Our grandparents used to tell us, "if it ain't broke, don't fix it".Management gurus, in their race to the finish line have turned this sentiment on its head by telling us that, if it ain't broke now, it will be soon, and if you do not fix it before it breaks, you will be behind the competition. This sentiment drives the annual corporate reorganization at every corporation that I or ...
July 2010
All Stories
Watchful waiting may be appropriate for most prostate cancer cases
by Crystal PhendDeferring curative treatment for low-risk prostate cancer may be a good option for many men ages 70 and younger, a population-based observational study affirmed.In the national Swedish prostate cancer registry, the cumulative 10-year prostate cancer-specific mortality rate was only 2.4% for men at low risk who opted for watchful waiting or active surveillance, according to Pär Stattin, MD, PhD, of Umeå University Hospital in Umeå, Sweden, and colleagues.This ...
USA Today op-ed: Physician burnout harms patients
My USA Today op-ed was recently published: Burnout hurts doctors as well as their patients.
I discuss physician burnout, and how patients suffer from medical errors by burnt out doctors. Furthermore, doctors leaving medicine won't help the tens of millions newly insured patients that will be looking for care in the coming years:
Burnout affects more than half of doctors, ...
What bored doctors can do after they retire
by Michael Woo-Ming, MDAs the baby boom generation nears retirement, there will be a flood of doctors left wondering what to do with their time. Some doctors will continue to work in practice and, although it is certainly rewarding to work hands-on with patients and new staff, after 30, 40, or 50 years in the business many start to explore other options.The motivation that drives one to medicine often stays ...
Prior authorization required by health insurers impedes primary care
by Charles R. D’Agostino, MDIt strikes fear in the hearts of doctors across the country; it is not the deadly Ebola virus or a new strain of cancer, but its malignancy is equally apparent.It is the dreaded “PA”, which is insurance-speak for “prior authorization” and it seems that no matter which way we turn it appears, standing between our patients and the care they need.To their credit, PAs are truly ...
Cancer patients need compassion and balanced information
If you have to ask what jazz is, you will never know. - Louis Armstrong The stillness in the meeting room was electric.First, one panelist addressed the audience members who have never experienced a malignancy. She described the unique and powerful bond that exists between cancer survivors. She described how the brush with mortality forces each survivor to renegotiate terms with Life itself. She reminded everyone that the cancer care system too often lets ...
Health blog posts of the week, ending July 14, 2010
Here are the top posts from this past month, based on the number of times they were viewed.1. What residents and medical students should wear in the hospital2. iPhone, Android or Blackberry? The right smartphone for doctors3. The grief men face when their wives undergo mastectomies4. Mark Midei and the failure of peer review5. Best free Android medical apps
Beware of fake Tamiflu sold online
by Cole PetrochkoThe FDA warned consumers to be alert for websites selling a fake "generic" version of the flu drug oseltamivir (Tamiflu), which may be dangerous to patients allergic to penicillin.The Tamiflu fake does not contain the active ingredient of the drug it imitates but does contain cloxacillin, which can cause anaphylaxis in patients allergic to antibiotics in the same class as penicillin.The FDA uncovered the mimic through purchasing the ...
A new primary care payment model with health savings accounts
by Charles Smith, MDEverybody seems to be dissatisfied with the current model of primary care.Concierge and retainer practices are all the rage, but they serve too few patients. While some highly integrated systems (Mayo Clinic, maybe Kaiser Permanente) may be thriving, they are difficult to replicate. Most primary care physicians are demoralized by a system that overburdens them with administrative hassles and liability while providing insufficient revenue to improve ...
How doctors can discuss advance directives with patients
A recent blog post and series of responses on KevinMD.com aroused my interest.Dr. Kevin Pho posed the question: Why are doctors so reluctant to discuss end-of-life care? Responders, including patients, doctors, nurses, and even a veterinarian highlighted the stress inherent in this discussion for patients and for medical professionals alike.To me, the real issue is not whether the discussion should occur, because clearly it should, but when and how? ...
