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 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....
