There's a increasing chance that the next time you undergo surgery, it will be by a locum tenens physician.
Because of rising overhead costs, combined with declining surgeon pay, more physicians are opting to become temporary doctors. They travel from hospital to hospital, and are paid a fixed rate, without worrying about office costs and struggling to stay open.
Numbers estimate that 1 in 20 general ...
January 2009
All Stories
Would you take a prescription drug for longer eyelashes?
A side effect of a glaucoma medication is being put to good use.
MedPage Today reports on Latisse, which is applied to the base of the upper eyelashes and promotes growth within eight to 16 weeks.
Side effects can include red, itchy eyes, as well as changes in the skin pigmentation around the application area.
The drug has to be continued daily, or else the eyelashes ...
Designing a physician waiting room
A lot of thought goes into waiting room design.
Love seats or chairs with arms? How many of each? What kind of patient education materials should be offered? Should you install a flat-screen television showing medically relevant educational videos? And if you see children, how big should you make the play area?
A primary care doctor gives his opinion on each of these ...
Did Ambien lead a man to freeze himself to death?
"How in the hell can a guy walk out in 20-below zero and not wake up?"
The answer may be Ambien (via Schwitzer), where there have been previous reports of patients sleep-walking or sleep-driving while on the medication.
The deadly episode wasn't the first time for this particular patient, who previously "drove into the side of his own garage, knocked a neighbor's hanging plant off the ...
Tufts Medical Center versus Blue Cross Blue Shield, who blinked?
Boston's Tufts Medical Center took on the state's largest insurer in a battle over physician fees.
A resolution to the impasse was recently announced, but the details were not disclosed. According to newspaper reports, Tufts agreed to accept the insurer's "Alternative Quality Contract," where instead of being paid fee for service, a fixed amount was paid to doctors per patient. Doctors can earn more "by ...
How should health care be reformed? The inauguration edition of Grand Rounds gives us answers
Medical bloggers give their suggestions to reform our health care system.
Val Jones hosts Grand Rounds over at MedPage Today, where she posts thoughts and ideas from those who see the problems with our dysfunctional system on a first-hand basis: the doctors, patients, nurses and ...
Blame the RUC for the primary care crisis, or not
The maligned group that advises Medicare on physician payments has been frequently targeted by generalist doctors, as well as this blog.
Hold on, says the ACP's Bob Doherty, who provides some arguments in their defense.
Indeed, the RUC did vote to marginally increase payments to evaluation and management codes, the ones frequently used by primary care doctors. Furthermore, Mr. Doherty brings up a good point, asking ...
Being sued for malpractice, for doctors it’s personal
What is it like to be sued for malpractice?
Although many say "every physician gets sued," and, "never to talk about it," how does it affect doctors?
As I've written before, being sued for malpractice is a traumatically scarring experience. So much that up to 10 percent of doctors in this situation contemplated suicide.
George Hossfeld writes about his malpractice ordeal (via Dr. ...
Will medical tourism drive domestic doctors out of business?
Will American physicians go the way of the Big Three automakers?
Insurance companies are subtly pushing their members towards having their surgeries performed in countries like India or Thailand, in exchange for substantial cost savings at hospitals that are comparable in quality to those in the United States.
Also on another note, many hospitals are using so-called "nighthawk" radiologists from India to interpret many of their radiology studies, ...
What can doctors learn from Captain Chesley Sullenberger?
Medicine has borrowed before from the field of aviation safety.
The pre-surgical checklist, discussed last week, is one recent example.
Patient safety guru Bob Wachter discusses the procedures that went into training the US Airways crew in preparation for their harrowing landing in the Hudson River.
How many times do doctors receive similar training, especially as they manage dangerous situations on a daily basis?
Is Steve Jobs dying? Two reasons that can explain his medical leave
Steve Jobs' health has been much discussed, and of concern particularly to nervous Apple shareholders.
He recently took a 5-month leave of absence because his condition was "more complex" than originally thought.
Since that announcement, medical pundits have not been in short supply trying to explain what's going on. Of the speculation that I've read thus far, here are two leading possibilities.
1) Cancer ...
CT scans in the ER, are emergency doctors ordering too many tests?
Internist Robert Centor provides some suggestions to fix health care.
On one point, he calls out emergency physicians, saying because of high exposure to malpractice claims, "technology trumps the history and physical examination." Often times, "when in doubt, they image."
This draws a sharp rebuke from Texas emergency physician GruntDoc, who points out that "ED care was 3.5% of the total healthcare budget. Squeeze ...
Colonoscopy by primary care doctors, is it time to start joining the proceduralists?
As mid-level providers are starting to take over primary care, can generalist doctors start doing specialist procedures?
If they're smart, they'll try. Better to take advantage of a specialist-favoring physician payment system, rather than wait for things to change.
Colonoscopies are among the more lucrative of procedures, and signs are pointing to a shortage of gastroenterologists in the coming years to perform them.
MedPage Today ...
