Patient

Executive physicals, and what the Mayo Clinic doesn’t want you to know

The Mayo Clinic has been touted by policy wonks as a low-cost, high-quality integrated health system that American physician practices should aspire to.

What’s somewhat less publicized is that they are also a leader in so-called “executive physicals.” (via Schwitzer)

These exams, which often exceed thousands of dollars, offer CEOs and other executives a battery of tests that are often not evidenced-based. These can include stress tests, cardiac CT scans, and …

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Can patient empowerment be taken too far?

Donald Berwick is a physician at the forefront of the patient empowerment movement.

In a recent interview, he believes that medical care needs to be more patient-centered, in effect, “transfer[ring] control from doctors to the patients themselves,” and, “patient preference occasionally putting evidence-based care “in the back seat.”

I wonder how, as a pediatrician, he’s handling the anti-vaccine movement.

In response to a question on patient choices that come in conflict with …

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Losing the anti-vaccine fight, and what we should do next

The fight versus anti-vaccine proponents is a losing one.

Orac, a general surgeon who blogs over at Respectful Insolence, is on the front lines of the debate. In this post, he writes about how vaccine supporters are facing an uphill battle:

One problem is that vaccines have been so successful that parents rarely see the full, ugly consequences of the diseases against which vaccines defend anymore. The other problem is that …

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Doctors and midwives need to cooperate more

There has always been an underlying tension between obstetricians and midwives.

From the doctor’s side, the only times they interact with midwives is when trouble arises. Or, as this article in Time puts it, “When hospital-based obstetricians see midwives and their clients it’s usually because something has gone wrong . . . OBs don’t see the uneventful births that proceed successfully at home [and] doctors in this position find themselves …

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Same-sex partners being denied visiting rights

A hospital that denied a woman from visiting her dying partner at a hospital is now at the center of a federal lawsuit.

Tara Parker-Pope details the case, which is sparking outrage. I won’t rehash the discussion, which has been quite vigorous over at her blog. Indeed, the results of the pending lawsuit can have far-ranging effects, including “the way hospitals treat all patients with non-marital relationships, including …

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Should Oprah be giving medical advice?

When it comes to influence, you need not go further than Oprah Winfrey.

Just ask Kentucky Fried Chicken.

With the recent news that she is giving anti-vaccine proponent Jenny McCarthy prominent airtime, as well as her previous endorsement of Suzanne Somers’ book on “bioidentical hormones,” is she doing more harm than good?

That’s what Rahul Parikh suggests in a piece on Salon. Despite her soaring ratings captive audience, Dr. Parikh thinks that, …

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Poll: Should doctors discuss the price of medical treatment?

A recent poll conducted by the Consumer’s Union, publisher of Consumer Reports, found that only 4 percent of patients said their doctors talk with them about the cost of prescriptions. And 60 percent find out what the price is for the first time when they pick up their drugs at the pharmacy.

Should doctors discuss the price of medication before prescribing it?

As physicians, we’re trained to make treatment decisions without the …

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Costs are forcing more patients to leave against medical advice

But can that be a good thing?

More patients have higher deductible health insurances, making them question the costs of emergency room tests and treatments. The fear of sticker shock is causing some to leave the hospital against medical advice.

In fact, discharges against a doctor’s advice jumped by almost 50 percent over the last decade.

Such cases can range from patients not willing …

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Worrying about a miscarriage while performing a liver transplant

Transplant surgeon Pauline Chen uses that harrowing personal account to discuss the intersection between motherhood and medicine.

Women currently make up the majority of students at most medical schools, which means that female physicians will comprise a major part of the future medical workforce. But, despite the stress that you’d intuitively associate between juggling medicine and raising children, “work-family conflicts were not a major source of stress …

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How the physical exam can affect the doctor-patient relationship

The physical exam is increasingly being overlooked, and replaced by diagnostic tests, which are easier, and take less time, to order.

At this new blog over at The Atlantic, Abraham Verghese talks about how the physical exam, when done well, “earns the trust of the patient, and it also lays the foundation for the patient-physician relationship.”

