As doctors, we have pills to treat infections and high cholesterol. We have scalpels to replace hips and open clogged arteries. But beyond pills and scalpels, what tools do we have? Walking out of the doctor’s office without a prescription is a rare occurrence these days. And the famous surgeon tagline has always been “a chance to cut is a chance to cure.” We see people when they’re sick and ...
December 2011
All Stories
MKSAP: 67-year-old man with confusion, agitation, and malignant hypertension
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.A 67-year-old man is evaluated in the emergency department for confusion and agitation secondary to malignant hypertension. Initial blood pressure is 230/130 mm Hg, and funduscopic examination reveals papilledema.He is admitted to the intensive care unit, and therapy with nitroprusside by continuous infusion is begun; ...
The positive effects of palliative care on quality of life
“I’ve been a fighter all my life,” said my new patient, a middle aged man with thinning hair, a worried wife, and a dismal prognosis. He had worked all his life as a plumber with no health insurance. When he was healthy, it was okay. But now he was sick.I was meeting him for the first time in the community health center where I work as a family physician, tending ...
Balancing precaution and the apparent risk in medicine
One will find many examples of precaution and their corresponding examples of risk in how medical care is provided by physicians and accepted by patients. In fact, not only do these two elements correspond but at times the price, itself, of precaution becomes the risk.Risk is everywhere in medical practice. Risk is present when a patient is selecting a physician. The risk is becoming the patient of a doctor whose ...
2011 KevinMD posts of the year
This year, nearly 4 million of you visited KevinMD.com. Thank you.I'm humbled that so many of you find the time during the day to visit the site and participate in the discussion that often ensues.As our health care world dramatically changes around us, it's important that medical professionals have a say in the process. KevinMD.com provides an influential platform for your voice, and I will continue to do my best to ...
Simulation is a disruptive and transformational technology in medicine
Incredible innovative and entrepreneurial skills have led to many new techniques and technologies in medicine. Some are both disruptive of the old way of doing things. Others are transformational. Over the next few weeks I will review some of those that I believe are among the most disruptive and transformational. Medical simulation is such an advance. It is dramatically transforming the way medicine, especially medical procedures, are taught and it ...
Human papillomavirus and the risk of oropharyngeal cancer
Cancers of the tongue and throat, all categorized as oropharyngeal cancers, are appearing at an epidemic rate.The old paradigm is that such cancers most often occur in older men who drink and smoke. But this is no longer true. Now the most common cause of cancer of the tonsil and tongue is human papillomavirus (HPV). That’s right, the sexually transmitted disease. And it is occurring in ever younger people ...
Solving information overload in the EHR
I have been using electronic health records now for over 10 years. Like most physicians who have used EHRs, I would not ever go back to a paper-based medical record.Having said that, it is important to recognize some of the potential problems created by some EHR products. One potential pitfall of some EHRs is the number of steps it takes to find information that is in the system. Yes, it ...
Why your EHR note may not be accurate
With paper exam notes, the doctor and staff record information and the note reflects what they recorded. Unfortunately, EHR based notes may not be as direct.Many EHR systems store the information that you enter in one way, and offer a variety of presentation and reporting options. The ability of the EHR to offer multiple presentation options is a powerful tool. For example,You may generate an exam note, referral form, and a ...
Doctors who make the dysfunctional health system work
Now that it has been a couple of weeks since finishing my family medicine rotation, it struck me on the invaluable lessons I learned there from two amazing preceptors. My family medicine experience was in a community group practice based in the city where I am doing my rotations. This city is in a suburban/rural environment with an incredible mix of patients ... the age range one day was from ...
Is ethical for parents to refuse surgical treatment for their child?
The principle of autonomy is one of the four guiding principles of medical ethics, the others being beneficence, nonmaleficence, and justice. It means that patients have the right to decide what is done to their own bodies. For children under eighteen, the age of majority, this means their parents decide for them. What happens when parents refuse a treatment that their child’s doctors recommend? (The right of a minor child ...
