I like reading Maggie Mahar’s Health Beat.She usually gets it, from the function of insurance to the complexities of assorted payment systems, I get the sense that she is generally rational when it comes to paying for health care. This doesn’t mean there aren’t times when she gets it wrong. Her embrace of primary care provided by nurse practitioners shows a truly spectacular ...
November 2010
All Stories
Help patients synchronize their prescription drugs
Here's the scenario: on the 2nd of the month, a patient with diabetes on metformin and high blood pressure on benazepril sees her family physician for a routine follow up.The patient's blood pressure is elevated and the decision is made to add carvedilol to help get the blood pressure to goal. The patient's metformin and benazepril "drop" (are renewed) at the pharmacy on the 18th of every month, a date ...
Autonomy versus supervision for residents is a fine line
When one is a medical student, pretty much everything one does is directly supervised. Though a student is allowed to assess patients and make recommendations, rarely is a student given the autonomy to make decisions that will affect patients. They practice these decisions, but there is always someone more senior ratifying them.Once a student becomes a resident, things start to change. As residents are physicians, they have the power to write ...
Papillary carcinoma of the thyroid in young people
Cancer is a really bad diagnosis and I hope I never get one. But I was taught a long time ago that if I had to get a cancer, a papillary carcinoma of the thyroid would be a good one to get.An article in the World Journal of Surgery in June 2010, selected as highly credible by McMaster PLUS, bears that out.Long-term follow-up really is the best way to learn ...
Why patients in Grand Junction, Colorado have better health outcomes
The New England Journal of Medicine analyzed Medicare statistics from the beloved Dartmouth Atlas of Health Care study revealing a wide disparity in the number of coronary bypass procedures in Golden Colorado compared to other areas.The report reveals a 60% reduction in the number of procedures as compared to Miami, Florida. The Dartmouth Atlas Study has been used to justify changes in payment systems by Medicare. The ...
Using the internet for health information before surgery
Diana Cole told me, “The internet saved my life,” and recounted a story about using the internet to identify a bat bite and learn about rabies in bats, leading to an emergency room trip.She later introduced me to her sister, Carolyn Kingston, who attributed her successful outcome from hip replacement surgery to her use of the internet. I asked Carolyn about her general use of the internet for health, her ...
AMA: Patients and physicians call on Congress to stop Medicare cut
A guest column by the American Medical Association, exclusive to KevinMD.com.Medicare physician payment cuts are once again looming in the immediate future, with a cut of 25 percent now threatening to hurt access to care for seniors and military families. As many doctors know all too well, the looming cut is forcing physicians to make difficult decisions about the continuing role Medicare can play in their practices.The AMA is working on ...
Using servant leadership to teach medical students
I spend much time talking with medical students. It is part of my job, but more than that I like medical students.What should be the goal of medical schools? I believe we have an obligation to help our students grow into great physicians. What philosophical principles should we use?Perhaps the answer to success is Servant Leadership. As I learn more about this concept, I hope that have become ...
Why moral hazard fails in health care
I’m going to take the time to review a topic that is one my pet peeves, one you hear bandied about all the time in discussions of more consumer directed health care. It’s a topic I came back to repeatedly on my old blog – the moral hazard.Basically, the moral hazard is the idea that people insulated from risk behave differently than people exposed to risk. For instance, ...
Pertussis can be prevented by giving the Tdap vaccine to adults
by Joyce FriedenA recent report from the CDC found that not enough adults were getting their tetanus booster -- specifically, their tetanus, diphtheria, and acellular pertussis (Tdap) booster shot. Overall, the report found that more than a third of adult patients (36.5%) were overdue on these booster shots.Although the report focused on the tetanus part of the vaccine, the editors of the Morbidity and Mortality ...
Medical malpractice reform in exchange for paying doctors less
The bipartisan debt commission appointed by President Obama recently released its recommendations on how to pare the country's debt.Of interest to doctors is the suggestion to change the way doctors are paid. Physician lobbies have been advocating for removal of the Sustainable Growth Rate formula -- the flawed method by which Medicare, and subsequently private insurers, pays doctors.According to this method, physicians are due for a pay cut of ...
How medical students can improve our health system
Many fellow medical students are eager to improve "the system."However, an overeager attitude offers both promise and peril -- promise that budding physicians are inspired to improve the inner workings of their chosen field, peril in that our naiveté may simply clutter the very complexities we seek to improve.How do we strike a balance between getting involved and getting in the way?I found guidance in law professors Raustiala’s and Sprigman’s ...
The patient experience needs to be improved: here’s how
by James Merlino, MDThe patient experience is the right thing to do, and a business necessity. But improving it is not necessarily easy.The fact is, large medical centers are at a real disadvantage when it comes to performing well on HCAHPS. The Centers for Medicare & Medicaid Services (CMS) do not discriminate or differentiate the scores of small community hospitals from those of large academic tertiary ...
Thank you for making October 2010 the busiest month ever
KevinMD.com continues to break traffic records, with October 2010 being the busiest month on record.
I'm deeply appreciative of your continued readership and support, not only on the blog, but also on Twitter and Facebook -- which now have over 31,300 combined followers.I'd also like to thank the over 150 regular guest bloggers, who each contribute a diverse and poignant health ...
MKSAP: 44-year-old man with chronic joint pain
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 44-year-old man is evaluated for a 2-year history of joint pain in the wrists, hands, knees, ankles, and feet. He also has a 12-year history of plaque psoriasis. His current medications include acetaminophen for joint pain, topical hydrocortisone and calcipotriene ointments, and ...
Patients seeing the visit notes their primary physicians entered
This item has nothing to do with OpenNotes itself – it’s what I’m seeing now that I’ve started accessing my doctor’s notes. In short, I see the clinical impact of not viewing my record as a shared working document.Here’s the story.In OpenNotes, patient participants can see the visit notes their primary physicians entered. Note – primary, not specialists. I imagine they needed to keep the study design simple.So, ...
Understand your options before monitoring Internet use
As medical practices become more advanced, staff members gain improved access to the Internet during work hours. Cyber-slacking is a well-known problem in corporations; in fact, one study found that over thirty-five percent of employees admit to using the Internet for personal surfing at work.The New York Times cited that twenty-five percent of Net use on work computers isn’t actually work-related. Although it is unknown how severe the problem is ...
Benefits of mammography may not outweigh the harms
Stop pushing screening mammograms now.One by one, the big-time screening tests for dread diseases, begun with good intentions, the best science known at the time, and a mass public health campaign, bite the dust.Real science, that of statistically and clinically valid outcomes over time, obviously takes time to be realized. It also takes unbiased scientists and physicians with minimal conflicts of interest to study, deduce, report and then take the ...
Cancer screening and treatment cannot focus on mortality alone
When patients undergo medical treatment -- like radiation therapy for prostate cancer, for instance -- little is reported about the lifelong side effects that can arise.That's because outcomes have disproportionally focused on survival. Whether a patient has incontinence, impotent, or blood in the urine stemming from prostate cancer therapy has largely been overshadowed.In a recent New York Times' column, Pauline Chen highlights the Patient-Centered Outcomes Research Institute. According to ...
Will the new Congress allow the physician Medicare cuts to pass?
Well it's that time of year again.No, not Thanksgiving or Christmas, or even the venerable Interim Meeting of the AMA. It's the time that physicians nationwide anticipate another mandatory cut in Medicare reimbursement rates.This time the recurrent temporary fix will result in a cut of 23.6 percent on December 1st. Assuming political gridlock the rate will fall another fraction of 6.5 percent on ...
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....
