One of the more frustrating hospital experiences is trying to reach either the doctor on call, or the covering physician, outside of business hours.And reaching the wrong doctor happens more often than you think. According to a recent study from the Archives of Internal Medicine, "14 percent of in-hospital pages were sent to the wrong physician when that physician was off duty and out of the hospital."That's a lot.Many ...
July 2009
All Stories
Will the lack of primary care doctors make universal coverage useless?
It appears that one source of agreement among health reformers is that there isn't enough primary care doctors.The New York Times wrote a front-page piece on this issue last month, which I had commented on. Now, an article in the Washington Post re-iterates the same theme:
As the debate on overhauling the nation's health-care system exploded into partisan squabbling this week, virtually everyone still agreed on one point: There are ...
Are we finding too much breast cancer?
Breast cancer screening has lead to an over-diagnosis of breast cancer.Ramona Bates talks about a recent study in the BMJ, showing that there was a "52% over diagnosis of breast cancer in a populations of women who are offered organized mammography screening," amounting to, "one in three breast cancers being over diagnosed."When it comes to cancer screening, it's hard to accept the consequences of over-diagnosis. But that risk ...
Will this picture prevent you from buying cigarettes?
A display of attention-getting cancer artwork to potentially deter smokers from buying cigarette packs. Will something like this work in real life?
(via Street Anatomy)
Primary care doctors face burnout, and how that affects health reform
Not only are primary care physicians in short supply, there more evidence that they are burning out and leaving the field.According to a study in the Annals of Internal Medicine, "large numbers of physicians claimed a lack of control of their work, a chaotic work pace and time constraints during patient visits," and, "more than a quarter complained of burnout. More than 30 percent indicated they would leave the ...
Should health policy be mandatory for medical students?
With health reform upon us, it would be helpful if future doctors knew a bit more about health policy.Although some schools give some token courses on the subject, the majority don't. For instance, everything I learned about health policy was from reading medical and policy-related blogs over the past few years.This piece from Slate gives one reason: medical students are too busy. Indeed, "Faced with a choice ...
The unintended consequences of preventing patient falls
When it comes to preventing Medicare's so-called "never" events, sometimes the solution is worse than the problem.I wrote about it last year in the USA Today, saying, "While withholding payment for inexcusable medical mistakes is a sensible concept, Medicare’s decision to penalize hospitals for more nuanced complications raises the bar too high. You cannot regulate perfection."And preventing patient falls has nuance written all over it.The New England Journal of ...
Should severe birth injuries be pulled out of the court system, and can defensive medicine be good?
Two recent op-eds were recently published in The New York Times concerning medical malpractice.With health care costs spiraling out of control, there is some grudging acceptance within both the Democratic party and mainstream media that something needs to be done to fix the American malpractice system.The stance that the American Medical Association is taking, namely, exempting doctors from malpractice if they adhere to evidence-based clinical guidelines, is a good one. ...
Should doctors support Congress’ health reform efforts?
The American Medical Association recently gave unqualified support to the House health reform bill, H.R. 3200, and that is drawing the ire of some of their supporters.To be sure, H.R. 3200 is the most left-leaning of the proposals, and there is clear ideological opposition to the so-called "public plan," which expands the government's role in our health care system. It's a tremendously sensitive topic, with some expressing their ...
Health Care Reform: Putting Patients First, medical bloggers at Washington, DC
Well, that was fun.
This past Friday, I participated in Health Care Reform: Putting Patients First, an event put together by Better Health's Dr. Val Jones. It was an impeccably organized gathering, and provided medical bloggers a valuable opportunity to discuss health care reform. Great timing too, given the fact that two major reform bills were introduced earlier ...
Poll: Is easy patient access to the medical record a good idea?
Boston's Beth Israel-Deaconess Hospital is engaging in a year-long project called OpenNotes, which will look at what happens when patients are given real-time unrestricted access to their medical chart. HIPAA gives patients the legal right to access their medical records, but actually getting them is often a slow, laborious process. This project will give patients access to their electronic record immediately following an office visit.Is this a good idea?Having easy ...
Rahul Parikh on the KevinMD Live Q&A: Tuesday, July 21st at 10:30pm Eastern
Pediatrician Rahul Parikh will be my next guest on the Live Q&A.Dr. Parikh blogs at sWell at Open Salon, and is a contributor to the Los Angeles Times and San Francisco Chronicle. He touches upon a wide variety of issues, including, health care reform, educating the public on the mythical link between vaccines and autism, and commenting on Oprah's medical endorsements. In fact, his opinion on ...
Improve primary care access before guaranteeing universal health coverage, my address at the National Press Club
The following are my prepared remarks at Health Care Reform: Putting Patients First, held at the National Press Club in Washington, DC, on July 17th, 2009. President Obama recently declared that, "We are not a nation that accepts nearly 46 million uninsured men, women, and children." And indeed, finding a way to provide universal health coverage to every American is one of the focal points in today's health care debate. ...
Did the Avandia scare harm patients, and is Steven Nissen to blame?
