by Patrice VillarsRecently, a physician colleague expressed her concern about signing routine hospice admission orders for her elderly patient with end stage heart failure. The routine ‘as needed’ (PRN) orders included phenobarbital, pentobarbital, haloperidol, lorazepam, and morphine. “The hospice nurses know more about this than I do, don’t they?” she said.Yesterday, a longtime palliative care nurse told me she didn’t want to put her mother with end stage heart ...
February 2010
All Stories
Health blog posts of the week, February 20-27, 2010
Here are the top posts from this past week, based on the number of times they were viewed.1) Does your cardiologist deserve his salary?2) What doctors do when they don’t know the answer3) Why Medicare and health care should be deregulated4) How the ER is now used to triage every patient5) How pediatricians should handle families who refuse vaccines
A beautiful Valentine’s Day patient story
“I’ll be back in a little while, Hon’. Will you be okay without me?” the frail old woman asked of her husband. She was standing at the front door and breathing heavily.“I’ll be fine,” her husband replied from his wheelchair. His voice sounded as weak as his body looked – emaciated, scaly, and full of cancer. “I’m sorry I can’t come with you.”The woman opened the front door. A gust ...
How patient comments will affect your physician practice
Originally published in HCPLive.comby Owen Dahl and Altamash Rahman“Her MA is very rude, uncompassionate. Dr. ABCD doesn’t return phone calls. They’re not helpful and not good with following up with the care plan for patients. We’re new seeing this doctor, but will never go back. I would not recommend this practice at all!!!!!!”
How would you handle a comment like this ...
The Haiti earthquake and its broken health infrastructure
Dr. Barth Green co-founded Project Medishare, which has worked in Haiti for two decades. He led the first team of U.S. physicians to Port-au-Prince after the earthquake and, together with the University of Miami’s Global Institute, spearheaded the development of a 240-bed tent hospital that is now the country’s largest functioning urgent care hospital. His group is working with the U.S. government to establish Haiti’s first rehabilitation hospital. Green ...
Why cancer screening is not a black or white decision
Last month I saw a 65 year-old woman with a mass in her kidney in clinic for follow up. She had recently transferred her medical care to our clinic after her insurance changed.She came with a few medical problems including high blood pressure, tobacco use and arthritis — diseases which are the bread and butter of primary care medicine — but she also came with a history of a mass ...
How patient satisfaction scores can affect physicians
I am very blessed. The hospital where I practice, while concerned with patient satisfaction, does not worship at its altar.That is, so far our administrators seem to understand that people will occasionally be angry or unsatisfied, and that such dissatisfaction is within the realm of real life. We still have people storm out of the emergency department, prattling on about lawyers and lawsuits, promising to go to another hospital in ...
Condoms don’t work all the time, and here’s why
Originally published in MedPage Todayby Chris Emery, MedPage Today Contributing Writer
Condoms that don't fit properly are more likely to break, slip off, and decrease the pleasure of both partners during sex, which may discourage their use and undermine their public health benefits, a survey found.Ill-fitting condoms were reported by 44.7% of the men polled. They were more likely than ...
How hospitals can lose money by relying on hospitalists
Are hospitals victims of hospitalists' success?Interesting observation from cardiologist Dr. Wes, writing in Better Health. He notes that hospitalist services are so busy that they are limited in the number of patients they see. That's similar to the caps many medicine programs have on their residents.Who, then, takes care of the patient?It won't be the primary care doctor, who has divorced himself from inpatient care (besides, as ...
Can doctors learn medicine from physician lounges?
I just finished rotating at a community hospital where one of the most interesting things I’ve enjoyed is stopping by the Doctor’s Lounge. I can always count on a getting coffee there and hearing some good conversation – doctors asking for input on interesting cases, laughing, sharing stories, both personal and professional, and catching up on each other’s busy lives. In fact, I ran into an old friend of mine ...
