The following is a reader take by Val Jones.
As a new member of the National Press Club in Washington, DC, I am taking full advantage of my opportunities to get an inside look at what people are saying about healthcare, and how policy makers and advocacy groups are proposing to improve it.
Three of the presentations that I witnessed last week were some ...
October 2008
All Stories
Dr. Ken
In light of the rough economic week, it's time to lighten the mood. Ken Jeong is a primary care physician turned comedian and actor. He's in a variety of recent movies and TV shows, and was especially hilarious in Knocked Up.
Here's one of his stand-up bits. It's offensive, so consider yourself warned.
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Medicine and the economic crisis
MedPage Today talks about how the economic crisis will affect physicians, hospitals, and medical education.
First, many older physicians will delay retirement. Perhaps this can temporarily stave off the predicted physician shortage:
"I look at my 401k and think 'Okay, I just turned 62, and 70 is starting to look like a better retirement field,'" Dr. Jessee said.
An en masse delay in retirement may ...
Single payer to fix malpractice?
Advocates are saying that a single payer system man be an answer to solve malpractice woes:
She noted that if health care was guaranteed through government funding there would be no need for malpractice suits and settlements to take into account the future health care costs of plaintiffs. This is particularly important in obstetrical cases given the future medical interventions and life expectancy of these babies.For physicians to ...
Fecal DNA tests
As a follow-up to my post on the updated USPSTF guidelines on colon cancer screening, a reader asks me to comment on fecal DNA tests, which along with virtual colonoscopy, was given an "I" recommendation meaning there was not enough data to provide guidance:
I would be very interested to hear your thoughts about their omission of a less well-known new option, stool DNA (SDNA).
The task ...
Specialists and zebras
The dark secret of specialists is that they are trained to see the bizarre. In order to adequately train a specialist in diseases and illnesses that rarely occur, they must train at large, academic medical centers. In such places, where doctors throughout the region send their difficult cases, they do end up seeing quite a few bizarre cases. To deal with the bizarre, they ...
Having everything done
This anesthesiologist sums up the end-of-life conundrum nicely:
There are families who accept death with peace, dignity, and an unselfish regard for their loved one's wishes.In the ...
There are other families who cling to the one they love, and want "everything done" for the person, not because that's what their loved one wants, or would benefit from, but because they, the family, aren't ready to say goodbye.
When the mundane isn’t
Residency trains you for the critical or severe cases, leaving the seemingly simplest cases to be the most challenging. Shadowfax reflects on an example where a 1-week old infant presented vomiting blood.
Similarly, when I first started primary care I was comfortable running codes and knowing what to do in an acute MI. It was the rashes that I saw in the office that I found ...
Celiac disease
Celiac disease is an oft-overlooked diagnosis that can cause a wide constellation of common symptoms, including fatigue, decreased exercise tolerance and a variety of IBS-like gastrointestinal manifestations.
Athletes in particular should suspect this with an unexplained loss in performance or worsening fatigue. It's diagnosed with a simple blood test.
Because there's no known medication for treatment, little has been spent in researching new cures apart from ...
Making pay for performance difficult
Medicare is offering bonuses to doctors who adopt e-prescribing. However, the process is convoluted and practices that do everything right still don't receive payment:
Richard McArdle, the CEO of an ophthalmology practice in Portland, Maine, who attended the CMS-sponsored conference, told MedPage Today that his group's experience with PQRI will make it hard to convince his doctors to seek the Medicare bonus for e-prescribing.
"We did everything ...
Test post
This is a test post. Please ignore it.
Archives:
September, August, July, June, May, April, March, February.
Internet support groups
They can sometimes give fatal advice, like influencing liver transplant patients to stop taking their immunosuppresive medications. Transplant surgeon Pauline Chen reflects on this tragic case and speculates why some patients do what they do.
Chief complaint, not otherwise specfied
When you can't categorize a chief complaint, you're often in for something strange. Or as Shadowfax puts it, a mixture of "curiosity and utter dread."
Internists
Here's what we do, in a nutshell. Multiply that by 20 to 30 patients a day, and you get an idea of the complexity of the profession.
The biggest tragedy of Hurricane Ike?
The shaky future of the University of Texas Medical Branch in Galveston:
After sustaining a direct hit by Hurricane Ike, UTMB has been slow to recover and its future is in jeopardy. UTMB suffered over $700 million in damages from Ike with only $100 million covered by insurance, and given their $50 million per month payroll and impaired ability to generate income, this week university officials were warning of ...
Value of primary care
Dr. Rob comments on the recent preventive medicine piece in the NY Times. To summarize, asserting that screening tests save money is a myth.
The real value of primary care physicians, is that we can prevent unnecessary testing :
For example: if you go to the neurosurgeon with sciatic nerve pain that has gone on for 2 weeks and is excruciatingly painful, what do you think the ...
The economy and doctor’s visits
The current economic turmoil is resulting in a flood of office visits in some cases:
Doctors say people's financial troubles can, in fact, spread to your body and cause everything from ulcers to heart attacks, often disrupting people's lives and relationships.I personally haven't seen ...
