Colonoscopies are routinely performed without sedation in Europe and Asia.
With health care costs rising, and staffing become scarce, a study suggests that a no-sedation colonoscopy can help on both fronts. Of 145 patients who elected to undergo a colonoscopy without sedation, 112 completed the procedure.
As a gastroenterologist shortage is looming, a no-sedation colonoscopy may become an option for some patients.
Additionally, patients ...
January 2009
All Stories
Are there too many hospitals?
Should hospitals be run more like fire departments?
"Each neighborhood has its own firehouse," says #1 Dinosaur, adding that "because the training is generally similar from one company to another, you don't have huge, expensive advertising campaigns touting the superiority of the Main Street Fire Company over the one on Church Street."
Calling it "the ultimate in capitation," he envisions hospitals to be funded like police and ...
Physician assistants and nurse practitioners are staffing rural ERs full time
The physician shortage is forcing rural ERs to use mid-levels exclusively to staff their emergency departments.
Local doctors are the backup, available by phone and able to go the hospital within minutes for emergencies.
Some hospitals have no choice, since the alternative would be to shut the ER down due to the lack of available physicians.
There is a marked difference in the amount of training an ...
Providing universal care, should patients be held accountable?
Should there be preconditions for patients in order for universal care to be enacted?
Chris Rangel weighs the "practical interest in keeping the workforce healthy and reducing the economic burdens from people who become sick and disabled as a result of unhealthy or risky lifestyles" versus the "undue burdens on beneficiaries" that can "lead to decreased participation."
Dr. Rangel points out that under any reform plan that increases ...
Does a checklist before surgery really save lives?
A simple tool can potentially yield huge beneficial results.
As reported by MedPage Today, Atul Gawande led a team that studied whether surgical teams who completed one-page procedural checklist in the operating room affected patient care.
The results, published in the NEJM, were stark. In eight hospitals in eight different countries, both 30-day death rates from non-cardiac surgery and inpatient complications were significantly lowered.
Is the fee for service payment system affecting oncology practice and cancer patients?
Paying doctors to do more isn't in a cancer patient's best interest.
An oncologist pens a brutally frank letter discussing how the current fee for service system influences the decisions when administering chemotherapy.
Currently, up to 70 percent of a cancer doctor's earnings come from the sale of chemotherapy drugs. There is a strong financial incentive from "doing more," and doctors are not immune to this ...
When was the last time you actually saw a doctor?
Ever schedule an appointment with a physician only to see a mid-level provider instead?
Patients better get used to it, as the doctor shortage, especially in primary care, is leading hospitals and practices to staff mid-level providers like nurse practitioners and physician assistants instead.
A retired doctor reminisces about the old days, and notes that "it is really all about economics," and that the doctors patients really ...
What should you have in your medicine cabinet?
Here's what an emergency physician would recommend.
In addition to everyday things like gauze, alcohol wipes, bandages, and select over the counter medications, some of the non-traditional items include hemostats and trauma shears (both available online), as well as Krazy Glue.
Why Krazy Glue? Dermabond, liquid bandage that's often used in the emergency department, has the same active ingredient that's found in Krazy Glue.
The data argues against an annual physical, but is it still needed?
I've written in the past that the routine physical exam does not have data to back up its efficacy.
Family physician Ben Brewer (via the WSJ Health Blog) has a different take, saying that it provides time to build relationships, which can have "a beneficial impact on health quality, costs and outcomes that goes way beyond disease detection and health screening."
There are some variables that ...
Banning balace billing is tantamount to single-payer
California doctors are going to lose a lot of money.
Emergency physician Shadowfax analyzes the recent California decision that bans balance billing. Calling it "a disaster in the making," he writes that removing the option to directly bills patients removes the leverage physicians have when negotiating with insurance companies. Namely, the option to stop accepting insurance.
Without this option, doctors "have to accept whatever pittance ...
