April 2010

All Stories

Doctors need more eye contact with patients, not computers

by | in Physician | 18 responses

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.

Eye Contact ...

Dean Kamen invents a brain controlled prosthetic arm

in Patient | 2 responses

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

in Physician | 2 responses

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

by | in Policy | 4 responses

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

in Conditions | 5 responses

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?

in Physician | 35 responses

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

by | in Physician | 12 responses

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?

in Meds | 5 responses

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

in Physician | 8 responses

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

by | in Policy | 11 responses

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

in Physician | 17 responses

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

in Tech | 9 responses

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

in Physician | 15 responses

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

in Physician | no responses

Donkey Kong has a new record holder.And he's a plastic surgeon.Donkey Kong record being a marker of surgical skillHank 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

in Patient | 21 responses

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

by | in Physician | 19 responses

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

in Conditions | one response

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

in Conditions | one response

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

in Policy | 12 responses

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:Health care administration is a source of medical wasteIn 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

in Conditions | 2 responses

Bret Michaels continues to be monitored in the intensive care unit after suffering a subarachnoid hemorrhage.Aneurysm as a cause of the Bret Michaels brain 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 ...

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