Recently JAMA published a special theme issue on critical issues in U.S. health care. Among the contributors was Dr. Ezekiel Emanuel, the oncologist, bioethicist and former White House adviser on health policy. In his article, “Going to the Moon in Health Care: Medicine's Big Hairy Audacious Goal (BHAG),” Emanuel argues that contemporary medicine is in need of vision, an overarching, aspirational goal "like going to the moon that can make ...

Read more...

Physicians in Congress are on the rise. From 1960 to 2004, only 25 of the 2196 members of Congress were physicians. During an era that brought such fundamental changes to health policy as the creation of Medicare and Medicaid, physicians were disproportionately less likely to hold congressional office than their counterparts in law (979) and in business (298). In recent years, the ranks of physician-representatives have swelled -- twenty physicians ...

Read more...

The title itself should make us all cringe!  If there’s one thing I know to be true, it is that putting clinicians at the helm of electronic medical record (EMR) design is doomed to create a product with limited scope and lack of forward-thinking trajectory.  Yet, the concept of integrating and considering the physician point of view and workflow is critical to successful EMR functionality. The question is how can clinician ...

Read more...

The discovery of antibiotics is one of the most significant medical achievements of the 20th century. In the 1920s Alexander Fleming pioneered the discovery and use of penicillin, winning the Nobel Prize in Physiology and Medicine for his work. Other pioneers built upon his success and scientific research to pave the way for even more antibiotic development. The ability to fight infections has ultimately resulted in longer life spans and ...

Read more...

Poverty is a significant public health concern affecting 10-15% of individuals living in Canada and the United States. Recommendations to eliminate poverty have focused on areas of income, housing, food security, and early childhood development. Calls for government action and provision of resources to healthcare professionals have been issued. Notably, educating medical trainees to address poverty has been absent from the discussion. Low socioeconomic status (SES) is a ...

Read more...

It was like watching the news footage of shoppers trampling each other to get through the doors of a Filene's Basement sale or witnessing people standing outside all night for the new iPhone even though it isn't a sale and it will be made in mass production for months or years to come.  I am talking about seeing people line up in the dark of pre-dawn to get their fingers ...

Read more...

Safety net emergency departments are frequently blamed for being the source of rising health care costs. After all, they care for the millions of underserved and un-insured Americans forced by a variety of circumstances to visit ERs for their primary care and low-acuity concerns. With the Affordable Care Act (ACA) reforms initiated in January, demand for emergency services will rise significantly. Medicaid already covers over 50 million individuals – most of ...

Read more...

Supporters of the most recent paper from the Canadian National Breast Screening Study (CNBSS) falsely contend that only radiologists are criticizing this study. This simply is not true. The Canadian study flaws have been well documented for decades. Robert E. Tarone at the National Cancer Institute (who isn't a radiologist) wrote in 1995 that there was a statistically significant excess of advanced cancers that were allocated to the mammography ...

Read more...

Schuur and colleagues in JAMA Internal Medicine listed five low value services in the emergency department (ED). Although compilation was not solicited by the American College of Emergency Physicians as part of the Choosing Wisely program, it has its ethos. The list was developed by a technical expert panel after multiple iterations. The list is not only wise but derived from sound methodology. Most importantly, the recommendations are ...

Read more...

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 35-year-old man is evaluated for a 2-week history of nonproductive cough and fever. He has a 20-year history of asthma. Three weeks ago, he visited friends in Indiana. He has no dyspnea, hemoptysis, or worsening of his baseline asthma symptoms. His only medication is an albuterol inhaler as needed. On physical examination, ...

Read more...

I was reading a medical home advocacy group’s upbeat approach to a recent JAMA study that had found scant benefit in the concept when, suddenly, we tumbled into Alice in Wonderland territory. The press release from the leadership of the Patient-Centered Primary Care Collaborative (PCPCC) started out reasonably enough. The three-year study of medical practices had concluded that the patient-centered medical home (PCMH) contributed little to better quality of care, lower cost ...

Read more...

In the first recent piece of good news about the child obesity epidemic, the latest statistics on preschoolers -- those 2- to 5-year-old bundles of joy whom we worry about so much -- suggest that they’re less obese than they used to be. Between 2003/2004 and 2011/2012, according to the Centers for Disease Control (CDC), there was a huge drop in the ...

Read more...

Recently, a patient I have known for several years called my office and spoke to my nurse. She said that while she was driving, her vision had gone blank for one second and then she was fine. My schedule was already overbooked. Almost all of the slots were filled with patients with the usual array of multiple chronic medical problems for follow-up and management of what were, for the most ...

Read more...

Deductibles and donuts change the flavor of health careA guest column by the American College of Physicians, exclusive to KevinMD.com. In the annual cycle of a medical practice, there are seasons. For example, we have "flu season," "poison ivy season," "camp or school physical season," “snowbirds back from Florida season,” and in my part of the world, "Lyme disease season." There are other seasons that physicians must endure that have ...

Read more...

The administration has confirmed that the individual policies that were supposed to be cancelled because of Obamacare can now remain in force another two years. For months I have been saying millions of individual health insurance policies will be cancelled by year-end -- most deferred until December because of the carriers' early renewal programs and because of President Obama's request the policies be extended in the states that have allowed it. The ...

Read more...

I went to see my oncologist for my six-month checkup yesterday. All was routine, other than my blood pressure being 131 over something when it's usually in the 115 range, even when I see my family doctor. No anxiety there. When he asked what had changed in the last six months, I told him about the endoscopy I had in December, which turned out to be normal. But what prompted it ...

Read more...

From MedPage Today:

  1. The Role of NPs and PAs. What role should NPs and PAs play in a 21st century medical model?
  2. Patches Fail Smoking Test in Pregnancy. Nicotine patches were no better at increasing smoking cessation during pregnancy than a placebo.
  3. Diabetes in Pregnancy a Risk Factor for CVD. A history of gestational diabetes may be a marker for early atherosclerosis, ...

    Read more...

The other day at an interdisciplinary rounds meeting at the hospital, one of our nurses who is also an emergency medical technician mentioned that in Britain injured patients receive tranexamic acid before arriving at the hospital because it reduces death from bleeding. "What's that?" I said. I kind of barely remembered hearing this medication's name associated with the treatment of a rare disease, but not treatment of trauma. So I was guessing ...

Read more...

More than a century of American medical history was turned on its ear recently by the announcement that the groups that accredit medical residencies will unify their standards. Don’t be too hard on yourself if you failed to understand the significance (or notice at all). But this should be viewed as good news across the land. As someone who trains doctors from both traditions, I certainly welcome a more level playing field. First, ...

Read more...

When patients ignore the evidence: Try to understand their valuesI still remember being taken aback by how young she was. “She” was Mary -- a 28-year-old woman who had completed chemotherapy for stage II breast cancer. She was treated elsewhere and had moved cities when her husband got a promotion. “I’m still getting used to this area, but I am happy my hair came back before we had to move. I ...

Read more...