Happy Halloween, courtesy of an inpatient unit with entirely too much time on their hands.
(via Dr. Wes)
October 2009
All Stories
Is the impending physician shortage worse than we thought?
Originally published in MedPage Todayby Charles Bankhead, MedPage Today Staff WriterThe physician workforce in the U.S. is growing smaller and younger, according to data from the Census Bureau, but conflicting estimates make it difficult to determine just how many doctors are out there -- and how many the nation will need.
The census survey showed 67,000 fewer physicians than estimates based ...
Implementing an EMR or health IT system is harder than it looks
In 2001, when my colleagues and I ranked nearly 100 patient safety practices on the strength of their supporting evidence (for an AHRQ report), healthcare IT didn’t make the top 25. We took a lot of heat for, as one prominent patient safety advocate chided me, “slowing down the momentum.” Some called us Luddites.Although we hated to be skunks at the IT ...
Health reform ignores primary care doctors at its own peril
I would like to introduce you a remarkable article by Edward J. Volpintesta, MD, a 65-year old solo primary care doctor in Bethel, Connecticut. Dr. Volpintesta is a veritable writing machine and has been published in The Wall Street Journal, the New York Times, medical journals, and other publications. His articles cry for a deeper understanding of primary care dilemmas.In the October issue of Connecticut Medicine, Dr. Volpintesta hits the ...
Depression is bad for your heart
Originally published in Journal Watch Psychiatryby Steven Dubovsky, MDAnd attaining remission significantly improves mortality risk in patients with acute coronary syndromes. 
Depression is common after myocardial infarction (MI), and medical outcomes are worse in depressed patients. These researchers addressed long-term survival in a 6.7-year follow-up study of 361 patients with acute coronary syndromes (ACS) and major depression. The patients had ...
Are doctors getting enough skin cancer exam training?
Originally published in MedPage Todayby Nancy Walsh, MedPage Today Contributing WriterOpportunities to learn how to perform skin cancer examinations during medical training are inadequate, a survey of residents found. More than half (55.3%) of residents said that they had never observed a skin cancer examination, 75.8% said they'd never been taught to perform one, and 57.4% had never practiced doing ...
Health care reform needs to improve physician satisfaction
Of the myriad of proposals meant to change the health care system, including switching to electronic records, paying for performance, and adhering to evidence-based standards, very little attention is being paid to how they will be implemented, and the unintended consequences that may arise.Annie Brewster, an urgent care provider in Boston, outlines this in a nice commentary: "Reform should make my job more, not less, satisfying. Of course, doctors should ...
ACP: How to fix the primary care problem in health care
The following is part of a series of original guest columns by the American College of Physicians.by Steven Weinberger, MD, FACP
Many would argue that lack of universal coverage is the primary problem with health care in the United States, accompanied by the logistical and financial difficulties of obtaining coverage for someone with a pre-existing medical condition. Others would argue ...
An obsession with making money can be a sign of physician burnout
Originally published in HCPLive.comby Jeff Brown, MDPhysician burnout has a tremendous effect on the financial bottom line and is far more common than docs want to talk about.
When I say the bottom line, I am referencing studies that have been done on "workaholics," another softly defined term, that show in spite of increased hours and apparently focused activity, productivity ...
Beware using the web for H1N1 pandemic flu drugs
Originally published in MedPage Todayby Michael Smith, MedPage Today North American CorrespondentThe Internet can be a great source of information about the pandemic H1N1 flu, but it's also the mother lode of swine flu scams, the FDA is warning. The agency says consumers should beware of products sold over the Internet that claim to diagnose, prevent, treat, or cure the ...
Doctors have a duty to engage in social media
Some physicians may be hesitant to participate in social media outlets, like Facebook and Twitter.Well, get over it.Great post by pediatrician Bryan Vartabedian who addresses this topic. Indeed, physicians have lost control of the online message, especially with, according to recent data, 60+ percent of patients visiting the web first when looking for health information.Instead, anti-vaccine proponents and homeopaths have embraced the Internet, and now exert tremendous influence ...
Are specialists preventing the government from spending more on primary care?
After a painful, summer-long labor, Senate Finance eventually had to be induced before it gave birth to a health reform bill of its own. But give birth it finally did, and the products of its conception now stand alongside the offspring of 4 other proud Congressional committees.But please! Save the silver spoons and bunting! None of the quintuplets does enough to assure there will be enough PCPs out there to ...
This is why children need the H1N1 flu vaccine
by Crystal Phend, MedPage Today Senior Staff WriterThe pandemic H1N1 influenza virus continues to disproportionately attack the young, the CDC warned. Children and adults under age 25 have accounted for 53% of hospitalizations for laboratory-confirmed H1N1 and 23.6% of related deaths since Sept. 1, the agency reported at a press briefing.Seniors, on the other hand, have accounted for just 7% of ...
Medscape op-ed on how to help today’s tense, frustrated doctors
My latest opinion piece, co-written with Placebo Journal's Doug Farrago, was published in Medscape today.
Entitled, Help for Today's Tense, Frustrated Doctors (registration required), we discuss how doctors benefit from finding a ray of humor, despite the glum practice environment many physicians find themselves in:
Patients also can benefit from some levity during their doctor's visit. We've ...
Incentives promote unnecessary, excessive tests in the ER
A professor of medicine visits the emergency department with a seemingly routine case of shingles, and gets the million dollar workup.Writing in the Washington Post, Jack Coulehan describes how he was subjected to neurology and ophthalmology consults, several MRIs, and a CT scan. All for shingles, a disease that is diagnosed clinically, and treated with an anti-viral medication, pain relievers, and in some cases, steroids.Soured from the experience, ...
Have drug companies really curbed gifts to doctors at medical conferences?
by Roberta Friedman, PhDBanning pharmaceutical companies from handing out token items to doctors at conferences is so tip of the iceberg.I have tales to tell of conferences past, where the excesses were beyond farcical. As a medical reporter covering such meetings, I have seen everything. When my kids were young, I enjoyed roaming the floor of the exhibit hall along with the docs, collecting such swag as bouncy balls that ...
Is the newest, long-lasting insulin necessarily the best?
Originally published in HCPLive.comby Anita Ramsetty, MDWe are very fortunate to have a number of newer insulins available for our patients. For years we had animal insulins only. NPH and Regular, then we had Ultralente. The development of analog insulins marked the upswing in technology that we would sustain for a period of time. The most recent big blip in ...
What does H1N1 pandemic flu as a national emergency mean?
Originally published in MedPage Todayby Michael Smith, MedPage Today North American Correspondent President Barack Obama's declaration that the H1N1 pandemic flu is a national emergency doesn't mean the course of the outbreak has changed, health experts said.But as the volume of cases increases, the declaration allows doctors and hospitals more flexibility in handling the expected surge in patients, they said."I ...
Doctors lose a part of their training when resident work-hours are capped
The restrictions on resident work-hours arguably most impacts the field of surgery.I understand that fatigue increases the risk of medical errors, but in this excellent post, Jeffrey Parks notes some benefits of being immersed in the hospital. Something is lost as doctors are scuttled out of the hospital when the 81st hour starts.Dr. Parks notes that "there's more to being a doctor/surgeon than just learning how to fix a ...
How teamwork can improve patient care
I spent the entire day in meetings today. One would think that is a boring or unproductive way for a physician to spend time, however these meetings made me proud to be a doctor and proud of my colleagues in medicine.The morning was spent with nurses, respiratory therapists and quality experts who came together to celebrate success with patient safety and quality initiatives that have saved at least 151 patient ...
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....
