I had an interesting juxtaposition of events. While waiting in Peets, a coffee shop in Lexington Center, I watched the friendly discussions between the baristas and customers.I then went to a doctor’s appointment, where a nurse stood typing at a laptop asking me a series of questions, including “Are you in pain?” and “Do you feel safe at home?” She didn’t look at me once as she read and typed.
April 2010
All Stories
Dean Kamen invents a brain controlled prosthetic arm
Dean Kamen discusses one of the first brain-controlled prostheses in the history of robotics. Possessing fine motor skills in addition to strength, Kamen's arm is capable of picking up a raisin without dropping it.Fascinating lecture from TEDMED 2009.width="430" height="385">
Healthcare reform and the new role of hospitalists
by John GeverWith growing pressures on hospitals from the new healthcare reform law and from the stakeholder community to become more efficient and effective, administrators may find they already have the necessary expertise under their own roofs, a prominent hospitalist said."Some organizations with hospitalist programs need look no further than these programs to chart a course toward more effective physician-hospital integration," wrote Robert M. Wachter, MD, of the University of ...
Physician supply trends for primary care doctors and specialists
Health care reform continues to be a key political topic of discussion in the U.S. Physician supply and specialty training are important elements in designing an efficient system that provides the highest quality of care.To understand where U.S. physician supply and specialty training is headed, I examined the U.S. trends from 1990 to 2007 (latest year data is available).Physician supply has been growing during this period. In 1990, there ...
CT scans for lung cancer screening may not save lives
Should smokers receive screening CT scans?As it stands, there's no evidence that screening patients with either chest x-rays or CT scans save lives, but a large, federally-funded study should yield some answers in the next year or so.Recently, however, there's data suggesting that screening chest CT scans for lung cancer gives a lot of false positives. Needless to say, these false positives are magnified with CT scans versus ...
Internal medicine is dead, will concierge physicians thrive?
by Steven Knope, MDFor the last several years, writers in the New England Journal of Medicine and the Journal of the American Medical Association have authored doomsday editorials about the prognosis of primary care medicine. There has been much discussion about the fact that internists and family practitioners cannot keep pace with rising overheads and falling reimbursement under the traditional third-party payment system.Paraphrasing a recent ...
Cardiac arrest resuscitation, with wife as witness
The patient arrived in cardiac arrest. He had been brought to our emergency department in the middle of the night. Although he had a significant cardiac history, he was only in his late-forties. His transport from his house to our department had been less than ten minutes and, along the way, the pre-hospital team had done an excellent job of intubating this patient and establishing an IV.His wife was with ...
Statins for heart disease prevention, is the luster fading?
by Peggy PeckFirst, my disclosure: I've written at least one news article about every major statin trial since 4-S, and I've been mightily impressed with almost all of the statin data. So, I was also impressed when the JUPITER results were reported about a year and a half ago -- although I became a little less "impressed" as JUPITER continued to spew forth ...
Top hospital rankings doesn’t mean the best medical care
Hospital rankings matter. Specifically, those published in the US News & World Report carry additional weight. Hospitals use these numbers in advertising campaigns, and patients often choose hospitals based on these rankings.But does a high place really mean you're getting better care?Not necessarily.The Annals of Internal Medicine took a closer look at the hospital ratings, and found that "reputation score" was a significant factor. Indeed, "the ...
Medicare will soon cover preventive exams
A nice surprise buried somewhere in health care reform is that, starting next year, Medicare patients will be able to get annual preventative care exams that are paid for by their health insurance.It may come as a surprise to those of you with commercial insurance who think of coverage of an annual exam as a routine thing for insurance to cover, but up to now Medicare has only covered a ...
Hospital practice can come with pitfalls for doctors
by Victoria Rentel, MDI read recent New York Times and KevinMD.com items about the migration of doctors to hospital-owned practices. The benefits are obvious: guaranteed salary, regular hours, malpractice coverage, paid benefits, school loan repayment.I worked for a hospital system in a small suburban practice in a large Midwestern city for almost four years. I did indeed enjoy the subsidized salary. Who can argue with vesting? I had ...
VA information technology saves billions of dollars
by John GeverThe Department of Veterans Affairs' long-term investment in healthcare information technology paid off at a rate of more than $500 million in net annual benefits from 2001 to 2007, researchers said.That added up to more than $3 billion in benefits for the Department of Veterans Affairs (VA) during the study period, after an initial billion-dollar loss.In particular, the department's computerized patient record system "was the dominant contributor to ...
Primary care is burdened by excessive paperwork
by Charles R. D'Agostino, MDWe’ve all seen the headlines –- “Primary Care Physicians Becoming a Scarce Breed”, “Wait Times for Appointments Increasing”, “Primary Care in Crisis” –- and have heard the pundits pontificating on the deteriorating state of primary care.But rarely do we hear what’s happening from physicians on the front lines, those actually seeing patients. Consequently, with direct access to the primary care trenches, replete with an overworked ...
Donkey Kong record being a marker of surgical skill
Donkey Kong has a new record holder.And he's a plastic surgeon.
Hank Chien, MD scored 1,061,700 points in 2 hours, 35 minutes, breaking the world-record score for the classic arcade game Donkey Kong.Go and read the piece as to how he did it, and more interestingly, the painstaking steps he had to take to verify his score.The feat does lend some anecdotal ...
Questions for doctors are powerful patient tools
by Toni BigbyOur Federal Government is investing in a consumer education campaign called, “Questions are the Answer.” The idea is to encourage people to watch out for themselves a little better and be their own advocate by asking their doctors questions like, “Why do I need this surgery?” and “Are there any side effects from this drug?”Why are we as health care consumers, who collectively spend trillions of dollars each ...
Primary care shortage solutions after health care reform
The new reform law which is called the Patient Protection and Affordable Care Act (PPACA) will be a huge disappointment to the millions of previously uninsured people who finally purchase insurance policies when they try to find a doctor.Primary care physicians are already in short supply and the most popular ones have closed practices or long waits for new patients. Imagine when 2014 hits and all of those patients come ...
Treating critically ill patients on Mount Everest
Ken Kamler tells an incredible story of collective resilience in the face of one of the most dangerous mountaineering expeditions ever attempted: "I was faced with treating a lot of critically ill patients at 24,000 feet, which was an impossibility."Incredible lecture from TEDMED 2009.width="430" height="340">
Speep apnea increases stroke risk in men
by Charles BankheadSevere obstructive sleep apnea almost tripled stroke risk in men, data from a prospective cohort study showed.Among men with mild or moderate apnea, each one-unit increase in the obstructive apnea hypopnea index (OAHI) raised stroke risk by 6%. Obstructive sleep apnea did not have a significant association with stroke risk in women, investigators reported online in the American Journal of Respiratory and Critical Care Medicine."This study provides compelling ...
Health care administration is a source of medical waste
Administration comprises one of the biggest factors for health care waste.But does health reform do enough to streamline it? It's doubtful.Consider the following chart presented by David Cutler, a President Obama advisor:
In other words, for every one doctor there are 5 more are employed to do administrative tasks.And, frankly, it's ridiculous. As Dr. Cutler says, "There is a lot ...
Aneurysm as a cause of the Bret Michaels brain hemorrhage
Bret Michaels continues to be monitored in the intensive care unit after suffering a subarachnoid hemorrhage.
According to his road manager, "further testing this week will help locate the source of the bleeding."What exactly does that entail?As I mentioned previously, aneurysms are responsible for the majority of brain bleeds. Finding that source is critical. Angiography, or ...
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...
