Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.A 76-year-old woman is reevaluated after results of thyroid function tests performed 2 weeks ago are abnormal. The patient otherwise feels well. She has a history of hypertension, atrial fibrillation, gastroesophageal reflux disease, and depression. Current medications are metoprolol, amiodarone, warfarin, omeprazole, and sertraline.On physical ...
August 2011
All Stories
Absence of joy: A doctor’s journey with depression
The scene was picture perfect, an absolute characterization of a tropical island paradise. White deserted beach, overhanging palm trees, crystal clear, gentle lapping waters, and a blood red sun sinking slowly into a Fijian ocean.I found no pleasure in it. Perhaps it was the heat, or that my new wife and I had been travelling for six months? Or that we had been on many other tropical islands and amazing places in ...
Banned in Boston: Access to psychiatric care
Imagine you have severe depression and go to a Boston emergency room for treatment. You are told to follow up with a psychiatrist within two weeks. You have good health insurance, so this shouldn’t be a problem, right?Wrong. In a new study just published in the Annals of Emergency Medicine, we found quite the opposite. Access to outpatient psychiatric care in the greater Boston area is severely limited, even for ...
Rationing is a logical outcome, and any changes must be incremental
This post continues my Ten Principles of Affordable Healthcare Reform.Health care changes should be made in small increments, easily understood by the People. Any changes that are made should be made in small increments and they should be cost effective and easily accepted by the public. It is clear at this juncture that we cannot afford the breadth and the scope of “reform” that is being currently proposed; to ...
Ingredients of a good team meeting in a medical setting
At Camden Community Hospital (a fictional hospital), Shana, a senior RN, is leading a team meeting to discuss standardizing the handoff of patients between shifts. She quickly looks over the team members, who are chatting among themselves, some not very quietly. "May I have your attention, please," she says. Some stop talking and others keep on. She raps her hand on the table and now she has everyone’s attention. ...
Patients want and need to take a greater role in their medical care
Today the patient is far different than the patient of a few decades ago. Patients can find healthcare information just as easily as a physician and many patients are taking a greater role in their healthcare and want to be involved in the decision making and work with the doctor as a team with the doctor being the captain of the healthcare ship. This new attitude has been referred to ...
When specialists try to practice primary care
Recently a good friend asked me to recommend an excellent primary care physician in New York City. When no one immediately came to mind, I asked a couple of doctor-friends who trained in New York. One friend, a cardiologist, gave me two names—one was a rheumatologist, who also practices general medicine, and the other an infectious disease doctor by training. My initial reaction to my cardiologist friend’s suggestion that ...
The free market of smartphone apps can teach medicine a lesson
So I have a Droid. I purchased it in July, not long after taking my old flip-phone for an oceanic bath at Hilton Head, SC. I waffled for a long time. In fact, I almost purchased a Casio phone that was marketed as water and impact resistant. "Mil-spec," was the phrase used ... a phrase which appeals to me as a one-time Air-Guard flight surgeon. What it meant to me ...
Using Twitter as an audience response system
In general, educators are often trying to find unique ways to engage their students.This is certainly true of medical educators, given that little has changed in medical education in the past 100 years, and for that reason there have been many recent efforts to change this. Similarly, there is often a generational gap between teacher and learner, and thus teachers look for ways to connect with the younger generation they ...
Cosmetic gyn continues to grow during the recession
Though the recession has blunted overall demand for cosmetic surgeries, one subcategory appears to be entering a growth phase, at least judging from the fifth annual Congress on Aesthetic Vaginal Surgery, held late last year in a luxury resort outside Tucson. There, about 60 doctors, most of them OB-GYNs, converged to discuss the expanding field of "cosmetic-gyn"—elective surgeries for women seeking to "rejuvenate" and/or "beautify" their vaginas. Attendance at the ...
Bullies in older adult communities
Bullies are terrorizing residents in long-term care and assisted living facilities, senior centers, and retirement communities around the country. The first time I witnessed older adults bullying others was at a senior center where, after a great deal of resistance from members, the age for joining the center had finally been lowered from 62 to 55 years old. Most local senior centers had already lowered their membership age years ...
Hope and warnings to other states from California family physicians
A guest post from the California Academy of Family Physicians, exclusive to KevinMD.com.Despite the slight upward tick in medical students opting for careers in family medicine over the last two years, efforts aimed at solving the primary care physician shortage are often thwarted by state and federal policy decisions.There is reason for hope, however: The number of medical school applications in California is extraordinarily high. A higher proportion of ...
More should receive vaccines to prevent cancer
What disease do people fear most? It’s no contest: Cancer.At one time we fantasized about having a weapon against cancer that’s better than early detection. Now we do, and I’m not just talking about better treatment. We have vaccines to actually prevent some cancers by preventing the viral infections that lead to them.So why doesn’t everyone get these vaccines when they should?The youngest generation, if they received the complete ...
Doctors diagnose diabetes 10 years later than the disease warrants
I like my patients vertical. Not horizontal.If I can help it, I want to make sure that nobody gets a disease that could have been prevented. Sure, accidents happen. And illnesses show up every day in the lives of people who did nothing to deserve them, and who could have done nothing to prevent them. But not all illnesses.Physicians know that newly diagnosed diabetic patients present to the doctor ...
Should Lipitor go OTC? A cardiologist says yes, an internist says no
With the patent for Lipitor expiring, Pfizer is considering selling an OTC version of the statin.It's generated a firestorm of debate, with doctors speculating on the impact for patients.According to Pharmalot, "an OTC version would allow Pfizer to capture some of the sales that will be lost when the Lipitor patent expires in November. In fact, Pfizer execs ...
Experiencing the professionalism of nurses and medical residents
Today I became a patient. If you follow me on Twitter, then by now you know what happened. Yes, I am embarrassed by what happened, but I’ll relinquish my HIPAA right to privacy for this moment.This afternoon I swam nose-first into the sidewall in the pool. (I haven't been swimming in awhile and I forgot to bring goggles, so I wasn't really looking. Laugh all you want ...) It ...
What is the best type of infant thermometer?
A fever in an infant can be the first sign of an illness. While a rise in body temperature above 100.4 degrees Fahrenheit is part of a healthy immune system response, it does signal potential danger and need for further evaluation. Since a reading may lead to a call or visit to the child’s doctor or emergency room, accuracy is key. What is the best type of infant thermometer?A ...
Educated online by people with diabetes
Recently, I saw one of my sons blithely dipping a chip into salsa, happily munching away while multi-tasking at something else – not a care in the world about his food.It brought a smile to my face – but there was a touch of sadness with it.You see, my work has brought me into contact with a number of PWDs (People With Diabetes) who are active on-line. And as I’ve ...
Hospitalist care is more expensive but don’t blame hospitalists
Hospitalists save money. Until the patient leaves the hospital, at least.A recent study from the Annals of Internal Medicine ignited debate over the cost effectiveness of hospitalists. Looking at Medicare patients from 2001 to 2006, researchers found that "those who were followed by a primary care physician spent about half a day more at the hospital, costing ...
What would a smart, compassionate, affordable health care system look like?
One year after passage of the Patient Protection and Affordable Care Act, the debate roars on, in Congress and everywhere else. And these debates often revolve around a big question, even when it is left unspoken or implied: Is health care a basic human right?In 1990 I made a quantum leap from practicing in the Navy’s single-payer, universal-coverage health care system into civilian pediatrics. Having been insulated from ...
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....
