An open letter to Justin Timberlake
While I recognize that I have a better chance of contracting dengue fever in my suburban city than there is of you actually reading this, I will try anyways. Here it goes.
My name is Megan. I am a family medicine doctor practicing in Northern California, and I love my job. I’m nothing fancy. I don’t spend my day in the OR. I don’t spend my day in the emergency room treating gunshot victims. I spend my day (my often 12 hour day) in a quiet office where I see 18 to 22 patients all with various complaints.
Some have a cold. Some have abdominal pain. Occasionally one will come in with a complaint of chest p...
Source: Kevin, M.D. - Medical Weblog - January 13, 2016 Category: Journals (General) Authors: Megan Babb, MD Tags: Physician Pediatrics Source Type: blogs
Failure to communicate is a patient safety issue
My 66-year-old professional athletic patient had a history of a scar tissue related small bowel obstruction seven years ago related to a previous appendectomy. He now had similar symptoms with cramping, lower abdominal pain, and some nausea.
Since his office was next door to his longtime friend and gastroenterologist, he called over there. He was given an appointment with the junior partner since his buddy was out of town. Thirty years earlier I had referred him to that practice. The junior partner examined him, thought it was a self-limited viral illness and sent him home.
The next day the two met in the emergency departm...
Source: Kevin, M.D. - Medical Weblog - November 6, 2015 Category: Journals (General) Authors: Steven Reznick, MD Tags: Physician Hospital Source Type: blogs
The AMA’s Forgotten Fight Against Physician Greed
By MICHAEL MILLENSON
Perhaps the most well-known part of the 1965 Medicare creation tale is the opposition by the American Medical Association (AMA) to “socialized medicine.” Yet with financial incentives assuming a new prominence for provider and patient alike, we shouldn’t overlook the AMA’s equally unsuccessful battle against the excesses of capitalistic medicine. The forgotten story of the professionalism’s failure to contain physician greed provides an important policy perspective.
The Myth Of Medicine’s ‘Golden Age’
Medical practice pre-1965 is often portrayed as a mythical “Golden Age.” The truth...
Source: The Health Care Blog - September 10, 2015 Category: Consumer Health News Authors: John Irvine Tags: THCB Source Type: blogs
Medicare, Fair Pay, And The AMA: The Forgotten History
Perhaps the most well-known part of the 1965 Medicare creation tale is the opposition by the American Medical Association (AMA) to “socialized medicine.” Yet with financial incentives assuming a new prominence for provider and patient alike, we shouldn’t overlook the AMA’s equally unsuccessful battle against the excesses of capitalistic medicine. The forgotten story of professionalism’s failure to contain physician greed provides an important policy perspective.
The Myth Of Medicine’s ‘Golden Age’
Medical practice pre-1965 is often portrayed as a mythical “Golden Age.” The truth, as I found researching ...
Source: Health Affairs Blog - September 10, 2015 Category: Health Management Authors: Michael Millenson Tags: Costs and Spending Health Professionals Hospitals Medicaid and CHIP Medicare Payment Policy Quality Affordable Care Act American Medical Association George H.W. Bush Kenneth Arrow Physicians Richard Nixon socialized medicine Source Type: blogs
Antibiotics for Appendicitis: Penny wise but pound foolish
By SAURABH JHA
A Finnish group randomized patients with acute appendicitis to surgery and antibiotics and found that antibiotics were successful in 73 % of patients. Depending on how this is framed, you can celebrate a 70 % success or lament a 30 % failure. Much of the debate in healthcare is a battle of framing.The study has limitations. Finland is not just a land of the midnight sun but a land of fewer laparascopic surgeries than the USA. This is important because if done properly laparoscopic surgery has a lower morbidity than open surgery, as Skeptical Scalpel explains.
Should we be excited that antibiotics can be us...
Source: The Health Care Blog - August 20, 2015 Category: Consumer Health News Authors: suchandan roy Tags: THCB Saurabh Jha Source Type: blogs
Antibiotics for appendicitis: What does a surgeon think about this?