ER visits rise because of prescription drug abuse
by Michael SmithThe number of emergency room visits for nonmedical use of prescription painkillers more than doubled between 2004 and 2008, according to a CDC estimate.The increase was part of a trend that saw emergency room visits for nonmedical use of all prescription and over-the-counter medications reach the same level as those for abuse of illicit drugs, the agency said in the June 18 issue of Morbidity and Mortality Weekly ...
Unnecessary testing needs more than tort reform to cure
Recently, while covering for one of my partners on a weekend, I was consulted by a physician to do a procedure.The doctor wanted his patient to undergo an EGD, which is a scope test that examines the esophagus, stomach and first portion of the small intestine called the duodenum. We gastroenterologists do this test routinely to search for an explanation for a patient’s symptoms, or to determine if these organs ...
Why general internists are quitting clinical medicine
The Association of American Medical Colleges predicts that by 2025, the US health system will have 46,000 fewer primary care physicians than it needs.If the prediction proves correct and we fail to develop effective mitigation strategies, the manpower shortage will create quite a mess. Ironically, the health reform law signed by President Obama in March will exacerbate the problem by increasing demand for services provided by primary care physicians.The American ...
Facebook friend issues between doctor and patient
My friend and colleague Katherine Chretien has a provocative op-ed in USA Today entitled, "A doctor's request: Please don't 'friend' me," which asks the question whether doctors and patients should interact in social networking sites such as Facebook.Social networking has huge potential in health care regarding the sharing of information and ideas, and could possibly even enhance communication between doctors and patients. However, as Dr. Chretien points out, many ...
Echocardiogram reading by cardiologists needs to improve
by Crystal PhendInsufficient training among cardiologists in reading echocardiography results is wasting healthcare dollars and subjecting patients to unnecessary procedures, researchers said.A review by sonographers of cardiologist-interpreted echocardiography findings at a Milwaukee medical center during a period of just over a year indicated major discrepancies in 29% of cases, leading to unnecessary further diagnostic testing or treatments for the wrong indication, according to a study presented here at the American ...
Poliomyelitis doesn’t make the health reform cut
Early in paralytic poliomyelitis, the patient exhibits weakness; hyperesthesia; muscular pain, frequently quite severe; antalgic (reflexive) immobilization (spasm) of involved muscles; and normal or accentuated tendon reflexes.This phase is rapidly followed by loss of motor function, which is usually asymmetric and noncontiguous: one or both legs in 60 percent of the cases; one or both arms in 25 percent. Involvement of the diaphragm and intercostal muscles reduces ventilatory capacity. Cranial ...
Money drives medical students to become specialists
A video excerpt from The Vanishing Oath, a film directed by Ryan Flesher, MD.With medical students graduating, on average, with almost $160,000 of debt, it's a major reason why they're choosing more lucrative specialty practice, which can offer salaries multiple times more than those of primary care fields.In this clip from The Vanishing Oath, medical economist Amitabh Chandra, Professor of Public Policy at the Harvard Kennedy ...
Why doctors run late and how patients can help
A friend recently asked me in great frustration after her visit to her doctor why doctors “always run late.”Why do doctors make their patients “dance around” the office, getting moved around to different spots in the clinic, but still having to wait and wait at each location? Instead of explaining what really goes on at the doctor’s office, I ended up emailing her a couple of links to some of ...
Stents to treat blocked heart arteries are not an easy fix
Cardiologist Richard Fogoros -- aka DrRich -- has put out an incredibly timely and pertinent piece of advice concerning the common practice of stenting blockages in the coronary arteries.He succinctly summarizes a small retrospective study that showed an increased risk of cardiac events after non-cardiac surgery in patients who have recently undergone either a bare metal or drug-eluting coronary stent.On a website clearly designed to educate patients, DrRich rightly ...
Why having a primary care physician is important
by ChrysalisI read a post that disturbed me the other day. It was discussing the value of primary care physicians (PCPs). I was stunned by some of the comments. Surprised that people’s perceptions of what a PCP does would be viewed in such a poor light.Well, I do value the primary care physician and I’ll tell you why. I am just simply going to state some of ...
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....
