The Israeli-Palestinian conflict is obviously a hot-button issue. And I'm not taking sides, nor am I proposing a solution. But here's where it affects me.There's a Parkinson's Disease medication called Azilect. It has some unique properties, and there's no generic, or direct competitors, currently available. It's manufactured by Teva, a company that does most of their business in generic drugs. It's the world's largest generic drug manufacturer, and if you've ...
August 2011
All Stories
Our country fails to view physicians as humans
As a patient, and reader of KevinMD.com, I'd like to respond to a recent piece, Doctors face difficult choices to save Medicare.The funny thing about this entire situation is that people refer to numbers. Numbers that consist of how much doctors are in debt when actually entering into the working world, how much Medicare reimburses or pays annually, how many patients are actually on Medicare, and how much ...
KevinMD posts of the week, August 21, 2011
Here are the top posts from this past week, based on the number of times they were viewed.1. What this doctor learned when he was a patient. I would have to advise that you hit the road when paired with doctors incapable of communicating—especially if your doctor will need to manage your problem longer than a 2 hour surgery.2. Think about mindfulness when seeing a new patient. I ...
The entire approach to food based on nutrients is wrong
The science of nutrition is changing and not in the way you might expect. After years of "reductionist" thinking — where food has been viewed as the sum of its parts – a call to treat food as food has been sounded. No more poring over nutrition labels to calculate grams of fat or chasing down the latest go-to chemical – be it vitamin E, fish oil or omega-3. ...
Practices have failed to analyze the clinical content of their EHR
Clinical content refers to the various checklists, documents, and forms that address an area of medicine when using an EHR. For example, a pediatric practice would be interested in documentation tools for a newborn visit. Not all EHRs have clinical content for all areas of medicine. For example, some EHRs have clinical content for internal medicine, but lack the details needed for dermatology or cardiology.A disturbing number of practices ...
A medical student experience in the newborn nursery
So many times we feel so overwhelmed by the crush of medical school that we forget to share the really amazing moments that come along each day. One of the incredible gifts you get as a medical student is that you get to step inside medicine as a worker and observer. Often, you get overwhelmed with being the "worker" and do not remember to be an "observer" of the ...
KevinMD media mentions, August 2011
I’d like to thank various media outlets for recently citing KevinMD.com.US News and World Report, How to Find the Right Doctor: "'You can tell how transparent a doctor is based on how friendly his site is,' says internist Kevin Pho of Nashua, N.H., a popular medical blogger. 'What kind of communicator does he appear to be? Does it seem like he's available via E-mail?'"Health Data Management, Top Social Media ...
MKSAP: 89-year-old woman is evaluated for dizziness
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.An 89-year-old woman is evaluated for dizziness that she has had for the past year, mainly while standing and ambulating. The dizziness is described as a sense of unsteadiness. The symptoms can last for minutes to hours, and she has at least 4 to 5 ...
The emotional costs of malpractice mean more to doctors than money
Every year, according to a recent study from the New England Journal of Medicine, a typical physician has about a 7% chance of being sued for medical malpractice.Surgeons almost certainly will face a malpractice claim sometime during their career. Neurosurgeons, for instance, have a 19.1% chance of being sued in a given year, while that number is 18.9% ...
What do tonsils do and why would we take them out?
There are some important new recommendations about tonsillectomy — taking out the tonsils — as a treatment for recurrent strep throats.Some of us can recall a time when getting your tonsils out was one of the rites of passage of childhood. Usually a related procedure is added — an adenoidectomy, removing the adenoids as well. It’s called a T&A in the medical world, and it’s one of the ...
Why physicians will be sacrificial lambs in future Medicare cuts
This year, total federal spending in the U.S. is projected to be $3.6 trillion. The top three budgetary categories are:
- Medicare/Medicaid -- $826 billion
- Social Security -- $717 billion
- Defense/Wars -- $703 billion
Are doctors to blame for long waiting room times?
As a physician, I was inspired by the Lesley Alderman article –"The Doctor Will See You ... Eventually" – that appeared in the New York Times recently.There is a great deal of emotion in this country surrounding the debate over waiting-room delays in physicians’ offices. Doctors feel as though they are being unjustly blamed for making patients wait when physicians are now forced to see more patients in less time, and ...
Medical device innovation saves lives but often at a high cost
Innovation in medical devices has been profound in recent years – cardiac devices are a good example. The combination of engineering advances to create small, strong and wear-resistant devices and computational advances with smaller and smaller semiconductors loaded with more and more information have led to truly amazing advances. With more and more people with more and more chronic illnesses, the need is great and the opportunities for innovators is ...
Peer review at medical journals, from a former JAMA editor
Picture this: A medical journal receives an unsolicited manuscript from an unknown author, and then ... Type 1 medical journal.The peer review process employed by Type 1 medical journals uses secret, anonymous peer reviewers working behind an opaque shield hiding clueless and spineless editors who may use either no reviewers, or a few cronies, or those reviewers known to be opposed or known to be in favor of some ...
A note to doctors from a patient labelled as idiopathic
I am an enigma. I always have been. Some doctors think of me as a challenge while others make it clear they dislike dealing with my case. I’ve had gastroparesis since I was born. Idiopathic gastroparesis. I’ve had debilitating migraines since I was 3. Idiopathic migraines. I’ve had several-month bouts of low grade fevers for years. Idiopathic fevers. Over the past 6 months I’ve started going into anaphylaxis. Idiopathic anaphylaxis.Every ...
How basic healthcare can be provided to the truly needy
It is in this arena that the public treasury has been most abused by government ineptitude, institutional inertia and Congressional negligence. The waste and fraud in the Medicare and Medicaid system is scandalous and is now the target of well-organized international crime. Estimations of the extent of this waste and fraud run as high as $150 billion.The United States Government has done nothing to effectively stop it. ...
Why cutting Medicaid will cost more in the long run
I usually write about healthcare reform from a pediatrician’s viewpoint, but what grabbed my attention recently was a story my husband, Randy, told me about an adult in his practice – a patient on Medicaid.Randy is a neurologist in a private practice, and Medicaid patients come from every corner of Rhode Island to see him. They make this cumbersome pilgrimage because he is a member of a dying breed: ...
An opportunity for hospitalists to improve patient care
Some hospitalists are in denial. Some hospitalists have become methodologic critics. But all hospitalists should take the findings of the recent Annals of Internal Medicine article seriously. We should not argue about the article, but rather ask whether these findings point out a weak point in our care of patients.This article provides an opportunity, not a scolding:
In an accompanying editorial, two other researchers from the VA Medical Center ...
Without wives, men’s health suffers
I was working as a PA in an internal medicine office seeing patients. One afternoon, I was in the clinic hallway when I saw an elderly looking wife in her 60s actually pushing her husband into the next exam room. He had his heels dug into the floor, but she was winning, due to his obvious shortness of breath and audible wheezing.I walked in behind the medical assistant who ...
How social media has changed my medical practice
Last summer, I joined millions of others in the deluge of social media. I committed one year of effort to see if social would enhance or distract from my pediatric practice.That was my goal, just one year.At that time, I wanted to dip my foot in the pool, and see if it made any ripples. The unexpected consequence was how much social media has changed my medical practice, and ...
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....
