“These are exciting and very promising times for the widespread application of information technology to improve the quality of healthcare delivery, while also reducing costs, but there is much yet to do, and in my comments I want to note especially the importance of the resource that is most often under-utilized in our information systems – our patients.” – Charles Safran MD, testimony to the House Ways & Means subcommittee on health [Emphasis ...
June 2010
All Stories
Let the Medicare physician payment cuts take effect
by Stella Fitzgibbons, MD, FACPYou know what? I think the AMA should tell Congress to just go ahead and let the Medicare pay cut go into effect.Doctors will, of course, be squeezed further than we already are, and more outpatient practices will shut down or stop accepting new Medicare patients. More hospitals will close, and ER crowding will get worse -- maybe causing some of the primary care docs who ...
How healthcare reform will affect Medicaid
by Cole PetrochkoMedicaid expansion under new healthcare reform laws could add millions of participants to the program over the next nine years and greatly decrease the number of uninsured Americans -- with the federal government picking up most of the tab, according to a Kaiser Family Foundation report.One set of projections in the report, prepared by the Urban Institute for the Kaiser Commission on Medicaid and the Uninsured, estimates that ...
How transparency reduces malpractice and defensive medicine
Physician errors have been the subject of discussions about both health care costs and health care quality.We are told that if we reform the malpractice system -- capping damages -- that physicians will practice medicine less defensively and costs will go down as a result. We are also told that the quality of care delivered by our health care providers is less than optimal -- there are estimates that nearly ...
A screening test incidentaloma can make healthy people ill
An "incidentaloma" is a finding on a diagnostic test that's found, well, incidentally while looking for something else.In many cases, these findings are benign but may necessitate more invasive tests to prove so.Writing in the New York Times, cardiologist Peter Libby notes the problems of the incidentaloma.When a patient undergoes a screening exam -- a CT scan for lung cancer, for instance -- findings on the study may require ...
ACP: Increasing the attractiveness of general internal medicine
A guest column by the American College of Physicians, exclusive to KevinMD.com.by Steven Weinberger, MD, FACP
In this era of health care reform, much has been written and discussed about the shortage of primary care physicians in the United States, which is projected to get substantially worse over the coming years.A number of different types of physicians have been ...
Treating friends, and when worlds collide in the hospital
All the world is a stage, And all the men and women merely players. They have their exits and entrances; Each man in his time plays many parts. -Shakespeare“There’s a consult downstairs, Campbell. Go check it out and I’ll catch up with you later.”“Sure, OK.” I was a third-year medical student fumbling through my first clinical rotations. The resident headed off to whatever he needed to accomplish and I trotted down the back ...
Screening studies that blur the mortality and case fatality line
When do tests improve mortality?This is a question well worth asking, particularly as we argue about the merits of mammography screening. The USPSTF has really stirred up the hornet's nest with this one, and the politicians cannot help but get on their populist pulpit, ignoring the facts completely.But the question remains, do screening or diagnostic tests that are more sensitive save lives? We all hear that mortality from many diseases ...
Citalopram and other SSRI drugs can reduce hot flashes
by Charles BankheadHot-flash frequency and severity declined by 50% in postmenopausal women treated for six weeks with the antidepressant citalopram, according to data from a placebo-controlled, randomized clinical trial.The trial, conducted among 254 women with frequent hot flashes (at least 14 hot flashes a week for a month or longer), found that the lowest of three citalopram doses was as effective as the highest for dousing hot flashes, but the ...
Clinical trial conflict of interest for doctors
This is a painful story to write.A close friend of mine, in his 40's, had a persistent light cough for many months. Finally, when he had an X-ray taken, it showed a large tumor on his lungs. He was diagnosed with stage 4 lung cancer. As a non-smoker and strapping, physically fit man, he was shocked, as you can imagine.He went to his non-Boston-based medical practice, and he was told ...
