Some have argued that there is an innate conflict between faith and science. I am not sure that is so. Not only do the two seem to co-exist; but to my mind, they may even be synergistic.A few months ago, at Schwartz rounds, a case of a pregnant patient who was being given chemotherapy was presented. When the nurse ...
October 2011
All Stories
tPA is the standard of care for stroke but with significant risks
Under current guidelines from the American Stroke Association, tissue plasminogen activator (tPA, commonly known as a "clot buster" drug) should be administered within 3-4.5 hours of “last seen normal” – and 1 hour of patient arrival – to potentially ameliorate a new onset stroke. ("Last seen normal" means exactly what it says. A patient who went to bet at 10 PM and awoke with slurred speech at 6 AM was ...
Is Groupon legal for doctors?
Groupon and other similar social sites, like Living Social and CoupTessa, are all the rage now. But is it legal for doctors and dentists to advertise their services on these websites?Groupon is a deal-of-the-day website that features discounted gift certificates usable at local or national companies. If a certain number of people sign up for the offer, then the deal becomes available to all; if the predetermined minimum is not met, no one ...
The rewards of medicine can be overwhelming
As I greeted my next patient of the morning, I knew from the early folder number that I had seen him six or seven years before. I no longer expect to remember everyone I have ever met professionally. The man before me was tall, fit and well built. There is usually some inkling of recognition, but nothing about him was familiar to me at all.We made small talk for some ...
Cardiac surgery is a team sport
It is my strong contention that patients facing cardiac surgery should choose an institution, not a particular heart surgeon. Although individual judgement and technical dexterity are obviously important, best surgical outcomes reflect the performance of many medical providers before, during and after the operation. Professionalism and a competitive business environment both stimulate open heart centers to continuously focus on quality assurance programs to improve patient safety. Also, continuing medical ...
MKSAP: 60-year-old man with type 2 diabetes mellitus and hypertension
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.A 60-year-old man with type 2 diabetes mellitus and hypertension visits the office to establish medical care. He reports monitoring his blood pressure and blood glucose measurements at home with good results. He had a cholesterol panel checked approximately 5 years ago, at which time ...
Chest pain is where protocol driven medicine breaks down
On the theme of knowing when and when not to follow the diktats of emergency medicine, one of the greatest challenges for a practicing ER doc is chest pain. Missed MI is still the biggest driver of malpractice costs, and last I hear, ER docs still send home something like 2% of patients who are having MI or unstable angina. Not good. So over the last decade we've gotten all ...
A test of faith during Ramadan
Of all possible times, it happened during Ramadan. The test of faith would be extreme.Azka was the first of four children born to Persian parents in a small town thirty miles outside of Tehran, Iran. Being devout Muslims, her father chose the name Azka in part because it meant “pious”. His wife later revealed to Azka that he also liked how the name rolled off the tongue when spoken in ...
What exactly is unnecessary care?
It’s become one of those trendy phrases, "unnecessary care." When you hear it on television or talkshow radio it’s usually said with a sneer. Indeed, the speakers almost spit the phrase out -- "unnecessary care" -- like it tastes bad. It’s almost always accompanied by "fraud and abuse," or a not so subtle accusation that some doctor is profiting off this unnecessary care at the expense of some poor ...
A urologist responds to the new prostate cancer screening guidelines
"U.S. Panel Says No to Prostate Screening for Healthy Men" was the title of an article on the front page of the New York Times on October 6, 2011. The article goes on to suggest that healthy men should no longer receive a PSA blood test to screen for prostate cancer because the test does not save lives over all and often leads to more tests and treatments that needlessly cause pain, impotence and incontinence ...
Do most parents use the alternative vaccine schedule?
I see this as a glass half-full, glass half-empty issue. Recently, a study was published in Pediatrics detailing research conducted in May of 2010 about parents’ preferences to use alternative vaccination schedules versus following the recommended CDC vaccination schedule. The majority of the media coverage focused on the finding that over 10% of parents followed a schedule other than the one recommended by the CDC. Not perfect and not ...
Why 99 percent of health care should be angry
As Occupy Wall Street has gone from an obscure protest covered only on blogs and social media to a national phenomenon, the apparent parallels between the issues it is raising and the issues we have been raising in health care grows. A growing number of protesters are calling themselves the "99 Percenters," referring to those who are not in the top 1% of earners. The top 1% of income is clearly greater than $250,000 per year, and likely ...
AMA: Act quickly on Medicare deadlines
A guest column by the American Medical Association, exclusive to KevinMD.com.There are several upcoming deadlines that are critical to physicians who care for Medicare patients. November 1, November 23 and January 1 are dates that should be marked on all of our calendars.The deadline for physicians to apply for a hardship exemption in order to avoid the 2012 Medicare ePrescribing ...
Steps you can take to prevent developing diabetes
In the past decade, the incidence of diabetes in the U.S. has nearly doubled – this is due in large part to the obesity epidemic. Currently, it is estimated that the lifetime risk of developing diabetes is around 1 in 3 for males an 2 in 5 for females born after 2000. When you consider that type II diabetes has a strong genetic component – the risk for a ...
Handshakes during viral outbreaks
Suffice to say, as a physician, I’m not germ phobic. If I were, I wouldn’t work as a health care provider in the “culture media” of an ambulatory care clinic. I certainly respect the pathogens I come in contact with daily, along with the host who harbors them. For the most part, the virus and the patient know I don’t have much effective artillery to fight back with and my ...
Can I do residency again in a better rested environment?
"How are residents supposed to prepare for real life as a surgeon if they can’t even work twenty-four hours straight now?"I hear this complaint about once a month from a someone trained in the Golden Age of hazing. Outside of anecdote, we’ll never know if surgeons are better trained now or twenty years ago, or fifty. But it’s too painful to imagine every-other-night-call wasn’t of critical importance.Residency resembles the ...
Use body language to improve your patient encounter
While body language can be interpreted in many ways and it's not an exact science, it is often possible to read body language and have a basic understanding of a persons mood or dispositions and the rapport that people have with each other through observing non-verbal communication. This issue focuses on reading everything that hands can tell you and ways to use your hands to influence interactions with others.What's ...
Inspiration for new primary care doctors
Congratulations! You are an amazing group of young men and women. In college, medical school and residency your dedication and discipline, but most of all your idealism helped you to persevere and conquer some difficult challenges. In college your friends studying philosophy and literature and history wondered how you had the endurance to study biochemistry and organic chemistry and calculus. Not to mention the Krebs Citric Acid Cycle.You studied hard ...
Why Dr. Oz is wrong about arsenic and apple juice
The Dr. Oz show recently featured a scary show about deadly arsenic in apple juice. On his own web site, he trumpets "Dr. Oz’s Extensive National Investigation," and claims "After testing dozens of samples from three different cities in America, Dr. Oz discovered that some of the nation’s best known brands of apple juice contain arsenic."His show further claimed that based on his independent testing, many brands of apple juice ...
The decision not to become a surgeon
Every medical student goes though a process of elimination when deciding what kind of doctor they want to become. We hear the old saying, "Internists know everything and do nothing; Surgeons know nothing and do everything; Psychiatrists know nothing and do nothing; Pathologists know everything and do everything but it's too late." We hear that pediatricians wear bow ties, are short, and love to laugh and play; that surgeons ...
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....
