by Brad Stuart, MDThe emergency department phoned my office right before lunch.I was on call for our general IM group, so when I was done with my morning schedule I walked across the street to the hospital. Greg, my partner's 38 year old patient, was a woodworker admitted with fever, chills, cough, a sharp pain in his right side, and a WBC of 18,000. On the chest x-ray, I ...
July 2010
All Stories
Does restricting work hours hurt surgical training?
by Michael SmithLife is better but the quality of surgical training has gone down in the wake of a Swiss law restricting surgical residents' hours.That was the view of both the residents and the surgical consultants who supervise them in a survey conducted by Daniel Oertli, MD, of University Hospital Basel in Basel, Switzerland, and colleagues.Less than 9% of residents and less than 5% of surgical consultants saw the change ...
Can patients demand changes in the healthcare system?
Are healthy people patients? Sometimes I wonder.If you’re healthy, you rarely see a doctor. If you go for a “routine” checkup every five years, you just aren’t very affected by the system. You might not even know what the system is. Your health insurance premium is deducted from your paycheck, so you never really see that money -- not the way you would if you had to write a check in that ...
The Massachusetts gift ban benefits health insurance companies
by Edison Wong, MDWith the recent proposal to repeal the so-called Massachusetts “gift ban” (more appropriately referred to as the “interaction ban”), I asked myself who stands to gain the most from such bans?Is it the consumers or patients? Is it the physicians or their practices? Is it the federal or state governments? Nope. Sadly, it is the insurers who gain the most, at the expense of patients.The ...
America has a disease industry, not a health care system
The decade ahead is one likely to be full of turbulence. How everything will shake out is anybody’s guess.But we can be sure that technology advancements will slow for no one. The rate of medical technology advancement now is very fast and the speed will only accelerate. One big problem is that technology advances so fast that there is no time for a purchase – say new CT scanner or ...
Dana Jennings interview, the world’s most famous patient blogger
Dana Jennings writes what is arguably the world’s most famous patient blog about his treatment for prostate cancer.Just to be clear, I don’t have any statistics about how many readers he and other patient bloggers have. I believe his blog is the most widely read and best-know patient blog because of the number of comments he receives and its prominent location in the New York Times Health section, itself ...
Smoking, hypertension, obesity, and 7 other stroke risk factors
by Kristina FioreThere are 10 factors that appear to make up the vast majority of stroke risk, and half of those are modifiable, a large population study found.Hypertension appears to be the strongest predictor of stroke, along with smoking, abdominal obesity, diet, and physical activity, according to Martin J. O'Donnell, MB, PhD, of McMaster University in Hamilton in Ontario, Canada."This is good news in the sense that the causes of ...
Why Medicaid would be better off as a federal program, like Medicare
This is a perfect example of why Medicaid is not the same as Medicare:
Having counted on Washington for money that may not be delivered, at least 30 states will have to close larger-than-anticipated shortfalls in the coming fiscal year unless Congress passes a six-month extension of increased federal spending on Medicaid.Governors and state lawmakers, already facing some of the toughest budgets since the Great Depression, said the repercussions would ...
Viagra for muscular dystrophy and publicity for accidental insight
by Jeoffry B. Gordon, MD, MPHAs a family doc in practice for over 30 years I have been always tried to conceptualize disease states beyond the standard text book parameters.Thus I was elated by the prospect of discovering a new beneficial treatment for muscular dystrophy when 5 years ago I gave some Viagra to a 57-year old patient of mine with limb girdle muscular dystrophy for the usual purpose. In ...
How can doctors minimize unnecessary testing?
A recent comment raised a minor controversy about the strategy of minimizing tests. I actually do not think that the disagreement is that great, but I feel like exploring the issue.This is the sentence that triggered the comment, courtesy of primary care physician Rob Lamberts:
Order as few tests as possible. No test should be ordered for informational purposes only; the question, “What will I do with these results?” should always ...
Understanding balance billing, a primer for patients
The topic of balance billing has arisen once again, this time in this post by Movin’ Meat about the new health care insurance bill and emergency medicine.Without further explanation, “balance billing” is generally thought of as a bad thing; a way for rich doctors to squeeze even more ill-gotten gains from their poor beleaguered patients. And that’s without even realizing what it is. ...
