The new definition of participatory medicine at the Society’s website notes that patients “shift from being mere passengers to responsible drivers of their health, and … providers encourage and value them as full partners.” As with any collaboration, this must include a hefty dose of listening by both parties.I recently returned from an extraordinary week in Minnesota, with visits to several thought-provoking care facilities. The week was all about ...
May 2010
All Stories
Proton pump inhibitors associated with fracture and C. difficile
by Charles BankheadProton pump inhibitors (PPIs) significantly increased the risk of both fracture and recurrent infection with Clostridium difficile, investigators in separate studies reported.PPI use increased the odds of spine, forearm/wrist, and total fractures by 25% to 50% over three years, but had no effect on the risk of hip fracture. Overall, the acid-fighters had a modest effect on bone mineral density (BMD), Seattle researchers reported in the May 10 ...
How the oil shortage will affect hospitals and healthcare
I believe in the peak oil theory.Think about it, in a closed system nothing is infinite. Since oil is a product of millions of years of decay, unless we use it at the same rate that is it produced, we will run out. I do not have a crystal ball any more than anyone else I know, so I will not hang my hat on when, but will commit to ...
Health blog posts of the week, ending May 28, 2010
Here are the top posts from this past week, based on the number of times they were viewed.1. A medical student chooses dermatology because of family2. Evidence based medicine at the expense of the art of medicine3. Waterbirth dangers to newly born babies4. Patient relationships with their doctors over time5. House, M.D. physician technical advisor interview
Paperwork results in wasted work for doctors, insurers and patients
by Marianne Mattera"I Hate [Insert Health Insurer Here]"Not long ago I sent an e-mail with those headline words as the subject line -- I have withheld the name of the insurer to protect . . . , well, myself.A combination of circumstances has led to massive hassles costing me what is easily 100 hours of checking, rechecking, e-mailing, and phone calling over the last 3 months. ...
Waiting is a part of surgery, and how a surgeon perceives time
People like us, who believe in physics, know that the distinction between past, present, and future is only a stubbornly persistent illusion. - Albert EinsteinThe surgical case is delayed for ten minutes and I am getting restless. I anticipate a very difficult dissection. The cancer has returned after extensive prior treatment with surgery, chemotherapy and radiation. I have enlisted additional help to make certain that everything goes as smoothly as possible. ...
Virtual colonoscopy access may not reduce lower endoscopy rates
by John GeverEasy access to CT colonoscopy may not reduce the number of conventional colonoscopies performed.After the University of Wisconsin's (UW) health system persuaded local insurers to cover the imaging-based screens in 2004, there was little sign that patients preferred them to standard endoscopic exams, according to Patrick Pfau, MD, the university's director of clinical gastroenterology.Mean quarterly counts of optical colonoscopies performed at UW rose from 1,104 in 2003 to ...
HSA-compatible high deductible health plan advantages
by Ray CarlsonWith so many health insurance consumers familiar with standard “PPO” or Preferred Provider Organization health plans that feature lower annual deductibles, the HSA-compatible health plan might be getting overlooked.These same consumers who – because of the downturn in the economy and subsequent job loss - are now shopping for, or considering shopping for, a new individual or family health plan might gravitate towards a PPO that features the ...
Your asthma or COPD inhaler is not available, and what to do
As reported in MedPage Today, the FDA announced the end for CFC-propelled inhalers. Of the seven inhalers with deadlines for removal, only three are still being made:Flunisolide (Aerobid Inhaler System) on June 30, 2011 Albuterol and ipratropium combination (Combivent Inhalation Aerosol) on Dec. 31, 2013 Pirbuterol (Maxair Autohaler) on Dec. 31, 2013The reason for this is because CFC's are harmful for the environment, and the newer inhalers have to be replaced ...
How doctors choose which specialists they refer to
There is an aspect of professional sports that I greatly admire. This transcends the athleticism and skill of the athletes, the work ethic, coaching expertise, teamwork and the thrill of the game. This is one of the only institutions that is a pure meritocracy. The philosophy is simple and not blurred by arguments for diversity or massaging the qualifications for admission to serve another agenda. Coaches, managers and owners want ...
Most primary care visits don’t need to be seen in the office
by Emily P. WalkerIf a Martian visited Earth and wandered into a primary care physician's office, he'd marvel at how inefficiently the average doctor spends his or her time.The Martian might wonder why the primary care doctors sees 20 or 30 patients a day when many of the consultations could be done over the phone, which would make things easier for both doctor and patients.At least, that's what Larry Casalino, ...
How primary care should manage chronic pain patients
In April 2010 the American Society of Anesthesiologists (ASA) published updated guidelines for the management of chronic pain. The guidelines were based on a review of recent scientific evidence as well as a survey of expert opinion. As I read through the guidelines, summarizing the efficacy of various therapies for chronic pain ranging from epidural injection to medication management, some of my most challenging clinical cases involving pain management ...
Physician rating sites shouldn’t worry doctors
Physician rating sites have caused some consternation among doctors.I wrote about it last year, pointing to a Slate piece which demonstrated their lack of rigor and reliability.Besides, there was a suspicion that doctors' negative reviews are overblown, and could be easily outweighed by a physician encouraging patients to post positive ones.Now, there's some data showing that to be the case.Tara Lagu, a physician at the Tufts University School of ...
Female sexual dysfunction treatment options
Female sexual dysfunction has been reported in up to 40% of women, and described as causing actual distress in approximately 12% of women.Therefore, it is an important topic to familiarize with and screen for as a primary care physician, as many patients may not report these symptoms unless they are elicited during the history taking process of the patient encounter. Female sexual dysfunction is often multifactorial and complex; it is ...
