KevinMD.com

June 11, 2010Jun 11, 2010

by Chris Emery Single and childless surgical residents in the U.S. are more likely to pursue specialized surgical fellowships, and a majority of surgical residents believe a successful career depends upon specialty surgical training, a new survey found. Of residents…

by Chris Emery

Single and childless surgical residents in the U.S. are more likely to pursue specialized surgical fellowships, and a majority of surgical residents believe a successful career depends upon specialty surgical training, a new survey found.

Of residents who responded to the survey, 28.7% believed general surgery is becoming an obsolete career path (30.1% of men and 25.9% of women, P=0.004), and 55.1% believed specialty training is necessary for career …

Patient voices

Third world doctors are the real physician heroes

Dr. Martin Young

June 11, 2010Jun 11, 20106

I recently was involved in a web discussion on elective choices with a group of medical students. Financial considerations aside, I was surprised how few were interested in visiting third world countries to see how medicine is practiced outside the…

I recently was involved in a web discussion on elective choices with a group of medical students.

Financial considerations aside, I was surprised how few were interested in visiting third world countries to see how medicine is practiced outside the first world comfort zone of unlimited expertise, investigation and therapy — where “want” often exceeds “need.”

The third world however is completely different. It’s an environment where doctors and nurses are in …

Conditions and diseases

Treating a child with fever and leukemia

StorytellERdoc, MD

June 10, 2010Jun 10, 20105

I walked into Room 35 to find a three year-old lying on the hospital cot. Her father sat alongside her bed, whispering softly to her. The patient appeared quite tired, wiped-out even, and if it weren't for her complacent eyes…

She was visiting our ER because, after a few days of cough and congestion, she had developed a fever. …

Real physician voices, twice a week

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Health technology

Electronic medical records and detail obsessed doctors

Paul Sax, MD

June 10, 2010Jun 10, 20105

When it comes to writing consult notes, it often seems as if we ID specialists have a blatant form of obsessive-compulsive disorder. Every detail is fair game — travel history, dietary habits, all sorts of seemingly trivial exposures, and of…

I’ll never forget receiving sign-out from the graduating first-year ID fellow when I started my fellowship. It included a photocopy of a …

Medical education

ABIM responds to doctors sharing board certification questions

Christine K. Cassel, MD

June 10, 2010Jun 10, 201012

A guest column by the American Board of Internal Medicine, exclusive to KevinMD.com. The American Board of Internal Medicine (ABIM) is sending a clear message to doctors this week: Compromise the integrity of the certification process and face swift and…

A guest column by the American Board of Internal Medicine, exclusive to KevinMD.com.

The American Board of Internal Medicine (ABIM) is sending a clear message to doctors this week: Compromise the integrity of the certification process and face swift and serious penalties.

ABIM is sanctioning 139 physicians for sharing, buying, or soliciting confidential, copyrighted questions that were part of the exam …

Drugs and prescribing

Primary care antibiotic resistance for common infections

MedPage Today

June 10, 2010Jun 10, 2010

by Nancy Walsh Primary care patients prescribed an antibiotic for a urinary tract or respiratory infection consistently developed resistance to that antibiotic lasting as long as one year, a British meta-analysis revealed. In five studies that included 14,348 patients treated…

by Nancy Walsh

Primary care patients prescribed an antibiotic for a urinary tract or respiratory infection consistently developed resistance to that antibiotic lasting as long as one year, a British meta-analysis revealed.

In five studies that included 14,348 patients treated for urinary tract infections, within one month of receiving an antibiotic an individual patient’s odds ratio having a resistant pathogen was 4.40 (95% CI 3.78 to 5.12), according to Céire Costelloe, PhD, …

What medicine was like in ancient Babylonian society

Jan Henderson, PhD

June 10, 2010Jun 10, 20102

Each issue of the Journal of the American Medical Association includes an excerpt from an issue of exactly 100 years ago (JAMA has been published continuously since 1883). The May 7, 1910 issue of JAMA included remarks on how much…

Each issue of the Journal of the American Medical Association includes an excerpt from an issue of exactly 100 years ago (JAMA has been published continuously since 1883).

The May 7, 1910 issue of JAMA included remarks on how much physicians were paid and, by implication, how they were regarded in 2250 B.C.

