by Gary R. Gibson, MD, FACPIn his 2007 book Critical, Tom Daschle said lawmakers were "flummoxed" when attempting to craft specific reform legislation. They seem flummoxed again as they fail to recognize the primacy of the patient-physician covenant and try to analyze a complex problem without a suitable conceptual model.The formula below represents a valid conceptual model describing health care costs."E" is expressed in monetary units ...
September 2009
All Stories
What doctors can learn from patients in the health care reform debate
Two things are missing from the bustling conversations on health care reform jamming the Internet highway. First, where among the finger-pointing anecdotes and critical analyses of our “broken” American medical system are the stories and discussions of all that is right? Second, where is our sense of hope?I’ve experienced American health care from an unusual, yet useful, vantage: that of a physician with chronically recurring cancer. From both sides of ...
How to reduce primary care physician burnout
Originally published in MedPage Todayby Todd Neale, MedPage Today Staff WriterPrimary care physicians who took part in a continuing medical education program emphasizing reflection about their clinical experiences reported improvements in burnout and mood, researchers found.
The participants also indicated positive changes in empathy and psychosocial beliefs, suggesting a more patient-centered approach to care, according to Michael Krasner, MD, ...
How much unnecessary testing goes on in the ER?
Plenty, if you ask the people most familiar with the situation, the emergency physicians themselves.According to a survey from Emergency Physicians Monthly , many tests performed in the ER are deemed unnecessary to good patient care. Here's how doctors responded to the following question: "Given that in a typical shift of eight hours you see an average of two patients per hour (16 patients/shift), could you have eliminated ...
Are hospice doctors relying too much on symptom scores to assess pain?
by Eric Widera, MDA recent issue in The Lancet included an article entitled “The Death of Ivan Ilyich and pain relief at the end of life.” This is a thought provoking article focused on the question of whether there is overuse of pharmaceuticals to treat various forms of suffering in hospice and palliative medicine.The authors argue that a good death, as seen through their interpretation of The Death of Ivan ...
The left, right, and health care reform poetry
Into the valley of health reform Bestrode the one hundred senators. Comprehensivists to the left, Incrementalists to the right. Squarely in the middle sat the arcane, Senator Olympia Snowe of Maine.Bespoke the comprehensivists. It must be done all at once. Evoked the incrementalists. No, it must be done one at a time.Bespoke the comprehensivists. We simply cannot wait any longer. Evoked the incrementalists, Why not,you've waited a century already.Bespoke the comprehensivists. It must be done right now. Evoked the incrementalists. No, it must be ...
How to provide safe, quality hospital care by increasing transparency
Paul Levy is the CEO of Boston's Beth-Israel Deaconess hospital, and one of the nation's foremost patient safety advocates.He blogs at Running a hospital, where he openly talks about the various issues facing a major academic institution. Increasing transparency, such as shining a light on medical errors and hospital infection rates for instance, can provide an effective way to confront each of these issues, so patients can benefit.Better ...
Migraines and the stigma of chronic pain medication use
by Diana LeeA recent episode of the A&E show Intervention about a woman with occasional migraines and other serious health problems who takes up to 50 Percocet pills a day made me uncomfortable. Maybe Danielle, the woman featured in the episode, really does have migraine attacks. But she is also an addict. One condition really has nothing to do with the other. Many people with acute or chronic pain use ...
Will there really be an impending shortage of cardiologists?
There can be little doubt that the lethal combination of aging baby boomers, the obesity epidemic, and the growing success of medical and interventional therapies for CV disease (resulting in more and more survivors of major events) is going to produce a flood of cardiovascular disease in the coming decades, and cardiologists in great numbers will be needed to care for these people.However, that doesn’t mean that the message conveyed ...
What’s the latest on prostate cancer and the PSA screening test?
Originally published in MedPage Todayby Chris Emery, MedPage Today Contributing WriterProstate specific antigen (PSA) tests may lead to unnecessary treatment of healthy men for prostate cancer, and there is little evidence supporting the common but controversial test for routine cancer screening, two new studies found. Measurements of blood concentrations of PSA failed to predict cancer with the accuracy generally ...
Reasons why doctors practice defensive medicine
Here's a simple chart that sums it all up. Apologies for the small type.
