A version of this op-ed, co-written with Doug Farrago, was published on October 26th, 2009 in Medscape.It's tough to be a doctor these days. Whether it's listening to the difficulties of our medical colleagues as they try to best care for their patients, or engaging other health professionals about the uncertainties surrounding health reform, we've noticed a tense, sometimes gloomy, atmosphere among physicians.A recent survey from the Annals ...
November 2009
All Stories
When women should have their first Pap smear; the new cervical cancer screening guidelines
Originally published in MedPage Todayby Charles Bankhead, MedPage Today Staff WriterWomen can wait longer for their first Pap smear and then repeat the test less frequently, according to recommendations from the American College of Obstetricians and Gynecologists (ACOG).
The organization now says women should begin cervical cancer screening with a Pap test at age 21. Subsequent tests should occur at ...
Discharged from the hospital without answers; the death of Jane Q. Patient
by Dan WalterWe found out that her real name was Cindy Chapman, and that she died alone and afraid.Cindy was a paralegal, an activist and a fighter of lost causes who lived in Worcester, Massachusetts. She was part of an online community called RATEMDs, where she had many soul mates. Her posts on health care were funny and cynical and wise. Her screen name was Jane Q. Patient.My wife, Pam, ...
Are older nurses being forced out of the profession?
Originally published in HCPLive.comby Colleen O'Leary, RN, MSN, AOCNSLast time I talked about how I had never really experienced the concept of nurses eating their young in action.
However, I have seen the opposite begin to evolve. I see this as a bigger issue in nursing these days. The “putting out to pasture” of seasoned, experienced nurses is happening more ...
How should the FDA regulate the social media advertising of drugs?
Originally published in MedPage Todayby Emily P. Walker, MedPage Today Washington CorrespondentDrug and device makers are urging the FDA to establish clear guidelines that will allow the industry to discuss and promote products in the unsettled world of online social media. The FDA is hearing testimony from drug and device companies, online marketing experts, and consumer groups about what steps ...
Primary care disrespect starts early in medical school
In medical schools, primary care continues to be among the least respected fields a student can choose.No where is that more starkly illustrated than in Pauline Chen's recent New York Times piece, where she tells a story of a bright medical student who had the audacity to choose primary care as a career:
Kerry wanted to become a primary care physician.Some of my classmates were incredulous. In their minds, primary ...
Can less aggressive cancer screening recommendations be better for patients?
Doctors have understood for some time that it was inevitable. The American Cancer Society has acknowledged that cancer screening has been oversold.It seems like every day you read in the newspaper that what was standard medical care yesterday is now no longer recommended. Don't doctors know anything? Well, actually they do. And what seems like paradoxical behavior, no longer recommending aggressive screening for certain cancers, actually represents a more sophisticated ...
How to choose the right electronic health record (EHR) consultant
Originally published in HCPLive.comby Jonathan Bertman, MDYou may have seen advertisements, or may already have been contacted by people who’ve promised to help you figure it all out so you can get your share of the stimulus money. Be wary. The truth is that the Obama administration is still defining many essential elements of the Health Information Technology for Economic and Clinical Health Act (HITECH), and full details about ...
Why health reformers should be worried about the breast cancer screening backlash
What if a non-partisan, authoritative entity wrote a robust, evidence-based guideline, but nobody followed it?That is precisely what's happening with the USPSTF's recent revision of their breast cancer screening recommendations. The change most find problematic is their recommendation that women younger than 50 not undergo any breast cancer screening, such as with a mammogram.Here are their reasons explaining why:
The harms resulting from screening for breast cancer include psychological ...
Senate health reform plan analysis
Originally published in MedPage Todayby Emily P. Walker, MedPage Today Washington CorrespondentAfter weeks of closed-door meetings, the Senate leaders released their $849 billion healthcare reform bill on Wednesday evening, paving the way for a procedural floor vote soon. The bill, combining versions approved by the Finance Committee and the Senate Health, Education, Labor and Pensions (HELP) Committee, would create a ...
How a personal injury lawyer views the medical malpractice system
Personal injury lawyer Eric Turkewitz responds to my recent USA Today piece on fixing the medical malpractice system.by Eric TurkewitzIn a USA Today op-ed, Kevin Pho tackles the medical malpractice liability system. Some stuff I agree with, but suggestions regarding improvement of the current system are unlikely to work.Kevin correctly states that malpractice legal fights often go on for years. In New York, it could easily take three years ...
Medical students post inappropriate content online
Originally published in InsidermedicineThe posting of unprofessional and inappropriate content online by medical students is a relatively common occurrence that medical schools are going to have to learn to deal with, according to research published in the Journal of the American Medical Association.id="play_continuous_flvs" classid="clsid:d27cdb6e-ae6d-11cf-96b8-444553540000" width="385" height="239" codebase="http://download.macromedia.com/pub/shockwave/cabs/flash/swflash.cab#version=6,0,40,0">
Can family doctors do safe first trimester abortions?
Originally published in MedPage Todayby Chris Emery, MedPage Today Contributing WriterComplications from first trimester abortions performed by family practitioners are rare, and family doctors could help address abortion provider shortages across the U.S., a new study found. Among more than 2,500 abortions performed by family physicians, abortion was successful without complications in 96.5% of patients using medications (95% CI 95.5% ...
A lack of computer skills will make a doctor unemployable
How important is it for doctors to have computer skills?
It's imperative.
Emergency physician Shadowfax is recruiting doctors for his hospital, and balances the typical choices one must make balancing clinical knowledge versus interpersonal skills.
One deal breaker, he notes, is the lack of computer skills:
Unfortunately, in this modern age, if an employee can't use a computer effectively, they are a liability. Our group performs most of its essential communications ...