However, when done poorly, “it does the opposite–it creates …

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How you can catch the flu after touching money

Yes, cash can transmit the flu.

In an interesting report (via Well), it’s noted that the flu, including the H1N1 virus, can last for as long as an hour on money and other forms of paper currency. Worse, “mix in some human nasal mucus, and the potential for the virus to hang on long enough to find a victim increases, according to one of the few …

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Is IV sedation being overused?

Prior to a breast or bone marrow biopsy, intravenous sedation is typically offered to, and accepted by, patients.

But, what if some don’t really need such heavy sedation?

Over at Better Health, Harriet Hall wonders if some patients would do just fine with a simple local anesthetic: “Has it become a knee-jerk reflex to sedate everyone as a general principle? Why? To avoid complaints and keep patients …

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How is swine, or H1N1, flu affecting your doctor’s office?

Coverage on the H1N1 influenza has been nothing short of constant.

But, how is it affecting your physician’s office? For me, there’s been many questions, some patient anxiety, and lots of diagnostic nasal swabs. But, being in New Hampshire, the prevalence of the H1N1 virus has been relatively low, compared to other parts of the country.

For a more detailed look behind the scenes, Rob Lamberts …

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Abraham Verghese on the KevinMD Live Q&A: Monday, May 4th at 10:30pm Eastern

Abraham Verghese will be answering your questions at my next live Q&A.

Dr. Verghese, a Professor for the Theory and Practice of Medicine at the Stanford University School of Medicine, is one of the most accomplished and admired physician educators today. His pieces have appeared in The New York Times and The Wall Street Journal, and one of his recent articles, entitled Culture Shock, …

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When is it alright to advise a patient to smoke?

Believe it or not, there are such instances.

Peter Ubel tells us of one, in a sad case of end-stage metastatic lung cancer. While observing a patient and his wife arguing about his cigarette use, Dr. Ubel realizes that in this instance, it’s quality of life that matters.

So, instead of watching them fight, he encourages them to see the bigger picture: “My duty as a …

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Why doctors skip medical interpreters, and how that damages physician-patient communication

Physicians are often pressed for time, both in the hospital and the clinic.

And for those who don’t speak English, that represents a huge problem. Not only are many cash-strapped hospitals cutting back on interpreter services, those that have them aren’t always being utilized.

As surgeon Pauline Chen notes, “Patients who speak English poorly or not at all face longer hospital stays, an increased risk of …

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Poll: Should salt intake be regulated by the government?

New York City mayor Michael Bloomberg recently introduced an initiative to pressure the food industry to cut salt intake by half over the next decade.

Combined with the city’s ban on trans-fats and move to post calorie counts in restaurants, this is part of an emerging trend where the government is taking decisive steps to control what we eat. But, in the case of salt – to what end?
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Stanford’s Abraham Verghese has open office hours on Facebook

Abraham Verghese is an internal medicine physician at Stanford, and a prominent physician-writer.

Stanford University is utilizing Facebook as a way to ask Dr. Verghese questions. He’s one of the most eloquent and introspective doctors working today, so it’s a treat to hear him talk about the various issues readers bring up.

Here are the first few videos in the series.

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A pediatrician takes the anti-vaccine movement head on

Would you rather have your kids get measles or autism?

That’s the choice that anti-vaccine proponent Jenny McCarthy lays out on the talk show circuit. But in a LA Times column, pediatrician Rahul Parikh comments, “At best, that’s a false choice; at worst, it’s a sick, horrible wish for her or anybody else’s child.”

He further observes, rightly, that the anti-vaccine movement has done a much better …

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Professional athletes going half-speed, and the dangers of overtraining

With the NBA playoffs now upon us, do basketball players go all out, all the time?

Not necessarily.

Over at Better Health, Nick DeNubile, orthopedic consultant to the Philadelphia 76ers, says that there’s “an important distinction between going half-speed and being tentative. If you’re tentative ““ in any sport at any time ““ that’s when you risk injury.”

The key is staying relaxed, and Dr. DeNubile notes …

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