United Airlines and Dr. Dao: Who we should be really mad at
As the world digested the events that unfolded aboard United Airlines Flight 3411 at Chicago O’Hare, and watched the horrific video of Dr. David Dao being forcibly dragged off the plane that was supposed to be taking him home, social media was red with rage at United Airlines. People vowed never to fly with them, customers ripped up their loyalty cards, and United’s stock fell over a billion dollars in a single day.
I was just as outraged as anyone else with what I saw. The site of a 70-year-old grandfather having his head smashed against an arm rest, and then dragged semi-unconscious across the floor with blood drippi...
Source: Kevin, M.D. - Medical Weblog - May 10, 2017 Category: General Medicine Authors: < a href="http://www.kevinmd.com/blog/post-author/suneel-dhand" rel="tag" > Suneel Dhand, MD < /a > Tags: Physician Primary care Source Type: blogs
It ’s bad luck to say that in a hospital
Doctors and nurses like facts. After all, we’re evidence-based thinkers — rational scientists. Yet, we can be surprisingly superstitious.
Many of us believe in a thing called “call karma,” which is when certain doctors attract sick patients while working on call (these people are said to have bad call karma). Other doctors attract less sick patients, meaning they have good call karma.
As a medical student, I quickly learned that I fell into the “bad call karma” category. When I was on call, I always had the sickest patients. My colleagues typically became familiar with the nature of my luck ...
Source: Kevin, M.D. - Medical Weblog - May 10, 2017 Category: General Medicine Authors: < a href="http://www.kevinmd.com/blog/post-author/sarah-fraser" rel="tag" > Sarah Fraser, MD < /a > Tags: Physician Primary care Source Type: blogs
A patient ’s view on cancer surprises this physician
I had an upsetting encounter the other day with a 22-year-old woman, who mentioned (secondary to the purpose of the visit) that she was pretty sure she had breast cancer.
Why did she think that?
She’d found a lump in her breast.
(Somewhat unusually for the specific setting, she let me do a breast exam. All I felt was a small area of lumpy breast tissue, possibly a fibroadenoma at worst. Of course, I would recommend ultrasound and possibly excision, but I wasn’t acting in the capacity of her primary care physician.)
Had she seen a doctor about it?
Continue reading ...
Your patients are rating you online: How to respond...
Source: Kevin, M.D. - Medical Weblog - May 10, 2017 Category: General Medicine Authors: < a href="http://www.kevinmd.com/blog/post-author/lucy-hornstein" rel="tag" > Lucy Hornstein, MD < /a > Tags: Physician Cancer Source Type: blogs
The elderly need hired professionals to administer their medications
One of the most challenging and difficult parts of my professional day is trying to determine if my patients are actually taking their as prescribed.
I ask my patients to bring their medications to each visit in the original pill bottles, and we count pills. I ask them to bring their medication lists as well, and we go through the time-consuming practice of reviewing each medication against the prescribing date and amount and reviewing whether the correct amount of medication has been taken and is left in the pill bottles.
Many of our patients inadvertently make medication mistakes routinely. The toughest groups of patient...
Source: Kevin, M.D. - Medical Weblog - May 9, 2017 Category: General Medicine Authors: < a href="http://www.kevinmd.com/blog/post-author/steven-reznick" rel="tag" > Steven Reznick, MD < /a > Tags: Meds Geriatrics Source Type: blogs
The Joint Commission surveys matter more than we think
Recently, the online version of JAMA published an original investigation entitled “Patient Mortality During Unannounced Accreditation Surveys at US Hospitals.” The purpose of this investigation was to determine the effect of heightened vigilance during unannounced accreditation surveys on safety and quality of inpatient care. The authors found that there was a significant reduction in mortality in patients admitted during the week of surveys by The Joint Commission. The change was more significant in major teaching hospitals, where mortality fell from 6.41 percent to 5.93 percent during survey weeks, a 5.9 per...