Like many practicing general surgeons I read with interest the recent Finnish paper published in JAMA that attempted to challenge the long held surgical dogma that the best treatment of acute appendicitis is cold hard steel. The paper itself, in terms of design, was beautiful. This was no retrospective review of a series of case studies. This was a rigorously conducted multi-center randomized controlled trial that assigned 530 patients over the course of 3 years into either surgical or non-surgical treatment arms:
Interventions. Patients randomized to antibiotic therapy received intravenous ertapenem (1 g/d) for 3...
Source: Kevin, M.D. - Medical Weblog - August 7, 2015 Category: Journals (General) Authors: Jeffrey Parks, MD Tags: Conditions Surgery Source Type: blogs
Analyzing the deficit of African-Americans in academic medicine
The number of African-American physicians in academic medicine is dismal, and this leads to an abundance of problems. Academic hospitals (teaching hospitals associated with universities) generally do not have a proportionate representation of underrepresented minority faculty as compared to the surrounding population. According to a U.S. News & World Report article, the number of African-American faculty increased by 0.2 percent in ten years from the year 2000 to 2010; yet, the growth of this group in the general population was 30 percent. This fact has been duly noted and highlighted as a discrepancy that deserves a...
Source: Kevin, M.D. - Medical Weblog - July 25, 2015 Category: Journals (General) Authors: Dr. Mary Tags: Education Medical school Source Type: blogs
Antibiotics for appendicitis? Not for this surgeon. Here’s why.
The long-awaited Finnish randomized controlled trial of antibiotics vs. surgery for appendicitis was just published in JAMA. Depending on your perspective, 73 percent of patients were successfully treated with antibiotics or 27 percent of patients failed antibiotics and needed surgery.
The good news is that it was a large multicenter study involving 273 patients randomized to surgery and 257 to antibiotics. Patients included in the study had uncomplicated appendicitis as diagnosed by CT scan.
The bad news is that the paper has many limitations.
Of the patients who underwent appendectomy as the primary treatment, only 15 (5...
Source: Kevin, M.D. - Medical Weblog - July 20, 2015 Category: Journals (General) Authors: Skeptical Scalpel, MD Tags: Conditions Surgery Source Type: blogs
Research and Reviews in the Fastlane 090
This study prospectively looks at 106 patients with either DVT or PE who were identified as low risk based on the Hestia criteria. All of the patients were started on rivaroxaban (a Factor Xa inhibitor) and none had VTE recurrence (while on anticoagulation), major bleeding events or death due to VTE. This study further supports outpatient management for low risk VTE but a randomized controlled trial is needed (keep your eye out for the MERCURY-PE study)
Recommended by Anand Swaminathan
Further reading: SGEM #126: Take me to the Rivaroxaban — Outpatient treatment of VTE (The Skeptics Guide to EM)
Research and critic...
Source: Life in the Fast Lane - July 9, 2015 Category: Emergency Medicine Authors: Jeremy Fried Tags: Airway Clinical Research Emergency Medicine Intensive Care Neurology R&R in the FASTLANE Respiratory Review critical care EBM Education recommendations research and reviews Source Type: blogs
Arkansas Payment Improvement Initiative: Expanding Episodes To Other Clinical Areas
Editor’s note: This post is part of a periodic Health Affairs Blog series, looking at payment and delivery reforms in Arkansas and Oregon. The posts are based on evaluations of these reforms performed with the support of the Robert Wood Johnson Foundation. The authors of this post are part of the team evaluating the Arkansas model.
After the first year of implementation of the episodic payment component of the multi-payer Arkansas Payment Improvement Initiative (APII), the state has identified both successes and challenges. While previous posts go into greater detail on the nuances of Arkansas’ approach to episodes and...
