by WhiteCoat, MD
After seeing Mrs. WhiteCoat argue on the phone with Medco representatives for 20 minutes about why one of her 80+ year old patients hadn’t received her medicine despite three lost faxes to Medco, I had to write this post to let the public know what is going on with some mail order pharmacies.
If you’re like most Americans, you want to try to save some money. One of the ways that patients can save money is by cutting prescription costs.
Enter Medco.
Medco is a mail-order pharmacy that receives prescriptions by mail or by facsimile and then sends patients their prescriptions by mail. Often, the prescriptions are for a three month supply of medications. By having warehouses instead of multiple “brick and mortar” retail buildings, Medco can save costs and presumably undercut the competition. An analogy might be that Medco is the “Netflix” of the pharmaceutical industry.
With the cheap prices come problems, though.
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by Douglas Perednia, MD
Thinking is hard work. This is why so few people bother. At least voluntarily. So whenever it seems like the threat of brainwork looms in modern American medicine, we can thank our lucky stars for the geniuses behind healthcare reform and guidelines of care.
This comes up as a result of a conversation that I had with a patient the other day. A pleasant, obese gentleman. He had been struggling with his weight and type 2 diabetes for some time, and there were now some early indications of some potentially serious long-term complications. He mentioned to me that he was working hard to prepare for gastric bypass surgery. I asked him how he was doing that.
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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 62-year-old man is evaluated for an asymptomatic nodule on his shoulder that has been present for more than 1 year. Skin findings are shown.
MKSAP image © 2010, American College of Physicians, Medical Knowledge Self-Assessment Program (MKSAP® 15)
Which of the following is the most likely diagnosis?
A) Basal cell carcinoma
B) Pyogenic granuloma
C) Seborrheic keratosis
D) Squamous cell carcinoma
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by Josh Herigon, MPH
Some reflections on my first semester of medical school.
1. Medical school is hard. Yes, it’s true — medical school is as hard as people who have been through it make it out to be.
I was skeptical when I started mostly because I felt I had challenged myself while doing my undergrad degree and in graduate school. I had taken heavy loads of difficult classes in both of my degrees. My last semester of graduate school I took 18 hours of the highest level epidemiology classes at one of the top programs in the country. I didn’t see much daylight that semester and thought I was prepared for anything med school could throw at me.
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by S. Irfan Ali, MD
Being a hospitalist, I often see patients sitting in the hospital for days at length for no reason other than poor planning.
Sometimes I feel that physicians who are involved in patient care are oblivious of each other. Everyone is in their own domain rather than working as a team. An increased length of stay in the hospital not only increases the cost of health care but also adds to the risk of medical complications like infections and medical errors.
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by Dennis Grace
So, you have to go to the hospital. You’ve had an accident and the doctor wants to keep an eye on you for a few days. Maybe you need major surgery. Whatever the reason for the stay, a lot a people think you should have an advocate with you.
Why? In my life, I’ve had lots of hospital stays. Why is this suddenly a big deal? I didn’t have an advocate when I was in for observation after a concussion at age eight or when I had my tonsils out at age ten or when I had pneumonia at age twelve. Hospitals were supposed to be the safest place to be when you were hurt or sick. Of course, at ages eight through twelve, I had my parents there making sure I got the best possible care. Still, I didn’t seem to need someone there all the time.
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by John Schumann, MD
Recently, I had the opportunity to decamp from the the friendly confines of GlassHospital and trek a few miles to the north.
GlassHospital has brokered a teaching and patient-sharing agreement with a nearby religiously-affiliated community hospital I’ll call Our Lady of Blessed Proximity.
Our Lady has a residency training program, just like ours, with the major difference being that nearly all of the doctors come from foreign lands.
Something you should know about medicine in America is that there are many more residency training slots (greater than twenty thousand) than there are U.S. medical school graduates each year (fewer than seventeen thousand). International graduates compete to fill those few thousand “extra” spots. These spots typically occur in less prestigious hospitals that are often in locations less desired by U.S. graduates.
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by Michael Gonzalez, MD
We all hate it when the cable company tells us that the technician will be at our house sometime between 11 a.m. and 5 p.m. Fantastic! Going to the pediatrician’s office can be the same way.
Your appointment may be at 9 a.m. but you may not get out of the office until noon. Unfortunately, this is the nature of running a medical practice. What should take ten minutes for one reason or another may take 30 minutes. Once the doctor is 20 minutes behind schedule, every patient will likely have to wait an additional 20 minutes for the rest of that day.
Here are some tips to make your appointment as fast and efficient as possible.
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by Kevin Pho, MD
Concierge care is often discussed as a way for primary care to survive in the United States.
Pauline Chen talks about the concept in her recent New York Times column, discussing the well-known issues involving “two-tiered” care that boutique practices inevitably bring.
But what I found fascinating was how Tufts University utilized the concept.
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by Chris Rangel, MD
In response to a recent article on the topic of economic motivation theory, Michael Kirsch sent me information about a very interesting study (May 2010 issue of the British Medical Journal) done to evaluate the effects of monetary incentives on clinic, physician, and staff work performance.
From 1999 to 2007, 35 medical facilities of Kaiser Permanente in Northern California, were given financial incentives for ensuring that their patients got regular screening for diabetic retinopathy and screening for cervical cancer – eye exams and PAP smears*.
The results were less than stellar. In eligible patients (i.e. diabetics and sexually active women without hysterectomies) over 4 years, the rate of screening for diabetic retinopathy increased a little over 3 percentage points from 84.9 to 88.1% and over one year the rate for screening for cervical cancer increased by a paltry 0.6 percentage points. And then it got worse.
