An ethics professor takes an interesting look at how elitist the US health care system is becoming. On one hand, we have concierge practices:
Now, one might wonder why it is necessary to pay a bounty to get a doctor to call you back, especially if you are already paying through the nose to belong to a managed care plan. The answer is that under the watchful eye ...
June 2004
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What discounts?
It seems the effect of the Medicare drug discounts was simply higher drug prices. The more things change, the more they stay the same.
The myth of July syndrome
The NY Times today writes about the so-called July syndrome - the time when the new house staff start at teaching hospitals across the country. There is no data to support worse patient outcomes in July - although I can certainly remember the potential for disaster.
My very first day was being the night-float intern at the former Boston City Hospital. This meant cross-covering every ...
Practicing evidence-based medicine in real life is difficult
Refraining from testing and evidence-based testing is nice, but difficult in today's practice environment:
In one study in which Dr. Kroenke said he examined 500 patients with physical symptoms, 70% of all subjects improved two weeks after seeing a primary care physician. While symptoms persisted in about 25% of patents, follow-up studies showed that serious diseases not suspected during initial evaluations rarely emerged after one year.
The ...
Should doctors charge patients more for increasing malpractice premiums?
Seems like practices who have a liability surcharge may become increasingly common:
Physicians gathered at the AMA Annual Meeting last month explored a variety of options for immediate relief for a profession besieged by increasingly unaffordable medical liability insurance premiums.
The hottest topic of discussion: liability surcharges. The idea is that physicians would tack a charge onto patients' bills to help offset their insurance payment. Low ...
Statins and macular degeneration
One of my patients this morning wanted a statin prescribed to ward off macular degeneration. She had perfect cholesterol. I wasn't aware of any trials connecting the two and told her I'd look into it. Here's what I found:
A new study from UAB indicates that patients who take cholesterol-inhibiting drugs known as statins are less likely to develop symptoms of age-related maculopathy (ARM), better ...
A nice overview . . .
. . . to medical weblogging can be found on Medscape today (via Tales of Hoffman).
Bribery
I was just in NYC this past weekend and was going to comment on this NY Times article, but Nick at Blogborygmi has eloquently summarized everything up.
As follow-up . . .
. . . to physicians denying treatment to lawyers, Medpundit gives an insightful opinion on this desperate tactic.
More malpractice ranting
Nothing like coming back from vacation and seeing more inflammatory articles on the malpractice controversy. Medrants summarizes some of the more recent articles.
Update:
After catching up on some weekend reading, our friend Medpundit has also chimed in on the recent ignorance by the NY Times and the esteemed Mr. Herbert.
Sorry for the dearth . . .
. . . of posts in the past few days. My blogging time will be limited in the next week or so, but I'll link to some interesting reading meanwhile.
Response to the NY Times malpractice op-ed
There has been much discussion on the recent NY Times piece on "Malpractice Myths", seen here at Medrants. Now comes some more criticism from the law world, highlighting the obvious ignorance of the article (via Medpundit).
The switch to EMR
So the big deal in my practice is the transition to an EMR in the upcoming months. Finally. Our administration has chosen the HealthMatics EMR by A4 Health Systems.
The plan will be to carry these laptops into the exam room, and in an ideal situation, directly enter notes into templates while doing the history.
Anyone have any experience with this system? ...
Why PAP smear guidelines are being ignored
Stories are coming out regarding the recent JAMA article concluding that the USPSTF recommendations on PAP smears are being ignored:
Twenty-two million US women 18 years and older have undergone hysterectomy, representing 21% of the population. The proportion of these women who reported a current Pap smear did not change during the 10-year study period. In 1992 (before the US Preventive Services Task Force recommendations), 68.5% of ...
Billing for sex
Lest I be accused of taking a continual pro-physician bias, comes a story that brings shame to our profession:
An Oregon doctor, who had sex with a patient and then charged the state about $5,000 for his "treatments," has been jailed for 60 days and stripped of his license, officials said on Friday.
Dr. Randall J. Smith, 50, told the woman that massaging her "trigger points" would ease ...
On mammograms
The mainstream press has gotten hold of the recent MGH study detailing that only 6% of women obtain a screening mammogram yearly during a 10-year period. With the barriers today to mammogram access, I'm not sure that improvement is on the horizon.
An impossible standard
Medpundit writes an insightful piece on how recent lawsuits have equated risk with harm.
Money talks
Paying patients to lose weight. It's the American way:
One doctor paid $1,044 to 150 of his patients who lost weight . . . The patient with the greatest weight loss, a 51-year old woman, took off 35 pounds and will get a vacation to Las Vegas, a bonus prize Dr. Chemplavil threw in as an added enticement.
