Malpractice and heart catheterization have been in the news recently.A spicy concoction for sure. An epidemiological study published in an online subsidiary of Circulation addresses the role of three major medical issues facing cardiologists today: malpractice, heart catheterization, and medical costs.It is hard to get more controversial.Heart catheterization, the invasive assessment of the coronary artery lumen, has always been a hot-potato topic. The "percent-normal" was the buzz word when I ...
June 2010
All Stories
Should prisons require co-pays for inmate health care?
In the U.S., correctional facilities are required by law to provide inmates with access to medical care. As health care costs have spiraled out of control everywhere, jails and prisons have attempted to develop innovative ways of reducing this hefty financial burden while simultaneously meeting their legal obligation to provide care.One approach that has gained significant popularity in recent years is to require inmates to pay a small fee, usually ...
Gay men and whether they should donate blood
by Michael SmithIt's time to revisit the touchy issue of gay men and blood donation now that accurate HIV testing is widely available, Canadian researchers argue.The lifetime ban on giving blood for men who have had sex with other men was justified in 1983 when HIV testing was relatively insensitive but can no longer be supported, according to Mark Wainberg, PhD, and colleagues at Montreal's ...
Why abstinence only sex education is a waste of money
Since 1992, the federal government has spent close to $1 billion on abstinence-only sex education, despite growing evidence that these ideology-based programs are ineffective in delaying the onset of sexual activity, preventing teen pregnancy and the spread of sexually-transmitted disease among teens.Meanwhile, comprehensive sex education—the kind where teens are given information about both abstinence and contraceptives—has received virtually no federal funding.That’s why it was so encouraging when President Obama released ...
Facebook friends with patients can violate HIPAA privacy laws
Should you friend your doctor on Facebook?It's a question that's gaining increasing relevance as Facebook increases its social networking dominance.I've touched upon the issue in the past. So has the New England Journal of Medicine.Washington, DC physician Katherine Chretian gives her take on the issue in a recent USA Today op-ed. She is an expert of the Facebook-medicine intersection, having authored a JAMA study on the ...
Tips for students who want to shadow doctors
On a recent Saturday, I rounded in the hospital. I met up with Zainab, the president of the minority premed association for the University of Chicago, who asked to shadow me. While she was doing research at the hospital, she had not ever rounded in the hospital before. It was Saturday so our team was mostly off so it was just me and my very capable resident who is about ...
Measles from rejecting vaccines, and the price society pays
Vaccine rejectionism is based on a profound lack of knowledge about immunology, statistics and science. Virtually every single empirical claim of vaccine rejectionism is factually false, but parents who lack even the most basic understanding of immunology are often incapable of evaluating those empirical claims.Indeed, those parents most likely to proclaim themselves "educated" on the topic are generally the most ignorant.A new paper on a recent measles outbreak, Measles ...
E-mail can screen college students for depression
by Kristina FioreE-mail may be a simple and cheap way to screen college students for depression, but it's not likely to motivate them to seek treatment, researchers said.A commonly-used depression screening tool sent in e-mail blasts to students at four colleges put the prevalence of major depressive disorder at 14.5%, Irene Shyu, MD, of Massachusetts General Hospital in Boston, and colleagues reported at a poster session at the American Psychiatric ...
Extra fees may save private practice primary care
I was interested in an article in USA Today about the growing number of physicians, especially primary care doctors, who are boosting their revenues by requiring patients to pay new fees for services that insurance doesn't cover.No longer is your insurance payment "all-inclusive". These fees can include annual administration fees, no-show fees, medical report fees, and extra fees for email or phone consultations. If private practice medicine is going to ...
Health IT requirements that few doctors and hospitals can meet
Saying that you're going to spend billions of dollars to modernize the country's health IT system makes for good press.But, as many doctors and hospitals a finding out, the devil is in the details.As it stands, the requirements to receive some of that money are so onerous, that it's unlikely that most will qualify for the payments.Maybe that's what the government wanted all along.According to a recent article in ...