Healthcare needs to be simpler and more like real economics
A middle aged patient whom I have seen in the past for benign palpitations called today because of atypical chest pain. Although I have criticized the overuse of nuclear imaging studies, and probably order the fewest of any cardiologist in the city, there are times when they are appropriate --this was one of those occasions. Symptoms did not rise to the level of an invasive angiogram, but could not be ...
EMR use may not save money but can save lives
by Joyce FriedenTwo new studies of electronic medical records (EMRs) have come to different conclusions: one found that they don't save money or staffing time, but the other suggested that at least one part of EMR -- electronic prescribing -- does save lives.In the electronic prescribing study, at a single California hospital, the mean monthly adjusted mortality rate decreased by 20% ...
Patient relationships with their doctors over time
by Sandeep Grewal, MDWe as doctors and patients as well as medicine as a whole have evolved over time. What used to be a simple conversation of between a doctor and a patient has turned into a melee of medical issues, legal issues, insurance and financial issues and not to mention the complicated ICD 9 and CPT code system.Conversation between a doctor and patient in 1960s:Patient: Sir, I am ...
Electronic medical records and its rushed implementation
Electronic medical records are being aggressively pushed by the government.As most know, they're pouring billions of dollars into the initiative, hoping the spur adoption among doctors and hospitals.But, like most government-provided financial incentives, they come with a host of regulations designed by those with little understanding of physician practice.As reported in Politico, hospitals and doctors are taking issue with the meaningful use guidelines demanded of them:
In January, the CMS ...
Treating patients in prison for murder
Correctional psychiatrists inevitably treat patients who have been convicted of a broad array of crimes. There is a correlation between the security level of the institutions in which one works and the severity of the crimes of the inmates being housed there.Since I’ve treated inmates of minimum, medium, and maximum custody levels, I’ve had the opportunity to work with people who have been convicted of everything from drug possession to ...
Hospitalists are killing primary care, and other myths debunked
by Vineet Arora, MDThose who hate hospitalists believe that students and residents are choosing hospital medicine over primary care so hospitalists are to be blamed for the primary care shortage. They also believe that the rise of hospital medicine has made primary care less attractive. Then, there is the salient argument that care transitions are more inherent and vulnerable due to hospitalists.Of course this hatred is not new. ...
Kevin Pho, MD
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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....
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Radiologists who cheat on their board exams: Who’s to blame?
In a widely circulated CNN article, many radiologists have been found to cheat on their board exams: "Doctors around the country taking an...
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Doctors: Don’t be ashamed about going bankrupt
Are doctors really going broke? According to this piece from CNN Money, some are: "Doctors list shrinking insurance reimbursements, changing regulations, rising...
Physician
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Patients will understand an honest mistake if the doctor tells the truth
It was 1976 and I was a junior resident in urology at Baylor College of Medicine in Houston, Texas. I was assigned...
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Diagnosing an illness is an art
Diagnosis is the foundation on which all care and treatments rest. If the diagnosis is wrong, most probably so is the treatment. ...
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Physicians have a natural role as advocates
As physicians, we are often called upon to be advocates for our patients. Sometimes they have no other person to turn to....
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Our society expends huge sums on futile care
Mike was a runner, outdoors-man, and fitness nut. This was not so much as for health reasons as for "feeling good", but...
Patient
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How will the Baby Boomers age and die?
I love listening to life stories. As a hospice chaplain, I loved sitting with our patients and their loved ones engaging in...
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Patient engagement is the holy grail of health care
For health care professionals, patient engagement is the holy grail of health care. It is the key to patient adherence – a...
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Why do doctors delay hospice referrals?
This is a response to Deb Discenza's article requesting a one page informational sheet informing a patient about hospice or palliative care. This would...
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How touch can calm patients
So, Megen at Not Nurse Ratched wrote post recently about therapeutic presence. The following passage really caught my attention: "Question is: are...
Policy
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A lack of incentive for medical schools to train primary care doctors
A social media movement is happening before our eyes with action starting to take shape. The #occupyhealthcare movement has begun within to...
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What should be the stated aim of health care in America?
The triple aim of health care, as defined by the Center for Medicare and Medicaid Services (CMS) is: improving the experience of care, bettering...
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How Moneyball applies to healthcare
The storyline is familiar. An organization is challenged to achieve better results without spending more money. An executive is committed to obtaining...
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The problem of insurance gaps in cancer patients
Why are cancer organizations waiting until it starts to rain before they suggest buying an umbrella? “Join my Medicare Advantage plan and...
Tech
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Repetition is the curse of the doctor-patient engagement
How many times as a doctor do you ask the same questions over and over again as part of the routine process...
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Why the prognosis of patients is difficult
Many clinical decisions in older persons are dependent on life expectancy. For example, as life expectancy declines, cancer screening is likely to...
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Innovative technologies can markedly enhance safety
“To Err Is Human” is the title of the now famous book from the Institute of Medicine on patient safety published about...
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Google knows more about certain diseases than physicians ever will
Professor Gunter Dueck, is a calm and eloquent german mathematician who’s also the CTO of IBM Germany. He studied mathematics and philosophy...
Social Media
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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...
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5 ways doctors can benefit from professional connections
Looking ahead to the next several months, I’ve found myself frequently wondering how many physicians will make this their year to take...
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Twitter Is my third office location
The physician’s decision to first dive into social media can be stress-inducing. Issues of time management, maintaining professionalism, and determining a return...
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The impact of social media on a physician assistant
The impact of social media on medicine could arguably be compared to the impact of the industrial revolution on the human condition....