Cardiologist Ramin Oskoui says he's seen a 30 to 40 percent jump in the number of patients complaining of chest pains or tightness.
Wasted billions in health care
Arthur Garson talks about unnecessary health care spending in his op-ed. He goes over the common arguments, including practice variation, lack of comparative effectiveness, paying for quantity, and malpractice.
Here's his solution:
The next president, whoever that is, should start by appointing a group made up of those responsible for wasting our dollars "“ as well as members of Congress and the administration "“ to examine ways ...
Physicians and blogging
Dr. Wes has recently undergone some trying times associated with his blog. He's wondering whether it's worth it to continue the effort:
There is no question that placing one's online self in the world for all to see adds vulnerability and potential liability. When I told a colleague Friday about my recent predicament he responded, "Why the hell would anyone want to blog?"To this end, he asks some relevant ...
Universal coverage and primary care
Elissa Mummolo summarizes Massachusetts' problem of adopting universal coverage before addressing physician access.
Waiving tuition for medical students who choose primary care is a good start.
However, there is a lag time of about 10 to 20 years before these changes take effect. Every medical school has to offer similar incentives, and it will take years for the attitudes of medical students to change. ...
Kevin Pho, MD
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Why Priscilla Chan may become the country’s most influential doctor
Who has the potential to be the most influential physician of our generation? It's Priscilla Chan, who not only recently graduated from...
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Confused about prostate cancer screening? Make a shared decision
In a widely anticipated move, the USPSTF officially recommended against prostate cancer screening in healthy men. Case closed, right? Hardly. The prostate...
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When it comes to doctors and social media, hospitals fail miserably
When it comes to medicine and social media, much of the attention is negative. Doctors losing their hospital privileges because of Facebook....
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Warren Buffett’s prostate cancer choices aren’t right for every man
A version of this column was published on April 24, 2012 in USA Today. There has been a recent uptick of elderly men...
Physician
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Why test recalls should not be considered cheating
I was appalled recently by the coverage of radiology “test recalls” by CNN, amplified by Dr. Gary Becker of the American Board...
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Why physicians are susceptible to hardball tactics
I was invited to a medical staff leadership conference sponsored by our hospital. A company specializing in training physician leaders ran the...
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How we deliver bad news is critical to how families deal with grief
As a cardiac electrophysiologist, I have had to discuss bad news with patients and families more times than I would like during...
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His father’s suffering had already been too great
He looked dead. The paramedics brought him down the hall toward one of my critical care beds, and for a moment I...
Patient
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How death can be a beautiful experience
I was honored to be part of a beautiful experience in late January of 2011. It was the death of my mother-in-law...
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What meaningful encouragement can be given to someone who is dying?
Theirs is a lonely journey; to be moving towards the separation and end of all things known and loved. Being with a...
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Health care journalists have tendencies similar to those of doctors
As a patient who was asked to speak at the Association of Health Care Journalists 2012 conference, I felt a bit covert....
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Adaptation can be painful, but it can also be a gift
Nothing will force you to live life on your own terms faster than almost losing it. In 2008, I was on fire....
Policy
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What should America’s health care vision be?
America has this paradox of excellent biomedical science, innovative drug manufacturers and entrepreneurial device developers along with outstanding providers but at the...
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Hospitals around the world aim to remain relevant to patients
"It was the best of times, it was the worst of times ..." So begins a story called A Tale of Two...
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Repairing the tear in health care’s safety net with social media
The nation’s “safety net” hospitals are designed to ensure that uninsured, lower income and indigent populations receive adequate medical care – a...
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Look to technology to reduce health costs
Technology to lower costs rather than accelerate them. Smart phones to increase physician and other providers’ productivity. Fewer primary care physicians but...
Tech
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When patient care becomes secondary to filling out the medical record
The policeman was two cars in front of me. I meandered down the road cautiously adjusting my speed a few ticks above...
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Doctors, use Google to get more patients in less than 7 minutes
Every month, hundreds of thousands of people look for a doctor on Google. As an amazing practitioner, your site deserves to be...
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The user interface for EHRs should be uniform
The first thing I noticed when I walked into the physician’s office were the tall cabinets filled with manila folders, tabbed with...
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EMR liability needs to go further than just the physician
This example of a disaster waiting to happen, in the form of an error-promoting CPOE, is a poster example of why the...
Social Media
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We need to see the potential harm of social media
Prior to 1794, farms across the world could only pick cotton as fast as humanly possible. In the late 18th century, Eli Whitney...
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Why social media may not be worth it for doctors
Social media in healthcare is all the rage these days. You can’t visit even one physician-oriented website without someone breathlessly advising you...
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Transparency defines social media success for doctors
Want to understand social media? Physicians wanting to learn about social media must learn transparency. We must learn transparency on a personal...
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How Twitter was used in a potential mass casualty scenario
It was my first ER shift in charge of the resuscitation area. Needless to say, my adrenaline and nerves were firing like...
