Apparently, 9 patients in Texas, the majority of whom had mental health issues, visited the emergency department nearly 3,000 times during the past 6 years.
Many of those visits were due to non-emergency causes, and it is speculated that these patients' mental health history played a role, as this physician comments, "They have a variety of complaints, [and] a lot of anxiety manifests as chest pain."
The ...
April 2009
All Stories
Susan H.: Cura te ipsum
The following is a reader take by Susan H.
To solve the current healthcare crisis
And obviate unconscionable insurance prices
We should all get requisite medical degrees,
And minister alone,
To our own maladies.
This may present a quandary
To the Juris Doc., M.D.;
What will the legal remedy be
For a literal personal injury?
Anti-smoking ads use a crying child, is it too much?
A three-year old boy is made to cry in this anti-smoking commercial, outraging viewers.
Advertising mogul Donny Deutsch applauded the spot, and dismisses the crying, saying, "Maybe sometimes they make a kid cry, but if it saves 20,000 lives for five seconds of crying, I'll take it."
So, how far should commercials go to implore smokers to quit?
Almost 30 percent of Medicare beneficiaries have trouble finding a new primary care doctor. Their recent editorial on electronic medical records is bang on, albeit a bit late, as their conclusions have been discussed on the medical blogs for the past year or so. Only 2 percent of medical students said they planned to enter primary care internal medicine. With the recent controversy surrounding prostate cancer screening, it's now time to look at mammograms and breast cancer screening. Should mortality be the only outcome that matters? This was entirely predictable. The majority of patients on Medicare have several medical issues to contend with. One piece of big news out of the recent American College of Cardiology meetings was a "proof of concept" study involving a cardiovascular polypill. Here's an update on what's happening over at the medical center in Galveston, Texas. The University of Chicago Medical Center is under the national microscope, with a recent death in their emergency department's waiting room, and an alleged, inappropriate transfer of a patient needing surgical care. The zeal to rapidly implement quality measures to improve patient care has had some unintended consequences. The purging of drug companies from continuing medical education courses continues. Recent studies in the NEJM have fueled the uncertainty surrounding prostate cancer screening. President Obama has called for the nation's health care system to adopt electronic medical records "“ a move that he says will lead to 80 billion dollars in savings. This is called making the most of the situation after losing a finger. One oft-heard complaint is how difficult it is for patients to talk to an actual physician. One of the most contentious health reform issues going forward is the possible inclusion of a public plan as one of the health insurance options patients can choose.Once you hit Medicare age, good luck finding a primary care doctor
Expect that number to rise dramatically in the near future, as the number of Medicare beneficiaries balloons, and the amount of primary care physicians plummets.
The whole scenario is a perfect example of how poor physician access makes medical coverage practically worthless.
Contrary to popular belief, Medicare's paperwork requirements and ...The New York Times finally gets it on electronic medical records
The NEJM study in March, showing a 1.5 percent hospital adoption rate for comprehensive digital records, probably finally persuaded them. They acknowledge that, even though money is the primary issue, cash alone won't solve the problem.
What would happen if every doctor chose to specialize?
Hospitalist Chris Rangel offers an interesting analogy for that grim statistic, applying the specialization phenomenon to other fields.
"Imagine if only 2% of police academy graduates took jobs as beat cops while the rest became detectives, forensic specialists, or SWAT members," writes Dr. Rangel. "Imagine if only 2% of nursing graduates became floor ...How much do we really need mammograms?
Like the PSA test, there is little data saying that mammograms decrease the mortality rate from breast cancer. And indeed, some of the harms of breast cancer screening are being publicized in the UK.
The number needed to treat, a statistic that is gaining increasing relevance in ...How screening for prostate cancer can be a gamble, and why either screening or not has consequences
Dartmouth's Gil Welch has a nice op-ed in the LA Times, discussing whether the very small benefit in lives saved from prostate cancer screening (via Schwitzer) is worth the substantial cost of side effects from overtreatment.
When talking about the recent European study finding a very small benefit to screening, Dr. Welch observes that, "Being 50 times more ...How hospital rankings may deny sick patients cardiac care
Public reporting of hospital death rates (via Dr. Wes) is pushing institutions like Massachusetts General Hospital to "modify" who to place cardiac stents in.
Previously, the hospital prided themselves in performing heart procedures in the "sickest of the sick," but now, with reputations on the line, they may deny the chance that a sick patient, or someone with cancer, would receive ...Multimorbidity, and why it’s difficult to care for complex medical patients
For instance, according to this piece in the NY Times, "Two-thirds of people over age 65, and almost three-quarters of people over 80, have multiple chronic health conditions, and 68 percent of Medicare spending goes to people who have five or more chronic diseases."
And, often times, these patients are seeing anywhere from five ...Should we believe the polypill hype?
Made up of five cheap, generic medications - aspirin, a statin, a beta-blocker, diruetic, and ace-inhibitor - the pill was shown to be well tolerated and reduce both blood pressure and cholesterol.
Which is exactly what this 5-in-1 pill should do.
That ...Why more emergency departments are shutting down and becoming urgent care centers
I've previously blogged about how Hurricane Ike devastated the University of Texas Medical Branch in Galveston, and its struggles in recovering.
Now, it appears that they've shut down their emergency department, and converted it to an urgent care center. There are several important ramifications to that action. First, ...Did the University of Chicago sacrifice patient care for profit?
Blogging over at MedPage Today, Shadowfax gives a more detailed look at their indiscretions.
With margins are already well above the national average, the hospital has decided to double down on profits, by limiting hospital ...Adopting hospital quality measures too quickly can harm patients
Bob Wachter writes about the latest episode, namely, tight control of glucose in intensive care patients.
Initial studies in 2001 showed a marked improvement in mortality when sugars were closely monitored, but since then, recent data has actually concluded the opposite.
Citing a recent NEJM study, not only were ...If the pharmaceutical industry won’t pay for CME, who will?
Psychiatrist Daniel Carlat points to what's happening at the University of Wisconsin, where company-funded CME lectures conveniently left out side effects of the medications that were mentioned.
For instance, in a Pfizer-sponsored course on smoking cessation, not one of Pfizer-marketed Chantix's many side effects were mentioned.
CME is a big money industry, and in the ...Will patients accept the limitations of prostate cancer screening?
The USPSTF recommends against screening men older than age 75 for prostate cancer, and gives an "I" recommendation for younger men.
Despite the controversy, there are plenty of anecdotes of men whose lives were saved by the PSA blood test. Will the lack of evidence sway men away from getting the test?
Poll: Will electronic medical records really save money?
That figure comes from a theoretical study done in 2005. But analysts admit that real-world evidence doesn't support the claim. For one thing, 100 percent of physicians would have to adopt digital records, while at the moment less than 20 ...The man who had a USB flash drive as a finger
(via Dr. Wes)How much would you pay to e-mail your doctor?
The reasons are myriad, but the main factor is that doctors are not reimbursed for e-mail and telephone communication with patients.
A group in California is going to find out how badly patients would like to use e-mail as a communication tool. For an annual fee of $60, patients get the ...Should a public plan option be part of any health reform initiative?
Progressives see this as a vital part of any reform initiative, but those on the right see it as a "backdoor" to a government-run, single-payer system.
I won't hash out all the details here, instead, I'll leave it to ...
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....