Ability to pay and malpractice

According to the famous Babylonian Code of Hammurabi (“an eye for an eye”), a physician’s …

Conditions and diseases

Demerol used to treat shivering in patients

Christian Sinclair, MD

June 9, 2010Jun 9, 20107

If you have spent anytime with a palliative care team in a hospital you will know of their efforts to essentially blacklist Demerol (meperidine) from use in the hospital. Some hospitals have removed it or restricted it from the formulary…

If you have spent anytime with a palliative care team in a hospital you will know of their efforts to essentially blacklist Demerol (meperidine) from use in the hospital.

Some hospitals have removed it or restricted it from the formulary all together. In medical culture, Demerol has been a go to opioid peri-OR and mostly favored by surgeons. The drug has been purported to be less likely to cause biliary spasm, …

Patient voices

How to talk to patients with an EMR in the room

Edward Pullen, MD

June 9, 2010Jun 9, 201029

I see a lot of articles by physicians complaining about how the use of a computerized medical record (EMR) in the exam room with patients detracts from the physician-patient experience. The complaint usually follows the theme that the physician and…

I see a lot of articles by physicians complaining about how the use of a computerized medical record (EMR) in the exam room with patients detracts from the physician-patient experience.

The complaint usually follows the theme that the physician and patient are not able to have eye contact, and both the physician and the patient feel less intimate and connected during the visit because the physician’s need to use the keyboard, …

Conditions and diseases

Causes of stroke in young adults

MedPage Today

June 9, 2010Jun 9, 20102

by Todd Neale The recent stroke suffered by Delaware's attorney general Beau Biden, who is 41, has highlighted the fact that people of all ages are vulnerable, despite seemingly good health. A statement from Timothy Gardner, MD, medical director of…

by Todd Neale

The recent stroke suffered by Delaware’s attorney general Beau Biden, who is 41, has highlighted the fact that people of all ages are vulnerable, despite seemingly good health.

A statement from Timothy Gardner, MD, medical director of the Center for Heart and Vascular Surgery at Christiana Care Health System in Newark, Del., where Biden was initially treated, said he had suffered a “mild stroke,” although it remains unknown whether …

Read more…

Causes of stroke in young adults

Conditions and diseases

Peer review may require random over-reads

Larry Husten, PhD

June 9, 2010Jun 9, 201014

“Let’s kill all the lawyers.” It’s every doctor’s favorite Shakespeare quote. And if you’re giving a talk to doctors there’s no better way to get the audience on your side than by starting with a lawyer joke. But perhaps we…

But perhaps we shouldn’t be too hasty about killing all those lawyers. As recent commentary about the Mark Midei case makes clear, modern medicine doesn’t know how to police itself. And until medicine does …

Health technology

EMRs are ugly, and what the next generation of doctors can do

Josh Herigon, MPH

June 8, 2010Jun 8, 201030

I was in our family practice clinic today and couldn’t help but noticing once again that the electronic medical record (EMR) system they use looks like it was designed in the 1980s. Gray boxes with tiny free text fields and…

I was in our family practice clinic today and couldn’t help but noticing once again that the electronic medical record (EMR) system they use looks like it was designed in the 1980s.

Gray boxes with tiny free text fields and little check boxes. Unfortunately, the aesthetics are the least infuriating design element.

Why is nothing connected in current EMRs? The single most important thing that has led to the proliferation and usability …

Physician voices

Interruptions in the emergency department can lead to errors

MedPage Today

June 8, 2010Jun 8, 20102

by Nancy Walsh Busy clinicians in the emergency department reduce the time they spend on clinical tasks when interrupted, working faster and possibly cutting corners, a prospective observational study found. Overall, clinicians were interrupted 6.6 times per hour, and 11%…

by Nancy Walsh

Busy clinicians in the emergency department reduce the time they spend on clinical tasks when interrupted, working faster and possibly cutting corners, a prospective observational study found.

Overall, clinicians were interrupted 6.6 times per hour, and 11% of all tasks were interrupted, according to Johanna I. Westbrook, PhD, of the University of Sydney, in Australia, and colleagues.

The mean “time on task” for uninterrupted tasks was 1 minute and 26 …

Conditions and diseases

Clinical judgment and when neurologists should order an MRI

Vernon Rowe, MD

June 8, 2010Jun 8, 2010

With healthcare reform dominating the news recently, MRI and other imaging tests have become the (misguided) targets of many critics. Although MRI makes up only one-half of one percent of total healthcare expenditures, it is easy to demonize since the…

With healthcare reform dominating the news recently, MRI and other imaging tests have become the (misguided) targets of many critics.