The recent RECORD trial did not associate the diabetes drug Avandia with cardiovascular events.Internist Matthew Mintz, a staunch defender of the drug, argues that because of the scare, "over 100,000 type 2 diabetic patients [needed] insulin, which could have been avoided."Who's to blame? Dr. Mintz blames cardiologist Steven Nissen, whose questionable meta-analysis started the debacle, and The New England Journal of Medicine for fanning the flames. He ...
Can doctors resist the temptation of money?
That's a tall order for many American physicians.Atul Gawande recently addressed the graduating class of the University of Chicago medical school. In his speech, which is an extension of his celebrated New Yorker piece, he looks at so-called "positive deviants," or doctors who practice higher value, higher quality care, than everyone else.What makes these doctors so special? In essence, they have to "resist the tendency built into ...
AMA victory on the road to permanent Medicare payment reform
The following is part of a series of original guest columns by the American Medical Association.by J. James Rohack, M.D.Physicians started this month with some good news from the White House. After intense AMA education and outreach, the administration announced that it would remove physician-administered drugs from the archaic formula used to determine Medicare physician payment rates.This important development will significantly lower the costs of a permanent repeal of ...
Should geriatrics be mandatory in medical school?
Generally, all third-year American medical students rotate in medicine, surgery, OB/GYN, pediatrics, and psychiatry.Should geriatrics be added to that list?After all, patients aged 65 years and older make up more than 40 percent in medical specialty care, and over 30 percent in surgical care. For instance, heart attacks present differently in the elderly, and confusion can be due to infection or a drug reaction.Most doctors do not receive ...
Can you separate the businessman from the doctor?
An investment banker recently told a doctor, "I’d love a job where I didn’t have to constantly think about money."Oh, how wrong he was.In a recent essay in The New York Times, cardiologist Sandeep Jauhar talks about the difficulty divorcing revenue from medical decision making. While moonlighting, he writes that, "It is hard not to order a heart-stress test when the nuclear camera is in the next room. ...
Using Wikipedia for online health information, my USA Today column
Both doctors and patients are increasingly turning to Wikipedia to look up medical information.
See what I think of the phenomenon in my latest op-ed in the USA Today, Wikipedia isn't really the patient's friend. Here's an excerpt:
The ability to research diseases and drugs on the web has empowered patients in managing their health. More than 160 million adults in the ...
How to find an endocrinologist for your diabetes
A lot of time and effort needs to be spent finding the right patient-physician match. And no where is that more relevant than a diabetic looking for an endocrinologist.Diabetes blogger Amy Tenderich gives some great tips, most of which I hadn't thought of.Of course, it goes without saying that if the match isn't right, a second or third opinion is always within a patient's right.But, how do you ...
Kevin Pho, MD
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How patient satisfaction can kill
Patient satisfaction is all the rage. Medicare is beginning to tie patient satisfaction scores with hospital reimbursement, and doctors across the country...
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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....
Physician
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The analogy between baseball hierarchy and medical systems
From age six through high school, I played baseball. Playing baseball ended, rather abruptly it seemed, when I went to college, but...
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Saving patients from Internet health information
Lately, I get the feeling that I’m doing something wrong. I’m supposed to form a partnership with my patients. My patients are...
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Understanding what patient centered care really means
There was nothing the professor despised more then the syrup that oozed out of his partner's lips when dealing with patients. He...
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A letter of thanks to my organ donor
I have tried to write a letter of thanks but don't know what to say or even how to begin. I don't...
Patient
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Why patient engagement is reciprocal
It is said that "turn around is fair play." So if providers (physicians, hospitals and other health care professionals) expect patients to...
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Question the price of drugs and medical procedures
Hypertension was the trigger that forced medical cost awareness to the forefront. My doctor decided that with my rise in blood pressure...
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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...
Policy
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America has a medical care system not a health care system
As Americans we believe we have the best healthcare system in the world. But think again, it’s really not the truth. We...
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Reading between the lines of breast cancer treatment studies
Between the Susan G. Komen-Planned Parenthood debate and the study on treatments released by the Journal of the American Medical Association recently,...
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Why are labor and deliveries closing?
Labor and deliveries are slowly closing across the United States: California, Pennsylvania, and Ohio. In regional areas where there have been no...
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America has a health care paradox
We have a real paradox in American healthcare. On the one hand we have exceptionally well educated and well trained providers who...
Tech
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Why physicians don’t want patients to have their cardiac device data
There is a groundswell of discussion concerning patients demanding to have direct access to data derived from their implantable defibrillators and pacemakers....
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Impersonal communication on the Internet fuels cyberbullying
In the old days, bullying used to consist of name calling or physical aggression from someone in a position of power over...
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Health IT and doctors: A framework for successful partnerships
We are on the front lines of the healthcare revolution along side our patients and our colleagues in technology. We have firsthand...
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Break out of the prison of the American health care delivery system
Speaker after speaker at the recent Care Innovations Summit in Washington, DC concluded that increasing the quality and decreasing the per-capita cost...
Social Media
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Why doctors should embrace Google+
Lots of pressure out there for you to be on Facebook and Twitter, right? The ultimate question, though, is how are you...
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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...
