At no other time in my medical training was I as confident that, with hard work and dedication, I could master the field of internal medicine as when I was a newly minted third year medical student.

Fresh from having taken the USMLE step 1, I interpreted my ability to recite the mechanism of penicillin resistance or the role of histamine in the immune response, and describe in great detail the unabridged and factual accounting of the patient’s forty year occupational history as evidence that, while I still had a ways to go, the practice of medicine could become as comfortable and familiar as reciting passages from a play or riding a bike. One day, I would just know it.

Read the rest of Being a good doctor is no more an achievement than being a good Mom on KevinMD.com.

Category: Physician | Tags: OB/GYN, Specialist | No comment

From Outside Online, an article about how physicians are increasingly hesitant to provide volunteer medical coverage at athletic events:

“Last year, 13 Americans died during running races, and another eight while competing in triathlons. While those numbers might seem troubling, the deaths are attributable mostly to the booming popularity of endurance sports—13 million Americans enter running races each year, and 2.3 million compete in triathlons. But the rising participation and the proportional death toll—especially in cases like Hass’s—highlight the need for quality medical care at these events. And usually that care comes from volunteer doctors.

Read the rest of The malpractice risk of volunteer medical coverage at sporting events on KevinMD.com.

Category: Physician | Tags: Emergency, Malpractice | No comment

This example of a disaster waiting to happen, in the form of an error-promoting CPOE, is a poster example of why the net of litigation needs to be cast far wider than just clinicians when EHR-related errors result in injury or death.

This order entry screen, from a production system shows the following.  In all fairness, I do note it’s unclear if the vendor or the customer’s configuration “experts” were responsible for this:

COUMADIN (warfarin) tablet 2 mg Oral daily once.
CAUTION: Potential look-Alike or Sound-Alike medication – this product is COUMADIN

Read the rest of EMR liability needs to go further than just the physician on KevinMD.com.

Category: Tech | Tags: Health IT | 2 comments

This series is brought to you by MedPage Today.

1. Docs Win Most Malpractice Cases at Trial. Plaintiffs hardly ever win medical malpractice cases that go all the way to a jury verdict, and only 4.5% of claims filed ever go that far.

2. Colon Cancer Screening Studies Flawed, Researchers Say. Studies cited as support for colorectal cancer screening among individuals with a family history of adenomas are flawed.

3. Pressure Sores Not Prevented by Nutrition Support. Cognitively impaired nursing home residents had a two-fold greater risk of pressure sores when they had a percutaneous endoscopic gastrostomy (PEG) feeding tube.

Category: News | Tags: | No comment

I had a phenomenal day in clinic yesterday. Imperfect for sure but inspiring, connected, and busy. I felt useful and like anybody else, that feels so good to me. Productivity can be defined in various ways and yesterday I fulfilled my personal definition. I wrote an email to a friend and cardiologist this morning where I said, “But I must say, it’s a sincere fortune to be a doctor some days. Yesterday was one of those …”

Read the rest of What does a perfect pediatrics practice look like? on KevinMD.com.

Category: Physician | Tags: Pediatrics, Primary care | No comment

Physicians as guardians of science have an obligation to teach the facts of life to our patients and our legislators. And today the need to dispel ignorance of biologic facts is more urgent than ever. Just as President Obama is deferring legislation on marriage to the states, I will defer the issue of whether the government can or should regulate marriage to legal scholars and our duly elected representatives. However, when legislators pass laws that define marriage as a union between a man and a woman, I want to be very, very sure that they know biology and are fully informed on just who is a man or who is a woman. If legislators say they are against same sex marriage, do they know what they are talking about?

Read the rest of Why legislators need sex education on KevinMD.com.

Category: Conditions | Tags: Endocrinology, Specialist | 1 comment

I’ve received several inquiries from women living in various regions of the country, asking how they should choose where to go for their mammogram, and if it really matters.  I cannot emphasize this enough:  It matters!  Here are a few tips to help your search:

The most basic requirement is whether a facility is accredited under the MQSA (Mammography Quality Standards Act).  The accrediting body for most states is the ACR (American College of Radiology), which has a list of requirements and tests that facilities must comply with in order for the centers to achieve accreditation. They look at things such as equipment and film quality, radiation dose, credentials of the mammography technologists and of the radiology doctors who interpret the films, quality of reporting and follow-up, etc.  Inspectors visit centers at regular intervals for “site visits.”  If you are having a mammogram and the staff seems particularly stressed out, it’s likely that the inspector is lurking about.  Have pity, and try not to take it personally.

Read the rest of Where you have your mammogram, and who reads it, matter on KevinMD.com.

Category: Conditions | Tags: Cancer, Radiology | 3 comments

A guest column by the American Medical Association, exclusive to KevinMD.com.

Continuing our efforts to move medicine forward while prioritizing patient care and minimizing administrative and financial burdens for physician practices, the American Medical Association (AMA) along with 100 state and specialty medical societies submitted a detailed comment letter to the Centers for Medicare & Medicaid Services (CMS). We urged CMS to make revisions so physicians can more easily participate in Stage 2 of the Medicare/Medicaid meaningful use electronic health record (EHR) program and allow them more time to incorporate EHRs into their practices to support practice efficiencies, improve quality of care delivery and enhance patient safety.

Read the rest of AMA: Changes are needed in the stage 2 meaningful use EHR proposal on KevinMD.com.

Category: Tech | Tags: Health IT | 1 comment

This series is brought to you by MedPage Today.

1. Study Confirms Marijuana Helps in MS. Smoking marijuana cuts spasticity and pain that’s resistant to conventional therapy in multiple sclerosis (MS), although with some cognitive effects.

2. Stress Echo After PCI, CABG Questioned. Repeat coronary revascularization did not improve outcomes in asymptomatic patients with high-risk exercise echocardiography findings after an initial revascularization procedure.

3. Acupuncture May Find Role in COPD. Japanese scientists, evaluating the needle and the damage undone, say that acupuncture can relieve an important symptom of chronic obstructive pulmonary disorder (COPD).

Category: News | Tags: | No comment

The FDA is deciding whether to allow patients to purchase prescription medications over the counter for many common ailments.

This idea is controversial.

On one hand, deregulation would remove one of the largest barriers to receiving treatment for some conditions – the doctor’s visit. If no doctor’s visit is necessary to receive necessary blood pressure medications or diabetes medications, then patients don’t have to wait for an appointment and the patient/government doesn’t have to pay for the doctor’s visit. The move would also purportedly cost patients more money for their prescriptions because insurance companies (including Medicaid) don’t pay for over the counter medications. Therefore the costs for medications that go over the counter would be shifted to the patients who purchase the medications.

Read the rest of Go ahead, let patients buy prescription drugs over the counter on KevinMD.com.

Category: Meds | Tags: Medications | 8 comments