Is eliminating the presence of all disease a worthy goal?Gilbert Welch is part of the Dartmouth group of physicians and policy experts who advocate that we're doing too much testing and finding too many diseases. He asks, what exactly does "health" mean, and should it be defined as the absence of disease?Over time, the definition of "normal" has narrowed. For instance, more patients are being diagnosed with ...
August 2009
All Stories
Cheap asthma treatment using a homemade spacer
Do homemade spacers for asthma work?Take a look at how WhiteCoat "MacGyvered" a spacer for a metered dose inhaler, which can cost up to $100. So, instead of this:
You get this:
Brilliant.While keeping in mind that this blog does not give medical advice, consider a study from The Lancet that ...
Countries with worse health care systems than the United States
The United States is often compared, unfavorably, to health care systems of other countries.But it's refreshing to read that, yes, there are indeed countries that are worse off than we are. (via Ezra Klein)Like Russia, which allocates significantly less than the World Health Orgnaization's recommendation of 5 percent of government spending to health care. It's a hybrid public-private system gone wrong:
Ninety percent of Russians are technically covered. ...
Do some patients not deserve health care reform?
That's a controversial question that emergency physician Edwin Leap asks in a recent column.What's missing in the current health reform proposals is language enforcing one's sense of personal responsibility. So, as Dr. Leap writes, "there are people who really don't deserve health care reform . . .The 'elephant in the room' is that some patients (rich and poor alike) do nothing to care for themselves, take no responsibility for ...
Doctors take risks by treating celebrity patients
Treating a celebrity may not be all that it's cracked up to be.In the wake of Michael Jackson's death, a recent piece from American Medical News summarizes some of the dangers physicians face by taking on celebrities.The piece cites a study which concluded that "celebrities were an average 17% more narcissistic than the general public," and perhaps because of this, some "are extremely manipulative, and there is a lot ...
How many radiologists cheat or take short-cuts in their interpretations?
If you aren't following emergency physician WhiteCoat's account of his malpractice trial, you should.During one exchange with an expert witness, here's how he described what a radiologist routinely did at his hospital:
The radiologist that read the film had a habit of going to the surgeons the following day and asking them what they had found. He would open up a blank report so that it looked as if it ...
Doctors suffer too when they make medical mistakes
Much of the attention, rightly so, is on patients whenever a medical mistake is made.But the toll it takes on doctors can be significant. I've often referred to the statistic, for instance, that 10 percent of doctors who are sued for medical malpractice contemplate suicide.In a recent column in The New York Times, Pauline Chen examines how doctors fare after making a mistake. And the answer is, ...
Will Americans accept a trade-off in medical accuracy for lower costs?
With so much focus on health care costs, it's important to consider the mindset of the American patient.The Wall Street Journal asks whether simple, less expensive, health care strategies that work in developing countries can be implemented Stateside.For example an AIDS clinic in Alabama, by mimicking a similar program in Zambia, decreased its no-show rates by giving prompt appointments and interviewing patients looking for reasons why they may not ...
Should movies receive an R-rating for having smoking scenes?
Extreme? Perhaps not.Over at Better Health, Jonathan Foulds at first dismisses the somewhat radical suggestion that all movies that include smoking scenes should be slapped with an R-rating.But after thinking about it, he realizes it's not as extreme as it appears.He cites the work of anti-smoking crusader Stan Glantz, who reasons that, "movies made to be viewed by kids do not need to include smoking, and therefore should be ...
Should ER doctors be immune from medical malpractice?
Emergency physicians are forced by EMTALA to treat everyone who comes through the ER doors.Should these cases be exempt from medical malpractice? The Happy Hospitalist argues that the standard of care within the community sets an unreasonable bar. Consider this situation, for instance:
The [problem] I see in today's malpractice environment is the irrational standard of care that has been established, not by science, but rather by the ...
Do canes and walkers prevent falls in the elderly?
Not always.Although when used correctly they can help maintain mobility, MedPage Today reports a study showing that they are associated with an increase in falls when used improperly.According to the study, it's "estimated that 47,312 fall injuries associated with walking aids are treated each year among older Americans."And worse, falls associated with canes and walkers resulted in more severe injuries, with a third of these cases requiring hospitalization. ...
Why doctors order so many tests
And it's not always because, as is portrayed in the media, that they get rich from doing so.I, or many other doctors, do not make a dime if I send a patient for an MRI.Rather, it's because there is financial incentive to see and churn through as many patients as humanly, or in some cases inhumanely, possible. Chris Rangel has a nice list, giving 10 reasons why doctors order ...
When fat doctors talk to obese patients
How can doctors counsel obese patients why they themselves struggle with their own weight?That's the question pediatrician Perri Klass discusses in a recent New York Times column. On one hand, doctors who are obese may better connect with patients when they "understand their frailties."But on the other, patients also ignore advice from physicians who can't follow it themselves. Indeed, that's what pediatrician Julie C. Lumeng, an expert ...
Poll: Is Twitter necessary for physicians and other medical professionals?
Twitter has captured the mainstream imagination, with celebrities and news organizations embracing the medium.Will Twitter soon be an essential tool for medical practices?Twitter is a social media service where users can communicate with one another in 140 characters or less. More doctors are using Twitter to connect both with patients and other medical professionals. Some hospitals have "live-Tweeted" surgery, to great fanfare, allowing the public a peek into the operating ...
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....