Teaching medical procedures to interns and residents
The traditional method of learning medical procedures may need to be revamped.
Procedures, like inserting a central line, can be technically difficult and fraught with complications. The traditional way of teaching was to do one, have a medical resident watch, and then supervise the physician-in-training's first attempt. Today's focus on patient safety doesn't lend itself to medical trainees practicing on live patients.
Indeed, the teaching ...
If physician salaries were lowered, would people still want to become doctors?
Are the rewards of medicine itself enough to entice the best students to become doctors?
Edwin Leap reminds us that at one time, the rewards of medicine outweighed the financial benefits associated with the profession. Medical students and young doctors today may not be as altruistic, and indeed, seem to place greater priority on lifestyle. This is especially true in the current era of restricted work-hours ...
Op-ed: Medicare’s mistake
The following op-ed was published on January 14th, 2009 in the USA Today.Every patient's worst nightmare is going to the hospital for a procedure only to have a surgical instrument left in his body, the wrong limb or organ operated on or, worse, dying from a medical mistake. These types of mistakes should never happen.So when Medicare recently instituted a plan to deny hospital payments for ...
USA Today op-ed: Medicare’s never events and the unintended consequences affecting patient care
My latest USA Today op-ed was published this morning: Medicare's mistake
I discuss Medicare's recent "never event" initiative, the program where hospitals are denied payment for catastrophic medical errors.
However, the rapid expansion into not paying for "reasonably preventable" events, like hospital acquired infections and patient falls, can paradoxically have ...
When your office manager steals, a doctor learns the hard way
The office manager of a physician practice plays a vital role, and is trusted with a tremendous amount of private and financial information.
One doctor learns how her office manager has been routinely stealing from the practice, to the tune of almost $50,000.
"I had read countless times about victims of office embezzling, but that was always in large medical groups," writes Dr. Miriam Griggs, the victimized physician. ...
Should you stop taking Vytorin if you’re already on the drug?
There has been some controversy surrounding the combination cholesterol medication.
Vytorin, a combination of simvastatin and ezetimibe, was found to lower LDL cholesterol, but did not measurably decrease atherosclerotic plaque. Despite this, MedPage Today reports that the FDA recommended that those already on the medication may continue taking it.
As always, internist Matthew Mintz provides further insightful analysis of the situation. The question that the ...
Hospitalists are here to stay, or look how ER physicians are thriving
Hospitalist medicine is the fastest growing medical specialty in history.
Will they having staying power? This piece (via Dr. RW) describes how doctors in the 60's and 70's didn't want to practice in the emergency department, leading to the birth of emergency medicine specialists.
The same is happening now, as primary care doctors are loathe to practice in the hospital. This is even spreading to general ...
Should patients be advised that better care is available elsewhere?
Doctors may have an ethical obligation to do so.
An article cited by the NY Times says that especially in the cases of cancer treatment, "doctors have an ethical obligation to tell patients if they are more likely to survive, be cured, live longer or avoid complications by going to Hospital A instead of Hospital B. And that obligation holds even if the doctor happens to work at ...
An apology for medical errors, this lawyer says don’t do it
Apologizing after medical errors is the moral and ethical thing to do, but this attorney says otherwise.
Saying sorry can deny malpractice coverage, says attorney Steven Kern, and from a legal perspective, "saying I'm sorry is an admission. An admission is an exception to the hearsay rule, so anyone who hears it can be called to testify against you, should legal action ensue."
What about the 35 states ...
"You’re going to be an interesting clinical case"
Those are words no patient wants to hear.
Hospitalist Jonathan Roylance talks about his aortic valve replacement, embolic stroke, and ascending aortic aneurysm, all dealt with as he was going through medical training.
Would he have received the same care if he wasn't a medical "insider?"
"My ordeal taught me the value of responsibility, hard work, and compassion," writes Dr. Roylance, and points out "I was blessed ...
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....
