by Daphne Swancutt I’m having a weird, visceral reaction to all of the recent brouhaha surrounding the term “e-patient.” For some reason, semantically speaking, the term is slipping in to derogatorium. Up there with “cyberchondriac,” which definitely is derogatory. It’s kind of like research—one day, omigod, it’s Mecca; the next day, it’s the scab on a rotting wound. Whatever. I have a chronic condition—I’m not dying, it’s not ...

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by 911Doc, MD I can't help but stand in awe of surgeons. I thought I was going to be one when I went to medical school, but my short attention span and my lack of true interest in the procedures spelled doom for that. Still, when I work in the ER and I have a surgical patient, I especially want to dot my i's and cross ...

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A reader wrote, “A friend sent me a link to information regarding the pertussis vaccine for adults. I have a 6 month old. What are your thoughts?” I wrote about vaccines for parents of newborns last year, but recent news about several outbreaks of pertussis make this question especially important. It’s time for an update. Pertussis, also called “whooping cough,” is bad news. For children and ...

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Every once in a while, there's a magazine piece that so encapsulates the key moral issues -- and irrationality -- of 21st Century medicine that it warrants designation as mandatory reading for anyone who interacts with patients. Atul Gawande has written some of these; so too has Slate medical columnist, Darshak Sangavi. The latest entry on the required reading list is Katy Butler's "My Father's Broken Heart," which appeared ...

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Here are the top posts from this past week, based on the number of times they were viewed. 1. Moments of internal struggle in the ER 2. Stop eating before you become obese 3. Why are most physicians writing their prescriptions by hand? 4. Why are hearing aids so expensive, and reading glasses so cheap? 5. Medical school is hard, and other medical student thoughts

I’d like to thank various media outlets for recently citing KevinMD.com. In her New York Times diagnosis column, The heat of the night, Lisa Sanders discusses the case where a patient live-blogged his hospital stay, crowd sourcing his diagnosis:

[Physician blogger John] Schumann was worried, too. He lived nearly a thousand miles away — too far to come and see his friend. Besides, the patient was posting all his ...

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Health Affairs reports on a study that finds Evidence That Consumers Are Skeptical About Evidence-Based Health Care. According to the abstract,

We found many of these consumers’ beliefs, values, and knowledge to be at odds with what policy makers prescribe as evidence-based health care. Few consumers understood terms such as “medical evidence” or “quality guidelines.” Most believed that more care meant higher-quality, better care. The gaps in ...

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I recently joined my team while troubleshooting a complex infrastructure problem affecting our community EHR hosting private cloud. From years of experience doing this, here are my lessons learned. 1. Once the problem is identified, the first step is to ascertain the scope. Call the users to determine what they are experiencing. Test the application or infrastructure yourself. Do not trust the monitoring tools if they indicate all is well but the ...

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Several clients have endured the trauma of malpractice law suits, Medicare audits and stinging accusations or criticisms from patients or colleagues that leave them reeling. These clients have shared feelings of:

  • shame
  • despair
  • depression
  • loss of self-worth
  • disillusionment
  • confusion
  • hurt
  • defeat
Oddly enough, one of the least common feelings they're able to get in touch with is anger. Maybe it's because my clients are self-selected, and many tend to be goal-oriented strivers with a perfectionistic streak. They were, as was I, ...

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ZDoggMD, a hospitalist in California, gives us Diagnosis: Sesame Street, "a cluster of mental illness, all on one urban inner city avenue." Enjoy. width="430" height="340" classid="clsid:d27cdb6e-ae6d-11cf-96b8-444553540000" codebase="http://download.macromedia.com/pub/shockwave/cabs/flash/swflash.cab#version=6,0,40,0">

Psychotherapy appointments have traditionally lasted 50 minutes with 10 minutes for paperwork. This has lead to the expression, “the 50-minute hour”.

More recently there has been talk of incorporating psychotherapy techniques in brief visits in primary care. The provoking title “The Fifteen Minute Hour” is from a book about addressing the emotional aspects of disease in primary care during brief appointments. The title and the concept seem relevant to much of ...

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How doctors can cope with stress

by Walter van den Broek, MD, PhD Often I ask my residents that if you can’t take care of yourself, how do you expect to take care of your patients? Or in another way: the only difference between God and a doctor is that God knows he’s not a doctor. These sound like cliches but there is some truth in them. In short, doctors are just ordinary people ...

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A video preview of what's coming up this weekend on KevinMD.com. classid="clsid:D27CDB6E-AE6D-11cf-96B8-444553540000" width="430" height="288" id="viddler_kevinmd_3">

Do you know that the price of a contraceptive pill in Chicago pharmacies varies from $9 (Trinessa, aka generic Tricyclen, at Target pharmacy) to $84 (Loestrin 24 at Kmart pharmacy) a month? That means, over the course of the year, depending on what pill you take and where you shop, you could drop as little as $84 or -- let me get my calculator here -- $1008! These prices are if you pay out ...

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by David C. Kibbe, MD, MBA and Brian Klepper, PhD Finally, we have a Final Rule on the Medicare and Medicaid EHR incentive programs. The rules and criteria are simpler and more flexible, and the measures easier to compute. But they are still an “all or nothing” proposition for physicians, who will have to meet all of the objectives and measures to receive any incentive payment. Doctors ...

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Since there are many antidepressants with varying dosage ranges, and many more degrees of variations between individual responses to particular antidepressants, psychiatrists have been unable to agree upon an operational definition of an "adequate trial" of an antidepressant. However, it's worth looking at some guidelines. A 2003 study from the Journal of American Medical Association found that only 21.7% of Americans diagnosed with depression received "minimally adequate treatment" in the past 12 ...

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Speaking to the senior staff of the National Library of Medicine recently was like going before the best kind of murder board. Picture it: 30 of the nation’s smartest health information mavens around a polished conference room table, asking me sharp questions, suggesting new lines of inquiry, and offering their own insights. In other words, heaven. Our jumping-off point was the Pew Internet Project’s latest research on internet penetration, mobile use, and ...

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by Diana E. Lee Most of the resources I've read about how to prepare for a doctor's appointment recommend bringing a loved one with you so that person can help you remember what the doctor said and make sure you get your questions and concerns addressed. But when I read Paula Kamen's book All in My Head: An Epic Quest to Cure an Unrelenting, Totally Unreasonable and ...

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Howard Brody, a family physician, recently wrote an article in the Annals of Family Medicine discussing, “Professional Medical Organizations and Commercial Conflicts of Interest: Ethical Issues.” The article focused on how AAFP has “recently been criticized for accepting a large corporate donation from Coca-Cola to fund patient education and materials on obesity prevention,” and how this money has been called a “conflict of interest.” To that effect, Dr. Brody defines such ...

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After 5 successful years with electronic medical records (EMR), I am convinced that the promise of EMR to improve physician practices and to improve the health care system is real. If that is true, why is adoption of EMR currently limited to only 5-10% of medical practices?  Why is there so much resistance?  As folks who work in heath care IT so often ask, why don’t doctors “get it?”  I don’t ...

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