I met with a young patient recently, a woman who has been done with chemotherapy for lymphoma for close to a year. She was feeling well, and she had no symptoms of cancer, nothing that made her suspicious of a recurrence. After I examined her and reviewed her most recent CT scan and labs, I agreed. No recurrence. I wrote in my note, “NED,” the acronym for no evidence of ...
This series is brought to you by MedPage Today1. Election May Not Help Curb Health Costs, Wonks Say. Whether Republicans or Democrats win control in the November elections, nothing will happen that will bring healthcare costs under control without a willingness to deal, healthcare policy experts agreed.2. Cardiologists Urged to Lead in Smoking Cessation. Cardiologists as a group have largely ignored tobacco ...
If you Google “skinny definition” what will pop up is the following:Adjective: (of a person or part of their body) Unattractively thin.The word skinny according to Webster’s is defined as the following:1. resembling skin: membranous 2a. lacking sufficient flesh: very thin: emaciated 2b. lacking usual or desirable bulk, quantity, qualities or significance.So how did our culture take this word and use it to represent a goal, or rather set "skinny" as a ...
I have the great privilege of being a medical educator. Everyday, I have an incredible time working with internal medicine residents at their continuity clinic, teaching the art of ambulatory medicine. Our working environment here is academically rich and fulfilling. The name of the legendary Dr. Martin Leibowitz (an iconic figure in ambulatory medicine here) stands outside our conference room as a constant reminder of how medicine is practiced and ...
Shannon Brownlee’s recent post, "Don’t discard shared decision making on the basis of PSA testing," couldn’t ring more true. The crux of shared decision making is that the patient must decide, with his or her physician, which tests or procedures make sense, given the various risks, tradeoffs and outcomes. Discarding the construct on the basis of one test (PSA testing) is not only poor form in that it is a ...
Vaccines have been a hot topic among parents, pediatrician and in the media for many years. Recently, there have been many news stories about pediatricians who will not care for families who either choose not to vaccinate their children or who do not follow the recommended schedule. These policies are based on knowledge about the safety of vaccines, the effectiveness of the recommended schedule and concern about the spread of ...
A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com.On March 28, 2012, Governor Scott Walker signed into law SB383, a bill to license Anesthesiologist Assistants (AA) in Wisconsin. The Wisconsin Academy of Anesthesiologist Assistants (WAAA), the Wisconsin Society of Anesthesiologists (WSA), the Wisconsin Medical Society, numerous other medical specialty societies, the Medical Examining Board, and six major hospital systems supported the bill. Since 2001, seven states ...
Mark Twain once said, "The difference between the right word and the wrong word is the difference between lightning and lightning bug." He was referring to the power of language. With an allergist, the consequences of the right and wrong words have measurable consequences, ranging from comfort to chronic misery, to medical payments spent wisely or wasted, and sometimes life or death.For example, people with lactose intolerance will mistakenly believe ...
I have participated in two transitions in care with my mother. The first was when she was released from the hospital after undergoing neurosurgery for a malignant brain tumor. Immediately after surgery of her brain tumor, she went through two weeks of intensive physical, occupational, and speech therapy. At the end of this period, the recommendation was clear. She required around the clock supervision. The plan was to send her ...
It is both conventional wisdom and factual truth that, unimpeded, American healthcare cost inflation will bankrupt the United States economically, educationally, socially, and politically in the not too distant future.The inexorable upward trend line is unsustainable.In 2009, I described six ways to save nearly $1,000,000,000,000 per year without serious harm, and with positive benefit to the public health.They were:
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.A 65-year-old woman is evaluated because a screening urine culture for an insurance policy grows greater than 105 colony-forming units/mL of Escherichia coli. She does not have fever, dysuria, urinary frequency, or other symptoms. Medical history is unremarkable. She has no allergies and takes no ...
The first time I met Tom his head was on the table at the Christmas banquet held by the mental health support program where I worked. He was sitting next to his wife, who worked on the staff.Tom’s alcoholism soon brought him into the program, fractured his marriage, and I became his first case manager. The alcoholism had roots in childhood abuse. Years of drinking followed, with hospitalizations, chaos and ...
In our rush to establish a national electronic medical record (EMR) system as part of the American Recovery and Reinvestment Act of 2009, powerful silos of independent EMR systems have sprung up nationwide. While most systems are being developed responsibly, like the Wild, Wild West, many have been developed without an objective eye toward quality and the potential harm they may be causing our patients.As most readers of this blog are aware, ...
As the Supreme Court deliberates the Affordable Care Act, Americans should take a closer look at the commonsense reforms embedded in the law, including those that strengthen public health. Fixation on the law's individual mandate has overlooked the law's very important benefits for public health.Lost amid the rhetoric about individual liberty is the public interest and common good of protecting all Americans from the costly and deadly menace of preventable ...
