“Hey doc, all I need is this referral.”I’ve been encountering more of this lately. A patient who has not been seen in the office for months to years (well beyond when they were supposed to come back for a follow up visit) walks in and requests a “referral” for a specialist visit but they can’t be bothered with actually being seen and evaluated in the office or to be compliant ...
June 2010
All Stories
Surgeons need to reconnect with patients after an operation
It's worth your while to browse through Sid Schwab's sampler one rainy Saturday afternoon when you get a chance.The old man can write. I was reading through a couple of his old posts the other day when I stumbled upon this one. It's a shorter post (for him) but very powerful and moving.He describes what it's like to enter an abdominal cavity of a patient, with all its ...
Medication errors spike when new residents start in July
by Kristina FioreDeaths from medication mistakes appear to spike in July, when medical residencies begin, researchers say.Over nearly a 30-year period, fatal medication errors appear to jump 10% solely in that summer month in U.S. counties with teaching hospitals, David P. Phillips, PhD, of the University of California San Diego and Gwendolyn E.C. Barker, BA, of the University of California Los Angeles, reported online in the Journal of General Internal ...
How Medicaid will be affected by the recession
About half the uninsured who will get health care coverage under reform will get it through Medicaid, the state programs that provide health care for the poor and near-poor. Those programs are now more than 60 percent federally funded.A story in the New York Times reveals that the recession has pushed those programs to the brink of bankruptcy. Unless Blue Dogs in Congress join with their more liberal Democratic ...
Patients think most doctors are out to make money
A video excerpt from The Vanishing Oath, a film directed by Ryan Flesher, MD.That's the sentiment from patients polled in Boston in this video clip.I've often wondered if doctors were offered a reduced, fixed salary, but were given medical malpractice protection, more vacation time, and a weekly limit on the number of hours they worked, how many would take that deal?If it's less than, say, 50%, then ...
Vitamin D myths and advice for patients
As the mountain of vitamin D research showing its importance grows to Everest heights, you may be wondering about some statements that are thrown around as “truth.”Here are some fun vitamin D myths to pass along to friends, family and loved ones, because, when it comes to vitamin D, you want to get your dose (even of information) just right.1. Just go out in the sun, already. That will fix ...
Why the medical home may not save primary care money
When the Disease Management Care Blog saw the flurry of news reports about the Patient Centered Medical Home (PCMH) "saving money," it couldn't wait for the full print version of Health Affairs to arrive at the DMCB World Headquarters.The DMCB had previously reviewed Group Health's negative "no statistically significant.... cost differences" one year study and was looking forward to seeing researchers Robert Reid et al's reportedly positive two ...
Abuse of prescription drugs starts in high school
by Todd NealeOne high school student in five has taken a prescription drug without a doctor's order, according to a nationwide survey.Abuse of a prescription drug was most common among white students (23%), followed by Hispanics (17.2%) and blacks (11.8%), according to Danice Eaton, PhD, of the CDC's Division of Adolescent and School Health in Atlanta, and colleagues.Improper use increased steadily from ninth grade (15.1%) to 12th grade (25.8%). Girls ...
How EMR and EHR systems can kill patients
Back in the times when EHRs were just EMRs, they had a very simple and humble mission.The software was supposed to help providers of health care services better manage their business. EMRs were supposed to help physicians adhere to CMS documentation rules, automate patient flow management and get rid of all the mountains of paper floating around a typical medical office or hospital. It was assumed that EMR software will ...
Emergency physicians and the choice of overtesting or lawsuits
Emergency physicians are in a dilemma. Risk missing a diagnosis and be sued, or be criticized for overtesting.Regular readers of this blog, along with many other physicians', are familiar with the difficult choices facing doctors in the emergency department.The Associated Press, continuing its excellent series on overtesting, discusses how lawsuit fears is a leading driver of unnecessary tests.Consider chest pain, one of the most common presenting symptoms in the ...
Prevent bullying by accepting healthy aggression
“Momma, have you ever felt like there’s a puzzle and there’s a piece missing and you find the piece and it fits? When I’m with the Maasai all the pieces fit.”This is a quote from my friend Roland, a seven year old boy, on a trip to Tanzania with his mother. He was on a safari and, using a stick, he was learning how the Maasai use spears to protect ...
When patients don’t take their prescription drugs
One of my favorite patients in residency was a lady in her seventies who had longstanding high blood pressure, high cholesterol, and diabetes.Each time she visited the office, I would recommend that we start multiple medications to control these conditions, and every time she would politely decline. Her previous physicians had left frustrated notes in her chart littered with terms such as "non-compliant," "against medical advice" and expressing wonderment why ...
The public wants resident physicians to work less
by Emily P. WalkerA majority of the American public doesn't approve of doctors working 24 hours straight and supports tougher work hour regulation for resident physicians, according to a new public opinion survey.The survey, published in the online journal BMC Medicine, is the first to assess the public's perceptions about the controversial issue of medical residents' work hours.The survey found that 90% of Americans believe the maximum shift duration should ...
A cardiologist discusses screening for vascular disease
Just last week I saw a full-page ad in the newspaper for a series of medical screening tests -- EKG, echocardiogram, aortic ultrasound, and the like (all interpreted by “certified doctors”) -- that a person could arrange for oneself or a loved one.We newspaper readers were told we could arrange to have these tests performed without a doctor’s order as ...
Social mission as a way to train more primary care doctors
Medical schools are traditionally ranked on criteria like research funding and technological innovation. These rankings are highly significant. A place on the US News' annual Best Medical School list is a coveted spot indeed.So that's why there was some media attention paid to a recent study from the Annals of Internal Medicine, which ranked medical schools according to their "social mission" -- a phrase that defines a school's ...
Top medical blog posts of the week, ending June 25, 2010
Here are the top posts from this past week, based on the number of times they were viewed.1. Let the Medicare physician payment cuts take effect2. Measles from rejecting vaccines, and the price society pays3. 8 insomnia tips to help you fall asleep without drugs4. Tips for students who want to shadow doctors5. Twitter and Facebook can affect the doctor-patient relationship6. Clinical trial conflict ...
Why Obamacare scares this cardiologist
I recently visited my cardiologist. It was a routine follow up after a heart attack a year ago. I enjoy our relationship. As a token of my regard, I came bearing a gift. It was a copy of my book Obama, Doctors, and Health Reform.I knew he had qualms about Obamacare. He expressed doubts about the health reform bill’s merits. The bill will roll out over the next ten years. ...
American cigarettes contain more carcinogens
by Todd NealeLevels of tobacco-related nitrosamines -- known carcinogens produced when curing tobacco -- are higher in popular brands of American cigarettes compared with those from other countries, potentially leading to more cases of lung cancer, researchers found.The study of 126 smokers in four countries found that exposure to one carcinogen -- 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK) -- was highest among those from the U.S. compared with smokers from England, Canada, and Australia, ...
Local control can be used to empower patients
by James Baker, MDIn public mental health care, “local control” is the mantra that describes the desire to assure that mental health policy is dictated by local communities rather than by state or federal government.I hope that folks who insist upon this are mindful that power-hoarding in the form of “local control” is no blessing in itself, except when it is used, in turn, to empower the people we serve.I ...
Reducing salt is a good idea but won’t save your life
In case you missed it, salt is the new fat.It seems that everybody from the FDA to Steven Colbert of the Colbert Report has set their sights on limiting our consumption of salt. In the past week, I’ve seen dozens of articles from the blogosphere to the front page of USA Today and a recent edition of Time on reducing our alarming levels of salt consumption.Many of us are aware ...
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....
