KevinMD.com has undergone a major re-design to keep it updated with contemporary blog trends. Thanks to Chris Olbekson at C3M Digital who implemented the new theme, and also keeps things running smoothly on the technical side.I'd like to guide you through a few highlights.
Custom search bar. A much-requested feature, there is now a prominent Custom Google Search bar at the ...
July 2011
All Stories
Advice to new interns from a nurse turned medical student
If you’re a new intern you are hopefully a little afraid of the new found responsibility in your life. I say "hopefully" because there is nothing more frightening in healthcare than someone who is "unconsciously incompetent." That is, someone that doesn’t even realizethey have no idea what they are doing.Before starting medical school I was an emergency nurse. As an RN, I had the opportunity to see many medical ...
A medical student with anxiety and depression
A strange thing happens on your first day of med school. Yesterday, you may have joked with old friends about upping your Paxil dose, but starting today, you are expected to be professional. And professional is suddenly a word that prevents you from being open with your new friends, a word that hints admitting to any real struggle could be a career-ending mistake.I want to tell you that it isn't, but the truth is, I'm ...
Clinical competence, and whether a doctor is good, or not
Is Dr. X a good doctor?Being a doctor, I often hear this question being asked. More often than not, the response that I hear is a rather clear cut one, "oh yes, Dr. X is a great doctor," or "oh no, Dr. X is not a good doctor," making me wonder what such a definite response is based upon. Is it based on actual facts? Is it based on ...
The confusion surrounding comparative effectiveness research (CER)
We all know, broadly speaking, the mission of comparative effectiveness research (CER), now sometimes called patient-centered outcomes research. Such studies should inform clinical and health policy decisions made by physicians, payers, and regulators to help determine treatment guidelines, coverage policies, and the therapeutic value of new therapies relative to standard-of-care in real-world settings.
But dive deeper, and it’s clear there remains an uncomfortable level of confusion as to what CER ...
Walking out of the hospital for the last time as a third year student
On our first day of the Cambridge Integrated Clerkship, every student had a pager on their desk. We knew they would be there—the central idea of the clerkship was that students could be reached at any time when our patients came to the hospital. Still, it seemed to me a strange and antiquated device, only slightly less odd than a typewriter or rotary phone, and it was hard ...
Implications when technology catches up with medical practice
In 2009 I posted a blog here on videotaping of surgeries and the issues and challenges this would present. I did not say I am in favor of this as a means of policing medical practice, but for documenting surgeries the technology can be very useful. I do video as many of my surgeries as I can, and I offer to show these recordings when appropriate to my patients. ...
Psychotherapy from the psychiatrist’s point of view
We really don't even have a precise definition of what "psychotherapy" is, and CPT coding has defined it in terms of time spent in a session and reimbursements.A 50-minute session gets coded as 90807 which stands for "45-50 minute psychotherapy session with medication management on an outpatient basis in a physician's office." The frequency doesn't matter, nor does the content of what transpires-- at least not for the CPT ...
A TV should not be allowed in a child’s bedroom
I was getting ready for the day, my 2 1/2 year old was watching Sesame Street. In the show, the segments change every few minutes or so and seem to weave old-school 1970′s content (familiar to me) with newly created vignettes that have a modern feel and construction. I like it nearly as much as the boys. One of the stories this morning was about tooth fairies. An animated group ...
Grocery store tips to avoid poor dietary and financial decisions
Taking a trip to the grocery store can be more dangerous than you’d think.Waiting for you in each and every aisle are marketing ploys aimed at suppressing your better reasoning, the ultimate result being you making poor dietary or financial decisions – whether you know it or not (enter the 100 calorie pack, my arch nemesis, right behind diet soda). But it doesn’t have to be that way – ...
Vaccines on the horizon and vaccine economics
What else is on the horizon? There is progress to develop vaccines to control addiction to both nicotine and to opioids. Vaccination may be the best route to get control of the bacteria having a major impact on methicillin resistant Staphylococcus aureus (MRSA) and other highly pathogenic antibiotic resistant bacteria that have become endemic in hospital ICUs.A vaccine for dengue is likely within the next five years. The World Health Organization ...
Using technology to completely rethink the patient encounter
It’s time that we rethink the doctor's office encounter. It’s inefficient for doctor and patient, and doesn't optimize care for those that need it most. Everyone is treated the same, even though not every illness or medical need has the same urgency.To get to see a doctor I have to make an appointment days or even weeks in advance. I have to drive over to the complex, find parking or ...
Why patients should change their doctor
Sure you are comfortable with your current doctor, after all you are still alive and kicking. Besides it has taken you years to figure out what you can safely tell your doctor and when it’s ok to speak up.Yes, the fact that your doctor is often late and never seems to listen to you bothers you just a little. You aren’t displeased enough to stop giving your doctor high
The best defense against skin cancer is prevention
Skin cancer is the most common kind of cancer in the United States, affecting more than 2 million Americans every year. It is estimated that one in five Americans will develop a skin cancer in their lifetime.There are three main types of skin cancer. Melanoma is the most serious form of skin cancer, which can be fatal if not treated early. While melanoma accounts for a very small percentage ...
Domestic medical tourism saving employers money and improving outcomes
Over 1.5 million Americans travel abroad each year for medical procedures.Services typically sought by travelers include elective procedures as well as complex specialized surgeries such as cardiac surgery, dental surgery, joint replacement, and cosmetic surgeries. However, virtually every type of health care, including alternative treatments, psychiatry, convalescent care and even burial services are available.U.S. based healthcare providers have taken notice as have self-funded employers and health plans. The ...
ACOs and the modern day leper
In the Chicago Tribune recently, Bruce Japsen has an excellent article addressing Accountable Care Organizations, quality of care issues, and the change in how physicians will be paid in the future.Clearly, the government and insurers have decided that physicians will not be paid for services rendered. Physicians will be paid based on patient outcomes and will share in any losses insurers sustain due to poor patient outcomes. There ...
7 tips for students applying to medical school
Applying to medical school is really annoying, expensive, and hard for no reason. I’d like to share some wisdom I picked up along the interview trail.Become an expert stalker. You have had plenty of practice stalking your friends on Facebook. Use those skills to find out everything you can about the school. Admissions officers tend to ask you why you would like to attend their ...
Reducing the number of high pay residency slots has merit
I believe that Nilesh Kalyanaraman’s idea of reducing the number of high-pay residency slots has merit.Of course, this would have to be based on an accurate, bonafide need for the particular specialty service, and would require, at the very least, a biannually updated data base for medical schools to plan with. I believe that some states already make available disease prevalence data —broken down by regions or, in ...
Eric Appelt and his extraordinary commitment to medicine
Dr. Eric Appelt was born to be a superstar. During his career, he has redefined what it means to be committed to medicine, and he embodies the practice of perseverance on a daily basis. I am proud to say that he is one of my role models as I continue my medical education.As a young man growing up in Brenham, TX, Appelt was the kind of son every parent ...
5 ways to succeed as a new provider, guaranteed
Being a physician is an incredibly rewarding and fulfilling profession. I’ve been a physician for over 20 years and I still find joy in my work because I’ve learned to adapt to the changes we are experiencing in the medical field. And, I’ve use the tips I’m sharing with you to operate the best medical practice and provide the best health care possible.Know the "99" codes like the back of ...
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....
