A couple of emergency bloggers write about kidney stones, at around the same time. Eerie.

Shadowfax wonders why his hospital's urgent care center tried a boatload of Demerol first, before going to Toradol. I read a study somewhere that suggested that NSAIDs were just as, if not more, effective than narcotics for pain relief.

WhiteCoat shows us a small 3mm stone, responsible for a ...

Read more...

Reader Takes

Reader Takes is a regular feature where selected op-ed style pieces from the audience at KevinMD.com will be published on the blog. Posts are between 500 and 600 words in length, and can argue any opinion related to medicine and health care. Articles that are provocative, well-written, free of grammatical or spelling errors, and generally follow these guidelines are preferred. Pieces that have not been published elsewhere are ...

Read more...

Drive-thru flu shots

McFlushots? (via Dr. Anonymous)

The Annals of Emergency Medicine did a study earlier this year showing that much of the overcrowding is due to insured patients. JAMA recently re-iterated the findings. Newsweek interviews the lead author, who cites a lack of primary care access as a major culprit.

Politicians are focused on the uninsured, but it won't help with ED congestion. If anything, it will make things worse:

Providing insurance ...

Read more...



New England Patriots quarterback Tom Brady recently underwent repair of his anterior cruciate ligament at the Kerlan-Jobe Orthopaedic Clinic in Los Angeles. His doctor was Neal S. ElAttrache, who's a renowned orthopedic surgeon and former team physician of an NFL team.

Unfortunately, his post-op course has been complicated by an infection. On his website, TomBrady.com, he acknowledged this and said that the original procedure ...

Read more...

New Orleans Saints tight end Jeremy Shockey is upset at the treatment course of his sports hernia. Apparently, there isn't a way to definitively diagnose the condition, leading to multiple treatment options including surgery.

Buckeye Surgeon wonders about the efficacy of a surgical approach for a sports hernia, and thinks many NFL players are being subjected to unnecessary procedures.

Adding a beta-blocker prior to surgery used to be routine. Recent data however, challenges conventional thinking. A retrospective study suggests that patients treated with a beta-blocker pre-operatively had a higher rate of cardiac events.

Granted this was a retrospective study, but I can see the use of beta-blockers being curtailed, especially in low-risk patients.

Patient hand-offs

One of the biggest concerns about capping resident work-hours is that more doctors will be caring for a single, hospitalized patient. This increases the risk of miscommunication and medical errors.

The period where patient information is transferred from one team to another is an area that needs to be standardized and regulated. Too many details often slip through the cracks, which often negatively affects patient care.


Read more...

Sponges during surgery

Leaving sponges in a patient during an operation is a feared complication. Surgery teams are diligent in performing "sponge counts" to ensure this doesn't happen.

Plastic surgeon Ramona Bates talks about a recent study suggesting that there are sponge count discrepancies in 13 percent of surgeries. Seems like a high number to me.

Confusion can arise during trauma cases, or when multiple surgery teams are ...

Read more...

Medicare is considering expanding their no-pay list to include partially preventable conditions like delirium and falls.

By doing this, it is holding doctors and hospitals to an impossible standard, that ironically may lead to the detriment of the patient:

Regulators are implementing a "pay for perfection" system that isn't supported by science and ultimately may result in certain procedures not being done on high-risk patients.

Yes, according to a recent NEJM study. When comparing MRIs, climbers were found to have "a reduction in both white and gray matter in various parts of the brain."

Cognitive function was also impaired, with deficits in memory and executive function.

Apparently, there's also an association between brain damage other extreme conditions, like scuba diving in cold water.

There are just some things that the ...

Read more...

The Washington Post chronicles the difficult story of Michelle Mayer, a nurse who tragically passed away from scleroderma. She had blogged at Diary of a Dying Mom.

As medicine has plenty of gray areas, patients sometimes have to challenge doctors to receive the best care. That means obtaining second opinions and doing your own independent research, which risks placing some tension in the doctor-patient ...

Read more...

You'd think this is common-sense in today's practice environment, but it is surprising how business-inept many doctors are.

Most medical practices operate at small businesses, and having a demand for your services is imperative. That means patients. Granted, most primary care doctors don't have this problem, but for those that do, here's how to market yourself to the community.

I can attest to tip of writing a ...

Read more...

A survey of anesthesiologists is revealing in how they view potential upcoming health reform:

- "Universal healthcare will mean Medicaid reimbursement rates. All physician incomes will decline substantially and quality of patient care will erode due to inability to maintain practice costs."

- Any single payer would dictate fees to physicians, like Medicare does currently."

- "All physicians will work harder for the same income."

- ...

Read more...

"See your primary care doctor" isn't good enough advice anymore, since not all patients have one, or will follow-up on their own.

A workers' compensation physician noted a markedly elevated ferritin level, and was successfully sued for missing hemochromatosis. He had told the patient to follow up with his primary care doctor.

The same scenario could easily happen in the emergency or specialist setting. Actually making ...

Read more...

WhiteCoat gets worked up (sorry, couldn't resist) about defensive medicine in the ED, and how easy it is to order copious, expensive tests.

The problem is, if you are thoughtful and decline performing shotgun testing, the next doctor would gladly oblige the patient and order the studies that may not be necessary. Patients do not quite appreciate the specter of the false positive:

There aren't a lot ...

Read more...

Medical persuasion

Sometimes you have to play the enforcer in medicine. Like in this case when a young, previously healthy patient refuses potentially life-saving surgery.

A man in his 30's presented to the emergency department with weakness, inability to walk, and a markedly low potassium level. Good catch on the zebra, and a fascinating case.

Hospitals are closing

Physician-owned hospitals and outpatient imaging centers are increasing in number, skimming insured patients off the top and leaving the uninsured and Medicaid patients to the hospitals:

One of the ironies of this is that many of the same docs who were shocked, saddened, devastated, when the hospital announced it was closing were the same ones who referred their paying patients to the ambulatory surgery centers and free-standing imaging centers. I ...

Read more...

China's current system is profit-driven, fee-for-service on steroids. Doctors overtly prescribe the most expensive, costly treatment to maximize revenue.

It's going to be a huge undertaking to transform China's system to one that is government-run. It helps to have a Communist government to crush dissent, but that's probably the only way a country of that size can do it. (via the WSJ Health Blog)

Most Popular

Join 150,000+ subscribers

Get the best of KevinMD in your inbox

Sign me up! It's free. 
close-link
✓ Join 150,000+ subscribers 
✓ Get KevinMD's 5 most popular stories
Subscribe. It's free.