The rapidly ramifying crisis in health care may (we can pray) end all delusions. It may at least begin to weaken them by exposing them to the light, to the sobering effects of reality.The reform act has not brought us to the Promised Land. By bringing us access without capacity, fierce restrictions coupled with vague language and loopholes, mandates coupled with fines low enough to become the cheap way out, ...
September 2010
All Stories
Why a marketing study for Niaspan was published in a medical journal
The authors call it “an in-office linguistic study” and write that it “was conducted to assess physician–patient discussions of mixed dyslipidemia.” But it’s really an Abbott marketing study for Niaspan, the company’s long-acting niacin product, and the question is: why is it published in the American Journal of Cardiology?The study involves the recorded conversations of 12 cardiologists and 12 PCPs with 45 patients with low levels of HDL. The authors ...
We need a better way to share information to care for patients
This evening I went to a meeting of many of the independent physicians in our community who came together to discuss ways we can help each other to remain viable as relatively small independent practices of medicine. Two things about the meeting really hit home for me.First is how seldom I get to meet socially with my fellow physicians in the community. Now that many of us use hospitalists to take care ...
The primary care specialist pay gap shouldn’t be squeezed too hard
The primary care-specialist pay gap is a popular target for those eager for reform. The gap is hailed independently as an example of and a cause of the lack of focus on primary care and prevention in the United States.There is no doubt that the United States treats primary care, preventative care and triage much differently than most of the rest of the developed world. The distribution of primary care ...
Most doctors don’t like prescribing pills
I am a medical doctor. I am also called an allopath, someone who practices “Western medicine.”We allopaths like data, proof, science, randomized, double-blind, placebo-controlled trials. We want to know the “mechanism of action.” We want someone to prove that yoga or medication or some procedure actually helps your depression or blood pressure or back pain and that these treatments are safe before we prescribe them. We feel more confident about ...
Mail order pharmacies have cheap prices, but also problems
After seeing Mrs. WhiteCoat argue on the phone with Medco representatives for 20 minutes about why one of her 80+ year old patients hadn’t received her medicine despite three lost faxes to Medco, I had to write this post to let the public know what is going on with some mail order pharmacies.If you’re like most Americans, you want to try to save some money. One of the ways that ...
Preparing for gastric bypass surgery by eating more
Thinking is hard work. This is why so few people bother. At least voluntarily. So whenever it seems like the threat of brainwork looms in modern American medicine, we can thank our lucky stars for the geniuses behind healthcare reform and guidelines of care.This comes up as a result of a conversation that I had with a patient the other day. A pleasant, obese gentleman. He had been struggling with ...
MKSAP: 62-year-old man is evaluated for an asymptomatic nodule
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.A 62-year-old man is evaluated for an asymptomatic nodule on his shoulder that has been present for more than 1 year. Skin findings are shown.
MKSAP image © 2010, American College of Physicians, Medical Knowledge Self-Assessment Program (MKSAP® 15)
Medical school is hard, and other medical student thoughts
Some reflections on my first semester of medical school.1. Medical school is hard. Yes, it’s true -- medical school is as hard as people who have been through it make it out to be.I was skeptical when I started mostly because I felt I had challenged myself while doing my undergrad degree and in graduate school. I had taken heavy loads of difficult classes in both of my degrees. My ...
Hospitalist: Long hospital stays are often due to poor planning
Being a hospitalist, I often see patients sitting in the hospital for days at length for no reason other than poor planning.Sometimes I feel that physicians who are involved in patient care are oblivious of each other. Everyone is in their own domain rather than working as a team. An increased length of stay in the hospital not only increases the cost of health care but also adds to the ...
An advocate for patients might save your life in the hospital
by Dennis GraceSo, you have to go to the hospital. You’ve had an accident and the doctor wants to keep an eye on you for a few days. Maybe you need major surgery. Whatever the reason for the stay, a lot a people think you should have an advocate with you.Why? In my life, I’ve had lots of hospital stays. Why is this suddenly a big ...
Leading a hospital team of foreign trained doctors
Recently, I had the opportunity to decamp from the the friendly confines of GlassHospital and trek a few miles to the north.GlassHospital has brokered a teaching and patient-sharing agreement with a nearby religiously-affiliated community hospital I’ll call Our Lady of Blessed Proximity.Our Lady has a residency training program, just like ours, with the major difference being that nearly all of the doctors come from foreign lands.Something you should know about medicine in ...
Tips to make your appointment as fast and efficient as possible
We all hate it when the cable company tells us that the technician will be at our house sometime between 11 a.m. and 5 p.m. Fantastic! Going to the pediatrician's office can be the same way.Your appointment may be at 9 a.m. but you may not get out of the office until noon. Unfortunately, this is the nature of running a medical practice. What should take ten minutes for one reason or another ...
Traditional primary care needs concierge care to survive
Concierge care is often discussed as a way for primary care to survive in the United States.Pauline Chen talks about the concept in her recent New York Times column, discussing the well-known issues involving "two-tiered" care that boutique practices inevitably bring.But what I found fascinating was how Tufts University utilized the concept.Here's how it works:
Since 2004, the primary care physicians at Tufts Medical Center have offered patients the option ...