Although MRI makes up only one-half of one percent of total healthcare expenditures, it is easy to demonize since the average healthcare consumer can understand imaging much easier than the diagnosis related groups (DRGs), hospital facility fees or insurance contracts that have a much greater impact on the cost of health …

Physician voices

Why patients file medical malpractice lawsuits

John Schumann, MD

June 7, 2010Jun 7, 201044

Time to turn our attention to an unpleasant topic: Lawsuits. Who files them? Why? And what actually happens? There have been oceans of ink spilled about medical malpractice. An oversimplification of the various positions on malpractice and malpractice reform goes…

Time to turn our attention to an unpleasant topic: Lawsuits.

Who files them?

Why? And what actually happens?

There have been oceans of ink spilled about medical malpractice. An oversimplification of the various positions on malpractice and malpractice reform goes something like this:

(+) Malpractice suits are good. They keep healthcare professionals and hospitals on their toes; if the threat of a big payout improves safety and quality, then lawsuits provide an important regulatory

…

Conditions and diseases

MRI abuse can be dangerous and expensive for patients

Chris Rangel, MD

June 7, 2010Jun 7, 2010

What is “MRI Abuse”? This is when the health care provider orders MRIs (Magnetic Resonance Imaging) in excess or for the wrong reasons. There are many causes of MRI abusive behavior but most evolve out of a significant misunderstanding of how to properly utilize this diagnostic tool. MRI imaging has a high sensitivity to detect anatomic abnormalities, does not expose the patient to high doses of radiation like a CAT …

Health policy

Whistleblowers endure stress and personal hardship

MedPage Today

June 7, 2010Jun 7, 2010

by Charles Bankhead Whistle-blowers in the healthcare industry endure substantial hardship and often pay a high personal price for cooperating with Justice Department investigations, according to a report based on detailed interviews with more than two dozen informants. Loss of…

by Charles Bankhead

Whistle-blowers in the healthcare industry endure substantial hardship and often pay a high personal price for cooperating with Justice Department investigations, according to a report based on detailed interviews with more than two dozen informants.

Loss of employment, financial ruin, divorce, and a host of mental and physical health problems were common consequences of individuals’ decisions to report corporate fraud.

Cases can drag on for years before reaching a resolution, …

Health policy

Tort reform for doctors in exchange for less salary

Jeffrey Parks, MD

June 7, 2010Jun 7, 201030

Matt Steinglass at The Economist has interesting take on tort reform, specifically that limiting physician liability for adverse patient outcomes must come with an equable cost to doctors. In Europe, the costs accrued due to medical errors are covered by…

Matt Steinglass at The Economist has interesting take on tort reform, specifically that limiting physician liability for adverse patient outcomes must come with an equable cost to doctors.

In Europe, the costs accrued due to medical errors are covered by the wide-ranging social safety net; the lottery system of massive medical malmalpractice judgments is virtually absent.

It’s part of the social contract: doctors accept limited salaries in exchange for limited liability;

…

Health policy

The New York Times changes the Dartmouth Atlas narrative

Kevin

June 7, 2010Jun 7, 20107

Several have asked me to comment on the New York Times versus Dartmouth Atlas spat. In summary, the Dartmouth Atlas comprises of studies showing variation in care for Medicare recipients. Their main, take home message is that high-spending areas of…

Several have asked me to comment on the New York Times versus Dartmouth Atlas spat.

In summary, the Dartmouth Atlas comprises of studies showing variation in care for Medicare recipients. Their main, take home message is that high-spending areas of the country sometimes had poorer outcomes than lower-spending ones.

Their work has been influential with the current administration, and among progressive health reformers. Last week however, the New York Times published a …

Drugs and prescribing

How drug information fine print fails to communicate

Steve Woodruff

June 6, 2010Jun 6, 20103

As someone deeply immersed in pharma communications, and especially the newer realm of social networking, I’ve been closely following the ongoing process of the industry/FDA dance, trying to figure out how social media/web 2.0 approaches “fit” with pharmaceutical manufacturers and…

And I keep wondering if we’re going about the whole thing the wrong way.

Think about the fine print PI (Product Information) you see in a magazine, accompanying a …

Real physician voices, twice a week

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