You are in the middle of a deposition.Plaintiff’s lawyer asks, “Do you blog or tweet?” Before you answer, consider this. If you blog or tweet and respond in the affirmative, I believe anything you have ever posted would be subject to discovery by the plaintiff. Oh, you post anonymously? Would you then lie under oath and say you do not blog or tweet? For many physicians, admitting that you blog ...
January 2011
All Stories
Marcus Welby and the relentless growth of specialization
In the very first episode of the TV series Marcus Welby, MD, our hero delivers an after dinner speech to a group of young interns. As he’s introduced, he hastily scribbles the title of his talk and hands it to the hospital director: “The future of the general practice of medicine, if any.” The year was 1969.In his introduction, the director somewhat tactlessly remarks that many “eminent specialists” have addressed ...
Focus advance care planning on outcomes
by Drew Rosielle, MDThe Annals of Internal Medicine recently had a timely discussion of advance care planning, trying to focus the discussion away from helping patients specify what what they'd want, and more towards laying the groundwork for appropriate decision making by loved ones whenever that time comes. Good one for the teaching file.That is, instead of thinking of ACP as patients pre-specifying "if ...
Patient safety lapses in the hospital
Earlier this month, at the third annual American Medical Student Association Patient Safety and Quality Leadership Institute, I listened with sympathy -- and, frankly, a certain amount of discomfort -- to a fourth-year medical student's account of his grandmother's recent hospitalization at a well regarded inpatient facility in New York City.Admitted with an initial diagnosis of pneumonia, Cole Zanetti's grandmother languished in the hospital for almost four weeks.As the medically ...
Help your doctor formulate an accurate differential diagnosis
Last night, I turned on "House," a TV show about a physician who is in charge of a team of highly specialized diagnosticians. Every week the team solves a difficult to diagnose medical case by working through an exhaustive differential (DD) diagnosis list. While the show is absurd to the extreme (as the team of physicians almost kills the patient each week), eventually the correct ...
Patient advocacy is essential in health insurance appeals
An active 61 year female, who has been in my practice for 30 years, developed strange aches and pains and abdominal symptoms. My evaluation turned up nothing.I then asked for help at the University of Miami rheumatology and gastroenterology divisions. With the help of a brilliant local gastroenterologist and rheumatologist, and after a trip to Johns Hopkins Medical Center and the Mayo Clinic, collagenous ...
Having insurance does not mean you get health care
There's no question the Accountable Care Act needs work - everyone agrees on that.So let's talk about the specifics - what needs fixing, why, and how can we get those fixes passed.First, let's understand how bad our current system is. Some who want to repeal and/or replace the ACA continue to publicly state we have "the best health care in the world."While that may - or may not - have ...
KevinMD posts of the week, ending January 30, 2011
Here are the top posts from this past week, based on the number of times they were viewed.1. Useful things to buy during medical school. The following is a brief list of some of the things I think have been useful and worth their money in my first two years of med school.2. How MD anesthesiologists have become victims of their own excellence. If you can’t force or ...
Social media should be embraced by health care
The intersection of social media and privacy has made an older generation, and even some of my own generation, incredibly uncomfortable. There is talk of present and future consequences. Lost jobs, lost income, civil judgments, loss of respect/embarrassment, even criminal penalties for all that you put online. There is an idea that the blurring of intimate boundaries will come back and bite a whole generation.Being online has responsibilities and consequences, ...
Healthcare costs can be reduced with emerging business models
Here’s a simple key to parsing the future economics of healthcare. We have been trying for over 30 years to control healthcare costs. And there is little evidence that any of these efforts have had much effect. For decades the rise in healthcare costs has been consistently several times higher than the general inflation level.There have been dozens of schemes used in various parts of the industry — inpatient, ambulatory, ...
KevinMD keynote from the TMA 2011 Winter Meeting, watch it live
I will be giving the keynote at the 2011 Texas Medical Association Winter Conference at 9:30am Eastern, Saturday, January 29.My talk, entitled Medicine in the Age of Social Media, will be streamed below. It's an honor to speak, and I thank the TMA for giving me the opportunity to do so.classid="clsid:d27cdb6e-ae6d-11cf-96b8-444553540000" width="360" height="228" codebase="http://download.macromedia.com/pub/shockwave/cabs/flash/swflash.cab#version=6,0,40,0">
Where an extremely premature baby immediately receives care matters
When you think about giving a premature baby the best possible start in life, it is important to consider the hospital where they are born. The care an extremely premature baby receives immediately after birth makes a big difference in outcomes.A premature baby who is less than 32 weeks gestation or weighs less than 1500 g at birth should be cared for in a level III NICU. These babies also ...
