June 2010

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Doctors make far less money than most people think

in Policy | 41 responses

A video excerpt from The Vanishing Oath, a film directed by Ryan Flesher, MD.The average physician salary in the United States is $146,000 -- which is undeniably a lot of money at face value.But it's a lot less when you factor in the overhead costs that doctors incur.  And that's not including the medical school debt which, on average, exceeds $150,000.This clip shows how the take home pay ...

Paying patients to stay healthy, my take in the NY Times

in Policy | no responses

Should patients be paid to stay healthy?Paying patients to stay healthy, my take in the NY TimesThat's the topic in today's New York Times' Room for Debate blog.Included is my take, where I write that such programs need to be carefully implemented, so that all socioeconomic classes can benefit from financial incentives:

Those with more limited economic means may not have the ability to pay for gym memberships, smoking cessation drugs, ...

Medical loss ratios is not all about health insurance profits

by | in Policy | 2 responses

The new health insurance reform law will generally require health plans to pay out at least 80 or 85 percent of premiums in medical expenses, depending on whether they are selling to individuals/small groups or to large groups. Intuitively it makes sense that purchasers would want the medical loss ratio to be as close to 100 percent as possible –- since the purchaser doesn’t derive utility a plan’s administrative expenses ...

Prescription drugs and its copycats contribute to health waste

by | in Meds | 9 responses

I’ve recently posted about the insane costs of health care, and about how defensive medicine is a big contributor. Prescription drugs are another huge cost, accounting for about 11% of the 2 trillion spent each year on health care in The United States. And it turns out that the marketplace for prescriptions is also rife with bizarre sources of waste and sneakery.First, some good news: prescription medications ...

Statins do not decrease the risk of many cancers

in Meds | no responses

by Kristina FioreClaims of unintended benefits of statins appear to be largely unsubstantiated and known risks -- including liver and renal problems and myopathy -- confirmed, British researchers concluded based on findings from a large prospective open cohort study.The study involving more than two million people, "largely confirmed other studies that reported no clear association between statins and risk of cancers," Julia Hippisley-Cox, MD, and Carol Coupland, MD, of the ...

What is the best way to record allergies in hospitals and clinics?

by | in Tech | 3 responses

I was recently asked about the best way to record allergies in healthcare environments.At what point should allergy verification be occurring for a planned hospital admission? Should it be prior to admission or at the time of admission?Is there any data yet to support decreased adverse drug reactions when the patient is asked to complete their own history initially through a patient portal?Should data entry of allergies into smaller best ...

Unnecessary tests and treatments are commonly ordered for patients

in Conditions | 6 responses

Just when I've lost hope that mainstream media will stop perpetuating the myth the more medicine equals better care, the Associated Press came up this excellent piece.The article states, rightly, that "anywhere from one-fifth to nearly one-third of the tests and treatments we get are estimated to be unnecessary," and that, "it may lead to dangerous side effects."Regular readers of this blog should be familiar with those concepts.I wrote ...

Primary care is more than just office visits

by | in Physician | 3 responses

If you’ve ever been on a diet, you know that it really helps to keep a food log. Seeing your consumption chronicled in one place is illuminating – and often explains why those love handles aren’t melting away despite two hours on the treadmill each week.In a recent issue of the New England Journal of Medicine, internist Rich Baron Rich Baron chronicles the work of his 5-person Philadelphia office practice ...

Government and marathon runner motivation

by | in Policy | 2 responses

Giving advice is usually a thankless business. I have always been mindful of the unconsciously profound summation given by a six-year-old when she was asked to identify Socrates. "Socrates," she stated, "was a really old Greek guy who went around giving people good advice. They poisoned him."But here goes: We do not need government intervention to improve our health, and, by extension, the quality of our lots in life.This essay ...

Primary care doctors at a competitive disadvantage to midlevels

by | in Physician | 9 responses

A primary care resident wrote in one of the journals recently about making the limited time she has with each patient matter the most.How refreshing, I thought when she concluded that time ultimately is an absolute and finite resource. We often feel as if we are battling time as much as we are battling disease, and we sometimes have trouble admitting when we are losing either one of those battles. ...

