Among the litany of complaints about the (un)usability of EMRs, it’s easy to lose sight of the big picture. More than the poor design choices and overall ugliness of existing software, by far the single biggest failure of HIT companies is that none of them has yet to produce an EMR that nurses actually need.There is a huge opportunity being wasted here. Other industries have been able to incorporate computers ...
November 2010
All Stories
Patient safety suffers when doctors are forced to learn multiple EMRs
As a new intern at a well-endowed medical institution, I was disappointed despite the flurry of excitement that comes with orientation. I was disappointed despite the brand new privilege to save lives and relieve human sufferings. And the disappointment was made clear to me over the past two days.What has happened in the past two days? As I will be working at two separate hospitals, for the past two days ...
Uninsured Americans cannot afford many medications
I went to the doctor recently and got a new prescription.The doctor was kind enough to give me some free samples, and a voucher that I could redeem to fill the prescription once at no cost. In the future, it will cost me $50 if I decide to refill it. If I didn't have pharmaceutical benefits through my insurance coverage, the medication would set me back about $500 for a ...
How medicine is similar to painters in the Middle Ages
by Ted Bacharach, MDOn several occasions I was able to wander through various art museums including the Louvre and the Prado as well as several others.I was always impressed with the fervor with which the artists in the Middle Ages painted religious themes. I wondered whether they really were that religious. It was not until recently when discussing art with someone who had worked with ...
Why patients are leaving our practices
She was like ... Superwoman. A strapping medical visionary probably in her forties. Gray long coat falling below the knees. She strode confidently down the hallway towards the elevator, a father hurrying beside her with his young lanky daughter cradled in his arms. The girl's head nuzzled into her father's shoulder. She was old enough to walk by herself...but clearly she was sick. Unable.Undoubtedly they were headed from the medical ...
An ACO may or may not reduce health insurance premiums
Is the move towards accountable care organizations (ACOs) and capitated (aka, global) payments likely to reduce health care costs and insurance premiums, or will it do the opposite?Being an economist, my answer will be, "On the one hand ... On the other hand ..."On the one hand, ACOs offer the potential for a better integration of care across the spectrum of primary care, hospitalization, skilled nursing, rehabilitation, and hospice. If ...
Is your child’s behavior due to ADHD?
When my oldest son was 13 he began to do poorly in school. He often forgot to do his homework, or he did it but forgot to hand it in. He had difficulty paying attention during tasks, was extremely disorganized, and his teachers said he was easily distracted. They suggested that his behavior fit with many of the symptoms of attention deficit hyperactivity disorder (ADHD), but since this was mostly ...
Primary care private practice will die, will patients benefit?
Having more primary care physicians doesn't necessarily improve the quality of care.That may come as a surprise to regular readers of this blog, but that's one of the findings that came from a recent analysis of the Dartmouth Atlas.As reported by the WSJ's Health Blog,
having regular primary-care visits isn’t a guarantee of receiving recommended care. There was “no relationship” between rates of breast cancer screening for women age 67-69 ...
Coping with frightening circumstances after a cancer diagnosis
For myself I am an optimist — it does not seem to be much use being anything else. -Winston ChurchillEven before I met him, I could tell that his cancer was extensive. His problems had started several months before with a cough, a voice change, and some trouble swallowing. His primary doctor had not spotted anything but had kept an eye on him. Antibiotics and cough medicine had not helped. After ...
Can a social media manager convince doctors to get online?
A social media manager is becoming an imperative position for hospitals.Medical institutions are waking up to the fact that they need to engage their patients and physicians online. No where is there more fertile growth than in the various social media platforms that are prevalent today -- like Facebook, Twitter, and YouTube.American Medical News recently profiled the phenomenon, highlighting the position of social media manager, which some institutions pay ...
Alzheimer’s disease: 5 reasons why awareness matters
by Dennis FortierMore so than with any other major disease, our near-term progress in the battle against Alzheimer’s will be determined largely by our ability to improve awareness about several aspects of this encroaching threat.Summarized here are five reasons why greater awareness about Alzheimer’s disease, and a deeper public understanding of risks and prevention strategies, will play a key role in the nation’s ability to triumph against the prospect of ...
Questions about the early diagnosis of Alzheimer’s disease
Alzheimer's disease made headlines recently, first with news about a new biomarker test that is able to diagnose the disease with increased accuracy, then with a follow-up story detailing the collaborative model of data-sharing that contributed to the success of recent research.As I read the news with interest I couldn't help but feel that in our current climate, the manner in which it was reported was ...
Expanding hepatitis B vaccine recommendations for adults
My colleagues at the Advisory Committee on Immunization Practices (ACIP) are examining a proposed policy for hepatitis B vaccination for diabetic patients. If accepted, this would be the next in a series of baby steps expanding hepatitis B vaccine recommendations for adults. While we are taking these baby steps, HBV incidence rates among U.S. adults remain pretty flat, and they haven’t changed much since 2006.We know the vaccine ...
Why total body scans are a scam
Folks across the country are paying hard cash for total body scans, abdominal aortic aneurysm testing, CAT coronary artery scans and carotid artery evaluations to prevent disease or find important lesions early. It’s a seductive argument, and it’s a scam.Ordinary patients don’t understand about pre-test probability and positive and negative predictive values. Indeed, all physicians were taught to consider Bayesian theory when ordering diagnostic tests. This is very tough concept for ...
Avandia, Actos and behind the scenes of study 175
Though I am not going to say that the New York Times lied, they either purposely and grossly misrepresented the truth or did a horrible job of reporting.In their article, "Diabetes Drug Maker Hid Test Data, Files Indicate" the Times states that Avandia maker GSK "secretly began" a study which "provided clear signs that it (Avandia) was riskier to the heart."In fact, the study in question, called study ...
Health blog posts of the week, ending November 5, 2010
Here are the top posts from this past week, based on the number of times they were viewed.1. Doctors are quietly opting out of medicine. The following is a true story that occurred well before healthcare moved to its national platform, leaving uncertainty in its wake.2. If there’s a doctor on board, please ring your call button! Recently, I was somewhere over Saskatchewan, returning from a lovely ...
How fear may lead to infidelity
When we think of infidelity as "mere cheating" we are often overlooking the many fears that go along with this. Infidelity may be due to fears and fears themselves may lead to infidelity. Why is this, and what can you do about this?1. Fear of being trapped. One of the greatest fears of commitment is the fear of being trapped. When people feel trapped, their primitive brains start to rebel. ...
How much breast cancer chews up your schedule
Whether you’re newly diagnosed with DCIS or a more advanced form of breast cancer, you’ll notice it has a big time impact. One of the things that surprised me was just how much breast cancer chews up your schedule. I had something like 38 appointments in 20 weeks, and this did not include radiation, which was not in my treatment plan.In case you’re wondering what all those appointments were for, I had two ...
Vaccines and the diseases vaccination can prevent
by Val Jones, MDVaccines have saved more lives than any other medical intervention in history. They are incredibly safe and effective and are well-tolerated by most people. In the US, the Centers For Disease Control and Prevention (CDC) carefully reviews all reports of adverse reactions that could be associated with vaccines. Over decades of review, they have found that the rate ...
Physicians should establish rules with their patients before using a PHR
These days, it seems that for every consumer advocate out there who promotes the personal health record (PHR) as The Patient Empowerment Ubertool, there’s at least 10 physicians worried sick that the technology will further complicate their frazzled work lives.The fear and loathing derives from an increasingly common and distinctly distasteful experience in which a patient presents the physician with a thumb-drive, computer disk or Web-link to a site containing ...
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....
