Ten years ago, I wrote the Pew Internet Project’s first report on the impact of the internet on health care, calling it “The Online Health Care Revolution.”Back then, the idea that people were searching online for health information was revolutionary. All of a sudden, regular people had access to medical information that had always been locked up and out of reach.Ten years later, I am ready to declare ...
December 2010
All Stories
Tricks for helping patients save money on prescriptions
As a primary care doctor, I have figured out many tricks for helping patients save money on prescriptions. Some of them I am sure you have never heard of, and others , well -- you might have, but they bear repeating.All of the prices quoted here are from Costco, unless otherwise specified.1. Price compare between pharmacies. Can't stress enough the potential differences in medicine prices between pharmacies. Generic medicine prices vary more than ...
Are video podcasts are ready to replace medical lectures?
by Walter van den Broek, MD, PhDVideo podcasts are not ready to replace lectures.This disappointing result is recently published online.Teachers are eager to use new information technology to teach. When I’m doing a lecture at our medical school, these lectures are made to podcasts and posted on blackboard. Together with the slides, students can rehears or listen to the lecture afterwords when not present. This ...
Implementing site changes with Plan-Do-Check-Act
Many healthcare organizations are contemplating making dramatic changes in the way they do business and treat patients. Some of these are driven by the recently passed Accountable Care Act and the Tarp Bill. They are planning on adopting electronic medical records, becoming Accountable Care Organizations or becoming Patient-Centered Medical homes.Unfortunately, like many businesses, they will undergo a lot of stress and loss of resources in time and money in making ...
A postmortem on the patient safety movement
Are patients better off than they were ten years ago?Just over a decade ago the Institute of Medicine (IOM) released its celebrated report on patient safety, To Err is Human. Many credit that report, which was released with great fanfare, with launching the patient safety movement. So it's appropriate to assess the movement's impact eleven years later. How did we do?On November 25 the New England Journal of Medicine published ...
Percy Harvin and how sleep apnea affected his migraine headaches
by Diana E. LeeIt sounds like NFL Wide Receiver Percy Harvin (Minnesota Vikings) is one of the luckier chronic migraine patients out there.He was actually able to identify a specific reason for his drastically increased number of migraine attacks (sleep apnea) and implement a treatment that seems to be helping (CPAP). He is performing solidly and confidently and taking contact without any issues.I know a ...
Commercially funded CME programs and whether bias can be removed
The growing criticism of industry funded continuing medical education (CME) over the past several years has had a number of significant effects on the CME community. As the Accreditation Council of Continuing Medical Education (ACCME) annual report showed, from 2007 to the present, commercial support of CME dropped 29.3%, and the number of directly sponsored CME activities decreased over 7% between 2008 and 2009.CME funding is extremely important ...
William Osler’s humor, and finding fun in medicine
In 1905 William Osler gave his farewell address as he prepared to leave Johns Hopkins for Oxford and England. After speaking to the assembled medical students about the tragic side of medicine he said:
The comedy, too, of life will be spread before you, and nobody laughs more often than the doctor at the pranks Puck plays upon the Titanias and the Bottoms among his patients. The humorous side is really ...
Open dialogue on medical malpractice and patient safety
A response to my recent post, The malpractice system doesn’t improve patient safety.by Brian NashIn his blog, Dr. Kevin acknowledges that in the "world of medical error, truth is often clouded in secrecy." He then points out that "... taking the bold step of publicly describing your mistake is a brave one. Some would say it’s long overdue."Well so far, Dr. K, we’re on ...
Playing hurt and when to return to football after a concussion
The September issue of Journal Watch General Medicine included an article from the American Academy of Pediatrics about new criteria for diagnosis and management of concussions in children and adolescents.Shortly after this issue was published, a segment aired on ESPN regarding a confrontation between the head football coach at Texas Christian University and its team physician over holding a player out of the game due to a concussion.As a sports ...
