The most high-powered rotation in my medical school was endocrinology. There, you got to see things most doctors never come close to diagnosing themselves. Uppsala University’s Akademiska Hospital served as a referral center for the Swedish population north of Uppsala, an area the size and shape of California. Back in the seventies, laboratory testing wasn’t as sophisticated as it is now. We didn’t have CT scanners even at the major hospitals, ...

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Drivers are distracted klutzes and computers could obviously do better. Self-driving cars will make all of us safer on he road. Doctors have spotty knowledge and keep illegible records. EMRs with decision support will improve the quality of healthcare. The parallels are obvious. And so far the outcomes are disappointing on both fronts of our new war against human error. I remember vividly flunking my first driving test in Sweden. It was early ...

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He spoke with an aura of superiority, in a slightly nasal voice, and his topic was migraines. It was in the late 70s, a time when there were few options to treat migraines. “Most people who claim to have migraines just have simple tension headaches,” he scoffed. And in a move that seemed unorthodox at the time, he disclosed that he suffered from “real migraines,” so he knew all about this ...

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Primary care visits are never quick; we don’t give much advice over the phone or online; and we prioritize the government’s and insurance companies’ public health agenda over our own patients’ concerns. Imagine health care as a retail customer experience for a few minutes: Imagine you’re going to Walmart to buy a bag of dog food, a new coffee maker or to equip a small kitchen in your newly built mother-in-law apartment. 1. ...

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There are many days in primary care when you feel like you are treading water; nobody gets substantially better as time and disease progression seem to always win over your own and your patients’ efforts. But sometimes you hit a winning streak. The past few weeks seemed to bring me one diagnostic or therapeutic coup after another. There was the depressed man who came in smiling and said: “I’m shaving again.” There was ...

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After a Harvard endocrinology course several years ago, I walked out into the weak afternoon spring sunshine and crossed the street to the Boston Public Garden. Among the multitude of faces of the other flaneurs I was certain I saw scores of people suffering from endocrine diseases -- probably undiagnosed, I thought to myself: I saw tall men with big jaws, typical of acromegaly; stout women with skinny extremities and ...

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For many years, I’ve held a brief huddle with my team every morning to make sure we are ready for the day: Anybody with complex problems coming in today? Anybody who’s been in the ER? How is Mrs. Jones’s husband over at the nursing home, is she worried about his condition? Where can we squeeze in more add-on’s? Now other people have tried to hijack the word “huddle” for a completely ...

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Brilinta, at $6.50 per pill, twice a day, reduces cardiovascular events more than generic Plavix, which costs 50 cents per pill, once a day. But only a little: 20% relative or 2% absolute risk reduction. The event risk was 10% with the more expensive drug and 12% with the one that costs 82% less. Put differently, if 100 patients were treated with Brilinta for a year, at a cost ...

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I can’t help myself from telling patients how things really work in health care. But I feel they have a right to know. When I see new patients their jaw usually drops when I sit down with them next to the computer with a stack of papers held together with a rubber band or a gigantic clamp and with yellow sticky notes protruding here and there with words like LAB, ER, ...

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One of the ways a doctor can document the value of an office visit is by keeping track of the number of symptoms the patient has and the number of items included in both the review of systems and the physical exam of the patient. This way, for example, we can get paid more if we do an extensive evaluation of a dizzy patient by looking for both inner ear, cardiovascular ...

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