Source: Kevin, M.D. - Medical Weblog - May 9, 2017 Category: General Medicine Authors: < a href="http://www.kevinmd.com/blog/post-author/tracy-cardin" rel="tag" > Tracy Cardin, ACNP < /a > Tags: Policy Hospital Hospitalist Source Type: blogs
Am I the only doctor who isn ’t burned out?
Throughout my premed and medical training, I’ve been deluged with a steady stream of negative thoughts regarding medicine as a career from outspoken, burnt-out physicians. To this day, nine years since I’ve finished my residency in family medicine, I remain passionately opposed to this sentiment. I’ve seen statistics and mathematical calculations painting a dark picture of the financial, personal and professional world of today’s physician, overwhelmed with debt, administrative nightmares, declining reimbursement, legislative red tape, and other headaches. Nonsense! I couldn’t be happier. I ha...
Source: Kevin, M.D. - Medical Weblog - May 9, 2017 Category: General Medicine Authors: < a href="http://www.kevinmd.com/blog/post-author/andrew-cunningham" rel="tag" > Andrew Cunningham, DO < /a > Tags: Physician Primary care Source Type: blogs
Why physicians should not complain about school debt
At the risk of vilification by my peers, I’m going to say something extremely unpopular. We physicians have it pretty good financially. Our salaries are generous, and we have a much higher standard of living than most others in America. When I read online physician complaints about student loan debt, I cringe a bit. Because of all the people in debt, we are some of the most likely to be able to pay it down quickly.
Medical school and residency are emotionally, mentally, and physically exhausting. There is no doubt that we are severely cash-strapped during those years, and yearn for the day when we can go out to a nice r...
Source: Kevin, M.D. - Medical Weblog - May 9, 2017 Category: General Medicine Authors: < a href="http://www.kevinmd.com/blog/post-author/val-jones" rel="tag" > Val Jones, MD < /a > Tags: Physician Medical school Source Type: blogs
This Nurses Week: Ask your nurses if they are burned out
July 10 will mark my tenth year as a nurse. When I began, I was shy and naive. Now I am already an old nurse, surprised by nothing and filled with battle stories. I’ve spent the last seven years working in a medical ICU, and I’ve seen and done so much. I counseled a bewildered husband on withdrawing care on his cancer-stricken wife. I got in a fight with a hematologist who insisted we transfuse a man who kept going into pulmonary edema. I’m convinced my antagonism prevented an intubation. I’ve pushed morphine, and through tears, told a widow-to-be to hold her husband’s hand while he breathed his last. They were b...
Source: Kevin, M.D. - Medical Weblog - May 9, 2017 Category: General Medicine Authors: < a href="http://www.kevinmd.com/blog/post-author/emily-weston" rel="tag" > Emily Weston, RN < /a > Tags: Conditions Nurse Source Type: blogs
“Are you in ISIS?” my patient asked
I pulled on my white coat and straightened my tie before walking into the patient room with my supervising physician, Dr. H. Our patient was a teenage boy with autism, and Dr. H let me take the lead. Towards the end of the visit I asked, as I always do, “Do you have any questions for me?” He had not made eye contact with me throughout the visit, which can be common for kids with autism, but now he turned his whole body into his mother who sat by his side and in a loud whisper said, “I’m worried he will be offended.” His mother held him lovingly as Dr. H, and I encouraged him to speak his mind.
“Are you in ISIS?...
Source: Kevin, M.D. - Medical Weblog - May 9, 2017 Category: General Medicine Authors: < a href="http://www.kevinmd.com/blog/post-author/asaad-traina" rel="tag" > Asaad Traina < /a > Tags: Education Medical school Source Type: blogs
What this medical student learned after working with foster children
During my two years off from medical school, I’ve been volunteering as a court appointed special advocate for children in the foster care system. And I’ve spent a lot of time reading about how these kids’ experiences could affect the rest of their lives.
The seminal research on this happened in the late 1990s using data from more 17,000 Kaiser patients. What the researchers found was that patients who reported more adverse childhood experiences were more likely to suffer from such long-term medical conditions as heart disease, liver disease, stroke, diabetes and chronic obstructive pulmonary disease — diseases...