Source: Health Affairs Blog - May 19, 2015 Category: Health Management Authors: William Golden, Joseph W. Thompson, Michael Motley, A. Mark Fendrick, Christopher Mathis and Michael Chernew Tags: Innovations in Care Delivery Medicaid and CHIP Payment Policy APII Arkansas Payment Improvement Initiative CMMI CMS Payment Reform PCMH SIM Testing Award States Source Type: blogs
Good health does not require an Apple Watch
Social media is awash in news about digital health.
I am a skeptic. Health is much simpler. I like this rendering from a kindergarten class.
"Kindergarten teacher asked class to create rules for living healthy. Here's what they came up with" via @rickplus3 pic.twitter.com/cRmHfcfjrf
— Brad Stulberg (@BStulberg) May 9, 2015
When I was a trainee in electrophysiology, I spent oodles of time learning the underpinnings of the heart and its rhythm. I studied molecules, then cells, and then the physics (vectors) of how it all worked together. Catheter ablation of focal circuits or implantation of pacemakers f...
Source: Dr John M - May 10, 2015 Category: Cardiology Authors: Dr John Source Type: blogs
Research and Reviews in the Fastlane 081
This article reviewed 17,583 adult ED intubations over 10 years at 13 different centers. The study found 95% of intubations were performed by ED physicians with good results: 99% of intubations were successful within 3 attempts.Orotracheal intubation with RSI was, of course, the most common technique, with 85% first pass success rate with this technique. And first pass success rates increased over time during the 10 year period, showing that we are continuing to get better!Interestingly, senior residents had 85% first pass rate, compared to just 72% for attendings.For drugs, etomidate was overwhelmingly the most commonly u...
Source: Life in the Fast Lane - April 30, 2015 Category: Emergency Medicine Authors: Anand Swaminathan Tags: R&R in the FASTLANE critical care Education Emergency Medicine Intensive Care literature recommendations research and reviews Source Type: blogs
Does Experience Matter? Study Finds Same Mortality Rates For Experienced and New Surgeons
Are the patient outcomes of newly trained surgeons comparable to the outcomes of experienced surgeons performing the same types of surgery at the same hospitals? A new study examined this question and came to a surprising conclusion: there were "no statistical difference between the patient mortality rates of new and experienced surgeons."
Researchers at the University of Pennsylvania went to great lengths to make sure they only tested for a surgeon's "experience." The study summary (available here) briefly describes the statistical method the researchers employed:
[T]he research team accessed a Medicare datab...
Source: Policy and Medicine - March 6, 2015 Category: American Health Authors: Thomas Sullivan Source Type: blogs
Deanna S.
After turning 50 I started “falling apart.” I had already been diagnosed with hypothyroidism, and my memory was failing me, even though it had always been sharp. Arthritis and carpal tunnel syndrome were increasing and causing me a lot of joint pain. The worst health issue I was experiencing was allergies to everything!
Skin sensitivity and eczema had always plagued me, but now my arms would get a pimple or bump and itch like crazy. Gas, bloating and indigestion seemed normal to me. Last October, after eating one of my favorite meals—deep-dish pizza—I cramped up so bad I couldn’t sleep. A visit to ...
Source: Renegade Neurologist - A Blog by David Perlmutter, MD, FACN - January 28, 2015 Category: Neurologists Authors: gbadmin Tags: Success hypothyroidism Joint Pain weight loss Source Type: blogs
Family medicine residencies should be 7 years. Here’s why.
I’m on my family medicine rotation right now. One of my preceptors is about 80 years old, and went through medical school in the 1960s. He is still sharp as a tack; he used to do C-sections, hernia repairs, appendectomies, fracture repairs, and get this — emergency burr holes for subdural hematomas (a.k.a. neurosurgery). He stopped around 1997, mostly because he got tired of his morning cases getting bumped constantly for overnight emergencies and throwing off his schedule for the rest of the day when he had clinic in the afternoon.
He has since moved out to Palm Springs, where he still sees more patients...
Source: Kevin, M.D. - Medical Weblog - December 29, 2014 Category: Journals (General) Authors: Vamsi Aribindi Tags: Education Primary care Residency Source Type: blogs