A sign of things to come?
We have concierge practices, now people can pay extra for "priority access" at emergency rooms:
The 95-year-old financially ailing Southampton Hospital - the only serious medical emergency center on the South Fork - is offering a plan aimed at wealthy summer visitors whose primary doctors are back in Manhattan and out of reach, presumably along with the hospital's sense of propriety. For $6,000 per family, or $3,800 for individuals, ...
New Hampshire bike week and helmet laws
This week is Bike Week in New Hampshire. It amazes me as I drive home how many helmet-less motorcyclists there are around here, zooming along at 70+ mph. As you may know, there is no helmet-law here.
Consider the following from the BMJ:
Deaths on motorcycles have increased 54% since 1997. As soon as helmet laws are reversed or weakened in a ...
Kevin Pho, MD
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How I approach ovarian cancer screening with patients
Ovarian cancer screening clearly touches a nerve. No one doubts that ovarian cancer is a devastating diagnosis, often found when the disease...
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Why more primary care doctors are referring patients to specialists
According to a recent study from the Archives of Internal Medicine, primary care physicians are referring more patients to specialists than ever...
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Should Google censor anti-vaccine claims?
One of the reasons there is such a movement against vaccines is the democratization of information, perpetuated by search engines like Google....
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Radiologists who cheat on their board exams: Who’s to blame?
In a widely circulated CNN article, many radiologists have been found to cheat on their board exams: "Doctors around the country taking an...
Physician
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Why an anesthesiologist would be needed for organ donation
I've only had to declare death a couple of times. Once in a three-year-old and once in an adult. In each case...
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5 ways to avoid a misdiagnosis
Billionaire Teddy Forstmann had been diagnosed with a serious form of brain cancer. There’s a tragic twist to the story: according to...
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Benefits of the Medicare Adult Wellness Visit
One of the things I love about family medicine is that I get to care for people of all ages. I almost...
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Cancer has a way of teaching us poignant life lessons
I just finished reading George’s recent post on Evelyn Lauder, who recently passed away from ovarian cancer, and am still stirred by...
Patient
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In love there is a life giving force
Here is a toast to the miracle of love. Not to the romantic, chocolate, dance club nightlife type of love. Not warm...
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How to get ready for death
No one wants to die. Even people who want to go to heaven don't want to die to get there. And yet...
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The long term cost of a pain in the neck
One morning this May, I woke up with a stiff neck. I applied hot and cold therapy all day and took an...
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Preparing for your visit with someone in hospice care
Visiting someone who is dying or critically ill is an experience many of us will have in the course of our lives....
Policy
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AMA: Advocating for Medicare, military and fiscal responsibility
A guest column by the American Medical Association, exclusive to KevinMD.com. This week, I’m joining hundreds of physicians and medical students in Washington, DC...
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A critical look at value driven health care
Everyone in the world is talking about “value-driven health care.” Or so it might seem if you pick up a medical journal...
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Surviving the new landscape of physician reimbursement
CNN recently posted an article titled "Doctors Going Broke." It described several cases of independent physicians who are near bankruptcy although they once...
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Doctors lobby Congress to repeal the SGR
One of the things that I like most about my job is engaging with ACP’s physician leadership—the internal medicine doctors who dedicate...
Tech
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There is a patient attached to that implantable defibrillator
As a follow-up to my post on why patients with implantable defibrillators should have access to their device’s data, I am going...
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The pitfalls of email communication with patients
A recent article in the Wall Street Journal reviewed the emerging role of email in healthcare, arguing that doctors should more aggressively...
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Why adoption of EHRs is a transformational event for physicians
Paul Conslato, MD, director of clinical affairs for Lancaster General Medical Group, recently was quoted in the PAMED Better Health Network eZine...
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Why EMR is a dirty word to many doctors
Don’t get me wrong, EMRs (electronic medical records) are inevitable. Over the long-run they are almost certainly good for physicians, patients and...
Social Media
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Using Twitter to deliver health improvement messages
I have decided to spam for public health. Phone calls, text messaging, and even apps have been shown to help improve health...
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Addressing comments on your medical practice’s Facebook page
Does your medical practice allow anybody to post links and comments on your Facebook page? The short answer is yes. We do....
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The Internet is where patients go for pre-visit consultations
As a physician, technology cannot replace you, but it can make you more efficient and effective. This was the message from Richard...
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5 ways doctors can benefit from professional connections
Looking ahead to the next several months, I’ve found myself frequently wondering how many physicians will make this their year to take...
