Your on-call doctor probably didn ’t receive training in telephone medicine
Physicians spend a lot of time counseling patients on the phone. Often, these conversations occur at night with patients we have never met before. When I am on-call in the evenings or on the weekends, these are some typical phone calls I receive from patients I have never met.
I have a very bad stomach ache for the last hour.
I started having rectal bleeding an hour ago.
My wife tells me that my eyes are yellow.
My chest is hurting. It feels different from my usual heartburn.
How do we manage patients with issues like those above? We get hundreds of calls like this every year. Do we send every patient to the emerg...
Source: Kevin, M.D. - Medical Weblog - May 3, 2017 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/michael-kirsch" rel="tag" > Michael Kirsch, MD < /a > Tags: Physician GI Source Type: blogs
No, pregnancy did not help Serena Williams win the Australian Open
The New Scientist wonders if Serena Williams pregnancy is making her a better athlete?|This is a new low in “pregnancy angles.”
I often get asked to comment on celebrity/athlete pregnancies, and I always decline. Why? Partly because I don’t want my name in articles like this, but also I don’t care what anyone does in their pregnancy and neither should you. If a celebrity or athlete is offering pregnancy advice or proselytizing about a medication that is different, but if they are minding their own prenatal business and just sharing their joy then it is of no relevance to me. Best wishes is basically what I have to...
Source: Kevin, M.D. - Medical Weblog - May 2, 2017 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/jennifer-gunter" rel="tag" > Jennifer Gunter, MD < /a > Tags: Physician OB/GYN Source Type: blogs
What is the right way to deliver bad news?
Recently, someone close to me was diagnosed with cancer. Due to a series of missed phone calls on both sides, he had not heard the results of his biopsy prior to his follow up appointment. When his young doctor walked in, he started with, “So you know you have cancer, right?” I just wanted to scream, “What the f*ck!” It is never easy to give someone bad news, but this obviously was not the way to do it.
This experience took me back to a patient of mine early in my practice. She was a young, fit woman with short brown hair that framed her face. Because she was healthy, I had only seen her twice in the couple years...
Source: Kevin, M.D. - Medical Weblog - May 2, 2017 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/andrea-eisenberg" rel="tag" > Andrea Eisenberg, MD < /a > Tags: Physician Cancer Source Type: blogs
Here ’s how your commute can help you
This is an open letter to everyone everywhere, especially people who live in small communities such as mine:
If you drive to work, you are missing out. If someone offered you an opportunity to improve your health, enhance your happiness and creativity, boost your self-esteem and even make you richer, what would you say? Many might think it would be an offer that was too good to be true — a scam; what’s the catch? There is no catch; I want to share how commuting to work on foot or by bicycle can do all these things. It can be a bit addicting, but this addiction is a good thing.
First the obvious: a self-propelled co...
Source: Kevin, M.D. - Medical Weblog - May 2, 2017 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/john-merrill-steskal" rel="tag" > John Merrill-Steskal, MD < /a > Tags: Physician Primary care Source Type: blogs
In their obsession with numbers, doctors sometimes forget who patients are
The consultant note read:
Weight 250 lbs. BMI 40.3. Patient is morbidly obese. Counseled on the dangers of excess weight. Counseled to increase exercise and decrease calories.
I walked into her room. She smiled at me as I walked in, a lovely smile that reached her eyes. I scanned her record. She was in my office for an ankle injury. Blood pressure normal. Weight 248 lbs., BMI 40.
When I looked back at her, she was still smiling. “I lost another ten pounds,” she said proudly.
Continue reading ...
Your patients are rating you online: How to respond. Manage your online reputation: A social media...
Source: Kevin, M.D. - Medical Weblog - May 2, 2017 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/rob-lamberts" rel="tag" > Rob Lamberts, MD < /a > Tags: Physician Primary care Source Type: blogs
My first mistake could have been fatal
Recently, our three-year-old wandered into our bedroom around 4 a.m. waking me up, saying he was scared. As I did the previous few nights when he did this, I muttered a curse word to myself and picked him up to carry him back to his room. Upon lifting him, a wrinkle in the routine emerged — he was naked below the waist. At some point, before he entered our room, his pajama pants and pull-up were removed.
A mystery had arisen. Yes, the game was afoot.
***
Rewind 10 years.
I am three months into intern year as a pediatric resident. I am taking call every fourth night on the inpatient pediatric hematology/oncology ward, wor...
Source: Kevin, M.D. - Medical Weblog - May 2, 2017 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/rogue-dad" rel="tag" > Rogue Dad, MD < /a > Tags: Physician Primary care Source Type: blogs
Patient-dictated vs. patient-centered care. What can physicians do?
Patient-centered care (PCC) seems to be a popular buzzword among policymakers and administrators in recent years. Indeed, many physicians see our health care system as payer-centric, many patients see it as physician-centric, and no one seems to see it as patient-centric. While putting the patient at the center of what we do as physicians is critical to improving the triple aim of better care, better health, and lower costs, it is important to keep in mind what this exactly means; PCC is not the same as patient-dictated care (PDC).
We have all experienced patients who demand certain tests or treatments and see the physicia...
Source: Kevin, M.D. - Medical Weblog - May 2, 2017 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/kyle-bradford-jones" rel="tag" > Kyle Bradford Jones, MD < /a > Tags: Physician Primary care Source Type: blogs
Stop the s.-shaming: HPV vaccines prevent cancer
I met “Samantha” during my first rotation as an intern. She was a strong-willed and optimistic lady who weighed about 100 pounds. She was dependent on a tube in her stomach for nutrition, and she appeared 10 or 15 years older than her age of 44 years. Pictures of her children were next to her bed. I asked her how we could help her. She cried.