Second hand smoke and your kids
Provocative ad campaign from the UK's Roy Castle Lung Cancer Foundation.
(via Ivor Kovic)
Why it’s so difficult to die in an American hospital
Dying has become a difficult and often excruciatingly slow process.
So says Minnesota internist Craig Bowron as he talks about treating some of the elderly patients on his hospital service (via Duncan Cross). Often times, these cases are among the most difficult, with family members contradicting previously discussed advance directives.
"There are no life-saving medications, only life-prolonging ones," Dr. Bowron eloquently states, adding that "medical advances ...
It’s a beautiful day for cancer
Australia's NSW Cancer Council goes rap to promote skin cancer awareness.
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Selling narcotics in the parking lot, a subtlety fail for this doctor
Brazen or desperate?
A family doctor was prescribing narcotics from his car, parked at various pharmacy parking lots.
Perhaps he was taking "customer service" to a new level.
(via GruntDoc)
Is conflict of interest influencing Uwe Reinhardt’s health care analysis?
Respected economist Uwe Reinhardt has been penning a series of NY Times blog entries explaining why American health care is so expensive.
In his latest entry, he takes on the physician payment system, writing that "studies have shown that physicians are not impervious to the financial incentives inherent in fee-for-service payments," and that "physicians who have a direct financial interest in the use of imaging services, like ...
What do doctors look for when they examine the abdomen?
A primary care doctor guides us through the abdominal physical exam.
He deciphers the much-written notation of "Abd: Soft, NT, Normal BS, no HSM or masses*," and explains what physicians look for when they poke, prod, percuss, and listen to when examining a patient's belly.
You'd be surprised at some of the things we find simply by pressing on the abdomen.
* For those who need translation, ...
The consequences of making medicine a business
Business principles are applied to American medicine to an extent found in no other country in the world.
Every procedure, office visit, or hospitalization is assigned a quantitative work value, known as relative value units, that is used to base revenue and salary decisions on.
Harvard physicians Pamela Hartzband and Jerome Groopman looks at how such a fiscal-based system affects medical decision making. The results are ...
Kevin Pho, MD
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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...
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Doctors: Don’t be ashamed about going bankrupt
Are doctors really going broke? According to this piece from CNN Money, some are: "Doctors list shrinking insurance reimbursements, changing regulations, rising...
Physician
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Patients will understand an honest mistake if the doctor tells the truth
It was 1976 and I was a junior resident in urology at Baylor College of Medicine in Houston, Texas. I was assigned...
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Diagnosing an illness is an art
Diagnosis is the foundation on which all care and treatments rest. If the diagnosis is wrong, most probably so is the treatment. ...
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Physicians have a natural role as advocates
As physicians, we are often called upon to be advocates for our patients. Sometimes they have no other person to turn to....
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Our society expends huge sums on futile care
Mike was a runner, outdoors-man, and fitness nut. This was not so much as for health reasons as for "feeling good", but...
Patient
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How will the Baby Boomers age and die?
I love listening to life stories. As a hospice chaplain, I loved sitting with our patients and their loved ones engaging in...
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Patient engagement is the holy grail of health care
For health care professionals, patient engagement is the holy grail of health care. It is the key to patient adherence – a...
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Why do doctors delay hospice referrals?
This is a response to Deb Discenza's article requesting a one page informational sheet informing a patient about hospice or palliative care. This would...
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How touch can calm patients
So, Megen at Not Nurse Ratched wrote post recently about therapeutic presence. The following passage really caught my attention: "Question is: are...
Policy
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Improve patient safety to improve healthcare quality
It has taken 13 years for us to revisit the issues in To Err Is Human, the 1999 landmark government report that...
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A lack of incentive for medical schools to train primary care doctors
A social media movement is happening before our eyes with action starting to take shape. The #occupyhealthcare movement has begun within to...
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What should be the stated aim of health care in America?
The triple aim of health care, as defined by the Center for Medicare and Medicaid Services (CMS) is: improving the experience of care, bettering...
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How Moneyball applies to healthcare
The storyline is familiar. An organization is challenged to achieve better results without spending more money. An executive is committed to obtaining...
Tech
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New classes of devices to diet and exercise
For many celebrities, their livelihoods depend on their physical appearance and they rely on armies of personal assistants, schedulers, stylists, trainers and...
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Repetition is the curse of the doctor-patient engagement
How many times as a doctor do you ask the same questions over and over again as part of the routine process...
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Why the prognosis of patients is difficult
Many clinical decisions in older persons are dependent on life expectancy. For example, as life expectancy declines, cancer screening is likely to...
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Innovative technologies can markedly enhance safety
“To Err Is Human” is the title of the now famous book from the Institute of Medicine on patient safety published about...
Social Media
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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...
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Twitter Is my third office location
The physician’s decision to first dive into social media can be stress-inducing. Issues of time management, maintaining professionalism, and determining a return...
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The impact of social media on a physician assistant
The impact of social media on medicine could arguably be compared to the impact of the industrial revolution on the human condition....