Can Shrek and Dora combat the junk food epidemic?
by Michael SmithCan Dora the Explorer help kids find a taste for carrots?It may be possible that licensed characters such as Dora, Shrek, and Scooby-Doo can tilt the balance away from junk food and toward healthy snacks, according to Christina Roberto, MS, and colleagues at Yale University.In a study of 40 preschoolers, the presence of a licensed character on a package influenced the children's perception of taste and their preference ...
Data and transparency is needed to reduce medical mistakes
An excerpt from On the Mend: Revolutionizing Healthcare to Save Lives and Transform the Industry.by John Toussaint, MD, and Roger Gerard, PhDAdmitting ErrorIn a lean environment, doctors and nurses must allow mistakes to be visible in order to perform root-cause analysis and fix the process. But showing mistakes hits most medical providers in a vulnerable place—right in the collective fear of lawsuits and a highly conditioned need to be ...
Kidney dialysis myths and answers
Diamonds are forever. However, kidney dialysis may or may not be forever. It just depends.Patients who are hospitalized who suddenly lose the ability to make urine or detoxify their blood may only need kidney dialysis for a short period of time. Dialysis is considered a bridge so that the kidneys, which are stunned, can wake up and start working again.On the other hand, patients who have a slow, worsening progression ...
Participatory medicine and evidence from medical journals
I’ve only been studying healthcare for two years and I hesitate to be overly assertive.But I have, finally, reached the point where I feel confident in citing cases where people are simply being unscientific: ignoring evidence. That’s always hazardous, and it becomes insidious when it’s caused by a blind, unquestioning belief in our institutions.Case in point:Julie Thoren is an active practitioner of Participatory Medicine who’s seen first-hand the tremendous value ...
Health care needs public acceptance of evidence based medicine
Although a majority of Americans probably couldn't give you an accurate description of the differences between fascism, socialism, and communism, they have no trouble applying--and often interchanging--those labels to any effort by government to reform health care.And, based on their efforts, one might conclude that the defining characteristic of any government involvement in health care is rationing. As if we don't already ration, but will as soon as the government ...
Thinspiration and pro-ana sites perpetuate eating disorders
by Kristina FioreWebsites that encourage teens to continue in their eating disorders tend to do so via "thinspiration" -- a combination of images and prose that drive the viewer toward continued weight loss, researchers say.About 85% of these sites provide thinspirational photos (or "thinspo") of ultrathin women and oaths to "Ana" or "Mia" -- nicknames for anorexia and bulemia -- according to Dina L.G. Borzekowski, EdD, of Johns Hopkins, and ...
5 principles of self-care for health professionals
by Lisa Chu, MDAs trained caring professionals, often we think of self-care as “selfish” or something that we do after we’ve taken care of our other “duties”, “responsibilities” and “obligations”.Just for a moment, I invite you to think of self-care in a different way. I invite you to consider that your knowledge and practice of self-care is essential in creating a healing relationship with your patients, and creating a healing ...
The value of comparative effectiveness reviews is locally based
by Craig A. Umscheid, MD, MSCEIn its 2010 comparison, the Commonwealth Fund has rendered the verdict yet again: the United States leaves other nations in the dust when it comes to healthcare costs -- and yet provides its residents with the worst outcomes overall. In the study, the U.S. underperformed on virtually every front in comparison to Australia, Canada, Germany, Netherlands, New Zealand, and the United Kingdom.The ...
How Massachusetts can set hospital payment rates
My suggestion last year that Massachusetts move away from the "free market" approach it uses to set hospital reimbursement rates was not well received by the hospital world.But, this year, as people notice that their rates are being set by insurance companies in an unaccountable and unreviewable fashion, more and more are saying, "Well, maybe. What would it look like?"There is a range of options. Let me lay out ...
Kevin Pho, MD
-
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...
-
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....
-
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...
-
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
-
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...
-
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. ...
-
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....
-
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
-
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...
-
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...
-
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...
-
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
-
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...
-
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...
-
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...
-
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
-
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...
-
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...
-
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...
-
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
-
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...
-
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...
-
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...
-
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....
