I don't have much to add to the medical blogopshere's discussion on the upcoming, landmark Supreme Court decision, so instead I'll point to two reasoned posts, arguing the case from opposite sides.
October 2008
All Stories
Advances in library research
Find out how this rural physician uses a dose of Twitter and a USB drive to research articles from medical journals. A change from the old days of going to the local medical library and waiting in line for the photocopier.
It also makes one realize how academic physicians can take access to medical literature for granted. In rural areas, articles are expensive to come ...
That’s how you cut emergency department use
More community health centers:
Family Health Center cuts its ER visits by 15 percent from 2006 to 2007 after creating a nurse triage system and adopting appointments for its urgent care department. Overall, ER visits dropped by 2 percent at the 21 health centers participating in a state initiative.Finding physicians to staff community clinics is another matter, but the bottom line is that increasing outpatient medical access will relieve ...
Prescribing narcotics in the Middle East
If you think the consequences are tough here, you haven't seen this case in Saudi Arabia:
Egyptian Raouf Amin languishes in a Saudi jail and is punished with 70 lashes once a week. Cut off from his family in Egypt, the 52-year-old doctor was convicted for prescribing painkillers to a Saudi princess that led to her addiction.
An appeal court judge ruled that Amin will be beaten weekly ...
Patients waiting for hospital beds
It is common to find patients waiting for admission sitting in the hallways of emergency departments.
A new study suggests there is no harm in transferring them upstairs to the floor, where they can wait in the hallways there.
The sight of waiting patients on a medical floor would put pressure on the administration to open up rooms, and transfer the patient's care to the floor nurses. ...
Is concierge care really too expensive?
Say a concierge doctor charges you a $2500 annual retainer fee. Sounds expensive, right?
But not after you break it down where the cost can be mere dollars per day, after savings from reduced wait times and improved access are considered:
Or is it just that giving up the daily Jamba juice or Pinkberry yogurt in exchange for personalized health care is just too much to ask of ...
Placebos in the emergency department
When one thinks about placebos, sugar pills come to mind.
As Shadowfax illustrates, it's can be so much more than that, ranging from IV fluids for flu-like symptoms to plain x-ray films for musculoskeletal pain.
A placebo can certainly be more vague than initially thought:
In the end, I don't really know what a placebo is. There's a no bright line that separates the "sham" treatments from ...
Remove jewelery before working with power equipment
Here's why.
Soft tissue finger injury
These are very common injuries that present to the emergency department. Who better than plastic surgeon Ramona Bates to talk about treatment and suturing techniques?
Health care and statistics
Here are some responses to last week's NY Times op-ed suggesting that a comparative effectiveness institute be considered.
Most of the resistance comes from the fact that medicine is infinitely more complex and variable than the current tools of empirical data can resolve:
The number of variables in medical care (patient and treatment variability, co-morbid conditions) and degree of subjective interpretation (severity of illness) is far greater than ...
Why primary care doctors shouldn’t be pain specialists
Managing chronic pain is becoming increasingly difficult. As Dr. Rob observes, many primary care doctors simply don't prescribe narcotic medications.Worse, pain specialists often won't either, preferring to focus on procedures and non-narcotic management:
What happens when, despite my best efforts, the person is still in significant pain? Most of the time I get to an impasse like this, I send the patient to a specialist. The job of ...
When government solves problems
When government gets involved, unintended consequences often ensue. One example is the so-called "moral hazard," where people are insulated from the consequences of risk:
The person may behave differently from the way the person would behave if fully exposed to that risk. Here's a familiar example: If you insulate people from the consequences of taking financial risks, they may behave recklessly and borrow or loan money for home ...
Should doctors want their children to become physicians?
Studies have suggested that more doctors than ever do not recommend the profession to their children. With all the interference from insurance companies and government, doctors are frustrated and the future of the profession does not bode well.
Brian Carty recounts an encounter with a prospective medical student, and emphasizes that those considering this career better not do it for the money (via The Happy Hospitalist):
Should doctors talk politics with patients?
Manoj Jain asks whether politics belong in the exam room in his recent Washington Post piece (via the WSJ Health Blog):
I have strong political opinions, but I am edgy about disclosing them to my patients for several reasons. For one, I'm in an authoritative position: When I talk about antibiotics, my patients listen and usually do as I advise. As a result, they might give inappropriate weight ...
ER waits, how long is too long?
3 1/2 hours, according to a study. After that, patient satisfaction scores plummet. I'm surprised the scores didn't drop sooner than that.
To help with patient satisfaction, hospitals are resorting to a time-tested marketing tactic. Underpromise and overdeliver:
Basically, the docs calculated the mean time it took to get through the ER for a given test or procedure "” then added 20% when they ...
Rewarding the most needed doctors the least
Another general internist leaves The Happy Hospitalist's area, and there is difficulty finding a replacement. It's not news that this scenario is mirrored throughout the country.
He goes on to say that half of the health care dollars is spent by 5 percent of the population.
Generalists are needed to coordinate care, which will help rein in costs from this demographic subset. Not just a ...
Why this doctor left primary care
Theresa Chan is a hospitalist physician in rural California. When she started out, she had the ideal of "doing it all," which is the type of doctor that is needed the most:
When I arrived in Rural I was determined to do it all: see patients for primary care, admit them to the hospital, assist surgeries, deliver babies--everything . . . I did I&Ds, skin biopsies, colposcopies, ...
UptoDate is superior to PubMed
It isn't even close.
UptoDate is geared towards everyday clinical use, and I can obtain succinct, evidence-based answers in a fraction of the time when compared to PubMed.
Health IT complexity
If only more information officers thought like John Halamka. He rails against complexity, and I completely agree:
In the world of IT, simplicity is often more reliable, more secure, and more usable. Whenever I'm tempted to add complexity to address the needs of a few customers, I remind myself that Less is More.Many electronic record systems are needlessly bloated with rarely-used features. This steepens the learning curve, ...
Physician costs exceed revenue
That's never a sustainable business model (via Jay Parkinson), especially in primary care. This will lead to more hospitals buying cash-strapped practices, and using them as "loss leaders" to drive traffic to the hospital.
I don't see how small, independent practices can survive without hospital help going forward.
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...