Early detection and improving cancer cure rates
Reading the newspapers and watching the news lately would lead you to believe that screening for cancer is largely a waste of time.Yet, in the same week that the NEJM published Norwegian data showing a remarkably small survival benefit of 2% associated with screening mammography, HealthDay reported a decrease in cancer incidence of almost 1% per year from 1999 to 2006 and a decrease in cancer deaths ...
10 most expensive errors in healthcare settings
Medical errors have been in the news lately. An Ontario provincial review probing unnecessary surgeries at a Windsor hospital found significant concerns with the work of a pathologist involved in a mistaken mastectomy case.In the US, avoidable medical errors added $19.5 billion to the nation's healthcare bill in 2008, according to a claims-based study conducted for the Society of Actuaries (SOA). The report lists the 10 most expensive errors in ...
Temperament of perfectionism in anorexia nervosa
Temperament is generally defined as innate early emotional and behavioral characteristics that precede puberty and adult development. Felt to have significant genetic components, temperament is also potentially influenced by environmental factors.There are a variety of temperament domains that have received significant attention in childhood, adolescent and adult populations.Some of the most commonly studied domains include:
- neuroticism
- harm avoidance
- novelty seeking
- reward dependence
- perfectionism (subdomains have included: concern about mistakes, personal standards, doubts about actions, organization
$11,000 hospital bill from the emergency department
by Steve Sanders, DO“What am I going to do now Doc?” asked Mike, a down on his luck, 29 year–old recently unemployed truck driver, as he handed me his hospital bill.Mike was seen at our local emergency department on a Friday evening with complaints of indigestion. Earlier that day he and his wife Susan celebrated their second anniversary by splitting a store bought pepperoni pizza. ...
Choose your primary care physician with particular care
I told a friend what I did recently to get in to see a dermatologist and she was shocked.“You wrote a letter asking her to take you as patient?” “Wow!” “Yes,” I admitted. “I’d called her office for an appointment; she wasn’t taking new patients; I needed to resort to an over-the-top approach.”You see, I’d researched her (ok, I Googled her) and after reading her background, schooling, and patient reviews, ...
Medicare rates will be influenced by comparative effectiveness
From its inception, Medicare has been agnostic about the effectiveness of different treatments when it sets payment rates. Once a treatment is found to be "reasonable and necessary," Medicare establishes a payment rate that takes into account complexity and other "inputs" that go into delivering the service. But it is prohibited by law from varying payments based on how well an intervention works.This would change under a "dynamic pricing" approach ...
Cholesterol medication cost should not be prohibitive
Recently, I had a patient visiting me for the first time. He basically a "syndrome X" type of guy: middle-aged, overweight, high cholesterol, high blood pressure. He's not the most personally careful individual, with a history of domestic altercation, some prison time. Almost goes without saying he drinks too much and smokes cigarettes.Well, he wanted his cholesterol medication restarted since he has just now started receiving "insurance", MassHealth, Massachusetts' state ...
Redundant tests waste health care dollars
B12.Sounds simple, huh?1 letter, 2 numbers. One of the B vitamins. It's important in a number of body functions, particularly the nervous system and blood cell production. It's in pretty much all meats and vegetables, and multivitamins you can buy.To me, it's also a good example of what's wrong in health care.Let's take Mrs. Olde.She goes to her internist, and is complaining of feeling weak and tired. So he checks ...
Medical blog posts of the week, ending December 5, 2010
Here are the top posts from this past week, based on the number of times they were viewed.1. How a plumber charges more than a neurosurgeon. So there was a neurosurgeon who called a plumber for a house visit.2. A neurosurgical resident’s typical day. I’ve made some fairly outrageous claims about the workload of a neurosurgical resident recently. Seems like a reasonable time to lay out exactly ...
Hospitals should not ban access to social media
"Instead of focusing on treating him, an employee said, St. Mary nurses and other hospital staff did the unthinkable: They snapped photos of the dying man and posted them on Facebook."What can you say about an article like this? I bet there is not a single physician or nurse who are not reasonably conversant about the basic tenets of the health care privacy laws under which they practice.Stupid is as ...
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....