Her husband of 20 years was by her side and answered for her. “She wants to eat again,” he stated. Her tears worsened.
The problem is that Samantha would probably not tolerate normal food again because her digestive organs were permanently damaged from radiation to her abdomen...
Source: Kevin, M.D. - Medical Weblog - May 1, 2017 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/cory-michael" rel="tag" > Cory Michael, MD < /a > Tags: Conditions Pediatrics Source Type: blogs
Facility fees are ruining quality care
The Affordable Care Act Medicaid expansion resulted in unanticipated negative consequences for many patients and physicians in rural, underserved or medically isolated communities across America. Consolidation of health care entities was financially incentivized by the ACA, and slowly my beloved corner of the Pacific Northwest is becoming a medical wasteland.
In a beautiful community on the Olympic Peninsula, just north of where I live and practice, it happened again; another private clinic sold to a large medical corporation. Peninsula Children’s Clinic was a bustling pediatric office meeting the vital, complex healthca...
Source: Kevin, M.D. - Medical Weblog - May 1, 2017 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/niran-s-al-agba" rel="tag" > Niran S. Al-Agba, MD < /a > Tags: Policy Hospital Source Type: blogs
That ’s it: MACRA must die!
The Trump administration has made clear its intentions to drastically reduce the size and intrusive nature of government. Let’s hope that extends to the Medicare Access and CHIP Reauthorization Act, otherwise known as MACRA, the heavy-handed new government “value-based payment” program for medical care, enacted in 2015, and set to rear its ugly head beginning this year. MACRA must die. MACRA is administrative overkill in an industry already overburdened by such things. And it makes little sense and will make little difference in our current dysfunctional health care environment.
For physicians, MACRA in practice is t...
Source: Kevin, M.D. - Medical Weblog - May 1, 2017 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/matthew-hahn" rel="tag" > Matthew Hahn, MD < /a > Tags: Policy Medicare Source Type: blogs
The problem in health care: Caring too much
Recently, I watched a disturbing video of a fellow physician being dragged out of an airplane. I find it hard to understand how these events unfolded despite Dr. Dao being a customer who chose to fly United, paid hundreds of dollars for his ticket and legally boarded his flight. Whether blame belongs with United or the Chicago Department of Aviation, this was an unsettling occurrence. Yet somehow — I wasn’t surprised. For the past few years, I have had moments where I have been less than enamored by the aviation industry. It’s not that I’m an unreasonable traveler. I understand that safety issues, equipment failure...
Source: Kevin, M.D. - Medical Weblog - May 1, 2017 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/dr-m-s" rel="tag" > Dr. M.S. < /a > Tags: Physician Primary care Source Type: blogs
Medical students are the future of health policy, let ’s start treating them like it
The media is quick to point out the important role of American Medical Association (AMA) and other professional bodies in shaping the future of health policy in the United States. While these organizations have a certain responsibility, it is becoming increasing clear that medical and public health students will shape the future of post-Obama health care landscape. Recognizing their role is pertinent.
While physician members from AMA are the practitioners of the health care, it is the students in lecture halls around the country that are vital for the formulation as well as the execution of health care policies. It is esse...
Source: Kevin, M.D. - Medical Weblog - May 1, 2017 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/junaid-nabi" rel="tag" > Junaid Nabi, MD < /a > Tags: Policy Health reform Source Type: blogs
Students are the future of health policy: Let ’s start treating them like it
The media is quick to point out the important role of American Medical Association (AMA) and other professional bodies in shaping the future of health policy in the United States. While these organizations have a certain responsibility, it is becoming increasing clear that medical and public health students will shape the future of post-Obama health care landscape. Recognizing their role is pertinent.
While physician members from AMA are the practitioners of the health care, it is the students in lecture halls around the country that are vital for the formulation as well as the execution of health care policies. It is esse...
Source: Kevin, M.D. - Medical Weblog - May 1, 2017 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/junaid-nabi" rel="tag" > Junaid Nabi, MD < /a > Tags: Policy Health reform Source Type: blogs
Should doctors be more conscious of consciousness?
Why does the universe have conscious beings? The physical and biological laws of nature do not seem to explain the existence of conscious creatures such as humans. Neuroscience has done well to explain many of our behaviors, illnesses and medical therapies based on purely physical and observable rules. But no one has ever measured consciousness. And yet it appears fundamental to whether my patient will recover from their disease.
After 15 years as a physician, I have become proficient at the scientific aspects of treating complex medical conditions in the hospital. I study hard, try to keep up-to-date and read my journals....
Source: Kevin, M.D. - Medical Weblog - May 1, 2017 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/kjell-benson" rel="tag" > Kjell Benson, MD < /a > Tags: Conditions Neurology Source Type: blogs
Bias is a dangerous condition in American health care
In medicine, there exists a dangerous condition that affects millions of Americans each year but is woefully underdiagnosed. It affects how long we live and how much we pay for health care. It impacts the way doctors treat us and care for us. Yet, many health care providers are reluctant to acknowledge that this condition exists.
That condition is bias in medicine.
We know that bias and discrimination kill. In politics, the nation is grappling with an openly biased President and confronting longstanding racial and religious divisions. Countless protests have ignited over police violence and the fight for human rights in Am...
Source: Kevin, M.D. - Medical Weblog - April 30, 2017 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/sofia-noori" rel="tag" > Sofia Noori < /a > Tags: Conditions Primary care Source Type: blogs
