by Nikolaos I. Kakavoulis, MDPhysicians are working harder than ever to generate even a small increase in their income. Despite seeing more patients, average physicians net income between 1995 and 2003 has declined about 7% after adjusting for inflation, according to a national study from the Center for Studying Health System Change.Why is this happening?Now more than ever, physicians face an avalanche of complex rules, regulations, and administrative processes needed ...
April 2010
All Stories
Healthcare reform profited lobbying firms
by Emily P. WalkerIn the postgame wrap-up on healthcare reform, analysts say the big winners are lobbyists, who managed to earn record amounts during the more than year-long battle.About 1,750 businesses and organizations spent $1.2 billion in 2009 to lobby for their positions on healthcare reform and other legislative issues, according to a new study from the Center for Public Integrity (CPI).An exact breakdown of how much money lobbyists made ...
The individual mandate may collapse health reform
Obamacare faces a shaky future because of its call for an individual mandate. This mandate requires people to buy insurance or face income tax penalties, which the IRS would presumably enforce.As I write, attorney generals in 35 states are in the process of challenging the individual mandate as unconstitutional.The individual mandate issue is important. Kill it, and you kill Obamacare.Why? Because the individual mandate is the political mechanism for controlling ...
Peer review helps doctors improve medical care
While typing words, the advertisement for yet another hospital is overheard from the TV. "Ignore it John," I think to myself, but, it is impossible to not look up and see. The head shakes with a smirk, like my grandfather did and without words displeasure was easily conveyed.Do people really think the graphical professionalism of a TV spot is even remotely an accurate metric of quality of medical care?At work, ...
Physicians should be involved in health care decisions
As physicians progress through medical training and acquire new knowledge and skills, something interesting happens. They also develop a new and increasing awareness of not only how much they didn't previously know but also how much they still don't know. This process sounds paradoxical but has been consistent with my personal experience: The more I learn, the less I think I know.Any seasoned clinician knows that in order for one ...
Children whose parents refuse vaccination may spread measles
by Todd NealeChildren whose parents refuse vaccinations for them provide fertile ground for the spread of vaccine-preventable diseases, an investigation of a 2008 measles outbreak in San Diego demonstrated.Although the rate of two-dose immunization against measles was 95% in the area, a single case of measles from a 7-year-old child returning from overseas sparked an outbreak that exposed 839 people and sickened 11 other children, according to David Sugerman, ...
Medicare for all may be next for healthcare reform
In the Journal of the American Medical Association on May 15, 1991, in our first of many theme issues dedicated to "Caring for the uninsured and underinsured," I wrote: "An aura of inevitability is upon us. It is no longer acceptable morally, ethically, or economically for so many of our people to be medically uninsured or seriously underinsured. We can solve this problem. We have the knowledge and the resources, ...
A DNR order may not always be best for the patient
Doctors are often encouraged to discuss advance directives with their patients.But sometimes, when it comes to act on a "Do not resuscitate" (DNR) order, the situation can be far from clear.In a provocative essay from the Washington Post, emergency physician Boris Veysman discusses a case where he successfully revived a man who, unbeknown to Dr. Veysman, had a DNR order.Despite the temporary nature of the illness, the family honored ...
Residency training is like James Cameron’s Avatar
Dr. Carolyn Clancy, head of the Agency of Healthcare Research and Quality, recently highlighted the definite need for enhanced patient safety and training on healthcare IT for residents who will be the practicing docs of the future.At the very end, she compared the future of residency training to James Cameron's Avatar – an epic battle followed by enlightenment.Because I am a huge science fiction fan and working in graduate medical ...
An iPad should be mandatory in medical school
We've heard of several medical schools requiring students to use either an Apple iPhone or iPod touch, but what about the iPad?Some schools have been experimenting with digital e-book readers like the Amazon Kindle. Medical textbooks are frequently filled with photos and other color-rich images, so the grayscale Kindle isn't the ideal e-book reader for medical students who wish to carry their textbooks electronically. This is where the Apple iPad ...
Insurance companies fail at rating physicians on cost
by Emily P. WalkerA physician profiling method used by private insurance companies to steer patients toward lower-cost physicians isn't reliable, researchers found.According to a study published in the March 18 issue of the New England Journal of Medicine, 43% of physicians who are ranked as "lower cost" doctors according to a common formula used by insurance companies are not actually treating patients for any less than physicians with comparable ...
How health reform can be popular with the American public
The health reform legislation was decidedly unpopular, with a variety of polls showing the majority disapproved of the bill.What did the people want?The ACP's Bob Doherty linked to a post by Princeton's Uwe Reinhardt, who observed 10 things that the public wants in health care reform:
1. Lets only patients and their own physicians determine how to respond clinically to a given medical condition, never an insurance clerk or, even ...
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...