Value doctors as listeners to prevent primary care burn out
A recent editorial in the Boston Globe addressed the dearth of primary care physicians. The piece concluded: “Federal funding for new residency slots should follow reforms that address the underlying reasons - principally money - that lead doctors to choose to specialize.”Money is certainly important. But there is another obstacle to attracting primary care doctors that is more subtle, though perhaps equally important. Consider the following story.Recently I had ...
Never events in hospitals depend on patient risk
Originally published in MedPage Todayby John Gever, MedPage Today Senior EditorOccurrence of some so-called "never events" in hospitals may depend partly on unmodifiable risk factors such as patient characteristics, undermining the rationale for denying Medicare payment for their treatment, researchers said. Analysis of some 890,000 surgeries performed in 1,368 hospitals showed that patient age and pre-existing conditions such as weight ...
Conscience prevents doctors from dropping Medicare
There's lots of talk about primary care doctors threatening to refuse Medicare and Medicaid patients. As some commenters point out, "If you don't like the system, just drop out."Why, then, do so many doctors continue to see patients on Medicare and Medicaid?Two words. Duty and conscience.Primary care doctor Rob Lamberts has an excellent post on this, entitled, Good conscience is bad business. He notes how Medicare (and ...
How doctors can improve patient interactions
by Lockup DocPhysicians learn a lot about many different topics, both in medical training and in practice. However, there are some life lessons that we never learn as well as when we become patients ourselves.When I was 13 or 14 years old, I regularly interacted with 2 different physicians with disparate interpersonal styles. Little did I know then that these seemingly meaningless encounters would indelibly shape my own beliefs about ...
Atul Gawande’s The Checklist Manifesto reviewed
Every now and then, I read and enjoy a book, but only later fully appreciate it as its lessons and insights slowly become apparent. Judging by the number of times I’ve said, “That reminds me of Gawande’s observations about ___” over the past month, The Checklist Manifesto is one such book.In this short, deceptively simple volume, Atul (who I count as both friend and inspiration) discusses the history ...
Why being President of the United States is a health hazard
Originally published in MedPage Todayby Liz O'BrienExactly whom are we honoring on Presidents (or is it President's) Day?A. George Washington B. George Washington and Abraham Lincoln C. All presidents The answer is more complicated than you'd ever expect. Probably A is most correct, but if it were up to me, I'd pick C.Certainly every one of these 43 men has earned the ...
How pediatricians should handle families who refuse vaccines
How pediatricians deal with families who refuse to vaccinate their kids is a contentious issue.There are some offices, for instance, that flat out refuse to treat kids who parents say "no" to vaccines. But is taking such a hard line wise?A recent piece from the Wall Street Journal looks at the issue. According to the former chairman of the American Academy of Pediatrics' bio-ethics committee, "the vast ...
Is Google Android or the iPhone the future of mobile smartphones?
by Felasfa Wodajo, MDOver the last few months, a great deal of time has been expended on the “hot competition” between Apple and Google in relation to smart phones.Much of this interest probably had to do with a partially imagined story of a once close friendship between Apple and Google, founded on their mutual enmity of Microsoft, now fractured on the rocks of competition and greed. While the truth probably ...
Is a new strategy needed in the war against cancer?
David Agus, professor of medicine at the University of Southern California, thinks so. See his lecture from TEDMED 2009.width="430" height="295">
Some hospitals tube feed patients with advanced dementia
Originally published in MedPage Todayby John Gever, MedPage Today Senior EditorTube-feeding patients with advanced dementia -- a practice whose effectiveness has been questioned by two widely cited literature reviews -- is most common in larger hospitals and those run for profit, researchers said. The odds of a feeding-tube insertion in a hospitalized patient with advanced dementia were about 50% greater ...
Kevin Pho, MD
-
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...
-
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...
-
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....
-
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
-
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...
-
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...
-
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...
-
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
-
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...
-
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...
-
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....
-
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
-
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...
-
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...
-
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...
-
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
-
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...
-
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...
-
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...
-
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
-
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...
-
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...
-
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...
-
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...