Integrity, discipline, respect: Using kung fu to control your eating
About seven months ago, I began training kung fu with my family. Our classes are intense and require the students to really pull out our personal best. Periodically our instructor will remind us by shouting out, "Train like a black belt!" when she catches us being sloppy or less than enthusiastic. Her exclamation inspires me to squat a little lower in my horse stance, amps up my intensity, and focuses ...
The Tdap vaccine and the rise in whooping cough
I recently went to the American College of Physicians Chapter Meeting in Seattle and came away with a lot of great information, including a significant change in immunization of adults against pertussis (whooping cough).When patients need a booster of tetanus immunization, we often give it in combination with a vaccine to protect against pertussis. As you may know, tetanus is a life-threatening infection by a bacteria that can cause severe ...
Haggling with your doctor about the costs of care
"How to Haggle With Your Doctor" was the title of a recent Business section column in the New York Times. This is one of many similar directives to the public in magazines, TV and Websites urging us to lower the high price of our health care by going mano a mano with our physicians about the price of tests they recommend and the drugs they prescribe. Such articles provide simple, ...
What’s next for doctors if pay for performance fails?
I recently pointed to a BMJ study concluding that pay for performance doesn't seem to motivate doctors. It has been picking up steam in major media with TIME, for instance, saying, "Money isn't everything, even to doctors."So much is riding on the concept of pay for performance, that it's hard to fathom what other options there are should it fail. And there's mounting evidence that it will.Aaron Carroll, a ...
The void between physicians and administrators in hospitals
In a hospital setting, administrators love to work with physicians; they make sure whenever a new system is being formulated and implemented, this is discussed with a team of physicians, as they are also an integral part of success. All physicians work with each other in harmony and synchronicity.Cardiologists never step on each other's toes, radiologists call admitting doctors for any bizarre findings and hospitalists notify the primary about their ...
Seeing a family physician at work is valuable for medical students
I recently headed off to a reception for students from the new Pacific Northwest University of Health Sciences in Yakima, WA who are spending their third year of osteopathic medical school in Puyallup, WA doing rotations with the physicians in our community. I’ve had a student with me recently, and it brings back memories of my third year in med school, and how things have changed. It also leads me ...
Electronic medical records and pay for performance don’t improve care
Electronic medical records and pay for performance are among the ways health reformers are going to improve patient care.It's a fundamental shift in how doctors practice, with more practices adopting expensive EMRs. And with the advent of Accountable Care Organizations, doctors will soon be compensated in part by quality measures.But will they work? Well, the jury's still out.Two articles caught my eye recently.The first, from the WSJ's Health Blog, reports ...
Solving the puzzle of patient compliance
by Dennis GraceI recently received a message from the Center for Connected Health. I must admit the opening of the letter really put me off. It asked:
How do you solve the puzzle of patient compliance?I responded to the gentleman who sent the invitation with:
Well, you might start by calling it something less offensive. Patient compliance? The phrase assumes “patient” as direct object rather than subject of participatory medicine. We ...
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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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...
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I learned the value of listening to the patient
William Osler famously said (among other things): “Listen to the patient. He is telling you the diagnosis.” I was doing my obstetrical...
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Repeated experiences of shaming are not good for a young child
The little boy, who looked to be about two, darted away in a fit of giggles. His young mother, who seemed thoroughly...
Patient
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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...
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How I became a hospice volunteer
People often ask me how I became a hospice volunteer. For the record, nobody is more surprised than I am. You know...
Policy
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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...
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The problem of insurance gaps in cancer patients
Why are cancer organizations waiting until it starts to rain before they suggest buying an umbrella? “Join my Medicare Advantage plan and...
Tech
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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...
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Google knows more about certain diseases than physicians ever will
Professor Gunter Dueck, is a calm and eloquent german mathematician who’s also the CTO of IBM Germany. He studied mathematics and philosophy...
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Robotics can revolutionize the delivery of medical care
Robotics has the potential to revolutionize the delivery of healthcare. It can help extend the delivery of information, expertise and clinical care...
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....
