A guest column by the Texas Medical Association, exclusive to KevinMD.com.by William H. Fleming III, MDSo we have this new health law that’s intended to provide better health care access for most Americans. Many of the reforms rely upon the sustainability and effectiveness of Medicare.Medicare, however, is doomed to failure unless Congress fixes a fundamental problem existing within the current program — the Sustainable Growth Rate (SGR) formula. The ...
April 2010
All Stories
Undocumented individuals make hospital discharge difficult
Working in the hospital this month, my team has been caring for Mr. M. He was here when we started on service at the beginning of the month, and unless his planned transfer to another facility goes through, he’ll be here when we sign off to the next team at the end of the month.Mr. M is in his fifties. He speaks Spanish. He is an undocumented immigrant from Central ...
Quality care requires open clinical transparency
Let's face it. Health care is an odd field. Costs are unknown or indecipherable. Prices for the services offered are hidden from consumers. Likewise, the value (efficacy, quality, safety) of the services received is hidden from consumers. In no sense does it represent other markets, in which transparency of these elements reigns and which therefore have a better chance of reaching the "efficient market" described by economists.In such an environment, ...
Alternative medicine isn’t taught to doctors in medical school
by Crystal PhendPhysicians don't know much more about complementary and alternative medicine than their patients do, according to a new survey.Most healthcare professionals who answered an online survey of Drug and Therapeutic Bulletin subscribers said their profession was just as poorly informed about herbal medicines (75.5%) as the general public (86.3%).And almost half of respondents rated their own knowledge about herbal medicines as "quite" or "very" poor (36.2% and 10.4%, ...
Health reform won’t help the ER
Contrary to popular belief, those without health insurance are not flooding emergency rooms as a consequence of being cut off from routine and preventive care. Actually, frequent visitors to the local ER are far more likely to have insurance according to a new review of 25 studies on ER use published since 1990.
Frequent users account for about 8% of ED patients but 28% of ...
Killing lice is a growing health field
What's one of the fastest growing health care fields?A professional nitpicker. As in, the profession of picking lice out of hair.In a recent New York Times story, it's becoming apparent that parents will do anything to get rid of lice. Part of it is the stigma associated with it, part of it is the "ickiness" factor. As a parent myself, I certainly understand the sentiment.This is ...
ADHD needs more than drugs to appropriately treat
I consider my most successful cases to be the ones that do not seem me any more. Not that they are "better", but they and their families have come to realize the full complexity of the problems they are struggling with, and are getting appropriate help.I inherited my "ADHD practice" from another pediatrician. He was wonderful man, a larger than life, toss babies in the air pediatrician with a hearty ...
Health blog posts of the week, ending April 23, 2010
Here are the top posts from this past week, based on the number of times they were viewed.1. Will Bret Michaels survive his subarachnoid hemorrhage?2. High blood pressure treatment that patients need to know3. Medical conditions as seen in the movies4. President Obama should have had colonoscopy without sedation5. Top doctors may not always be the best physicians
Don Berwick and whether he can change Medicare and Medicaid
by Marianne MatteraPresident Obama is planning to appoint Don Berwick -- the Harvard pediatrician, recognized health policy expert, and head of the Institute for Healthcare Improvement (IHI) -- as the new head of CMS.Berwick's nomination has been heralded by many as a terrific choice.Our own health policy columnist, David Nash, said that "Berwick's global following is a powerful political force ...
C-section rates and its association with lawsuits
The National Center for Health Statistics recently released a new report, Recent Trends in Cesarean Delivery in the United States. The report is most notable for a startling statistic; the C-section rate has reached the astronomical level of 32%, an increase of more than 50% since 1996. This is disturbing news.Why is the C-section rate sky high?The pervasive nature of the increase may hold some clues. The increase has ...
St. Vincent’s Hospital closes, but who’s to blame?
by Marie CooperSt. Vincent’s Medical Center in Greenwich Village was founded in 1849, making it the third oldest hospital in New York City. It has been an occasional scene of notoriety but mostly it has witnessed countless episodes of anonymous compassion and care. My two sons were born there. As a major teaching hospital, it has over 1000 affiliated physicians. It is where generations of ...
