I see nearly 100 patients a week.  Of these, easily 35% are overweight and 15-20% are obese with a BMI greater than 30.  I live in New Orleans, Louisiana, which along with Mississippi has the highest rate of hypertension, diabetes mellitus, arthritis, and other diseases commonly associated with obesity.  There are many explanations for the obesity academic in America but certainly poor nutrition and lack of exercise are at the ...

Read more...

I got the following email a few weeks ago (details changed for confidentiality reasons):

Dear Sir, I read about your unique practice online.   I have an 91-year-old ambulatory father who will not go to a doctor.  He definitely is not well and this is the only way I can get him the attention he needs.   He is adamant about not wanting medical interventions, however he still needs to be seen ...

Read more...

Is much of the annual physical a waste of time? So much in medicine and in life is done out of habit.   We do stuff simply because that’s the way we always did it.  Repetition leads to the belief that we are doing the right thing. In this country, we traditionally eat three meals each day.  Why not four or two? We prefer soft drinks to be served iced cold.  I’ve never tried ...

Read more...

Dont be stupid, and other wise words to new college students Welcome to college, young people! It’s an amazing time in your lives. These years will impact your life dramatically if you use them well. So, to help you along the way, allow me to give you some wisdom. First and foremost, get some wisdom. You are bright and capable, otherwise you probably wouldn’t be in college in the first place. But for all ...

Read more...

The electronic medical record that my office uses features a clinical protocol button that we are encouraged to click during patient visits to remind us about potentially indicated preventive services, such as obesity and tobacco counseling and cancer screenings. I once tried it out while seeing a 90-year-old with four chronic health problems. The computer suggested breast cancer, colorectal cancer, and cervical cancer screenings: three totally inappropriate tests for the ...

Read more...

What do eggs, roofing nails, men’s haircuts and plastic cups have in common? A bizarre fraternity ritual or my Saturday morning honey-do list?  Gasoline, copying paper and paperclips?  Shopping for a mobile accounting office?  Nope.  What these items share is that who ever makes them, wherever you buy them, they are essentially the same.  They are commodities. They do not vary significantly in construction or quality.  The only way to ...

Read more...

Dissent and cynicism: Learning from listening to doctorsDissent and cynicism: Learning from listening to doctors An excerpt from The Doctor Crisis: How Physicians Can, and Must, Lead the Way to Better Health Care I just listened. They were very unhappy and angry. I was elected executive medical director in November 1998 but would not assume the leadership role until January 2000. This was fortunate. I knew that ...

Read more...

My morning practice session started out with a few patients arriving early, so I was able to get a jump on the day, and it looked like I was going to actually be running on time. As I was walking from one exam room to the other, my administrator came down the hallway, grabbed my arm and said, "Can I have you for a minute?" It seems that a group of systems ...

Read more...

Part of a series. Over the past few months KevinMD.com has posted a series of articles by me on what I call the “crisis in primary care.”  Most recently have been a few posts related to direct primary care. They have generated many comments: some pro and some con. I have greatly appreciated everyone’s interest; it makes it worth the time to write. I am also working on a book on ...

Read more...

Cholesterol is bad. Cholesterol is an essential building block for important hormones. Eggs are bad. Eggs are a complete protein food. Salt is bad. Salt is essential for life. High blood pressure kills people. No blood pressure defines death. High blood sugar causes eye and kidney damage. Low blood sugar causes falls, fractures and car wrecks. Low potassium causes heart rhythm problems. High potassium causes heart rhythm problems. Too little vitamin B12 causes nerve damage. Too ...

Read more...