Why pay for performance does not work and may impair patient care
In response to a recent article on the topic of economic motivation theory, Michael Kirsch sent me information about a very interesting study (May 2010 issue of the British Medical Journal) done to evaluate the effects of monetary incentives on clinic, physician, and staff work performance.From 1999 to 2007, 35 medical facilities of Kaiser Permanente in NorthernCalifornia, were given financial incentives for ensuring that their patients got regular ...
KevinMD.com breaks traffic records in August 2010
Thank you for making August 2010 the busiest month ever on KevinMD.com.
With nearly 259,000 page views, traffic surpassed the previous record, set last fall.I appreciate your continued readership, and keeping the discussion in the comments lively and, for the most part, civil.I'll continue to work hard to find new ways to expand KevinMD.com's reach, so your voice -- whether you're a patient ...
Make your small private practice thrive in 4 steps
Health care is changing at lighting speed. If you don’t know this, or worse, don’t accept it you’re doomed. No. Really. It’s change or close shop. Whether you like it or not, health care reform is going to change the way we practice from now on.Many physicians are choosing to work for large group practices to buffer themselves from directly dealing with change. Mental health providers could do the same, ...
The TPA time limit for acute stroke causes mass chaos in the ER
I hate acute strokes. There are several reasons for it. Most of them are logistical. First, everyone gets into a tizzy because of the 3 (or 4.5) hour time limit after the onset of symptoms that which TPA can be given and hopefully improve the patient’s outcome. Unfortunately, this time limit (and the data for TPA’s efficacy is only OK at best) causes mass chaos and annoyance.First, one has to ...
Kevin Pho, MD
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Why Priscilla Chan may become the country’s most influential doctor
Who has the potential to be the most influential physician of our generation? It's Priscilla Chan, who not only recently graduated from...
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Confused about prostate cancer screening? Make a shared decision
In a widely anticipated move, the USPSTF officially recommended against prostate cancer screening in healthy men. Case closed, right? Hardly. The prostate...
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When it comes to doctors and social media, hospitals fail miserably
When it comes to medicine and social media, much of the attention is negative. Doctors losing their hospital privileges because of Facebook....
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Warren Buffett’s prostate cancer choices aren’t right for every man
A version of this column was published on April 24, 2012 in USA Today. There has been a recent uptick of elderly men...
Physician
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Why test recalls should not be considered cheating
I was appalled recently by the coverage of radiology “test recalls” by CNN, amplified by Dr. Gary Becker of the American Board...
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Why physicians are susceptible to hardball tactics
I was invited to a medical staff leadership conference sponsored by our hospital. A company specializing in training physician leaders ran the...
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How we deliver bad news is critical to how families deal with grief
As a cardiac electrophysiologist, I have had to discuss bad news with patients and families more times than I would like during...
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His father’s suffering had already been too great
He looked dead. The paramedics brought him down the hall toward one of my critical care beds, and for a moment I...
Patient
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How death can be a beautiful experience
I was honored to be part of a beautiful experience in late January of 2011. It was the death of my mother-in-law...
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What meaningful encouragement can be given to someone who is dying?
Theirs is a lonely journey; to be moving towards the separation and end of all things known and loved. Being with a...
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Health care journalists have tendencies similar to those of doctors
As a patient who was asked to speak at the Association of Health Care Journalists 2012 conference, I felt a bit covert....
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Adaptation can be painful, but it can also be a gift
Nothing will force you to live life on your own terms faster than almost losing it. In 2008, I was on fire....
Policy
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What should America’s health care vision be?
America has this paradox of excellent biomedical science, innovative drug manufacturers and entrepreneurial device developers along with outstanding providers but at the...
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Hospitals around the world aim to remain relevant to patients
"It was the best of times, it was the worst of times ..." So begins a story called A Tale of Two...
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Repairing the tear in health care’s safety net with social media
The nation’s “safety net” hospitals are designed to ensure that uninsured, lower income and indigent populations receive adequate medical care – a...
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Look to technology to reduce health costs
Technology to lower costs rather than accelerate them. Smart phones to increase physician and other providers’ productivity. Fewer primary care physicians but...
Tech
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When patient care becomes secondary to filling out the medical record
The policeman was two cars in front of me. I meandered down the road cautiously adjusting my speed a few ticks above...
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Doctors, use Google to get more patients in less than 7 minutes
Every month, hundreds of thousands of people look for a doctor on Google. As an amazing practitioner, your site deserves to be...
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The user interface for EHRs should be uniform
The first thing I noticed when I walked into the physician’s office were the tall cabinets filled with manila folders, tabbed with...
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EMR liability needs to go further than just the physician
This example of a disaster waiting to happen, in the form of an error-promoting CPOE, is a poster example of why the...
Social Media
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We need to see the potential harm of social media
Prior to 1794, farms across the world could only pick cotton as fast as humanly possible. In the late 18th century, Eli Whitney...
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Why social media may not be worth it for doctors
Social media in healthcare is all the rage these days. You can’t visit even one physician-oriented website without someone breathlessly advising you...
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Transparency defines social media success for doctors
Want to understand social media? Physicians wanting to learn about social media must learn transparency. We must learn transparency on a personal...
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How Twitter was used in a potential mass casualty scenario
It was my first ER shift in charge of the resuscitation area. Needless to say, my adrenaline and nerves were firing like...
