Part 2 of a series. Please read part 1, DTC advertising, and its history with the FDA.In the first installment, we looked at the history behind consumer advertising of prescription drugs. We also explored the concept of commercial free speech and why this form of advertising is legal. To fully appreciate the controversy about direct-to-consumer (DTC) advertising, we must now examine the commercial effects of these ad campaigns. ...
November 2010
All Stories
Grateful for a medicine career in public health
I have made a big life-changing, evolutionary decision: I am leaving my job with public health. It was not an easy one. It isn’t because I don’t love my job greatly; because I do. In fact, I feel like the queen of the jungle, leaving her subjects. It’s not easy to let go.My reasons for leaving have nothing to do with the job itself, but have everything to do with ...
Problems that arise when preventive medicine services waive co-pays
by Jeoffry B. Gordon, MD, MPHPreventive medicine services will soon require no co-pays.This is just another example of how complex and fouled up any health reform that depends on commercial insurance can be. In addition it demonstrates how pious morality infused into the democratic politics of health reform impairs the greater good.So after all current insurance policies renew, according to Affordable Care Act, preventive services must ...
Patient gender preferences for medical care
Patients’ gender preferences for medical care are a factor that we all know exists yet most physicians prefer to ignore it in daily practice hoping that modern medicine is gender neutral. Forty plus years ago when I started in medicine this wasn’t a consideration. Nearly all physicians were men and nurses were women. Patients simply had no choice. Male physicians felt entitled to see all comers and present day women ...
Why public support for health care reform is falling
The latest Kaiser Family Foundation poll, conducted in August, shows public support for health care reform falling. After two monthly polls in which reform was viewed increasingly favorably, the new poll shows a sharp decline in public backing for the new law.Kaiser polls in the first couple of months after enactment of Patient Protection and Affordable Care Act (PPACA) showed more confusion than clear support or opposition, but by June favorable ...
Conflicting stories on alcohol and heart disease
Have you ever had a cold beer after a mountain bike ride?Oh my!But does such indulgence put one at risk for an arrhythmia? Does alcohol exacerbate an existing arrhythmia? How much, if any, alcohol is acceptable?These are questions I am asked frequently. And for those asking, they are very important questions.I wish the answer was straightforward. But it is not.Undoubtedly, excessive alcohol can precipitate an abnormal rhythm. Look no farther ...
Screening for lung cancer with a CT scan: What the NLST results mean
Lung cancer screening has been an area of considerable controversy. Before today, there had been no evidence that screening patients for lung cancer, either with a CT scan or chest x-ray, saved lives.For years, doctors have been waiting for the results of the large, randomized National Lung Screening Trial (NLST), conducted by the National Cancer Institute.This morning, it was announced that the trial was stopped early, with a ...
Involving a psychiatrist in a patient’s care for the first time
The psychiatrist knocks on the door of the patient’s hospital room.Patient: “Come in.”Psychiatrist: “Good afternoon, Mrs. Jones. I’m Dr. Moodbetter, one of the psychiatrists here. Your doctor asked me to see you. Did he say anything about this?”Patient: “No, he didn’t! You know, I’m not nuts. I didn’t think he believed me. Great. Now he just thinks it’s all in my head.”Psychiatrist: “Well, I don’t think he meant to imply ...
Health IT will provide job security for the foreseeable future
Hospitals nationwide are racing against the clock to ensure their health IT systems meet meaningful use guidelines.The incentive? Money, of course. Systems that meet certain criteria make doctors eligible for up to $44,000 in bonus money from the government.As mentioned on this blog previously, implementing an electronic health system is difficult. The usability of the current generation of EHRs is still relatively primitive, especially when compared to other industries, and ...
Deeply connect and engage your patients with empathy
Doctors and nurses are leaders in health care. Being a great leader means having a clear vision, mission or goal. It means being committed, and knowing how to listen and communicate, but it involves much more. It’s about having heart, empathy, and an uplifting spirit.I value and respect a well written post by Thomas Goetz, author of The Decision Tree: Taking Control of Your Health in the New Era of ...
Tinnitus highlights poor doctor patient communication
I’m both interested in and disturbed by what some doctors have said to patients at the first consultation for tinnitus, an annoying perception of sound that comes from somewhere within their heads. Not many of these patients are referred to me – most come of their own accord for a second opinion. What they tell me their doctor said is a lesson in how not to communicate with patients, and ...
Communicating with men and women in the exam room
Who ever said you have to stay with the same doctor? I am always disappointed when I hear the stories that some people relate about how they sat and told their doctor this and that and that he/she didn't listen, didn't know what to do, didn't care, etc.Makes me sad of course, because I know how easy it is to just listen and look people in the eyes when they ...
Consider travel when applying for a non-clinical medical job
Travel is frequently required for non-clinical jobs.The big question is: how much travel? When a job description indicates 30% travel, do you know what that really means? What if you had to travel 30% each week? 30% each month? If there are 5 working days each week and 4 weeks each month, then there are approximately 20 working days each month. Are you willing to be gone 6 days each ...
Use technology and outsourced services to improve practice efficiency
What does it cost to improve operational efficiency using technologies and outsourced services?For some physicians, the first reaction to every new service or technology is that it's going to "cost too much."And you get pitches for plenty of new services:* Your clearinghouse vendor or your billing manager wants you to push all your claims, even the claims you can file directly at no cost, through the clearinghouse for efficiencies. * Your ...
Doctors are quietly opting out of medicine
by Nancy Pando, LICSWDr. Ryan Flesher was working his usual shift in the Emergency Department that night in July of 2006. The hospital was short-staffed, per usual, and patients continued streaming through the revolving doors. Neither the people at the front desk nor the nurses saw Dr. Flesher slip quietly down the hall that night.The following is a true story that occurred well before healthcare ...
Gaining market share requires gathering data for your practice
Who constitutes your market?The obvious answer is "patients". We provide services and in some instances products for patients. We receive compensation for doing this. It's instructive to ponder the source of these patients. How do they get to us? What other people and institutions play a role in this process. Existing satisfied customers? Other physicians? Hospitals? Health plans? Other institutions? Tracing the sources is a critical exercise if we are ...
If health care reform is killed, what happens?
by Maggie MaharIf conservatives manage to kill health care reform legislation, what will happen next?I really don’t want to go there.First, I’m convinced that conservatives won’t be able to repeal the Affordable Care Act (ACA). Democrats will hold onto the Senate, and President Obama still has a veto. If necessary, he will use it to protect the bill. Meanwhile, the majority of the public either favors ...
Induction of labor should be restricted to medical indications
It seems rather obvious that medical procedures should be reserved for medical indications. Why? Because almost every medical procedure, even some of the simplest, have small but real risks of complications. And risking complications can only be justified if the medical benefit outweighs the risk.That rule applies to labor inductions, although many obstetricians have forgotten it. Induction of labor for non-medical reasons, primarily convenience, is attractive, but labor induction is ...
Do patients want to be empowered or managed?
by Toni BigbyLately there has been a lot of conversation around patient empowerment – an ambiguous term, but one that is fodder for many conversations across the health care industry. Patient empowerment – to put it simply – is about providing the necessary tools and information to a patient so that he or she can take a more active and involved position in his or her health ...
Will California allow the government to regulate marijuana?
How are we going to solve the drug problem? The answer is we aren't.Psychoactive drug abuse is as old as recorded history. As long as drugs are available and humans are frail, there will be drug abuse and drug abusers.The main point for medicine is to follow Hippocrates. First, do no harm.So many of our drug laws, intended to do good, actually do more harm than good. Witness marijuana.Will California ...
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....
