In an editorial published the New York Times, a strong argument was made for studying the relative effectiveness of screening colonoscopy and sigmoidoscopy. Based on a review in JAMA of three studies conducted outside the US that showed no difference in colon cancer mortality or incidence when the two procedures were compared, the Times proposed a US study to answer this question.Comparative effectiveness (CE) research, a relatively new concept in ...
August 2010
All Stories
Adults living with dementia and disability need research funding
I heard a prominent speaker talk about studies at the National Institute of Aging. The speaker described several new large and well funded trials aimed at preventing illnesses associated with aging, such as dementia and disability. These studies are terrific, and worthy of funding.I was disappointed, however, that little was said about funding for studies of older adults already living with dementia and disability. Research in prevention will not help these patients. I asked: where is the ...
How patients can stop doctors from blaming them for their health
If doctors need to listen to patients to figure out what’s going on, patients need to tell doctors what’s going on. Why is that so hard sometimes? It’s hard to speak up when you feel rushed, but have doctors ever done other things that made it harder for me to talk to them?Sometimes doctors blame the patientYears ago I got a terrible abdominal pain. I could only explain that it felt like ...
Insurance does not have incentives to lower costs or improve quality
Whether we have commercial insurance through our employer or Medicare, the incentives are poorly aligned to lower costs and improve quality.In fact, they actually encourage greater and greater expenditures. In most instances, our insurance covers everything from prevention to basic routine care to complex care of serious illness. Coverage may not be all that good for some things like preventive care and our primary care ...
Is placebo a therapy, like surgery or medication?
The New England Journal of Medicine recently published a troubling article on acupuncture, which was ably deconstructed by Dr. Mark Crislip. This incident has reignited a discussion of what, exactly, “placebo” is.A common argument is that placebo is like any other intervention, something that can be intentionally harnessed for the benefit of patients. This is both true and overly simplistic.First, we must review what “placebo” is. ...
Fetal heart rate monitoring is given too much importance
Continuous fetal heart rate monitoring is at its core an almost laughable idea.We are checking a single vital sign and using that vital sign to extrapolate a host of ideas and meanings. OBs that have read strips for years can make some sense of them, but would we give so much meaning to any other single vital sign? Would we do it with an adult? Of course not, but there ...
Medicine is an old profession, but not the oldest profession
Medicine is a very old profession. Ancient and honorable. Sadly, for the vast majority of recorded history, honor was pretty much all it had. The Hippocratean ideals of “first do no harm” and putting the patient first and all held special importance when medicine truly had nothing to offer. Make no mistake: up until the last two centuries, the vast majority of what passed as ...
Prevent recurring urinary tract infections (UTIs)
I have helped scores of women with frequent, recurring urinary tract infections (UTIs) over the years.First, involvement of your primary care provider is critical. "Must not miss" disorders need to be considered prior to going forward with the recommendations given below.Second, how do you define recurrent urinary tract infection? Most define recurrent UTI when a woman has 2 or more symptomatic urinary tract infections in 6 months or 3 or ...
How patient stories can enhance health websites
Stories can enhance health websites because they resonate with health information seekers, who find support and encouragement from the experiences of others like them. Two excellent examples are Weight Watchers’ Success Stories and Livestrong.org’s Survivorship Stories. Both sites include extensive libraries of well-written stories about people’s experiences losing weight and surviving cancer, respectively.Because of the effectiveness of stories in health websites like these, I challenge my Online Consumer Health students ...
10 top health blog posts, July 2010
Here are the top posts from this past month, based on the number of times they were viewed.1. iPhone, Android or Blackberry? The right smartphone for doctors2. What residents and medical students should wear in the hospital3. Why doctors run late and how patients can help4. Florida EMTs may go bankrupt because of a malpractice lawsuit5. Unnecessary testing needs more than tort reform to cure6. ...
Why family medicine and internal medicine should not merge
Recently, I had a discussion with a prominent academic family physician. I had last seen him 37 years ago when he was getting ready to graduate from medical school and I was a new medical student.We had a wonderful discussion and agreed to disagree about merging primary care. Long time readers know that I dislike the term for the tasks that outpatient internists do. Most of the push for merger ...
Pay cuts for government health care subsidies
An eagle-eyed reader let me know that the Kaiser Family Foundation has a nice subsidy calculator up that you can play with. You enter information about your income and situation, and you get to see how much health insurance and care will cost you in 2014.It’s not all good news.Let’s say you are a 60 year old divorcee in 2014. You make $46,136, which is 401% of the ...
OpenNotes and whether patients should see their medical notes
The opening anecdote of the e-patient white paper tells of a patient who impersonated a doctor in 1994, to get his hands on an article about an operation he was about to have. He got busted. Two years later episode 139 of Seinfeld had something similar – Kramer impersonates a doctor to try to get Elaine’s medical record.It aired October 17, 1996. It was a turning point in ...
The public option dissonance in health reform
Health reform will do a lot of things that most Americans don't realize it will do, and it will not do a lot of things that many Americans mistakenly believe it will do.One of the most recognizable components of health reform that didn't actually become law is the public option. The public option was the lighting rod in the health reform debate. After all, it had a concise name, and ...
International medical graduates and their patient outcomes
Did you know that international medical graduates account for 30% of primary care doctors in the United States?And with American medical graduates continuing to shy away from the field, that number will undoubtedly go up.But that's not necessarily a bad thing.Recent news stories, like Pauline Chen's New York Times column, have focused on a landmark study comparing patient outcomes of doctors educated in the United States versus those ...
Healthcare reform ethical questions
Hard choices and healthcare reform are here. Donald Berwick, M.D., has been installed as the administrator for the Centers for Medicare and Medicaid services as a “recess appointment” by President Obama.Dr. Berwick is an academician, a pediatrician who has spent the bulk of his professional existence as the CEO of the Institute for Healthcare Improvement of Cambridge, MA. He is an outspoken advocate for the single-payer system, admires Britain’s National ...
Health care reform needs cooperation and compromise
There are strange things going on in the Massachusetts health care insurance market. For those from out of state, here are some quotes that will give you a sense of the contradictions in the public policy arena.They are, respectively, from two stories that appeared on the same day in the Boston Globe: "Rate cap for insurer overturned" and "Officials give up cutting health perks."
1. An insurance ...
Balancing a surgeon’s beliefs with the needs of the practice
Not long ago, we interviewed a physician for possible partnership in our practice. After showing him around our town, some of us partners had dinner with him to discuss business. He was a quite pleasant fellow, well trained, and seemed to be a good ‘fit’ for our practice. As dessert was being served, he said he needed to get one more thing off his chest: he prays aloud in the ...
Americans will need doctors but physicians are leaving primary care
Everyone understands the need for a robust primary care workforce in making healthcare more affordable and accessible while keeping those in our care healthy. With the aging of America and healthcare reform, even more Americans will need primary care doctors at precisely the same time doctors are leaving the specialty in droves and medical students shun the career choice. So as a practicing primary care doctor, I've watched with ...
Gifts and money influence physician prescribing
It is not a secret that large sums of money have passed from the pharmaceutical and device manufacturers into physicians' hands.This money has been paid not only for such socially beneficial pursuits as research and consulting, but also for lavish gifts and junkets. And interestingly, despite disingenuous assertions to the contrary by many a stake holder, these gifts generated a return on investment -- surprise! It turns out that the ...
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....