Colorectal cancer in blacks is affected by healthcare utilization
by Todd NealeThe greater burden of colorectal cancer in the black community appears to be related to healthcare utilization, and not biology, researchers found.Similar proportions of black and white patients had polyps or masses detected by flexible sigmoidoscopy, but black patients were less likely than whites to have the recommended follow-up colonoscopy (62.6% versus 72.4%), according to Adeyinka Laiyemo, MD, MPH, of Howard University in Washington, and colleagues.After adjustment for ...
Op-ed: Health insurance doesn’t mean doctors will be available
The following op-ed was published on March 30th, 2010 in AOL News.Health reform has passed, and the United States is poised to join the rest of the industrialized world in providing most of its citizens with affordable health coverage.But having health insurance doesn't necessarily mean it will be easy to find a doctor. Even before reform, reports projected a shortfall of 40,000 primary care physicians over the ...
Bret Michaels has a subarachnoid hemorrhage, and what that means
Bret Michaels is in critical condition from a subarachnoid hemorrhage.
I've been watching Celebrity Apprentice recently, and he comes across as a genuine person who, of course, has been raising awareness for Type 1 diabetes. As most people know, he has battled various diabetic complications on the show, and recently underwent an emergency appendectomy.What's his prognosis like?Not good, I'm ...
Total face transplant by surgeons in Spain
by John GeverSurgeons in Barcelona announced on Friday that they had performed the most extensive face transplant yet reported, including skin, muscles, teeth, and some bone.The procedure was performed March 20 by a team of 30 surgeons at Vall D'Hebron Hospital in Barcelona.classid="clsid:d27cdb6e-ae6d-11cf-96b8-444553540000" width="356" height="294" codebase="http://download.macromedia.com/pub/shockwave/cabs/flash/swflash.cab#version=6,0,40,0">Doctors led by Joan Pere Barret, MD, took 24 ...
Primary care physicians are heroes too
Not long ago, I attended the Shining Knight Gala, a fundraising dinner that benefited the trauma surgery and injury prevention programs at Virginia Commonwealth University Medical Center.The highlight of the evening was the dramatic presentation of the story of a young man who had suffered severe, life-threatening injuries in a car accident and, through the skill and dedication of first responders and the VCU trauma and rehabilitation professionals, was stabilized ...
Palliative care physicians confronting their own mortality
by Lyle Fettig, MDDr. Desiree Pardi was the palliative care medical director at Weill Cornell Medical Center in New York. She died of metastatic breast cancer in 2009 at the age of 41.Her story provides palliative care clinicians an opportunity to reflect on how our own personal mortality interacts with our professional lives.I did not personally know Dr. Pardi. I write this post knowing that many readers did indeed ...
Medicaid physician payment rates hurts primary care doctors
Across the country, state Medicaid health insurance programs serving low-income children and families, people with disabilities, and older adults are struggling in an environment of chronic underfunding.Consider that, nationwide, at least one child in four relies on Medicaid for health coverage. Medicaid funds healthcare services for two out of every five births and fills in gaps in Medicare coverage for the elderly and disabled.But inadequate payments and outmoded methods of ...
Paperwork prevents doctors from spending time with patients
Just how bad is paperwork for doctors?In a recent New York Times piece, surgeon Pauline Chen gives us some stark numbers.Paperwork takes up "as much as a third of a physician’s workday." That's a lot, and is coming at the expense of face to face time with patients.Worse, look how it's affecting medical residents.Researchers at the Mayo Clinic found that most residents spent as much as 6 hours ...
Patient adherence to drugs is low and what doctors can do
Frequently in preventive health we ask patients to take medications that will reduce the risk of a certain bad medical outcome years down the road: cholesterol-lowering agents that lower the risk of a heart attack, blood pressure-lowering agents that reduce the risk of kidney disease, glucose-lowering medications that reduce the risk of diabetes-related complications.Sometimes these medications make patients feel better — for example, insulin in patients with symptomatic diabetes or ...
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...
