hyped by headlines
The following op-ed was published on June 5, 2011 in USA Today.A patient recently asked me if I had heard about the new "wonder drugs" used to treat skin cancer. Indeed, I had. In a widely reported story in early June, two novel cancer drugs were found to benefit patients with advanced melanoma, a devastating form of skin cancer. ...
Complications of pregnancy and the conspiracy of silence
Most pregnancies are completely straightforward. A woman gets pregnant, she has a normal pregnancy that lasts nine months, she delivers a healthy baby, and she takes her baby home. End of story. But not all pregnancies are so straightforward. Complications develop. Challenges arise. Doctors guide their patients through unknown experiences, and parents make choices they couldn’t have dreamed possible before embarking on the road to parenthood.Complications of pregnancy occur anywhere ...
Tobacco cigarettes should be sold only in pharmacies to people with a permit
I like Iceland. It is a really neat place; great people; terrific scenery; lively nightlife; surprisingly temperate climate, considering the latitude, thanks to the Gulf Stream.Of course, it is true that some of the Iceland bankers, poorly regulated and without scruples, were even more predatory than many of the American Wall Street investment bankers, taking the money and running to lead a pack of nations into international fiscal calamity, a ...
KevinMD posts of the week, July 31, 2011
Here are the top posts from this past week, based on the number of times they were viewed.1. Why healthcare is a responsibility, not a right. There is no “right” answer to the healthcare reform issue. There are facts, opinions, myths, politics and reality, all in no particular order of magnitude.2. Why receptionists are integral to the health care team. Health care is a team sport, and one ...
We need a single payment system instead of single payer
One of the great myths of healthcare is that there is an actual "system" in the United States. If such a system exists, I have yet to become familiarized with it. What we have are mountains of paper that slavishly tie the patient, doctor, hospital and insurance carrier alike to a system of coding interpreted by individuals with no sense of what the codes mean or the labor and ...
Why Medicare is the solution to the soaring costs of health care
Not only is Social Security on the chopping block in order to respond to Republican extortion. So is Medicare.But Medicare isn’t the nation’s budgetary problems. It’s the solution. The real problem is the soaring costs of health care that lie beneath Medicare. They’re costs all of us are bearing in the form of soaring premiums, co-payments, and deductibles.Medicare offers a means of reducing these costs — if Washington would let ...
When well people seek medical attention in a system designed to care for the sick
Over the past several decades, there has been a shift in the kinds of patients seeking medical care.The progression has been from sick to early sick to well to worried well to worried sick.The reasons are beyond the scope of this article. There is a subtle and hidden, but potentially very damaging, factor operating in the diagnostic process when large numbers of well people seek medical attention in a ...
Why doctors can sometimes be their own worst enemies
"I don’t have the time … I don’t get reimbursed for that." This is an all too common refrain from primary care physicians and practice managers when ever the subject of improving physician-patient communications comes up.I get it. Primary care physicians in particular are under tremendous pressure to produce. Just imagine, physicians in small primary care practices spend about 3.5 hours per week just on dealing with insurance-related paperwork. Then ...
MKSAP: 33-year-old man with stretch marks in his groin
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.A 33-year-old man is evaluated because of the recent appearance of stretch marks in his groin that extend to his thighs. He has a history of long-standing psoriasis that at times has involved much of his body, including his intertriginous areas. His topical treatments include ...
Planning effective office meetings for your medical practice
Do you cringe when you hear the phrase "office meeting"? Some medical practices meet too frequently and some seldom meet, but others have it just right – routine meetings with preparation, an agenda, and follow-up. Your practice can get it right, too.And make no mistake, meetings are important. Medical practices, regardless of size, have a variety of positions that are not interchangeable, but do interact throughout the day.To make ...
Embracing different cultures in the service of the dying
She was overwhelmed with grief when she walked into the room and saw her mother silently and peacefully dead in the hospital bed. Her death was expected, but as always, no-one is ever quite ready to let go. She started to wail loudly and speak directly to her deceased mother about the pain she was inflicting by dying.She was compelled to hold her prayer beads and started to dance around ...
Physicians who treat inmates are at greater risk of litigation
Most psychiatrists and primary care physicians who work in corrections long enough will end up being named in a lawsuit or having a complaint filed against them with their licensing board. So, from a risk-management standpoint, is it worth the potential hassle?Yes, in most cases I think it is.It is a fact that physicians who treat inmates are at greater risk of litigation. I don’t have specific figures to give ...
Patient tips for your first office visit
Starting a new job can be exciting, a new challenge, while embarking on a new journey. I have the opportunity to meet many new fellow docs, staff, and kind patients. However, I have to admit that it is a tad more challenging in the beginning when starting a new practice from scratch. I do miss the familiar patient faces that knew me and trusted my medical abilities without question. But ...
Is there really a physician shortage, and do we need more medical schools?
"Whether you think you can, or think you can’t, you’re right," said Henry Ford noting how our mindset shapes our behavior. Now, let’s talk about our American mindset on healthcare, which is that "more is needed" and that doctors are the most important players.In a recent message to all physicians, Dr. Cecil B. Wilson, former president of the American Medical Association, calls on us to help take vigorous action to ...
Who takes care of doctors when they get sick?
I don’t feel so hot. No, that’s not quite right. I feel really lousy. That’s more accurate.I’m really not much of a complainer. I go to work unless I simply can’t rise from bed and crawl to the shower. The entire staff, my family, and every patient who walks into my office, all feed off my mood. No matter how I feel, how up or down I might be, on the ...
Why physicians are clueless about malpractice implications of DVTs
A medical malpractice attorney and an orthopaedic surgeon are on a golf trip. This sounds like the worst joke of all time, but it’s actually the story of my brother and I 20 years ago.Amidst the rough, he laid some serious philosophy on me. In most families, that might be about life and love and whatnot. Not in our family. We were engaged about deep venous thrombosis (DVT) and ...
Diagnosing Alzheimer’s disease sooner or later
A recent Harvard School of Public Health survey of more than 2500 adult in six different countries has found that Alzheimer’s disease is more dreaded than any other disease save cancer. The same survey also demonstrated that 85% of respondents would want to know their diagnosis as soon as possible if they began to show symptoms. The survey was reported recently at the Alzheimer’s Association International Conference (AAIC) meeting ...
The survival of Medicare depends on providers and patients
A few weeks ago a patient came into my office referred for evaluation regarding surgery on her carotid artery. Although she had no symptoms, her primary physician had performed carotid ultrasound and found a severe narrowing on one side. She presented the results of this examination, and several additional diagnostic studies that had been performed recently. As it turned out, the doppler was inaccurate and she did not have any narrowing. ...
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....
