A guest column by the American Medical Association, exclusive to KevinMD.com.Last month, physicians from all states and specialties came together for the American Medical Association’s (AMA) semi-annual policy-making meeting to adopt new policies that will impact the future of medicine. Of the new policies, some of the many noteworthy topics include national drug shortages, health insurance exchanges, private contracting and the ...
December 2011
All Stories
A doctor resolves to cut his heart attack risk
I have a 5% chance of having a heart attack in the next 10 years. That’s not so high, but it’s higher than I want it. Most of that risk is due to my cholesterol and my age. I can’t do anything about the latter, but the former is under my complete control. Cholesterol medications can improve my cholesterol significantly. So can proper diet and exercise. That’s not true of ...
Stop trivializing conflict of interest
"I’m sorry, Doctor, but we can’t have you give that talk; you have a conflict of interest since you’ve been paid to do research on that medicine.""Well, Senator, it’s a conflict of interest for a doctor to sell those crutches in his office.""It is the opinion of this newspaper that physicians should declare to each patient any ownership interest they might have in a surgery center so that the ...
A good death is a right we must fight for
The notion that dying is a right seems nonsensical to argue: death is given to all of us equally without the need of anyone’s sanction. The right to die well, on the other hand—well, that’s another matter entirely. A good death is, in many cases, something our fellow human beings have great power to grant or deny, and is therefore, sadly, a right for which we must indeed fight.The ...
Bury bad doctor reviews with a strong physician social media presence
When I talk about online presence to physicians, the first question I'm often asked is, "How do I remove a negative physician rating?"The short answer is, you can't.American Medical News came out with an article outlining the various legal options physicians have whenever a patient rates them poorly on the web.Many of those options, including suing the ...
A rheumatologist goes to spin class
Spin Class. For the uninitiated, this involves a dark studio in a gym, rows of stationary bikes, and a pounding beat, heavy on the volume and bass.The instructor out at the front cajoles and drives you through spurts of speed and tests your endurance with simulated mountain climbs. Some instructors are better motivators than others. One, I remember, stretched belief a little in trying to make us feel we were ...
Why patient complaints are an opportunity
I have not always been excited to hear patient complaints. As a younger manager I absolutely dreaded when a patient wanted to speak to me. I felt that I had little to offer a patient who expressed anger or frustration with something that had happened and I was very impatient to get past the complaint and get back to my “job.”Now, I can’t wait to hear patients’ complaints. Complaints ...
Should you consider genetic testing?
Some of your relatives have had cancer. And, you’ve heard that people with a family history of the disease may be more likely to get cancer.So, should you consider genetic testing to find out if cancer runs in your family?Here’s what you need to know to make a more informed decision.Most cancer cases aren’t related to family history.Only about 5 to 10% of cancer cases are due to an ...
An annual checkup on the Affordable Care Act
As we approach the end of what has been another roller-coaster year for our country, it seems an appropriate time for an "annual checkup" on healthcare reform in the U.S.Like many of my colleagues, I have followed the implementation of the monumental Patient Protection and Affordable Care Act (ACA) with great interest, mild trepidation, and a small measure of optimism.It's hard to believe that almost two years have flown ...
Why the future of the American medical profession is looking good
"I'm not a doctor, but I play one on TV." It seems that everybody wants either to be a doctor or to play doctor.There are "doctoring" nurse practitioners who some derogatorily call noctors; there are RNs who get a PhD, and are thus Doctors of Philosophy; and then there are those new DNPs, Doctors of Nursing Practice.Of course, there are Doctors of Pharmacy, Doctors of Chiropractic, Doctors of Podiatry, ...
Saying no to your oncologist is sometimes the right thing to do
Cancer is a dreadful disease. Just dreadful. Make no mistake: I have tremendous respect for the awesome doctors who treat patients afflicted with it day after day. Still, paradoxically, I can’t help but notice that some of them have just as hard a time as do other doctors with caring for patients at the end of their lives. I believe a large part of their difficulty stems from the ridiculously ...
The erosion of psychiatric training has consequences
One of my most vivid memories of medical school was during my internal medicine rotation, when it had become apparent to me that, despite spending my pre-clinical years studying complex pathophysiology and pharmacology, and the fine art of history-taking and the physical exam, the actual clinical work seemed to be more like a numbers game. I felt like I was always responding to a data point: a blood pressure reading, ...
They don’t make protocols for patients like me
The instruments were indicating to the two co-pilots at the controls of the Airbus that they needed to pull back on the stick.They held back on the stick for 54 seconds.This is the position they were in when the Air France jet plunged into the cold water of the Atlantic killing everyone on board.The fix?Recognizing that a protocol or guideline might be giving them wrong instructions, seeing that there ...
The myth of physician omniscience
How is a doctor allowed to mess around with body parts he doesn't understand?If doctors were required to understand everything we touched we wouldn’t be able to touch you at all!The human body is still a deep mystery. Doctors understand more than most people, but what we know is still a vague approximation. Just because our educated guesses often work out well doesn’t mean we have any idea what’s actually ...
A eulogy for the autopsy, and a call for its return
Evidence-based medicine and health insurers generally focus on what’s medically necessary, not what’s epidemiologically relevant, not what soothes the mind of the bereaved or of the physician grieved and mystified by the loss of a patient.Once, the autopsy was a venerated tool for medical advancement and humility. An invaluable means of learning one’s own limitations and the extraordinary diversity in nature and human physiology, it has now become an unreimbursed ...
Why emotional intelligence matters for doctors and medical students
A popular teacher at our school recently gave a lovely talk about "emotional intelligence." I was at once proud of my school for offering such a lecture and disturbed that it was necessary. Our schedules are flooded with lectures devoted to issues such as professionalism and emotional awareness. We’ve all heard stories about insensitive doctors with terrible bedside manner and outrageous faux pas by medical students, transmitted in whispers, and ...
The rise of citizen scientists and patient initiated research
Whether you call it Health 2.0, Medicine 2.0, or e-Health 2.0, the Internet is changing medicine in ways that challenge the status quo. This article explores how a group of amateurs who call themselves "health hackers" and "citizen scientists" are trying to use the Internet to connect with other patients, run experiments, and conduct clinical trials on their own diseases.Dr. Gunther Eysenbach states “Medicine 2.0 applications, services and tools are ...
MKSAP: 42-year-old woman with lymphadenopathy, fatigue, and edema
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.A 42-year-old woman is evaluated for a 3-month history of progressive cervical lymphadenopathy, fatigue, night sweats, bilateral lower-extremity and abdominal wall edema, and a 4.5-kg (10.0-lb) weight gain. History is significant for three episodes of weight gain and facial and lower-extremity edema lasting 4 weeks ...
Undocumented individuals will become a larger share of the uninsured
As of March 2010, there were an estimated 11.2 million undocumented immigrants in the United States. Currently, three in ten immigrants are undocumented, while only one in seven of the uninsured is an undocumented immigrant. As there exists no consensus on immigration reform, undocumented individuals will gradually become a larger share of the uninsured population due to exclusion from all programs of the Affordable Care Act.This study utilized data ...
Health reform that offers relief from fear and greed
What if we had considered the following items within health care reform?What if physicians were able to practice medicine with reduced fear of malpractice litigation? Some estimates believe the cost of defensive medicine approaches 30%.What if patients were to be offered a different process for conflict resolution before litigation, one that is partially driven by greed? What if this process provided a remedy which met all our future financial 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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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...
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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. ...
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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...
Patient
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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...
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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...
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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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...
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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...
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....