Why doctors are doing so many unnecessary Pap smears
The Wall Street Journal and other sources reported on a study from the Annals of Internal Medicine that showed that most US doctors don't know the guidelines of how often women should get a pap smear. More importantly, doctors were doing a lot of pap smears on women who didn't need them. In all the talk about health care reform, reducing costs by eliminating unnecessary testing has been mentioned multiple ...
Will patients accept the new, evidence-based, breast cancer screening guidelines?
Breast cancer screening has been scaled back, according to the recent recommendations of the USPSTF.That's the right move. Although women aged 50 to 74 years should receive a mammogram every 2 years, evidence of breast cancer screening in other age groups has been marginally conclusive at best, and non-existent when it comes to clinical self-exams.Furthermore, the guidelines implicitly acknowledge the downsides of cancer screening, including the possibility of ...
Can primary care doctors actually increase health care costs?
Poor McAllen, Texas.The much maligned city has been in the health policy crosshairs ever since Atul Gawande's seminal New Yorker article on health costs.Now, it has the added distinction of being the worst place in the country to live with allergies.The reason? Apparently, there's one allergist for the entire city. One. And according to this piece in Newsweek, that means more primary care doctors and non-allergy specialists ...
Learn how to conduct a family meeting by using a structured approach
On my last day of ward attending, I handed out an EKG that resembled the Dow Jones industrial average over the last 10 years (not pictured). The normal pattern of an EKG was completely disrupted: ST segments were markedly elevated, P waves were hidden, and beats were grouped in odd patterns. My medical team laughed and shook their heads.I asked why.A brave intern responded that he was completely at a ...
Why you should stop taking Vytorin for high cholesterol
At the American Heart Association meeting in Orlando, the results of the ARBITER 6-HALTS study were released. No Vytorin was used in the study, but I am sure that all the headlines will mention Vytorin.The actual study published ahead of press online in the New England Journal of Medicine. Essentially, they enrolled over 200 patients from Walter Reed and Washington Adventist who had known heart disease or were at ...
Niacin beats Zetia in the ARBITER 6-HALTS trial, and what this means for ezetimibe
Originally published in MedPage Todayby Peggy Peck, MedPage Today Executive EditorBoosting HDL cholesterol with extended-release niacin (Niaspan) is a more effective way of slowing atherosclerosis in high-risk patients on long-term statin therapy than seeking additional LDL cholesterol reductions by adding ezetimibe (Zetia), researchers here reported. Compared with ezetimibe, 2 grams of niacin led to significant reductions in both the mean ...
Kevin Pho, MD
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How patient satisfaction can kill
Patient satisfaction is all the rage. Medicare is beginning to tie patient satisfaction scores with hospital reimbursement, and doctors across the country...
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How I approach ovarian cancer screening with patients
Ovarian cancer screening clearly touches a nerve. No one doubts that ovarian cancer is a devastating diagnosis, often found when the disease...
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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....
Physician
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The analogy between baseball hierarchy and medical systems
From age six through high school, I played baseball. Playing baseball ended, rather abruptly it seemed, when I went to college, but...
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Saving patients from Internet health information
Lately, I get the feeling that I’m doing something wrong. I’m supposed to form a partnership with my patients. My patients are...
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Understanding what patient centered care really means
There was nothing the professor despised more then the syrup that oozed out of his partner's lips when dealing with patients. He...
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A letter of thanks to my organ donor
I have tried to write a letter of thanks but don't know what to say or even how to begin. I don't...
Patient
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Why patient engagement is reciprocal
It is said that "turn around is fair play." So if providers (physicians, hospitals and other health care professionals) expect patients to...
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Question the price of drugs and medical procedures
Hypertension was the trigger that forced medical cost awareness to the forefront. My doctor decided that with my rise in blood pressure...
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In love there is a life giving force
Here is a toast to the miracle of love. Not to the romantic, chocolate, dance club nightlife type of love. Not warm...
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How to get ready for death
No one wants to die. Even people who want to go to heaven don't want to die to get there. And yet...
Policy
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America has a medical care system not a health care system
As Americans we believe we have the best healthcare system in the world. But think again, it’s really not the truth. We...
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Reading between the lines of breast cancer treatment studies
Between the Susan G. Komen-Planned Parenthood debate and the study on treatments released by the Journal of the American Medical Association recently,...
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Why are labor and deliveries closing?
Labor and deliveries are slowly closing across the United States: California, Pennsylvania, and Ohio. In regional areas where there have been no...
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America has a health care paradox
We have a real paradox in American healthcare. On the one hand we have exceptionally well educated and well trained providers who...
Tech
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Why physicians don’t want patients to have their cardiac device data
There is a groundswell of discussion concerning patients demanding to have direct access to data derived from their implantable defibrillators and pacemakers....
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Impersonal communication on the Internet fuels cyberbullying
In the old days, bullying used to consist of name calling or physical aggression from someone in a position of power over...
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Health IT and doctors: A framework for successful partnerships
We are on the front lines of the healthcare revolution along side our patients and our colleagues in technology. We have firsthand...
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Break out of the prison of the American health care delivery system
Speaker after speaker at the recent Care Innovations Summit in Washington, DC concluded that increasing the quality and decreasing the per-capita cost...
Social Media
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Why doctors should embrace Google+
Lots of pressure out there for you to be on Facebook and Twitter, right? The ultimate question, though, is how are you...
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Using Twitter to deliver health improvement messages
I have decided to spam for public health. Phone calls, text messaging, and even apps have been shown to help improve health...
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Addressing comments on your medical practice’s Facebook page
Does your medical practice allow anybody to post links and comments on your Facebook page? The short answer is yes. We do....
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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...