Don’t let a doctor make you feel uncomfortable

in Physician | 5 responses

by Diana E. LeeOne member of my health care team is a migraine specialist in another state. Since we don't have many opportunities to work together in person, we generally try to pack a lot into my periodic two-day visits.Last time I was there I had an experience that has left me feeling guilty all these months later.My doctor, who I respect and admire greatly, asked if I was interested ...

Can chest pain patients be evaluated in the ER waiting room?

in Physician | 6 responses

by John GeverEmergency department patients with chest pain may safely be evaluated in the waiting room when necessary, researchers said.Among 303 patients triaged to waiting-room evaluation in a prospective study, no acute coronary syndromes were missed and adverse event rates overall were lower than among 804 patients who were assessed in conventional monitored beds, reported Frank Scheuermeyer, MD, of St. Paul's Hospital in Vancouver, British Columbia, and colleagues online in ...

Ask your pharmacy to price match prescription drugs

by | in Meds | 2 responses

As we have established repeatedly on LesliesList.org, prescription prices can vary a lot from one pharmacy to another.But did you know that some pharmacies will actually match a competitor's price? This could save you a ton of cash, but you have to know how, and whom, to ask for this service. Pharmacy retail chains all have different policies. I spoke to a pharmacist recently at each of the seven top ...

KevinMD.com in the Los Angeles Times, ABC News, and recent media mentions

in Social media | no responses

I'd like to thank various media outlets for recently citing KevinMD.com.ABC News: How long will you wait to see a doctor?

While coverage is expected to extend to between 31 and 35 million Americans without insurance currently, a shortage of primary care doctors may mean extended wait times to actually see a doctor -- if new patients can get in at all ...... "That situation, extrapolated to the rest of ...

AMA: Senate fails to stop a Medicare meltdown

in Policy | 14 responses

A guest column by the American Medical Association, exclusive to KevinMD.com. by J. James Rohack, MDAMA: Senate fails to stop a Medicare meltdownUnbelievable as it is, for the third time this year the Senate failed to act on time to stop this year’s 21 percent Medicare physician payment cut. Senators cut and ran on America’s seniors and their physicians, heading home for the Memorial ...

Diagnosis requires seeing patient problems with a wide lens

by | in Conditions | 8 responses

Susan Sorensen, FACP, an internist and hematologist in Palo Alto, Calif., told us of a case where the correct diagnosis took more than a year to make. The patient was a 24-year-old woman who had developed weight loss, fatigue and intermittent chest tightness. She was seen in a local emergency department, and was told that she should consult a pulmonary specialist. A chest X-ray and EKG appeared normal.Over the next ...

Wii Sports and Wii Fit Plus exercise equivalents

by | in Conditions | no responses

Regular exercise has been shown to be helpful in the prevention and management of a variety of clinical neuroscience conditions including: Alzheimer's disease, Parkinson's disease, major depression and anxiety disorders. However, motivating people to get involved in a regular exercise program is a significant challenge. Wii Sports and Wii Fit Plus may provide the motivation edge for some patients to start and maintain an exercise program.The Wii video game system ...

Residents who specialize in surgery are influenced by family

in Physician | no responses

by Chris EmerySingle and childless surgical residents in the U.S. are more likely to pursue specialized surgical fellowships, and a majority of surgical residents believe a successful career depends upon specialty surgical training, a new survey found.Of residents who responded to the survey, 28.7% believed general surgery is becoming an obsolete career path (30.1% of men and 25.9% of women, P=0.004), and 55.1% believed specialty training is necessary for career ...

Third world doctors are the real physician heroes

by | in Patient | 6 responses

I recently was involved in a web discussion on elective choices with a group of medical students.Financial considerations aside, I was surprised how few were interested in visiting third world countries to see how medicine is practiced outside the first world comfort zone of unlimited expertise, investigation and therapy -- where "want" often exceeds "need."The third world however is completely different. It's an environment where doctors and nurses are in ...

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