Prior to 1794, farms across the world could only pick cotton as fast as humanly possible. In the late 18th century, Eli Whitney discovered the cotton gin and a simple process done since 500 AD was instantly improved upon. This invention took 1200 years and a lot of hard labor before it was discovered. Once this invention was created it caused efficiencies but also caused concern for a decreased ...
This series is brought to you by MedPage Today.1. Maintenance Tx Prevents Relapse in Schizophrenia. Keeping schizophrenia patients on antipsychotic drugs after an initial episode has passed does prevent relapses.2. Everyone Needs Heart Attack Risk Assessment. The latest cardiovascular disease prevention guidelines from the European Society of Cardiology include a call for universal risk assessment, as well as a new approach to ...
As a medical student who just completed this third year of training, I took special interest in Dr. Pauline Chen’s recent article about Harvard Medical School’s “Integrated Clerkship” – a program that eliminates traditional block-style clerkships and asks students to follow a panel of “up to 100 patients” longitudinally over the course of a year in order to emphasize continuity of care and the humanistic aspects of medicine. ...
Another call night in downtown L.A. It had not been a particularly eventful day: the usual offering of people hit by cars, falling off of things, and victims of man-made violence. Some injuries happen as a result of an accident, some as a result of carelessness, and of course many happen because of an intentional act. At about 1am the trauma pager went off; the text announced a "Level 1 ...
A few weeks ago, my wife and I attended “A Conversation With David ‘Sonny’ Lacks” at the California Center for the Arts, Escondido. The event was a sellout with 900 attendees. As it turns out, most of the colleges and universities in San Diego County designated “The Immortal Life of Henrietta Lacks” as the book discussed by students and ...
The call came in the middle of a busy office day; the radiologist had found a suspicious area on the mammogram. I had received similar calls many times in my primary care practice. This time was different; the patient was me.My first thought "thank God I’m insured." My second thought was for all those who are not. It was hard enough waiting the week, until further testing could be performed; ...
Who has the potential to be the most influential physician of our generation? It's Priscilla Chan, who not only recently graduated from...
In a widely anticipated move, the USPSTF officially recommended against prostate cancer screening in healthy men. Case closed, right? Hardly. The prostate...
When it comes to medicine and social media, much of the attention is negative. Doctors losing their hospital privileges because of Facebook....
A version of this column was published on April 24, 2012 in USA Today. There has been a recent uptick of elderly men...
I was appalled recently by the coverage of radiology “test recalls” by CNN, amplified by Dr. Gary Becker of the American Board...
I was invited to a medical staff leadership conference sponsored by our hospital. A company specializing in training physician leaders ran the...
As a cardiac electrophysiologist, I have had to discuss bad news with patients and families more times than I would like during...
He looked dead. The paramedics brought him down the hall toward one of my critical care beds, and for a moment I...
I was honored to be part of a beautiful experience in late January of 2011. It was the death of my mother-in-law...
Theirs is a lonely journey; to be moving towards the separation and end of all things known and loved. Being with a...
As a patient who was asked to speak at the Association of Health Care Journalists 2012 conference, I felt a bit covert....
Nothing will force you to live life on your own terms faster than almost losing it. In 2008, I was on fire....
America has this paradox of excellent biomedical science, innovative drug manufacturers and entrepreneurial device developers along with outstanding providers but at the...
"It was the best of times, it was the worst of times ..." So begins a story called A Tale of Two...
The nation’s “safety net” hospitals are designed to ensure that uninsured, lower income and indigent populations receive adequate medical care – a...
Technology to lower costs rather than accelerate them. Smart phones to increase physician and other providers’ productivity. Fewer primary care physicians but...
Propaganda and non-truths abound all around the Internet saying that mobile health apps are everything from a threat to Big Pharma to...
The policeman was two cars in front of me. I meandered down the road cautiously adjusting my speed a few ticks above...
Every month, hundreds of thousands of people look for a doctor on Google. As an amazing practitioner, your site deserves to be...
The first thing I noticed when I walked into the physician’s office were the tall cabinets filled with manila folders, tabbed with...
Prior to 1794, farms across the world could only pick cotton as fast as humanly possible. In the late 18th century, Eli Whitney...
Social media in healthcare is all the rage these days. You can’t visit even one physician-oriented website without someone breathlessly advising you...
Want to understand social media? Physicians wanting to learn about social media must learn transparency. We must learn transparency on a personal...
It was my first ER shift in charge of the resuscitation area. Needless to say, my adrenaline and nerves were firing like...
