I sat at the checkout desk in my practice last week for the first time and as always, it was a revelation. If you haven’t worked your check-in and check-out desks recently, I highly recommend it.An insured patient that I checked out was shocked when I said the charge for her visit was $100. She said, “But he was only in the room for ten minutes!” I was briefly at ...
January 2011
All Stories
Top stories in health and medicine this morning, January 7, 2011
This series is brought to you by MedPage Today, Putting breaking medical news into practice.Welcome to Morning Rounds, where I preview the top health and medicine stories of the day.1. RA in Men Associated With Mortality Risk. Men with rheumatoid arthritis were more than twice as likely to die over a seven-year period as their counterparts in the general population.2. NICUs May Be Source of Donor Organs. ...
YouTube CPR videos a reflection of health care social media
There are plenty of instructional videos on YouTube -- in fact, I use them not infrequently to show patients educational videos.But who uploads them, and are they medically reputable?Like most social media sites, YouTube's quality of information is variable. And no where is that more apparent than in CPR videos. There are videos that use sex to teach CPR (a facetious take), or rap (a legitimate educational video ...
Why your health insurance medical appeal was rejected
One thing that many residents do not know is that there are more benefits to becoming a board certified physician than just that plaque on the wall. One of these benefits is that ability to pick up a few extra hours of work here and there doing consulting for the multitude of companies that would like the opinion or expertise of a physician.In some cases this consulting can be about ...
Will health care melt down, like the mortgage industry?
Clearly, one issue dominated the election this past fall: the economy, and more specifically the lack of jobs.So I would like to pose a few questions and ideas on just how government actually performs in creating economic growth and in kick starting job growth. I don't necessarily have the answers, but I'm real good at asking questions.Did government assisted mortgages help the economy? ...
Secrets of good health website design
I interviewed Tania Schlatter, one of the best designers I know and a guest-lecturer for Web Strategies for Health Communication, about color, imagery, and other aspects of health website design.Lisa: How is the design of health websites different than for other types of sites?Tania: The design of any site goes back to the goals of an organization and what people coming to a site need. Healthcare consumers can ...
MKSAP: 74-year-old man with gradually progressive dyspnea
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 74-year-old man is evaluated for a 5-year history of gradually progressive dyspnea and dry cough without wheezing or hemoptysis. For the past 2 years he has had pain and occasional swelling in both knees. He has not had fever or lost weight. He smoked one ...
A national license to practice medicine
Why are you, Dr. Jones, licensed to practice medicine by the state of New Jersey? And, if you live in Ewing Township, right across the Delaware River from Yardley, Pa., why can't you practice medicine in Yardley?In these United States, each of us physicians must obtain and retain a license in each state in which one practices.Since we may have gone to a medical school in any state, or even ...
Radiation risks from CT scans are underestimated by patients
Radiation from CT scans needs to be better taught to patients, as their risks are real.It's the best way to help curb the rampant ordering of these tests. Unfortunately, we aren't doing a very good job.In a study from the Annals of Emergency Medicine, most patients underestimate their risk from radiation.When asked to compare the amount of radiation from a CT scan to the amount that Hiroshima ...
Social media fears doctors face
It took me most of 2010 to weight up the pros and cons of starting a blog.I already have a busy, well-established rheumatology practice and our clinic has grown steadily through word-of-mouth. There’s also always enough jobs on the to-do list without adding another regular task. Is it worth the risk? What is the risk?In my first blog, I’ve tried to explain why I ended up agreeing to ...
Growth of retainer medicine follows simple economic principles
Recently, I had vigorous discussions about retainer medicine. In both discussions the "opposition" opined that every time an internist (or more recently family physician) leaves the CMS/private insurance grid patient access decreases. They imply that outpatient generalists have a moral responsibility to continue seeing too many patients and spending inadequate time with each patient.The growth of retainer practices follows simple economic principles. Patients want to buy physician time; physicians are ...
Doctors can reduce malpractice by being better people
My father, although retired, is a general and thoracic surgeon, triple boarded in critical care, who ran a trauma unit. My brother is a pretty successful lawyer. Whenever I visit them, inevitably at least one night ends with the three of us around a table, and the two of them going at it about who is to blame for the malpractice system.My father, of course, blames the lawyers; my brother ...
Measuring health outcomes is important but needs caution
I sat at home with a sense of relief. I had just finished my first month of residency - a grueling inpatient hospital month where I was pushed to new limits.I now finally had my first “golden weekend” (meaning I had both Saturday and Sunday off). More importantly, I had survived my first month without any patient deaths on my service. Given how sick people are when they come to ...
An ACO primer and get started on forming an Accountable Care Organization
In early 2011 Department of Health and Human Services will be issuing guidelines for the formation of Accountable Care Organizations (ACO’s) for CMS (Medicaid and Medicare).I know of several organizations looking into this type of organization as they anticipate the new guidelines. There seems to be great anticipation of the guidelines in various health care publications that I have recently read. On December 18, 2010 on the Health Affairs website ...
How you can reduce preventable mistakes in your medical care
There are nearly 1.5 million Americans who suffer each year from preventable mistakes. A report by the Institute of Medicine estimates that as many as 98,000 people die in U.S. hospitals each year as the result of medical errors.Most of these errors are related to drug mistakes. That’s the bad news. The good news is that your doctors and hospitals are trying to reduce these errors by using by using ...
Government and health insurance intrusion penalizes efficient doctors
I wish I knew how to express myself. I wish I knew how to put this into words. How the direction of things has just become depressing. How each day makes me wonder how we got to where we are today. And I think back. Back to the beginning.I think back to my childhood. And how I looked up to my father ... the physician. How he died when I ...
Start thinking about health literacy in a broader framework
I have a patient who I will call Antonia.Antonia is in her early 70’s. She came to the United States from Guatemala many years ago, but never learned to speak much English. This doesn’t cause her much of a problem; her community is small and tightly-knit, so she doesn’t have much need to speak English in her home or her neighborhood. And she has a large family—children and grandchildren and ...
KevinMD.com recent media mentions, January 2011
I’d like to thank various media outlets for recently citing KevinMD.com.HemeOncToday: Social media and physicians: A good pair, but guidelines for use needed
“We needed a way for physicians to offer commentary quickly for patients to know how medical news affects them,” Pho told HemeOnc Today. “Whenever a drug is recalled or there are changes in cancer screening recommendations, for example, I can provide that context on my blog, which ...
Patients will choose their medicine, based on their doctor’s advice
TEDMED is a truly extraordinary conference in San Diego, a fall sibling of TED talks focused on medicine. TED talks are just 18 minutes long, chosen and designed to blow your mind. They don’t all hit that level, but many do.True to form, the opening session was a mind-blower. 26 year old Charity Tillemann-Dick stepped out on stage and belted out a soprano aria. I thought that was ...
Pain contracts threaten the doctor-patient relationship
Doctors today are wary about treating chronic pain.One of the main worries is precipitating fatal opioid overdoses. Indeed, according to the CDC, and reported by American Medical News, "fatal opioid overdoses tripled to nearly 14,000 from 1999 to 2006 ... [and] emergency department visits involving opioids more than doubled to nearly 306,000 between 2004 and 2008."Requiring chronic pain patients to sign pain contracts is a way to mitigate this ...
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....
