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 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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Improve patient safety to improve healthcare quality
It has taken 13 years for us to revisit the issues in To Err Is Human, the 1999 landmark government report that...
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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...
Tech
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New classes of devices to diet and exercise
For many celebrities, their livelihoods depend on their physical appearance and they rely on armies of personal assistants, schedulers, stylists, trainers and...
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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...
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....
