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I believe we can find and promote joy in primary care

Mon, 20 May 2013 14:00:15 PDT

A few years after I entered my practice as a newly certified internist, about two decades ago now, I started to burn out. I felt I was becoming a documentation drone and a guideline-following automaton. I was embarrassed for some of the care I gave–attempting to fit patients’ round needs into the square peg of the medical model. Patients who came to talk about depression were marched through a complete review of systems because that is what I understood it meant to be a good doctor. In a brief visit, I would try to:

accomplish all the screening and advising that was recommended by every agency and organization;
do a credible job evaluating multiple complaints;
be compassionate and smart in the care of those who were ill;
dodge legal bullets by what I said and what I documented;
repeat the same detailed, normal physical exam into my recorder patient after patient because the note was how I thought my care was graded; and,
comply with the then new and confusing coding rules.

Your patients are rating you online: How to respond. Manage your online reputation: A social media guide. Find out how.

The legal risks of prescribing the AliveCor ECG

Mon, 20 May 2013 12:00:13 PDT

With the announcement that the FDA granted 510(k) approval for the AliveCor EKG case for the iPhone 4/4S, the device became available to “licensed U.S. medical professionals and prescribed patients to record, display, store, and transfer single-channel electrocardiogram (ECG) rhythms.”

Your patients are rating you online: How to respond. Manage your online reputation: A social media guide. Find out how.

Bringing OpenNotes to Geisinger

Mon, 20 May 2013 10:00:15 PDT

Recently, over 520 of our doctors began sharing their office visit notes with patients.

All primary care doctors and general pediatricians, and selected physicians within pediatric subspecialties, dermatology, endocrinology, pulmonology, nephrology, rheumatology, cardiology, cardiothoracic surgery, vascular surgery, neurosurgery, and women’s health—including obstetrics and gynecology and gynecologic oncology—are participating in OpenNotes.

That means tens of thousands of our patients will have access to the notes doctors write about them. After each visit to their doctor, patients will get an email inviting them to read their doctors’ notes via the secure MyGeisinger online patient portal.

Your patients are rating you online: How to respond. Manage your online reputation: A social media guide. Find out how.

Should you choose to have a robotic hysterectomy?

Mon, 20 May 2013 08:00:54 PDT

In a word, no (unless you have cancer). So, let’s take cancer out of the picture and discuss hysterectomy for non-cancerous (benign) reasons.

First of all. A hysterectomy (removing the uterus) can be done via one of the 4 methods:

1. Vaginal, a small incision at the top of the vagina and the uterus is removed entirely through the vagina without any incision on the abdomen.

2. Laparoscopic surgery, where incisions are made in the belly and an operating telescope is inserted. The uterus is then removed either through a small incision in the belly wall or through the vagina.

Your patients are rating you online: How to respond. Manage your online reputation: A social media guide. Find out how.

What are the health risks of eyelash extensions?

Mon, 20 May 2013 06:00:01 PDT

“Something bad has happened. I’ve got eyelash extensions,” singer and actress Kristin Chenoweth confessed on the “Late Show with David Letterman” last year while wearing large dark sunglasses, and visibly drowsy on Benadryl. “Here’s the problem: The glue has formaldehyde in it, and I’m allergic,” Chenoweth said. “I swelled up and I’m sneezing. . . . It looks like I have lips on my eyelids.”

The Broadway star is far from alone in her quest for longer, thicker eyelashes. Women have been enhancing their lashes since before the days of Cleopatra. Mascara, marketed since 1917, is a multibillion-dollar industry. False eyelashes went mainstream in the 1960s (thanks in part to Twiggy). The market has benefited from promotion by celebrity trendsetters including Nicki Minaj and Rihanna. The Kardashian sisters recently announced their line of false eyelashes and tweeted, “Faking fuller lashes are a thing of the past. For 2013 faux lashes are being worn BIG and without apology.”

Your patients are rating you online: How to respond. Manage your online reputation: A social media guide. Find out how.

There is no completely safe dose or form of alcohol

Mon, 20 May 2013 04:00:18 PDT

We live in a strange world. What would happen if tomorrow a common sedative was found to cause 21,000 cancer deaths every year? What if it resulted in breast cancer, mouth cancer, hepatoma and esophageal malignancies, and if the average patient lost 19 years of life? What if the drug also killed by cirrhosis, massive upper GI bleeding, accelerated dementia, and for good measure slaughtered thousands innocent children in car accidents.

Do you think this caustic concoction would last in the pharmacies for a month … a week … a moment? Of course not. Let us raise a drink to that.

Your patients are rating you online: How to respond. Manage your online reputation: A social media guide. Find out how.

Do nurse practitioners really need physician supervision?

Sun, 19 May 2013 16:00:45 PDT

Every year, a Gallup survey asks Americans to rank the professionals they trust the most. With the single exception of 2001, nurses have always been in first place. According to the Gallup poll, Americans view nurses as honest people with high ethical standards. There seems to be no doubt that the more than three million nurses in the United States are a highly-valued, integral part of prevention illness, providing health education, assessing and intervening when disease strikes, and collaborating with a wider healthcare system.

As Anna Reisman, MD wrote in her article, “Nurse practitioners should be released from their arbitrary bondage,” the most trusted profession is facing a disabling distrust.

Your patients are rating you online: How to respond. Manage your online reputation: A social media guide. Find out how.

Why the Oregon Medicaid study is misunderstood

Sun, 19 May 2013 12:00:03 PDT

Much has already been written about the Oregon Medicaid study that came out in the New England Journal of Medicine. Unfortunately, the vast majority is reflex, rather than reflection. The study seems to serve as a Rorschach test of sorts, confirming people’s biases about whether Medicaid is “good” or “bad”. The proponents of Medicaid point to all the ways in which Medicaid seems to help those who were enrolled – and the critics point to all the ways in which it didn’t. But, if we take a step back to read the study carefully and think about what it teaches us, there is a lot to learn.

Your patients are rating you online: How to respond. Manage your online reputation: A social media guide. Find out how.

How to have a hospital stay without pain

Sun, 19 May 2013 10:00:53 PDT

Too often patients feel like they’re in the passenger seat when entering the hospital. Even in the best of circumstances — such as planned admissions — patients often don’t feel in control of their own care.

One of the most unnecessary issues facing patients when they enter the hospital is untreated (or undertreated) pain. Often the focus of the medical team is to treat a condition, and controlling a patient’s pain comes second. Fortunately, this doesn’t need to be the situation. Here are a few tips for patients to ensure that their pain does not go overlooked:

Your patients are rating you online: How to respond. Manage your online reputation: A social media guide. Find out how.

KevinMD.com

I believe we can find and promote joy in primary care

The legal risks of prescribing the AliveCor ECG

Bringing OpenNotes to Geisinger

Should you choose to have a robotic hysterectomy?

What are the health risks of eyelash extensions?

There is no completely safe dose or form of alcohol

Top stories in health and medicine, May 20, 2013

Do nurse practitioners really need physician supervision?

Why the Oregon Medicaid study is misunderstood

How to have a hospital stay without pain