I’ve spent a lot of space on this site writing about participating in your healthcare so you get the right care.And, I talked about developing a "relationship" with your doctor so you can effectively communicate. Relationship does not mean drinking buddy, golf partner, or someone to do shopping with. What is meant by "relationship" is developing a trust that allows you to effectively and unashamedly discuss your medical concerns and question treatment options ...
August 2011
All Stories
Alzheimer’s inevitably leads to loss of financial capacity
"Mom's been writing goofy checks..." "Dad stopped paying his bills...." "Grandma wired her savings to Nigeria..."Have you heard these phrases from the family caregivers of your elderly patients? Have you ever been concerned that your patient may lack capacity for financial decision making? How do you decide if they lack capacity? What is the clinician's role in making these decisions? What is their responsibility?These important questions are addressed in a terrific new article in ...
Female doctors and the physician shortage
Someone has gone and rained the facts down on what is generally considered a feel–good story in American medicine, the dramatic increase in female doctors in America.In response to Dr. Herbert Parde’s "The Coming Doctor Shortage" article in the Wall Street Journal, Dr. Curtis Markel pointed out that there is a difference between the raw, gross number of physicians in America, and the effective number of practicing physicians. ...
HIV is devastating poor and minority communities
The HIV pandemic in the US has developed a stable appearance over the last few years, and that appearance is notably non-white and non-wealthy. When the pandemic was discovered nearly thirty years ago, it was---in the US---primarily a disease of gay men. In Africa, the disease is everyone's. Women make up significantly more than half of HIV cases in Africa, and tens of thousands of children are infected during ...
Why doctors should accept protocol medicine
We hear that doctors do not like "protocol medicine" – they do not want to follow a "cookbook" when every patient is different. It is not a good understanding of the issues.Some years ago when I worked in a branch of he National Cancer Institute and then the University of Maryland Cancer Center, we admitted many patients with acute leukemia. The treatment approach including the necessary special tests to ...
What medicine will be like 20 years from now
I was asked recently to predict the practice of medicine in 20 years. After stating that any such prediction is massively speculative, I indulged because it is massively fun.I am persuaded by Clayton Christensen’s arguments in The Innovator’s Prescription that healthcare will go the way of other massively disrupted industries, wherein healthcare will follow the arc of decentralization.Using the music industry as an example, the arc begins by ...
Why is the iPad be revolutionary for doctors and nurses?
As a nurse, I spend a lot of time with other nurses. When they ask me to explain why I think the iPad is great, I respond with the following metaphor: imagine that you are a nurse who has been asked to design a new hospital from scratch. You are free to question every prior assumption, to throw out old ideas that no longer fit, to redesign everything according ...
MKSAP: 64-year-old man with abdominal bloating and epigastric discomfort
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 64-year-old man is evaluated for a 3-month history of abdominal bloating and mid-epigastric discomfort associated with a 6.8-kg (15-lb) weight loss. The patient has no significant medical history and takes no medications.On physical examination, vital signs are normal, and the only significant finding is ...
How early closure can cause doctors to misdiagnose
I had a patient once—a fellow physician—who came to see me complaining of mid-back pain. When I examined him, I found I could reproduce his pain by pressing firmly on the spot he said was hurting him. He said pressing there also made the pain radiate around to his stomach, a phenomenon known as “referred pain” that meant his pain was almost certainly caused by a trigger point. I ...
Why doctors should stop wearing ties
I stopped wearing a tie to work at the start of 2004. It was summer and I was hot.Its much more comfortable working without a tie, particularly in my job. Its easier to examine patients, its easier when I need to perform a medical procedure. I’m sure you can see how a dangling tie would get in the way.I’ve also lost quite a few ties, sadly enough, to spillage, ...
6 reasons why doctors won’t call patients back
Patients want to know why they can’t get a return call from their doctor’s office – here are six reasons why the calls have increased and physician offices are having trouble meeting the needs of their patients.
- Medication questions and requests for a prescriptions change. The average number of retail prescriptions per capita increased from 10.1 in 1999 to 12.6 in 2009. (Kaiser Family Foundation calculations using data from IMS ...
An apology to patients with chronic fatigue syndrome
I've been sick since 2001 when I failed to recover from what appeared to be an acute viral infection. It has left me mostly house-bound, often bed-bound. In effect, I've had the flu without the fever for almost ten years: the aches and pains, the dazed sick feeling, the low grade headache, the severe fatigue. It cost me my career as a law professor; it cost me the ability to ...
There is no such thing as a complete physical examination
A reader writes, "Can you do a post on what procedures constitute a thorough physical, in your opinion? I haven’t had one in several years and thinking of making an appointment now. The last doctor I went to didn’t even listen to my heart or go though the motions with feeling my belly and that stuff. And of the last 3 doctors I went to, I realized they didn’t ...
Do patients accept hurried, fragmented, disconnected care?
A cover story by Gardiner Harris in the New York Times spotlights the changes in modern psychiatry, from extensive, psychotherapy-based interaction to brief, medication-oriented “psychopharm” practice.The article shares nothing new, particularly to anyone who has paid any attention to the rapid evolution of the psychiatric profession over the last ten years (or who has been a patient over the same period). While the article does a nice ...
How a nephrologist assesses your kidney function
Doctors use laboratory values to interpret your medical condition. With respect to kidney disease, the BUN and the creatinine help your nephrologist (as well as your internist and family physician) determine if your kidneys are working correctly. These two tests are commonly ordered for many reasons and are invaluable tools to help your doctor assess your condition. Let's define what BUN (pronounced by spelling out the letters "B", "U", ...
Are our privacy rules robust enough to protect our patients?
Ok, imagine this.You take a video of your little girl's soccer practice with your iPhone. Within moments it's posted on YouTube for the grandparents to see.Minutes later search engines called spiders begin to crawl across the data set of images on your upload. Face recognition technology identifies a face on the video and, with some assistance from the geo-tagging of the built in GPS metadata that accompanied the upload, ...
What this doctor learned when he was a patient
Doctor D has been blogging about the doctor-patient relationship for a while now. It’s sort of the thing I’m known for. I’ve usually been on the doctor side of this equation. Most of my blogging, however, is to help patients figure out the weird world of medicine.Doctor D recently found himself on the patient side of a nasty injury.Even as Doctor D looked down and realized his leg wasn’t ...
AMA working to improve e-prescribing incentives and help physicians adopt health IT
A guest column by the American Medical Association, exclusive to KevinMD.com.Health IT holds the promise of improving the efficiency of a physician’s practice, but physicians can easily become overwhelmed by the broad range of products and the multiple, varying federal incentive and penalty programs currently underway. The American Medical Association (AMA) continues to be in close contact with the Centers for ...
Women with these 5 pelvic symptoms should call their doctor
For most women, a couple of irregular menstrual cycles or an occasional yeast infection are just a part of life -- nothing that time or simple treatment won’t cure.However, there are a few symptoms that warrant a call to the doctor. This article will cover when you should call your doctor for problems "down there"?1. Pelvic pain. Pain at the time of ovulation, is referred to as Mittelschmerz. However, if ...
Caregiver burnout is just a fancy term for exhaustion
Are there moments when caregiving makes you want to scream?Any number of things related to caring for your aging parent can cause you to feel like you’re at the end of the proverbial rope including:
- your relationship with your parent
- elements of your work life/family life which are separate from, but inextricably linked to, your caregiving
- the myriad experiences inside the elder care maze
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....
