Dear patient: Your 5 minute appointment is awaiting you. Dear patient: I am writing to inform you of some recent changes to my practice. These changes have been implemented to improve the quality of your care. I will no longer be able to see you for a 20-minute or 40-minute appointment. These will instead be shortened to a 10-minute or 20 minute-appointment based on your stated needs. For example, if you just ...

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Having just retired on July 1st, my medical group's commercial health insurance policy is no longer available to me. However, being past 65, I started a year ago applying for Medicare benefits. Despite my knowledge in this field, I had assumed this would be a snap. I also had assumed that my Medicare patients who enrolled in a Medicare HMO (Medicare Advantage) did so for purely economic reasons. My experience has ...

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A popular television commercial shows a group of older women playing cards. One woman talks about her friend who is struggling financially since her husband died (the husband only had a small life insurance policy). Another lady said that she doesn’t have to worry about that happening since her husband has an XYZ insurance policy. The other ladies immediately ask about the policy. Then a TV pitchman describes the policy ...

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Top stories in health and medicine, July 25, 2014From MedPage Today:

  1. Vitamin D Megadoses Safe in Frail Elderly. Giving a very high dose of vitamin D -- 20,000 IU per week -- to older patients in nursing homes keeps them sufficient in the vitamin and appears to be safe.
  2. Medicare Tests Exceptions to 3-Day Rule. Medicare officials have allowed patients ...

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A 32-year-old woman recently came to see me for an opinion on stomach pain.  Why would I refuse to see her again?  Abdominal pain is an everyday occurrence for a gastroenterologist.  She was accompanied by her mother.  I had never met this woman previously. She had suffered abdominal pains for as long as she could remember.  She recalled frequent visits with the school nurse when she was a young girl. She has abdominal distress ...

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When Uncle Will needed a hip replacement, he chose an orthopedic surgeon, Jason Brockman, and Mountain Memorial Hospital because of their excellent reputations for low complication rates and satisfied patients. The process reminded him of when he bought his first brand new truck. Norm and Clara Anderson chose Dr. Wheeler as their family doctor once they had made the decision to relocate to Maine and raise their family away from the ...

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Before losing my health insurance in 2009, it never occurred to me to be concerned about a little thing like a blood test.  Since 1986 I’d been having three vials of blood drawn each year during my physical.  My doctor would authorize it, the nurse would draw the blood in the office and send it to the lab for processing. A few days later she would call me with the results ...

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3 ways to master the art of teaming in medicine A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com. As a physician anesthesiologist in a community hospital setting for more than 25 years, the quest for mastery keeps my practice from getting stale or boring. I relish the technological innovations in the past decade: the video laryngoscopes and ultrasound-guided nerve blocks that allow my ...

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Moving annual visits into the 21st centuryA guest column by the American College of Physicians, exclusive to KevinMD.com. The recent uproar over the American College of Physicians’ recommendation against routine pelvic examinations made me think about the status of the annual visit (a.k.a. yearly physical, annual exam) on average risk, asymptomatic adults that most internal medicine specialists perform. Some would say that ...

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Who knew questioning medical tests could be so much fun? Watch Pharrell Williams' "Happy" with lyrics that advocate more sensible medical testing. James McCormick, co-host of the Best Science Medicine Podcast, wrote this pitch perfect parody.  The ABIM Foundation's Choosing Wisely campaign educates both physicians and the public to question medical tests and treatments.

Top stories in health and medicine, July 24, 2014From MedPage Today:

  1. Weight Watchers Tops in Efficacy Vs. Cost. Among the most popular diet programs and drugs, Weight Watchers trims the most bulge for the buck, according to a new cost-effectiveness analysis.
  2. Probiotics: Moderate Impact on BP? Probiotics cut blood pressure by roughly 4 mm Hg systolic and 2 mm Hg ...

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As a doctor, I’m trained to do many things: I listen. I ask. I examine, order, and test. And then I assess. I certainly try to treat. All too often, this includes prescribing. What frequently gets obscured in this paradigm is that, on many occasions, the listening part is enough. Take Gene, for instance. He’s a retired biochemist. When I met him for the first time as a patient, I took a ...

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Another year of medical school soon begins.  There's no better way to greet incoming students than this The Book of Mormon parody from the University of Chicago Pritzker School of Medicine (who also brought you their gone-viral rendition of Let It Go).  Good luck, first-year medical students: The book of Netter's will indeed change your life.

We believe in data. We are scientists after all. And yet in this new era of big data is it possible we are measuring the wrong things? Most measures of physician performance are process or intermediate outcome measures aimed at a production line model of care. Was an A1c done, did the physician use a computer to send an order to the laboratory, were antibiotics given within two hours of presentation. Yet ...

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If you (or a loved one) have been admitted to a hospital recently, you were probably surprised by the number of times you were asked the same questions. At first you might assume that the staff are being diligent in double-checking your information, but after the fifth healthcare provider asks you to explain why you’re there, you start to feel as if interacting with “the system” is like talking to ...

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It’s easy to get frustrated in the ER. First, you’re at work. Second, most of your patients don’t want to be there. Third, many (if not most) of your patients don’t need to be there. Finally, by the time you see them, most of your patients are tired of being there. It’s easy to become jaded when you trudge through this never-ending mire of patient after patient, and indeed ER docs ...

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It all comes down to willpower, right?  Strength of purpose.  Muster the resolve to skip dessert, and you have a shot at losing that spare tire hanging off your belly.  Succumb to your temptations, however, and you are simply being weak. But is it just weakness that causes us to overeat? A study in Psychological Science suggests that our inability to resist that mouthwatering looking chocolate cake doesn’t arise simply because our ...

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The Veteran’s Administration is under fire for covering up deaths. Men and women who were eligible for care languished on impossibly long waiting lists and even worse when some died waiting for care their deaths were covered up. This is horrific and everyone wants to know how this tragedy could have happened? Veteran’s hospitals have long waits in my experience because they are underfunded, many (if not all) patients with complex ...

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Top stories in health and medicine, July 23, 2014From MedPage Today:

  1. Salt Consumption Tied to Heart Risk in T2D. Higher salt intake was associated with a greater risk of cardiovascular disease in patients with type 2 diabetes.
  2. Three-Drug Cocktail Has Promise in TB. An experimental, three-drug tuberculosis (TB) treatment regimen demonstrated bactericidal activity in patients with drug-sensitive or multidrug-resistant disease.

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In another entry for the communication category, here’s a little play I wrote: Scene: Pre-op area.  Patient arrives for surgery exactly at the scheduled start time, that is, 90-minutes late. Anesthesiologist (me): Good morning Mrs. Jones.  I’m Dr. so-and-so.  How are you this morning? Patient: Oh, doctor, I have the most terrible headache.  They told me my surgery was at 11 so here I am at 11, and now they tell me I’m late. Me: ...

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