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 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...
