An excerpt from Unhinged: The trouble with psychiatry- a doctor’s revelations about a profession in crisis. Copyright © 2010 Daniel Carlat. Excerpted with permission by Free Press, a Division of Simon & Schuster, Inc.My own education in pharmaceutical marketing began during my second year of residency at Massachusetts General Hospital.Suddenly, I noticed that Paxil bagels began appearing everywhere. I first saw them in the break room of the ...
October 2010
All Stories
Why doctors need an EHR, and why they should buy it now
The regulators have completed their work. CMS has defined how you should use technology in your practice or hospital (Meaningful Use) and technical requirements for EHRs have been finalized.Centers for Medicare & Medicaid Services (CMS) and Office of the National Coordinator for Health IT (ONC) have removed all ambiguity regarding Government financial assistance to those purchasing EHRs, and ONC certified EHRs will start appearing shortly.A national network of federally funded ...
Can accountable care organizations lower costs and improve quality?
Somewhere in the Obama Administration, there is an elitist central cabal that operates with the support of the highest organs of our central government. It conspires in windowless basement rooms to plot the gun control, mass vaccinations and the nationalization of key U.S. economic sectors like automobile and chardonnay manufacturing.Healthcare, however, is its maximum target. Much like pieces on a chess board, and with the support of renegade organizations like ...
Health blog posts of the week, ending October 1, 2010
Here are the top posts from this past week, based on the number of times they were viewed.1. What to say to a person who is sick2. Boston Medical Center gets screwed by the Massachusetts government3. Can a pharmacy profit from gouging patients without insurance?4. The story of vitamin D and its association with other diseases5. Relationship advice for those dating American medical students
Children who are difficult may not be simply toxic
As a pediatrician I have listened to many parents speak of their child in very negative terms. Dr. Richard Friedman, in his New York Times article entitled Accepting That Good Parents May Plant Bad Seeds shares his patient's description of her "rude and defiant" teenage son. Like the parents in his piece, the parents of my patients have other children with whom they have had no such difficulty. ...
Nurses are the greatest ally of medical students
by Shawn VuongBesides the fact that I am going to marry one, I want to say that nurses are the greatest ally to the medical student."Nurses can make or break you." I don't remember where I read this quote, so I do not know who to give the credit to, but the quote is true. Nurses talk about doctors and medical students all of the time. They ...
Heavy sleep debt extracts a price for patients
An excerpt from The Twenty-Four Hour Mind: The Role of Sleep and Dreaming in Our Emotional Lives.by Rosalind D. Cartwright, PhD
We live in a culture that values speed; fast foods, fast cars, fast service, and fast decisions.All of this takes a toll. Fast food is blamed for the epidemic of obesity, fast cars for motor vehicle accidents, and the wish for fast service and decisions ...
The benefit of a drug cannot be measured by the law of averages
One of the topics that I have often thought about (especially in light of our seeming inability to develop zero-risk obesity drugs) is the problem of averages. Our entire medical philosophy of “evidence-based” medicine seems built on the “Gaussian” assumption that averages can reflect the true benefit (or risk) of a drug, when in real life (or medical practice) there is no such thing as the truly average patient.Clearly, a ...
Using Twitter and mobile apps to make healthy lifestyle changes
There’s a lot of evidence that to prevent many serious health conditions, including diabetes, obesity, heart disease, and stroke, making healthy lifestyle changes are just as good, if not better than, taking medications. Lifestyle changes may consist of stopping unhealthy behaviors such as tobacco and excessive alcohol use, or starting healthy behaviors such as moderate daily exercise and eating adequate amounts of fresh fruits and vegetables.As anyone who has ever ...
Finding a doctor using ratings is a sound idea, but poorly executed
Let’s say you develop some heart problem and get sent to me for an evaluation. You show up to the office, check in, get ushered into an exam room, then you wait and wait and wait. When I finally come into the room I seem terse, impatient and rushed, and you end up visiting with me for less than ...
How much staff should a doctor have?
"How many staffers should we have per doctor?" That's a question I'm asked at almost every seminar I present. Of course, like many good consultants, I almost invariably respond "it depends."One of the factors that needs to be considered is what jobs we're talking about -- clinical or front office. It's staffing in the clinical area that will do most to enhance a physician's productivity, so that's what we'll focus ...
Coping with the culture clash between nurses and IT
by John RossheimIT professionals are great at coming up with nifty tools for bringing clinical data to clinicians – as long as nurses are willing to memorize lots of byzantine paths to that information.Nurses are dedicated to providing direct care for their patients and advocating for them in every way – as long as it doesn’t mean having to adapt to ever-changing computer systems.These two stereotypes ...
Weekend video preview, October 1, 2010
Answering a viewer question on tardy test result reporting, and a video preview of what's coming up this weekend on KevinMD.com. I invite you to leave general medical and social questions in the comments for me to answer in future video previews.id="viddler_ca968274" classid="clsid:d27cdb6e-ae6d-11cf-96b8-444553540000" width="430" height="370" codebase="http://download.macromedia.com/pub/shockwave/cabs/flash/swflash.cab#version=6,0,40,0">
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...