As The Happy Hospitalist writes, "Some doctors and patients may be willing to experience some anxiety for the unknown. But most won't, especially since neither party is directly paying for the testing. This selfish interest is rooted in moral hazard, at the expense of ...
Poll: Doctors and nurses should get vaccinated against the seasonal flu and H1N1 influenza
It's been shown that flu shots reduce the spread and severity of influenza. But despite CDC guidelines recommending that all health care professionals receive both the seasonal and H1N1 influenza vaccine, a significant number of physicians and nurses plan to decline the shots.Data from the CDC show that only 40 percent of health care workers receive the seasonal flu vaccine. Reasons include fear of side effects, including the perception ...
Should letting a premature infant die be considered health care rationing?
by an anonymous NICU nurseThere is a medical controversy brewing over in England that is threatening to invade the United States. Ms. Capewell, a 23-year old British mother, is claiming English doctors let her 21 5/7 week infant die, only because they were following national perinatal guidelines.If only he was born at 22 weeks, she insists, they would have tried everything to save him and admitted him to the ...
Is the seasonal flu vaccine associated with H1N1 pandemic influenza?
Originally published in MedPage Todayby Michael Smith, MedPage Today North American CorrespondentIn unpublished data, Canadian researchers have suggested that seasonal flu vaccination may increase the risk of catching the H1N1 pandemic strain, but such a pattern has not been found in the U.S., the CDC said. The Canadian data appear to suggest that people who had been vaccinated against ...
Doctors need to take ownership of the medical profession
by Matthew DiPaola, MDWhen the country was first founded, about 10 percent of national representatives cited medicine as their profession. Since 1960, only 1 percent of Congress has been made up by physicians. Historical differences in training duration aside, those numbers alone should tell you who is driving the Washington version of reform. It ain’t doctors.In medical school, we were fortunate enough to have a pretty extensive ...
Does the bulk of excessive medical care happen in the ER?
by Michael Kirsch, MDThe concept of medical excess is very difficult for ordinary patients to grasp. The medical community has worked hard for decades teaching them that more medicine meant better medical care. The public has learned these lessons well. Physicians who sent their patients for various diagnostic tests or specialty consultations were regarded as conscientious and thorough. Patients approved of doctors who prescribed antibiotics regularly for colds and other ...
Why our health care system promotes disease maintenance
When I was growing up in the 1970s, news was different, and this is not just the everything-was-better-in-my-day nostalgia. News was about news. News was not sexy. What has changed? Robert Reich's Supercapitalism, makes the answer obvious: competition.Interestingly, according to economic theories, competition is good for the consumer – it drives quality up and prices down. That may be true for toilet paper, but it has not panned out for ...
How to reduce the risk of medical errors from patient hand-offs
One of the consequences of capping resident work-hours is increasing the frequency of patient hand-offs.In a recent column in The New York Times, surgeon Pauline Chen cites a somewhat frightening statistic that during a course of a typical 5-day hospitalization, patients "are passed between doctors an average of 15 times."And residents sign over patients several hundred times during the first few weeks of training.One interesting solution would be to ...
HIV vaccine works in an investigational trial success
Originally published in MedPage Today by Michael Smith, MedPage Today North American CorrespondentFor the first time, an investigational HIV vaccine has shown it can protect people from the virus. In a large phase III trial, the vaccine candidate reduced the risk of infection by 31.2% compared with placebo.The trial, conducted in more than 16,000 volunteers in Thailand, enrolled volunteers from ...
Radiologists and communicating mammogram results to patients and their doctors
by an anonymous radiologistI recently read the article and comments on this link from this post, concerning radiologists, from Musings of a Dinosaur.I was disturbed to discover the animosity with which this topic is covered. The tenor of the blog is that radiologists are greedy, self-serving and are out to erode the doctor-patient relationship. The suggestion that radiologists would schedule percutaneous breast biopsies for their financial enhancement is both ...
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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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...
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The problem of insurance gaps in cancer patients
Why are cancer organizations waiting until it starts to rain before they suggest buying an umbrella? “Join my Medicare Advantage plan and...
Tech
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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...
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Google knows more about certain diseases than physicians ever will
Professor Gunter Dueck, is a calm and eloquent german mathematician who’s also the CTO of IBM Germany. He studied mathematics and philosophy...
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....