Back pain may be better treated with exercise instead of surgery
Most back surgeries are unnecessary.Despite that, they're being performed with increasing frequency. A recent Associated Press report details the issue, and illustrates why this is a growing concern.Almost $90 billion is spent on back pain annually, when, in reality, time is often the most effective treatment. In fact, studies show that 90 percent of back pain heal without further intervention.Both doctors and patients have to bear some ...
What if blogs were run like a paper medical record system?
I always find it very ironic to see doctors bashing EMR on the Internet. They are bashing a tool designed to gather and organize information, improve communication, and give immediate access to important information, while using a tool that gathers and organizes information, improves communication, and gives immediate access to important information.It is fine to bash the current state of EMR (I saw one site complain that EMRs have a ...
C. Diff and how dentists overuse antibiotics
Why do dentists prescribe antibiotic prophylaxis so often?Because they can.Why am I dissing my dental colleagues? Because I can.Perhaps, this is a simple case of dental envy, since their profession remains within secure borders far beyond the health care reform line of fire. Consider these dental incidentals:• Not a syllable in the ~2000 page health care reform law that affects dentists. Every filling is still worth its weight in gold • ...
Health blog posts of the week, ending June 18, 2010
Here are the top posts from this past month, based on the number of times they were viewed.1. Doctors make far less money than most people think2. Don’t let a doctor make you feel uncomfortable3. Why pediatricians and other primary care doctors leave medicine4. ABIM responds to doctors sharing board certification questions5. Tips for students who want to shadow doctors
Indoor tanning is associated with melanoma
by Michael SmithIndoor tanning is associated with a 74% higher risk of melanoma, researchers said.And, in a large case-control study, some forms of indoor tanning machines were associated with a four-fold increase in the risk of skin cancer, according to DeAnn Lazovich, PhD, of the University of Minnesota, and colleagues.The risk rose in a dose-response fashion depending on years of use, hours of use, or number of sessions, Lazovich and ...
Twitter and Facebook can affect the doctor-patient relationship
“I would be careful,” a fellow physician cautioned, as I told of my plans to attend a patient’s birthday party.In my 12 years of clinical practice I have lived in the community in which I practice, less than two miles from my office. I encounter patients daily in the supermarket, at soccer games, swim meets and school events. I have had conversations with patients at parties, on the street, and ...
Fracture risk with Prilosec and other proton pump inhibitors
The FDA released a Drug Safety Communication warning about a possible risk of increased fractures with acid blocking medications called proton pump inhibitors or PPIs.PPIs have been a major advance in medical science. Prior to these and earlier medications, the treatment for severe gastroesophageal reflux disease (GERD) was major surgery. PPIs are now commonly prescribed for GERD and less serious heart burn, many are generic, and some are now sold ...
Radiation or watchful waiting for prostate cancer treatment?
by Charles BankheadThere is still not enough evidence to show that radiation therapy for localized prostate cancer is better than surveillance, according to a report prepared for the Centers for Medicare and Medicaid Services (CMS).Only retrospective analyses have compared irradiation with no treatment or no initial treatment. Data comparing the relative efficacy of different types of radiation therapy also are insufficient to permit definitive conclusions regarding efficacy, safety, and toxicity, ...
Return control of our health system back to doctors and patients
by William Lawson, MDRepresentative David Price recently wrote the Chapel Hill News to “set the record straight” regarding Washington’s newly‐passed health care legislation.Rep. Price argues that the government’s central planning will make health insurance more affordable for small businesses and individuals. Touting tax credits covering 35% of premiums for small businesses with less than 25 employees and less than $50,000 in average annual wages, Rep. Price asserts that the ...
8 insomnia tips to help you fall asleep without drugs
Difficulty with sleep is one of the most common patient complaints presenting to the primary care office.Chances are, you will suffer from difficulty with insomnia at some point in your lifetime. It can be distressing, and cause difficulty with functioning during your wake hours. The first thing you may want to do is to run to the doctor for a prescription for a medication to help you sleep.However, you don’t ...
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....
