“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 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...
