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Obesity from a Pathologist's Perspective Print E-mail
Written by Jena Martin | KevinMD   
Wednesday, 20 June 2018 00:00
Envision a large, loafy muffin top. Not just a central bulge or even love handles. I'm speaking of an apron of skin and fat that hangs down over many an American's lower torso and groin. Surely you've seen it - you may even have one. Its medical name is the pannus. I had never heard of a pannus in medical school and I still never hear it mentioned outside of the pathology laboratory. In fact, this article is inspired by conversations I've had with friends who know about medicine and who were nevertheless shocked to hear about the pannus.

Last Updated on Friday, 22 June 2018 17:22
The quandary of cost transparency Print E-mail
Written by Ted Matthews, MBA | KevinMD   
Thursday, 07 June 2018 00:00
Why can I get a comprehensive estimate for something like a car repair, but not a hip transplant?
While a cost range or estimate can be provided  regarding what the physician will bill for a specific service, we can - at best - make an educated guess about other surgery costs (hospital bill? anesthesiologist's bill?) and follow-up costs (physical therapy? prescription drugs?). People, unlike cars, are not identical "under the hood," and treatment does not work consistently between people or even at different times for the same person. An expected procedure may need to be changed and additional testing or procedures may be necessary.
This can be a good time to discuss value transparency. Because, like so many things in life, what can look like a "good deal" at the start can end up costing a patient more later on.
Last Updated on Friday, 08 June 2018 17:36
Who Should Get the Liver Transplant? Print E-mail
Written by MD Whistleblower   
Tuesday, 15 May 2018 17:24

People with liver failure and cirrhosis die every year because there are not enough livers available. Who should receive the treasured life-saving organ? There is an organ allocation system in place, which has evolved over time, which ranks patients who need liver  transplants. Without such a system, there would be confusion and chaos. How can we fairly determine who should receive the next available liver? What criteria should move a candidate toward the head of the line? Age? Medical diagnoses? Insurance coverage? Employment status? Worth to society? Criminal record?

Consider the following 6 hypothetical examples of patients who need a liver transplant to survive. How would you rank them? Would those toward the bottom of your list agree with your determination?
Preventing CTE is a no brainer Print E-mail
Written by FHI's Week in Review   
Monday, 07 May 2018 16:23

Chris Nyte, DO, a former nose guard, reminds us of the horrors of chronic traumatic encephalopathy (CTE) in a May 4, 2018 KevinMD post. Clinical findings associated with CTE include memory loss, depression, anxiety, violent behavior, mood disorders and heightened suicidality, the author informs us. It tends to progress with time and can lead to dementia according to a recent study. And the fact that CTE is a direct result of blows to the head such as those suffered by athletes competing in contact sports, especially football, is no longer in doubt.

Read more in the current issue of Week in Review>>
A Call for Cost Transparency Print E-mail
Written by FHI's Week in Review   
Monday, 23 April 2018 16:33

Mukul Mehra, MD, in an April 20, 2018 KevinMD post, insists doctors need and want cost transparency. "Physicians are the building blocks of value-based care, yet the cumulative human and financial costs of our decisions are mostly hidden from us," he states.

Read more in the current issue of Week in Review>>

Last Updated on Monday, 21 May 2018 17:27
Why I Now Treat Hepatitis C Patients Print E-mail
Written by MD Whistleblower   
Tuesday, 17 April 2018 18:29

In a prior post, I shared my heretofore reluctance to prescribe medications to my Hepatitis C (HCV) patients. In summary, after consideration of the risks and benefits of the available options, I could not persuade myself - or my patients - to pull the trigger. These patients were made aware of my conservative philosophy of medical practice. I offered every one of them an opportunity to consult with another specialist who had a different view on the value of HCV treatment.

I do believe that there is a medical industrial complex that is flowing across the country like hot steaming lava. While I have evolved in many ways professionally over the years, I have remained steadfast that less medical care generally results in better outcomes. 

There was an astonishing development in HCV treatment that caused me to reevaluate my calculus.

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Last Updated on Tuesday, 17 April 2018 18:31
Take 2 Broccoli and Call Me in the Morning Print E-mail
Written by The Fit Physician via KevinMD   
Friday, 13 April 2018 16:09

We live in a pill-popping society. The first line treatment for many of the medical problems that walk through our doors is a medication. Have heartburn?  Forget about avoiding the foods that cause your symptoms - just take a pill.  New diagnosis of diabetes?  We give lip service to lifestyle modifications and then start patients on Metformin. Hypertension? Diuretics, ACE inhibitors, ARBs, beta blockers - take your pick, and I guess make the obligatory mention of weight loss.

I fully realize that there is a time and a place for medication. There are varied medical problems that can only be treated with medication, and there have been many life-changing discoveries on the pharmaceutical front. Heck, humanity owes a large part of our prolonged life expectancy to pills that we pop to treat chronic disease. I am not here to poo-poo taking pills.

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