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 Priscilla Chan may become the country’s most influential doctor
Who has the potential to be the most influential physician of our generation? It's Priscilla Chan, who not only recently graduated from...
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Confused about prostate cancer screening? Make a shared decision
In a widely anticipated move, the USPSTF officially recommended against prostate cancer screening in healthy men. Case closed, right? Hardly. The prostate...
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When it comes to doctors and social media, hospitals fail miserably
When it comes to medicine and social media, much of the attention is negative. Doctors losing their hospital privileges because of Facebook....
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Warren Buffett’s prostate cancer choices aren’t right for every man
A version of this column was published on April 24, 2012 in USA Today. There has been a recent uptick of elderly men...
Physician
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Why test recalls should not be considered cheating
I was appalled recently by the coverage of radiology “test recalls” by CNN, amplified by Dr. Gary Becker of the American Board...
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Why physicians are susceptible to hardball tactics
I was invited to a medical staff leadership conference sponsored by our hospital. A company specializing in training physician leaders ran the...
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How we deliver bad news is critical to how families deal with grief
As a cardiac electrophysiologist, I have had to discuss bad news with patients and families more times than I would like during...
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His father’s suffering had already been too great
He looked dead. The paramedics brought him down the hall toward one of my critical care beds, and for a moment I...
Patient
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How death can be a beautiful experience
I was honored to be part of a beautiful experience in late January of 2011. It was the death of my mother-in-law...
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What meaningful encouragement can be given to someone who is dying?
Theirs is a lonely journey; to be moving towards the separation and end of all things known and loved. Being with a...
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Health care journalists have tendencies similar to those of doctors
As a patient who was asked to speak at the Association of Health Care Journalists 2012 conference, I felt a bit covert....
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Adaptation can be painful, but it can also be a gift
Nothing will force you to live life on your own terms faster than almost losing it. In 2008, I was on fire....
Policy
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What should America’s health care vision be?
America has this paradox of excellent biomedical science, innovative drug manufacturers and entrepreneurial device developers along with outstanding providers but at the...
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Hospitals around the world aim to remain relevant to patients
"It was the best of times, it was the worst of times ..." So begins a story called A Tale of Two...
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Repairing the tear in health care’s safety net with social media
The nation’s “safety net” hospitals are designed to ensure that uninsured, lower income and indigent populations receive adequate medical care – a...
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Look to technology to reduce health costs
Technology to lower costs rather than accelerate them. Smart phones to increase physician and other providers’ productivity. Fewer primary care physicians but...
Tech
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When patient care becomes secondary to filling out the medical record
The policeman was two cars in front of me. I meandered down the road cautiously adjusting my speed a few ticks above...
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Doctors, use Google to get more patients in less than 7 minutes
Every month, hundreds of thousands of people look for a doctor on Google. As an amazing practitioner, your site deserves to be...
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The user interface for EHRs should be uniform
The first thing I noticed when I walked into the physician’s office were the tall cabinets filled with manila folders, tabbed with...
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EMR liability needs to go further than just the physician
This example of a disaster waiting to happen, in the form of an error-promoting CPOE, is a poster example of why the...
Social Media
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We need to see the potential harm of social media
Prior to 1794, farms across the world could only pick cotton as fast as humanly possible. In the late 18th century, Eli Whitney...
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Why social media may not be worth it for doctors
Social media in healthcare is all the rage these days. You can’t visit even one physician-oriented website without someone breathlessly advising you...
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Transparency defines social media success for doctors
Want to understand social media? Physicians wanting to learn about social media must learn transparency. We must learn transparency on a personal...
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How Twitter was used in a potential mass casualty scenario
It was my first ER shift in charge of the resuscitation area. Needless to say, my adrenaline and nerves were firing like...
