As the Affordable Care Act continues to impact millions of Americans through its second year of implementation, many things have become clear to both patients and health care providers alike: nothing is as it seems. While the ACA has provided health care to millions of previously uninsured Americans, it has also robbed many patients of their doctors and has forced others into higher premium, lower service plans.  Even those with ...

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The following article is satire. In the first application of a new “reverse AMA” system put into place to improve patient satisfaction, a patient was admitted to the hospital for the first time against the wishes of her treating ED physician.  Constance Dolor, a 37-year-old morbidly obese patient with chronic unexplained pain and a frequent visitor to the emergency department, became the first person in known history to be admitted the ...

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It came out of nowhere. One of those life lessons that I didn’t know I needed to learn. Until I did. There I was, at a weekend business retreat, hobnobbing with a group of women executives. Feeling only slightly out of my element. Trying to blend in. There was a break in the meeting. And what happened next made me rethink how I approached everything. Several of us walked to the ladies’ ...

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Behind every doctor is a little boy or girl who once watched helplessly. Maybe it was her father or grandfather who suffered under the weight of a disease that was deemed all but incurable. Perhaps her own skin was battered and bruised by the repeated trauma of an unrelenting tourniquet.  She swore that when (if) she got older she would protect the innocent from such things.  Her vow was the ...

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The other day some cardiologists on Twitter were discussing whether a patient should be blamed if a permanent pacemaker lead became displaced. The consensus seemed to be that it was probably poor placement (i.e., operator error), rather than patient behavior that caused leads to dislodge. The discussion reminded me of an attending plastic surgeon of mine during my resident days. He was one of the most obsessive-compulsive people I ever met. ...

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Where does doctor stop and computer begin? Who is in charge? Do we care? Are these silly, academic questions from some sci-fi future or is it an onrushing tomorrow? Consider:

  • Ten years ago, the EMR recorded the date you or your nurse gave Sam his flu shot.
  • Today, the EMR reminds you it is time to have your nurse give Sam his flu shot.
  • Soon, the EMR will order the flu shot that the nurse will give to Sam.
  • Tomorrow, the ...

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I recently had an interesting conversation with several co-residents about how our health care system should evaluate physician performance. If nothing else, the discussion highlighted how challenging this issue has been for almost all medical specialties, including internal medicine, where the controversy has been punctuated by debates about maintenance of certification (MOC) and licensure. It remains to be seen what will develop after the American Board of Internal Medicine recently ...

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How can physicians maintain a consistent brand online? With a hub and spoke strategy.  Watch the video above to see what that means. This is next in a series of short physician online reputation videos produced by The Doctors Company as part of their social media resources for physicians.  Enjoy.

The sun rises and the sun sets. It seems like the sun rotates around the Earth. Cancer cells rise and are killed by surgery, radiation and chemotherapy. It seems like cancer is a disease. But the sun does not rotate around the Earth, and cancer is not a disease. The many kinds of cancer cells are the products of the disease neoplasia that can emerge in our bodies’ organs and tissues. Strange ...

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SGR has been the bane of my time in policy.  And I want it to be yours. SGR, formally known as the sustainable growth rate, is a formula developed under none other than the Balanced Budget Act (the same one that set the cap for GME-funded residency slots at 100,000) to determine the Centers for Medicare And Medicaid Services (CMS) reimbursement payments to physicians.  And because the universe loves a good ...

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Over the course of pre-professional and professional education, my colleagues and I have had numerous moments of self-doubt.  Would the next organic chemistry exam eliminate my 3.99 GPA?  Would the MCAT decide what medical schools would immediately ignore me without ever meeting me?  Would the sheer volume of material weed out the persons sitting next to me in medical school or would it weed me out instead?  Would being yelled ...

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medpagetodayFrom MedPage Today:

  1. Uncertainty and Litigation Fears Drive ED Docs to Overimage. Nearly all emergency medicine physicians responding to a survey said that at least some of the advanced imaging studies they ordered were medically unnecessary.
  2. USPSTF: Not Enough Evidence for Thyroid Screening. The U.S. Preventive Services Task Force (USPSTF) said there ...

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Medicine is obsessed with numbers.  Or rather, journalists and medical administrators are.  Here are two related examples of how large a grain of salt one must put on numbers. Cardiac surgical procedures, like everything else in medicine, have quality indicators.  One of these is what we doctors call “30-day mortality.”  What this term means is that surgeons are evaluated in part on how many of the patients they operated on died ...

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Several years ago, a few colleagues and I performed a systematic evidence review to help update the U.S. Preventive Services Task Force's recommendations on screening for prostate cancer. One of our key questions asked about the harms associated with prostate cancer screening, other than the overdiagnosis (and resulting unnecessary treatment) of clinically insignificant tumors. Since routine prostate-specific antigen screening had been going on for nearly two decades by then, we expected to ...

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Question: My family (including two small children) and I are relocating this summer for my husband’s new job after seven years of living in the same area for residency and fellowship to a city where I know no one. I am scared about leaving our support network of friends and family nearby. Can you offer advice on starting over in a new place? Answer: I would guess that almost every physician family has ...

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When I was in kindergarten, my school bus used to drop me off at the hospital where my mother worked.  My older sister and I would sit quietly in my mom’s office and do our homework while she finished up her work.  Most of my friends would get stickers or McDonald’s for their good behavior, but if my sister and I were on our best behavior, my mom would reward ...

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The country is in a state of health care denial. Politicians, pundits, and executives proudly declare America’s medical care is the best in the world. But it isn’t. The U.S. lags behind other industrialized nations in many important health measures -- partly because citizens of certain races, ethnicities and incomes experience poorer versions of U.S. health care than others. The disparities are glaring. The solutions aren’t nearly as obvious -- but we’ll explore some ...

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An iconoclast must not only have abundant common sense but the gift of the gab to state the obvious. Simply stating won’t do. You must rub it in.

My favorite iconoclasts are Peter Skrabanek and Thomas Szasz. Skrabanek was a general practitioner who authored Death of Humane Medicine and Rise of Coercive Healthism. Szasz, a psychiatrist, who volunteered that he entered psychiatry to unveil its pseudoscience, is the Voldermort ...

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medpagetodayFrom MedPage Today:

  1. OA Patients Don't Face Higher Heart Disease Risk. Neither radiographic nor clinical osteoarthritis (OA) was related to a greater risk for cardiovascular disease (CVD) in older patients.
  2. Senators to Providers, Industry: Lobby Harder on End-of-Life Care. A strong coalition is needed to transform care for the dying, said U.S. ...

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As a fellow in cardiology, you sign up to be part of a specialty that can involve emergencies. As a first-year fellow, usually you are running things by other senior fellows and attendings, and typically you are not the first person to make a decision on a plan. At times, though, there can be an exception to that rule, and it is an exception that can make you realize that there ...

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