Part-maverick, part-unconventional, part-smart business owner Sir Richard Branson has business lessons to share in spades. Since I recently read his third autobiographical book Business Stripped Bare: Adventures of a Global Entrepreneur, I wanted to pass on some of what I learned from the book.Without knowing exactly why, I have long admired his acumen and chutzpah. His story has provided me insights into why I've been so drawn to his adventures in ...
July 2011
All Stories
From the brink of hospice to awaiting a reading machine
It was a beautiful Monday morning in May. Yawning uncontrollably, I hopped into a Ford Hybrid with my attending and drove off to visit a patient who lived two hours away from our hospital. I woke up especially early that morning since we knew the commute would take many hours.We drove past open fields and a few cows before pulling into a driveway of a lovely house with a cute ...
The first child patient at a pediatrics rotation
For the sake of patient privacy, I am going to tell this story very ambiguously and hope that the insanity of it is not missed with the lack of details.Because most of us do clinical training with non-pediatrician tutors, we have mandatory pediatric tutorial sessions. While I had already done a little bit of lung and heart listening on some children earlier on in ...
Doctor support critical in the fight for community prevention
by Larry CohenWhen Florida Governor Rick Scott recently signed legislation barring doctors from asking about gun safety practices in the homes of their child patients, it sounded the alarm that physicians’ roles in community prevention are chronically misunderstood. Rather than restricting doctors’ options for involvement in prevention, we should be supporting and expanding them.Community prevention is the creation of physical and social environments that ...
How physicians can incorporate genomic advances into clinical care
by W. Gregory Feero, MD, PhDThe 10-year anniversary of the publication of the sequence of the human genome offers primary care physicians a look into how they can incorporate genomic advances into clinical care in the next decade.The National Institutes of Health celebrated the 10th anniversary of the publication of the sequence of the human genome and the subsequent remarkable burst of scientific and clinical ...
Medical marijuana in psychiatric illness
Recently, 16 states and Washington DC have legalized medical cannabis.An additional 10 states have pending legislation. With all the attention legalized medical marijuana has been receiving, patients have started asking if they are candidates for a prescription. Well, my answer is easy. Right now it is not legal in Illinois, although it is one of the states that is pending. Even if it does become legalized, I ...
We need a radical change in the way health care is delivered
Many of you are familiar with the famous "invisible gorilla" experiment, wherein an audience, being instructed to watch closely for the number of passes made with a basketball, fails to see a rather large and deliberate gorilla march slowly across the screen, stop in mid picture and thump its chest.In fact over 1/2 of those tested failed to notice this obvious action. The predominant response is one of suspicion and ...
Should young athletes be screened for heart disease?
In the wake of sudden deaths in a young athletes, the question arises – as it does after each of these tragic events – whether all young athletes should be screened for occult heart disease before participating in sports. It appears, for instance, that 16-year-old Wes Leonard had an underlying heart condition which likely could have been identified with a simple echocardiogram.The question is controversial, and accordingly, even the ...
Do physicians have the courage to implement comparative effectiveness?
Comparative effectiveness outcome studies have shown that while percutaneous coronary intervention (PCI) may be more effective than optimal medical therapy (OMT) for treatment of acute coronary syndrome, it is not more effective for treatment of stable ischemic heart disease.Results of the Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) trial, published in 2007 and 2008 in the NEJM, demonstrated that PCI did not improve survival or prevent myocardial ...
What cash only practices should be careful of when taking payments
There is no question that bank failure, credit problems, and other issues create a situation where people find it necessary to make payments in cash, only.While you will never need to worry about this money clearing for payment, it is still important to be aware of some of the risks associated with taking cash payments. In most cases, once you address these issues, you ...
Staff who resist quality improvement efforts
Perhaps you are just beginning a quality improvement program or project. Perhaps you have several project improvement projects successfully completed at your healthcare site.No matter what your level of experience, you have encountered staff who are roadblocks to your efforts. What are you to do? Ignoring them or doing nothing will imperil your quality efforts eventually. Let me share some ideas on what to do based upon my own ...
Fixing primary care requires more than free medical school
by Nilesh Kalyanaraman, MDIt’s well known that there is a shortage of primary care physicians which is only going to get worse over time.To address this problem, Dr. Peter Bach, the director of the Center for Health Policy and Outcomes at Memorial Sloan-Kettering and Dr. Robert Kocher, a guest scholar at the Brookings Institution, propose making medical school free. They argue that medical students would be more likely to ...
Experiencing Dengue fever and lessons to prevent it during travel
by Rachel HenricksonEveryone wants to feel like they are making a difference.This is why, in my opinion, international medical mission trips are what every med student dreams of upon completing his or her first year of medical school. With one year of basic sciences and numerous standardized patient encounters under our belt, we are already eager to utilize our skills with “real ...
Attending physicians who work too many hours need restrictions too
Dr. Lewis didn’t sleep last night.All day he stood, heavy in full surgical scrub with a human heart in his hands, replacing damaged valves and calcified arteries until the heart beat on its own again. After he finished, there were a few hours before the transplant to get some dinner, to call home.The heart came on a helicopter. A young man, a bad accident, a perfect heart. Dr. Lewis pierced ...
The radiation delivered by CT scanners has gone largely unregulated
Although the medical profession has been harming unlucky patients for centuries, the patient safety movement didn’t take flight until 1999, when the Institute of Medicine published its seminal report, To Err is Human. And that report would have ended up as just another doorstop if not for its estimate that 44,000-98,000 Americans each year die from medical mistakes, the equivalent of a jumbo jet crashing each day.Come ...
Our health system defaults toward treatment rather than compassion
by Sara Billings, RNI believe knowledge is power. There is no more complex topic in the healthcare debate than end-of-life care. I have been a Registered Nurse for thirty years. I deal with this every day. All of us will confront this issue eventually. When it’s your turn, I hope the medical profession will guide you to the best options for you and your family.Often I see patients who have ...
An apology to a terminal patient with colon cancer
I'm sorry, Mrs. Lewis, for not making it to the hospital to see you yesterday.Yesterday was one of those days when I felt like I could never catch up. My wife was going downtown for work, and we had to get up early. While she prepared, I helped my two-year-old son get dressed. We walked my wife to the train, then waited for the nanny. She was running late: I ...
KevinMD social media speaking, Fall 2011
I have learned and seen a tremendous amount over the years on KevinMD.com, and am happy to share my social media experiences in person.Earlier this year, I keynoted the Texas Medical Association 2011 Winter Conference and gave the Dean's Lecture at Vanderbilt University School of Medicine.Here is my social media speaking schedule for ...
Why the human brain seems to struggle with comprehending risk
by Sam WainwrightThere's a fascinating blog post over at the New York Times math blog that has the health policy program here at New America scratching our heads, sharpening our No. 2 pencils, and dusting off our calculators.Turns out, German mathematicians have been studying how and why the human brain seems to struggle with comprehending risk. We find it difficult to translate the ...
Liability considerations with electronic health records
The more things change, the more they stay the same. The increasing use of Electronic Health Records (EHRs), "cloud-based" applications, Application Service Providers (ASPs), and offsite electronic storage has led to an increase in laws and court rulings governing them—and these could affect your practice.Expect more oversight from federal and state governments. Two reports recently issued by the inspector general of the Department of Health and Human Services found ...
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....
