There is a critical gap in the supply of primary care physicians in the U.S., and it should come as no surprise that our existing primary care delivery and payment models are at the heart of the issue. The traditional primary care model -- medical care provided by a physician and a small support staff, often without benefit of health information technology (HIT) -- was developed at a time when the ...

Read more...

Boston Medical Center has provided care to the underserved and Medicaid population in Boston for almost 150 years. And what's happening to the venerable institution is gut-wrenching to read. I trained at Boston Medical Center (BMC), completing my internal medicine residency there in 2002.  A recent write-up in Boston Magazine highlights the financial trouble the hospital is going through:

Boston Medical Center is almost broke, perilously close to what its ...

Read more...

I’ve worked in hospitals since I was 16 years old — 42 years ago now. I was first an orderly, then a nurse’s aid, then a practical nurse, and a finally a surgical technician before I became a physician. When I started, female nurses wore caps, the details of which identified which nursing school they had graduated from, as well as a pin that gave the same information. They wore starched, ...

Read more...

Dealing with an incurable illness or terminal condition is an inevitable reality of the practice of medicine. Not uncommonly, especially in the intensive care unit, we care for the patient with no chance for recovery and survival. Keeping that patient comfortable and allowing him or her to die with dignity becomes the priority of care. Occasionally, I hear requests from the family members of the dying patient – “Can you give ...

Read more...

A few years ago, a patient of mine was diagnosed with lung cancer.  A metastatic work up revealed a small mass in his liver that had the radiographic appearance of a benign liver cyst.  But in the setting of a newly diagnosed lung cancer, we couldn’t be sure it wasn’t a metastatic lesion, so we decided to biopsy it.  Due to scheduling issues, we couldn’t get it done for seven ...

Read more...

by Brad Stuart, MD Atul Gawande’s brilliant essay in the New Yorker sums up the dilemma we face, whether we’re patients, families, and/or clinicians, as we near the end of life. His point is that we have to face it together: “People die only once. They have no experience to draw upon. They need doctors and nurses who are willing to have the hard discussions and say ...

Read more...

As an e-Doctor, one with some IT literacy, I welcome the e-Patient movement. I think patients should be equipped, enabled, empowered, engaged, equals, and emancipated, as Wikipedia explains.  The link also adds “and experts” and here I have a problem, not because I don’t think patients should have access to knowledge or know a lot about their own disease, but because knowing one pattern of pathology, i.e. your own, does not make you an expert. No more ...

Read more...

Even as a medical student, I’m already complicit in exacerbating the problem of the high cost of health care. It hit me one day, during my medicine rotation.  We were working up a patient, and I was ordering tests with my resident.  The patient had liver disease and perhaps some ascites. He came in for another issue, and this wasn’t of primary concern to us, and we really wouldn’t have ...

Read more...

I'm taking reader questions to answer on future video preview editions, a reminder for both health care professionals and patients to get their flu shot, and a preview of what's happening on KevinMD.com this week. id="viddler_99fa4078" classid="clsid:d27cdb6e-ae6d-11cf-96b8-444553540000" width="430" height="370" codebase="http://download.macromedia.com/pub/shockwave/cabs/flash/swflash.cab#version=6,0,40,0">

It just shouldn’t be hard to get a refill on the medicines I’m taking:

  • phone the pharmacy to refill prescriptions
  • show up the next day to pick up refills
  • pay
Simple, right? Note that this is about my old pharmacy, not the new one.  For quite a while the pharmacy had been having difficulties, which is why I never trust the pharmacy.  Between the distance and the frustrations I had dealing with them, ...

Read more...

Today we mostly have prepaid medical care insurance with some co-pays and deductibles – both with commercial insurance and with Medicare. In other words, our insurance covers essentially everything from basic and routine care to the catastrophic. And the insurance pays out based on units of care – a visit, a test, a procedure, a hospitalization, a prescription. This creates a system in which providers (physicians, ...

Read more...

The average medical school debt today, according to the Association of American Medical Colleges, is $156,456. The United States is the only country in the world were future doctors have to bear such a financial burden of their education.  That places significant strain on any relationship involving an American medical student. Recently, there was an interesting piece in the New York Times discussing this very issue. The article profiled a female
Read more...

Vitamin D is a fascinating molecule with a fascinating story. Historically, “vitamins” were defined as chemicals that humans required from their environment that were “vital” to human health.  These chemicals were needed only in very small amounts to prevent disease; an absence of a particular vitamin in the diet led to a specific deficiency disease: vitamin C, scurvy; thiamine, beri beri.  Other vitamin deficiencies were found ...

Read more...

by Edward Stevenson One of the things that drew me towards medicine was the fact that I personally value health and the sense of well being. I would expect that if I inquired of my colleagues that a similar statements of values would echo this fact. Yet despite this near universal affirmation of value for health and well-being, a considerable amount of hypocrisy exists in the ...

Read more...

Before he tells you how to get a straight answers from physicians, Doctor D is going to stall for time by explaining why doctors give vague answers. Why would a good doctor give useless answers? 1. There is an answer, but your doctor doesn’t know it. Don’t be hard on doc for this one. There is no MD in the world that knows the entire breadth of medical knowledge. Some docs pretend ...

Read more...

One thing I have learned by being active in the obstetrics and birthing blogosphere is that there are a whole lot of people out there that think that most cesarean deliveries are unnecessary. While most of them will admit that some cesareans are medically required, its pretty rare that the ones that have had a cesarean looks at their cesarean that way. A popular term bandied about is “Unnecesarean”, a catchy ...

Read more...

I like Dr. Rob, the one with the distractible mind. And although I thoroughly agree with the stance he takes in his recent post against cholesterol screening in kids, I must take issue with his opening statement:

I have a unique vantage point when it comes to the issue universal cholesterol screening in children, when compared to most pediatricians.  My unique view stems from the fact that ...

Read more...

Doctors, both generalists and specialists, have constraints on their time. New practices and new approaches need to happen in order to maximize everyone's time. In addition to bringing your co-payment, you should "invest" in the visit and do your part, so that by the time the visit has ended, a successful plan of care is developed. Here are some helpful tips to make the most of your medical appointments.

When I ran into Paul S. not knowing he had cancer, I barely recognized him and struggled with what to say. “What happened?” didn’t seem appropriate, although it was my initial reaction. I believe I said, “I barely recognized you,” which was true. I’ve been in many situations where I wasn’t sure what to say to someone who was ill or in distress; I wanted to be supportive ...

Read more...

"Take a good history, do a good exam." I have not contributed to my treasure of quotes with this title.  No one reading the headline well hit their head and mutter, "Wow!"  Yet one can wonder about the lack of careful history taking and basic physical examination skills. This delightful new blog post written by an internal medicine resident says it well: Defensive medicine supersedes quality medicine. You should read the ...

Read more...

Most Popular

✓ Join 150,000+ subscribers
✓ Get KevinMD's most popular stories