Source: Kevin, M.D. - Medical Weblog - May 9, 2017 Category: General Medicine Authors: < a href="http://www.kevinmd.com/blog/post-author/natalia-birgisson" rel="tag" > Natalia Birgisson < /a > Tags: Conditions Psychiatry Source Type: blogs
3 communication mistakes doctors make. And how to fix them.
It is not something that is taught enough in medical school, but practicing physicians quickly realize that in this business: Communication is everything. The reality of health care is that you can be the worst physician in the world clinically (not that it’s something desirable to be), display great interpersonal skills, communicating well with your patients — and they will do absolutely anything you say and put you up on a pedestal. Everyone in health care knows a physician like this. Then, at the opposite end of the spectrum, we have the doctors who are superb clinically, can quote you any scientific paper over ...
Source: Kevin, M.D. - Medical Weblog - May 8, 2017 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/suneel-dhand" rel="tag" > Suneel Dhand, MD < /a > Tags: Physician Primary care Source Type: blogs
An ode to the nurse who saved Jimmy Kimmel ’s baby
Recently, a nurse at Children’s Hospital Los Angeles noticed that comedian Jimmy Kimmel’s newborn baby had a murmur and was cyanotic and brought it to the newborn intensive care unit for further evaluation. That triggered a rush of activity that led to a diagnosis of a congenital heart defect and heart valve problem and surgery to save the baby’s life.
Here’s what the public doesn’t understand: Nurses do this every day. We save lives. We are there twenty-four hours a day, seven days a week watching over your loved ones. We are the ones who notice trouble on the horizon. We trigger the alarm th...
Source: Kevin, M.D. - Medical Weblog - May 8, 2017 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/anonymous" rel="tag" > Anonymous < /a > Tags: Conditions Nurse Source Type: blogs
The evolution of prior authorizations
My old strategy for getting insurance approvals for imaging tests doesn’t seem to be working anymore.
I used to put my thinking in my office notes so that a reviewer at one of the imaging management companies would clearly see my rationale for ordering that CT scan or MRI my patient needed.
Now I am getting more and more requests to initiate a “peer-to-peer” call instead. My heart sinks every time; each one is a sure time robber. Even with today’s talk about paying for value and quality, I still live in a world where my “opportunity cost” is $7 per minute. That is what I must generate every minute of my work da...
Source: Kevin, M.D. - Medical Weblog - May 8, 2017 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/a-country-doctor" rel="tag" > A Country Doctor, MD < /a > Tags: Physician Primary care Source Type: blogs
What ’s the difference between health care in the U.S. and Haiti? Not much.
“How long have you had the bleeding?”
“About seven years,” my patient replies stoically.
Ange’s angular face no longer retains the beauty of her youth. The sharp lines around her mouth speak of a long life packed into a brief 42 years. She is well dressed, but her manner of speaking betrays the poverty in which she exists.
Ange has advanced cervical cancer — a completely preventable disease. In fact, cervical cancer can take as long as a decade to develop, during which time — in Ange’s case — any screening test might easily have determined that the abnormal bundle of cells on her cervix needed to be remov...
Source: Kevin, M.D. - Medical Weblog - May 8, 2017 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/vincent-degennaro-jr" rel="tag" > Vincent DeGennaro, Jr., MD, MPH < /a > Tags: Physician OB/GYN Source Type: blogs
Give your body a real immune boost
The human immune system is an amazing thing. There are thousands of microorganisms — millions, maybe — that are lurking out there, eager to make you sick. You breathe them in. They’re in every bite of food, and all over your hands when you rub your nose. We live in constant bombardment.
And they’re sneaky, too — with changing DNA and proteins to fool us. We’ve got soap and water and some pretty good antibiotics to fight them off, but, really, the vast majority of the work to keep us healthy is done by our own immune systems.
Wouldn’t it be nice to give your immune system a boost, to help it fight ...
Source: Kevin, M.D. - Medical Weblog - May 8, 2017 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/roy-benaroch" rel="tag" > Roy Benaroch, MD < /a > Tags: Conditions Pediatrics Source Type: blogs
