Most patients complain about the time they have to wait to see a physician.Not only the time between an appointment and the office visit, but once there, the time it takes to actually see someone.After internist Jan Gurley breaks down the numbers, it's easy to see why. Primary care doctors, on average, have patient panels averaging 2,500 patients or so. Assuming full-time working doctor who only takes ...
July 2009
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Poll: How should we pay doctors, and why we need to change the financial incentives
Medicare currently pays doctors in a "fee for service" system, with little regard for quality of care or patient outcomes. The more procedures or office visits, the more revenue a physician generates.Instead of spending time with patients or counseling them in preventive care, there is financial pressure to see as many patients as possible. And this financial pressure is a fundamental reason why health care costs are spiraling out of ...
5 top medical comments, July 5th, 2009
Here are some of the more interesting comments readers have left recently.1. Rogue Medic on how Oprah should be handling medical issues: If she is going to give medical advice, and she is giving medical advice, and she is going to focus on giving advice contrary to the guidelines of reputable medical organizations, maybe some of her viewers need to start suing her for the bad medical advice.I am guessing ...
Ten top medical blog posts, June 2009
Here are the top posts from the past month, based on the number of times they were viewed.1. How did Michael Jackson die, and the medicine behind sudden cardiac death2. Did Demerol cause Michael Jackson’s cardiac arrest and death?3. A surgeon dumps post-op patients to hospitalists4. The worst medical malpractice cases you can possibly imagine5. My reaction to President Obama’s speech to the AMA6.
The AMA and Sermo break up, and how it’s getting ugly
When the online physician discussion site, Sermo, and the American Medical Association joined forces in 2007, it was heralded as a promising partnership for both entities.In fact, as Sermo's CEO Daniel Palestrant said back then, "As a company, we had to take a very rational perspective on that by saying we're a small software company, not an advocacy organization. Who is the best entity to turn voice into ...
ER, homeopathy style
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Op-ed: Doctors are forced into running a business
A version of this op-ed was published on June 18th, 2009 in The New York Times' Room for Debate blog.In his recent address to the American Medical Association, President Obama noted that our health care system "rewards the quantity of care rather than the quality of care." This perverse incentive leads to unnecessary and potentially harmful medicine, while also being a major contributor to spiraling health care costs.Doctors ...
Should Steve Jobs talk more openly about his pancreatic cancer?
As you have read here and elsewhere, Apple's Steve Jobs recently underwent a liver transplant for a rare form of pancreatic cancer.He, however, is not talking publicly about his case, and Apple is tightly controlling the information surrounding Mr. Jobs' health.Certainly, he is entitled to his medical privacy, but there are some who believe he should use his stature and celebrity to raise the awareness of pancreatic cancer. ...
Is Chantix safe, and why Zyban, or bupropion, also received a black box warning
Popular smoking cessation drugs Chantix and Zyban received black box warnings from the FDA, the strongest of its kind.
Chantix, in particular, is quite effective in helping patients to quit smoking, but has been dogged by instances of increased suicidality, especially in those already having a psychiatric diagnosis.As this report in MedPage Today states, "Reports of behavioral changes, depressed mood, agitation, ...
Did propofol, or Diprivan, kill Michael Jackson?
As predicted, the details surrounding the singer's death continue to get more bizarre.
Recent reports have stated that the powerful anesthetic Diprivan, generically known as propofol, was found in the singer's house. Apparently, according to a nurse, Jackson "was begging for the powerful sedative to help him get over insomnia."There are zero circumstances where propofol should ever be used for ...
Why removing the tax breaks for non-profit hospitals could be dangerous
It's because of the unintended consequences, of course.In their regular column in Slate, physicians Zachary Meisel and Jesse Pines talk about the recent attention that non-profit hospitals are garnering. The problem is this. Many are acting like for-profits, and in some cases, have been caught mistreating the uninsured and those who are on Medicaid.So, when money is tight, you hear stories like this one a few weeks ...
America’s failed attempt at a single-payer system, the Indian Health Service
Contrary to what you may have been led to believe, the United States has already tried its hand at a pseudo-single-payer system. The VA is one example. Another, albeit less highly publicized, is the Indian Health Service. (via WhiteCoat)Based on an agreement in 1787, the government is responsible to provide free health care to Native Indians on reservations. And, as you can see from this scathing ...
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....