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Thank you for making August 2010 the busiest month ever on KevinMD.com.
With nearly 259,000 page views, traffic surpassed the previous record, set last fall.
I appreciate your continued readership, and keeping the discussion in the comments lively and, for the most part, civil.
I’ll continue to work hard to find new ways to expand KevinMD.com’s reach, so your voice — whether you’re a patient or health care professional — can be heard.
I invite you to visit my new LinkedIn group, and find out what’s new on the site.
by Susan Giurleo, PhD
Health care is changing at lighting speed. If you don’t know this, or worse, don’t accept it you’re doomed. No. Really. It’s change or close shop. Whether you like it or not, health care reform is going to change the way we practice from now on.
Many physicians are choosing to work for large group practices to buffer themselves from directly dealing with change. Mental health providers could do the same, I suppose. But is that what you want for your career? Do you want to work for someone else for a Relative Value Unit?
How about your patients and clients? Do you think they would prefer to receive care in a small practice where they are known by the staff and cared for with dignity?
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by ER Stories, MD
I hate acute strokes. There are several reasons for it. Most of them are logistical. First, everyone gets into a tizzy because of the 3 (or 4.5) hour time limit after the onset of symptoms that which TPA can be given and hopefully improve the patient’s outcome. Unfortunately, this time limit (and the data for TPA’s efficacy is only OK at best) causes mass chaos and annoyance.
First, one has to establish 100% what the exact time of onset was. This is not easy most of the time. I would say about 80% of “acute” strokes brought in by EMS turn out to not be within that window. It takes more than just saying “when did the symptoms start?”
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by Anesthesioboist T., MD
On my way onto the plane for my recent flight home from France I picked up a copy of Le Figaro thinking I might enjoy the article about actress Sophie Marceau, who was on the cover of everything while we were in France in celebration of her turning 40.
I did enjoy catching up on Marceau – I still remembering watching La Boum in my high school French class – but I couldn’t help but notice a two-page spread showing a large group of physicians in their white coats standing on the staircase at the Université Paris Descartes – a staircase I remember descending last year after my visit to the Musée d’Histoire de la Médecine.
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by Paul Sax, MD
Last year, I commented on the ironic sameness of ICU infectious diseases — that incredibly sick, complex patients entered the ICU with vastly different problems, then over time, seemed to converge, presenting similar kinds of clinical issues and management challenges for the ID doc.
Or, as a visiting medical student said to me, “My ICU attending said that every patient in the ICU should be on vancomycin and Zosyn.”
Which brings up the issue of empiric antibiotics.
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by Michele R. Berman, MD
During a recent speech from his American Revival tour, Glenn Beck, 46, announced that he has an eye condition called macular dystrophy that could cause him to go blind. Speaking in front of a large group at his “Revival America” tour, the Fox News pundit told the crowd:
“A couple of weeks ago I went to the doctor because of my eyes, I can’t focus my eyes…he did all kinds of tests and he said, ‘you have macular dystrophy …you could go blind in the next year. Or, you might not.”
The term “macular dystrophy” can be confusing because, according to Dr. Robert Enzenauer, macular dystrophy is a disease of the cornea of the eye whereas “macula” is a term that refers to the retina.
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by George Lundberg, MD
Only rarely does an experienced editor get a spine tingle from a new paper. For the first time ever, today, I predict that a Nobel Prize for medicine will be awarded to J. Martin Brown, DPhil, Oxford, a professor at Stanford University School of Medicine.
Professor Brown and his colleagues have discovered and reported a fundamentally new approach to the treatment of solid tumors, beginning with the devastating glioblastoma multiforme.
Here is how it goes: Tumors need blood in order to grow. Powerful radiation can kill many cancer cells. It also kills the cancer’s blood vessels. How then do any surviving cancer cells regrow after radiation if they have no blood supply? Where do the nutrient blood vessels come from?
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by Brandon Betancourt
I got a chance to fly JetBlue for the first time recently. Since I had heard so many good things about the airline, I was looking forward to experiencing the JetBlue, well, experience.
I took four flights in total with them. While outbound, they lost my bag. While inbound to Chicago, my last leg was delayed about 2 hours. I then I had to wait another 80 minutes for my bag to come down the carousel.
Would I fly them again? Read on and find out. Here are 10 observations I noticed while flying with JetBlue and how a medical practice can implement these observations.
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by Jeffrey Parks, MD
Lucian Leape MD, a public health professor at Harvard, wants to subject doctors in America to strict random and periodic drug testing to help identify those physicians who are impaired. All in the name of patient safety, of course:
“I’m very much in favor of random testing,” Dr. Leape says. “We have a responsibility to identify problem doctors and bring them into treatment.” And to protect patients in the process.
Ok, I get it. Impaired physicians are bad. We don’t want strung out cokeheads and stumbling alcoholics roaming the halls of our hospitals. But random drug testing?
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by Kevin Pho, MD
MobiHealthNews released a comprehensive infographic on physician use of the iPad, a distillation of their report on the issue.
The iPad has been covered previously on this site. The form factor holds tremendous potential, as this Dartmouth physician noted, “the iPad offers a ‘low profile’ that doesn’t seem intimidating to patients during exams.” That’s especially important as it can allow doctors to maintain eye contact with their patients, versus the more intrusive laptop.
The bottom line remains, however: it’s all about the apps. Especially those that interact with patient electronic medical records is where the iPad holds the most promise. Software will be the major determinant in how quickly physicians will take to Apple’s tablet.
Furthermore, young doctors need embrace it. That’s starting already, with some medical schools giving their students free iPads. Future widespread physician adoption is necessitated by today’s medical students viewing it as an indispensable tool as they train.
Click below to view the infographic.
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