Medicare needs to be reformed, but there's no easy solution to the problem. As the average life expectancy increases, more-and-more politicians have proposed an increase in the Medicare eligibility age. This increase in life expectancy, however, is an issue that only affects the wealthiest half of America -- the people that need Medicare the least -- because the life expectancy has only increased significantly in the richest half of ...
September 2011
All Stories
When people decide not to vaccinate their children, I take it personally
If the media and Internet are to be believed (and these days, really, what is the difference?), the act of parenting has become a full-scale cultural war. How to raise your kids. On what to raise your kids. How your kids sleep, eat, play, and practice "Little White Donkey" on the piano--nowadays, these are all grist for the mill.But if modern parenting feels like a war, its bloodiest battlefield surely ...
Slipping through the cracks in our health care system
Between the cracks is a frightening place to be.During the course of trying to improve our family’s financial stability, my husband and I were blind-sided by one hidden detail: We’d face $10,000 in costs to continue my husband’s serious medical treatment because we found ourselves unexpectedly without coverage for 30 days.This was money we simply did not have. We had been prepared to foot the full bill for good health ...
Should teenagers be screened to prevent sudden cardiac death?
It seems as if teenage student athletes have been dying by the month in often spectacular and dramatic fashion. Last September Texas high school senior Reggie Garrett died suddenly just after throwing a touchdown pass . Last week a 16-year-old Michigan basketball player died dramatically just after becoming a hero by scoring the winning basket to preserve an undefeated season. Then just a week later another 16 ...
It takes time to deliver efficient care
Obesity is linked to many serious medical conditions. Yet many physicians refrain from talking about "the elephant in the room" for fear of offending patients.The Archives of Internal Medicine published a study with the conclusion: "Patient reports of being told by a physician that they were overweight were associated with more realistic perceptions of the patients’ own weight, desire to lose weight, and recent attempts to lose weight."When in ...
Phil Mickelson’s psoriatic arthritis explained
Golfer Phil Mickelson has had a rough year and a half. First, his wife and mother are diagnosed with breast cancer, and then he has a health scare of his own. Last year, after the US Open, Mickelson began to experience some troublesome symptoms.In an interview with Extra’s AJ Calloway, Mickelson opened up about what was going on: "After the U.S. Open last year, I wasn’t able to move. ...
Private rooms in the ICU can reduce length of stay
We have known for quite some time now that the patient's environment in a hospital matters to his/her outcomes. The concept of biophilia was applied by Roger Ulrich back in the 1980s to surgical patients in a series of experiments. Famously, this work showed that looking out your hospital room's window on a bunch trees is associated with better and less eventful post-operative recovery than staring at a brick wall, ...
10 ways to make a difference in the lives of your patients
Most of us who write about health believe that knowledge can make a difference. But is the primary health issue facing us today a lack of knowledge? Or is it, instead, something I'd call the tenth-patient-of-the-day challenge?Here's what I mean: You pick up a chart and head to Exam Room B, reading as you speed-walk. Your patient’s blood sugar is running high again, she didn't show at the smoking cessation ...
Medical practice unintended consequences
The airlines, in an effort to recoup revenue, started charging passengers to check luggage a while back. Seems like a great strategy. Not only are they recuperating revenue, they are giving passengers a reason not to bring luggage they don’t need. This of course saves money on fuel.The result? More bags in the main cabin.Since there is an incentive not to check a bag, more people bring their bags as ...
Don’t always blame anesthesia for problems in the OR
People blame anesthesia personnel for everything. You name it, they blame us for it. They call us by the umbrella name "Anesthesia" and if there's a problem, it's always "Anesthesia's" fault.Got into the room late? Blame Anesthesia. (Even though the anesthetist's been sitting at the bedside for twenty minutes waiting for the surgeon or the nurses to be ready.)Patient craving ice cream when she woke up? Must be Anesthesia's fault.No ...
The problem with early detection of disease in medicine
Medicine is presented as being highly scientific. This is until information comes out which questions certain assumptions that underpin the practice of medicine.One of the mantras of modern medicine is that early detection is good. This seems logical enough.However there is an underlying assumption. That is that there will be a worsening of the condition if it is not detected and that treatment will improve the situation. What would happen ...
MKSAP: 20-year-old with fever, myalgia, headache, and a rash
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.A 20-year-old female college student is evaluated in December because of a 12-hour history of fever, myalgia, headache, and a rash. Her only medication is an oral contraceptive agent.On physical examination, the patient appears ill. Temperature is 38.8 °C (101.8 °F), blood pressure is 90/45 ...
The CSI effect and high tech medicine are driving up tests
I’m in Israel, home to some of the most innovative care in the world. Doctors here wanted to know if the high-tech tests that are an increasing part of their work help. A couple of weeks ago, they published their results.It turns out that in about 90% of cases, it didn’t matter.A physical exam, the patient’s history, and the basic set of tests that doctors have done for decades ...
How social media impacted a medical student’s career
Back in 2004, after I was accepted into Stanford University, a friend of mine at the university took me around on a campus tour. He showed me the building he lived in (Donner), his cafeteria (Stern), Hoover Tower, and all the usual sights. When it came time for him to tell me more about his classmates and dorm buddies, he promptly pulled up a webpage on his computer. "You have ...
Should the elderly with dementia be given anti-psychotic drugs?
The inspector general of HHS recently reported that nearly half of the anti-psychotic drugs fed to the demented elderly in nursing homes are inappropriately prescribed. That’s about one in fourteen nursing home residents.Forget about cost, which is over a quarter billion dollars a year. “Government, taxpayers, nursing home residents as well as their families and caregivers should be outraged and seek solutions,” wrote Daniel R. Levinson, the HHS I.G. wrote ...
How the price of preventing a preterm pregnancy went up
One of the reasons cited for our expensive health care system is that drugs cost more in America (part of our capitalistic system). In June of 2003, a study was published in the New England Journal of Medicine about the use of a form of progesterone to delay the birth of certain preterm infants. This particular hormone is found in the human body, but the formulation studied ...
KevinMD posts of the week, September 4, 2011
Here are the top posts from this past week, based on the number of times they were viewed.1. Health insurers have come up with the idea of the century. I have come up with the idea of the century. My idea will make your company the richest in the world while attracting millions of new patrons to your credit and debit card services.2. 10 tips from 10 years ...
A real doctor will first do no harm
I’m really miserable and need that 5 day antibiotic to get better faster.Ninety eight percent of the time it is a viral infection and will resolve without antibiotics.But I can’t breathe and I can’t sleep.You can use salt water rinses and decongestant nose spray.But my face feels like there is a blown up balloon inside.Try applying a warm towel to your face.And I’m feverish and having sweats at night.Your temp ...
Tips for doctors looking for the right EHR
Here we are going to talk about the second stage of shopping for an EHR. We are going to assume that you did your homework, defined your goals and constraints and prepared a comprehensive list of requirements for an EHR (if you have not done so already, go back and read part 1).To continue our car shopping analogy, we are now ready to go kick some tires, and ...
How diet and exercise beat high blood pressure
All day I badger and cajole my patients to take better care of their bodies:"We really need to get some of this weight off, Mr. Jones.""This blood sugar level means diabetes is right around the corner – it’s time to get serious about changing your diet, Ms. Smith.""This blood pressure reading tells me that you’re not getting enough exercise, Bill."I’ve got pills for everything, it seems. I just wish I ...
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....
