July is the month that new resident physicians begin their training all across the United States.Our future family physicians and pediatricians, neurosurgeons and emergency physicians, plastic surgeons and laser tattoo removal specialists (ok, not really a specialty, just a side-line) will begin learning how to be physicians, having completed four years of expensive college and four years of even more expensive medical school.Anxiety-filled and debt-ridden, they will embark on ...
July 2011
All Stories
Finding job opportunities by networking with other physicians online
Many physicians intentionally choose to avoid online social networking websites like LinkedIn, Facebook, and Twitter. Physicians want to maintain their privacy and they don’t want patients “finding” them on these public sites.If you’re thinking about a career transition or if you’re looking for non-clinical jobs that may provide supplemental income, it is very important to expand your social network by engaging others on social networking websites. There are ...
Patients who bill their doctor for being late
Meet Elaine.We lost touch for a while, but caught up with each other recently.Like most girlfriends, we shared adventures of love, travel, and work. I told Elaine that I left assembly-line medicine. Now I host town hall meetings-inspiring citizens nationwide to design ideal clinics and hospitals.Elaine shared: "If I’m kept waiting, I bill the doctor. At the twenty minute mark, I politely tell the receptionist that the doctor has missed my appointment ...
Consumer driven health care will only shift costs if implemented poorly
The creation of consumer-driven health plans (CDHPs), health insurance policies with high deductibles linked to a savings option and with more financial responsibility shouldered by patients and employees and less by employers, was completely inevitable.The American public likes to have everything, whether consumer electronics or other services, as cheap as possible. With escalating health care expenses rising far more rapidly than wages or inflation, it's not surprising employers ...
How might we think about EHRs globally while acting locally?
American health care information technology is undergoing two enormous leaps.First, it is moving onto Web-based and mobile platforms – which are less expensive and facilitate information exchange – and away from client-server enterprise-centric technologies, which are more expensive and have limited interoperability. In addition, more EHR development activity is headed into the cloud, driven by large consumer-based firms with the technological depth to take it there. Both these trends ...
Cost containment strategies for emergency care
It strikes me that in developing payment reform related, compensation driven cost-containment strategies aimed at constraining the cost of emergency care, policy makers, emergency physicians, and health insurers should adhere to certain principles.The American College of Emergency Physicians should be at the forefront when it comes to establishing these principles, which I hope will be focused on protecting our patients first, and our specialty second.The concept and practice of ...
When the parent becomes child and child becomes parent
I bet you didn’t know that the war for independence is being fought on a daily basis throughout our glorious country. From the time we are born until the time we die, each of us strives to assert our independence. Once the toddler learns to run, he insists on running wherever he wants to. As he ages, we foster his need to be independent and teach him ...
Why Jack Kevorkian had a profoundly correct message
Although Jack Kevorkian was only a few years older than I was, and we both practiced pathology in southern California for many of the same years, I never met Dr. Kevorkian.I found him from a distance to be a deeply odd character, and a profoundly flawed messenger but with a profoundly correct message.I can't improve on the quick summary of Jack Kevorkian by an unnamed author that the New ...
USA Today column: Do new cancer drugs deserve their flashy headlines?
My USA Today column ran in this morning's paper: New cancer drugs often get flashy headlines.
I discuss two cancer stories, reported the same day this past June. One included highly publicized drugs used to treat metastatic melanoma. The other was much less heralded, and involved the lack of efficacy in ovarian cancer screening.Despite the difference in coverage, ...
The older generation of physicians may disapprove of social media
In the last three years, less than fifteen minutes of the formal medical school curriculum at my school has been dedicated to social media.During our orientation, a faculty member showed us a series of images that she had found online, publicly available on Facebook, that showed what she considered to be inappropriate behavior: students drinking, dancing and in revealing clothing. She warned us about the impact that images ...
Use the National Cancer Institute’s Cancer Information Service
Brenda Bryant learned she had breast cancer while she was sitting alone in her car in the parking lot of her grandson's day care center. It was early evening on a Friday two years ago, and her surgeon called to tell her the results of a biopsy. "He just gave me my results and that was it," says Bryant, who lives in Northern Virginia. "It was like there was ...
Cost of care is related to the advancements in medicine
Much is being written about the ever increasing cost of health care in the US, especially compared to the rest of the developed world.As a nation, we spend nearly 16% of our GDP on health care. All estimates predict that this amount will continue increasing unless costs can be controlled now. Hence the passage of the Affordable Care Act. Not only was it designed to extend coverage to ...
Using genomic data to understand disease entities
Three recent studies point to the continued presence and increasing importance of genomic information to improving health care.We have discussed the power of personalized medicine in multiple posts and highlighted the potential of genomics and though this movement is really still in its infancy it is a burgeoning component of medicine.The first study, published in the American Journal of Gastroenterology, explores Helicobacter pylori, a common ...
Vaccines to prevent or treat non-infectious chronic illnesses
A major megatrend in medicine will be the use of vaccines to prevent or treat (non infectious) chronic illnesses.Although we tend to think of vaccines for preventing infections there are now two vaccines that prevent cancer (via preventing the infections that are in part causative), one vaccine on the market to treat residual cancer and many vaccines in development to prevent or treat other cancers ...
Why HB 155 undermines the trust doctors have with patients
Do doctors have any business asking patients about whether or not they own a handgun?Like many other paternalistic inquiries with which doctors routinely harass their patients (car seats, bicycle helmets, smoke alarms, etc), my answer to this question is "no.’"There is a fairly well delineated sphere of knowledge which is medical in nature and in which I have some expertise and other topics which are purely personal, moral, or lifestyle considerations and in ...
Death is inevitable, but it is almost always seen as tragic
Everyone liked him. Though his later years (the only ones in which I knew him) took away his ability to do most things, and though he was in great pain every day, it was easy to see the mischief in his eyes. The subtle humor was still there, coming out of a man who was weak, in pain, dying.She lived for him. She was always telling me of his pain, ...
Not engaging in end of life discussions is grounds for malpractice
by Barry Massie, MDIt’s not that I am fixated on death, but recently, the CMS (Medicare) has decided not to pay for discussions with patients about prognosis and planning end of life care.Reimbursement for such discussions was a key aspect of the health care reform legislation passed this year, and was widely mischaracterized as establishing "death panels." I cannot imagine a legitimate justification ...
Medicare should stop paying for prostate cancer screening in men over age 75
The following op-ed was published on June 1st, 2011 in the New York Times’ Room for Debate blog.Medicare should stop paying for prostate cancer screening in men over the age of 75.You may be surprised to hear that, especially coming from a primary care doctor. But evidence is mounting that screening for prostate cancer is not only ineffective in older men, but may actually be harmful.The cornerstone of ...
Medicine and the examples of unintended effects of technology
The interaction of humans and technology will always be unpredictable. A few months ago this thought was driven home to me in a rather malodorous manner.I have obstructive sleep apnea (OSA) and use a CPAP machine every night to sleep comfortably. With OSA your airway collapses when you fall asleep. A CPAP machine is a small technological marvel, quietly delivering heated, humidified air under gentle pressure through a ...
KevinMD posts of the week, July 3, 2011
Here are the top posts from this past week, based on the number of times they were viewed.1. Reasons why medical students burn out and become depressed. I began my third year with what most would argue is the most difficult rotation, surgery, and my experiences over the past 5 weeks have sparked introspection on the things that cause medical students to burn out and wall themselves off during ...
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...