The value of continuity of care is priceless
During my first week on a pediatric outpatient clinic as a third year medical student, I spent an average of 140 minutes caring for each patient. Looking back at that first week, the amount of time I spent with each patient ranged from a “brief” 79-minute visit to one whopper 188-minute visit where I reviewed several journals in the workroom and sought two attending physician opinions to be completely sure. ...
I’m proud that I’ve never had an MRI or CT scan
What is your personal experience with MRIs? Was your last one fun? How much did it cost whoever paid for it? Did it make a real difference in your outcome?I am a 78-year-old American man in robust general health and with good comprehensive health insurance all my adult life and I have never had an MRI.Until 2010, I had also never had a CT scan. And I'm proud of that.Why ...
The patient reality of a Medicare payment cut
Dear United States House of Representatives and Senate:I really hope that you enjoy your Christmas break going back home to your families. While you're home, I really hope that you will hear from those constituents who will be affected by the 27.4 percent Medicare physician pay reduction that is schedule to take effect January 1st. I really hope that the American Academy of Family Physicians, the American Medical Association, ...
How much guidance do patients want with their medical decisions?
The following column was published on November 10, 2011 in Medical Economics.I recently saw two patients in my primary care clinic, each with new-onset hypertension.The first, a middle-aged executive, brought printouts from the Internet and already had researched the various treatment options for high blood pressure. During the visit, we discussed this information, and I gave my thoughts on ...
Be an innovator in medical school
The practice of medicine is changing structurally, technology, and financially at an unprecedented rate. Scientific advances in genomics, electronic medical records, an increased focus on quality improvement, and changes in the health insurance structure are a few of the areas in which the landscape of medicine is changing. However, in many of these processes physicians seem to be bystanders. Medicine requires innovative physicians to be part of this change. At ...
The 7 types of medical students you’ll meet
The third year of medical school is definitely an interesting one. You leave the classroom and enter the big bad world of medicine, and you quickly realize that much of what you’ve learned is for naught. You also realize that the medical student next to you could become your best friend, or the bane of your existence -- or fall anywhere along that spectrum. Here is a list of the ...
Make an informed judgment on the abilities of your surgeon
How many of the 40 million plus patients undergoing an operation this year are truly informed of their surgeon’s track record? I suspect the vast majority of patients entering the operating room today are unaware of existing, vital information that would enable them to make an informed judgment on the professional abilities of their surgeon.Most patients who end up in a surgeon’s office are there because their primary care physician ...
Happy residents do much more for their patients
The resident’s training can be compared to the one received by Navy Seals or U.S. Marines in many ways. Physical endurance, psychological warfare towards the trainee, long service hours and quick life or death decisions are all aspects of both types of preparation. In most cases, this turns out to be a great burden on the resident’s life, especially on the interns, whose lives have dramatically changed from one day ...
Abbreviate your med list with caution
People who regularly take medicine should know what we’re taking. To me, this seems obvious, but there are always those who need everything stated explicitly. People taking prescriptions, vitamins, herbs, and any other treatments should know what’s being taken and why.It’s pretty easy to make yourself a list and stick it in your wallet so that it’s always available. If you need medical assistance (for instance, if you’re in a ...
Kevin Pho, MD
-
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...
-
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....
-
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...
-
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
-
Patients will understand an honest mistake if the doctor tells the truth
It was 1976 and I was a junior resident in urology at Baylor College of Medicine in Houston, Texas. I was assigned...
-
Diagnosing an illness is an art
Diagnosis is the foundation on which all care and treatments rest. If the diagnosis is wrong, most probably so is the treatment. ...
-
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....
-
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...
Patient
-
How will the Baby Boomers age and die?
I love listening to life stories. As a hospice chaplain, I loved sitting with our patients and their loved ones engaging in...
-
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...
-
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...
-
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...
Policy
-
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...
-
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...
-
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...
-
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
-
Repetition is the curse of the doctor-patient engagement
How many times as a doctor do you ask the same questions over and over again as part of the routine process...
-
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...
-
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...
-
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...
Social Media
-
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...
-
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...
-
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...
-
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....