Physicians need to focus on wellness to prevent burnout
by Aldebra Schroll, MDI recently received a bulletin from one of the medical societies to which I belong: the topic was on promoting physician wellness.My first reaction, “It’s about time “. Historically physicians have struggled with multiple health impacts from the demands of their work, with higher rates of depression, anxiety and suicide than in the general population. Physicians train under circumstances of extreme stress often resulting in unhealthy coping ...
Why a doctor chose OB over family practice
by RH+, MDMore than anything in life I wanted to be a family practitioner (FP).Going into medical school there was little doubt in my mind that this was my chosen path. I chose a school that had a significant focus on primary care and was president of the Family Practice Club my second year. I had shadowed several FPs and truly enjoyed the continuity of care that went into FP.When ...
Multiple vaccines in infants are harmful, a theory disproved
by John GeverWorries that cramming multiple vaccinations into the first months of life slows brain development have no basis in fact, researchers said.There was no evidence of neurodevelopmental delays or deficits associated with on-time vaccination in an intensively studied cohort of more than 1,000 children, according to Michael J. Smith, MD, and Charles R. Woods, MD, of the University of Louisville, in the June issue of Pediatrics."These data may reassure ...
Do large hospital systems increase healthcare costs?
In Rhode Island, hospitals that are part of hospital systems were paid more for the same services than independent hospitals.The price differences could not be explained by quality of care or severity of illness. The results suggested that market power determines the price of hospital services, and that increasing concentration of power in hospital networks is likely to further increase costs, without improving quality of care.Recently, a similar report out of the neighboring state ...
Pain requires doctors to accept false positives on drug seeking behavior
Patients requiring controlled substances to manage their pain have always been controversial to treat.Every time the subject is broached on this blog, the comments inevitably becomes a contentious discussion of "drug seeking behavior" versus treating legitimate pain.It's a problem that doctors nationwide grapple with every day, and is addressed in a recent essay from the New York Times.Michael Kahn is a Boston psychiatrist, who recently asked residents how they ...
Shingles vaccine is limited by cost and coverage
by Danielle Ofri, MD, PhDGood health is only affordable—for the majority of the population—if it is covered by insurance. An excellent case in point is the vaccine for shingles (herpes zoster).Shingles is the revisiting of the chicken pox virus. The virus lives in the body since the first episode of shingles as a child, and then flares up during later adulthood to give shingles.Shingles is rarely life-threatening, but it is ...
Who really benefits from President Obama’s health reform plan?
I don’t know about you, but as I watched coverage of President Obama signing the health care bill three months ago, it was hard not to notice the constant ads for power wheelchairs. Emblazoned across the ads was a flashing notice reminding viewers: Medicare may cover this!Don’t get me wrong. As a primary care doctor who takes care of low-income patients, I was glad to see something being done to ...
Why the medical chart may not improve patient care
Why do we physicians chart the way we do? Hopefully, you do it perfectly well and have no concerns at all. But where I practice emergency medicine, we are approaching maximum inefficiency in charting.It all became much clearer when we started using our new EMR system. Let me make it clear, I'm not against EMR. In fact, typing and templates work better for me than dictating. My dictations were usually ...
COPD perceptions in doctors and patients
by Ed SusmanDoctors and patients with chronic obstructive pulmonary disease (COPD) agree that shortness of breath is the condition's most debilitating symptom, but on other issues patients and clinicians are not on the same page, a survey shows.For example, "patients and physicians are both aware of the prevalence of morning symptoms, but physicians are less aware of the prevalence and importance of symptoms in the afternoon and evening," Ronald Balkissoon, ...
iPhone app that empowers patients may be harmful instead
by Satish MisraUnless you spent the last two years in a Himalayan monastery, you are certainly aware of the bitter healthcare battle that unfolded in Washington.Underlying the nonsense about death panels from the right and claims of impending doom from the left lies a far more legitimate conflict about how we view healthcare – as a basic human right or as a market service. Conservatives generally ascribe to the latter, ...
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....
