by Daphne SwancuttLast year, I was part of a group judging hospital and healthcare organization marketing campaigns for a national awards program.I left disgruntled. Not because of the experience itself. The coordinators were great; the other judges were thoughtful, thorough and serious about their roles. There was a nice camaraderie.But the work we were judging was predictable and unmemorable. For me, at the center of “why” were three ...
February 2011
All Stories
What makes a good, competent psychiatrist?
A reader recently asked, how does someone find a good psychiatrist?Stated another way, the questions are:
- What qualities make a good, competent psychiatrist?
- How do I find a good, competent psychiatrist?
- How do I get my concerns heard about the direction of my treatment?
Hospitals need healthcare flight crews
by John LaBineWhat are the root causes of communication inefficiencies in hospitals? Hovering around any given patient/case are many players, each with a huge variety of demands for his/her time, attention and presence. And they know there are costs of certain outcomes (medical errors, stress, wasted nurse/physician time, etc.). Each caregiver has his own long list of things to do, places to be, people ...
When more aggressive care is better for patients
The recurring narrative among health reformers is that hospitals that provide more care raise health costs, but don't necessarily improve quality.This has lead to a backlash against so-called "aggressive" hospitals and doctors, with upcoming financial penalties to match.But the situation, as always, appears to be more nuanced than that.In her column in the New York Times, Pauline Chen looks ...
Difference between proactive and reactive medicine
Looking back, some of my biggest medical mistakes have been times when I was reactive rather than proactive when faced with a clinical problem. A doctor may have to be one or the other depending on the circumstances, but knowing when and which approach to take is one of the harder skills of medicine, taking time and experience to master.What do I mean? Here are some examples from my field.Treating ...
Teamwork helps doctors with patient safety
One of the central tenets of the patient safety movement is that modern medicine is a team sport. Unfortunately, its players – particularly physicians – were trained and socialized to be free-spirited individualists. We need the Celtics of the 80s; what we have is a collection of young John McEnroes.
While this theory has been generally accepted, there is less agreement regarding how to change things. When I speak about
Top 5 NICU tips from a preemie parent
Heads up folks in the Neonatal Intensive Care Unit (NICU), parents of premature babies want you to succeed more than you may realize. It is just hard for them to communicate this through the fog of stress and exhaustion that has consumed them for countless hours, days and even months.So here is a little insight into the parent mind and what they want you to know about what it is ...
Why physicians should sell their practice
There are many reasons to sell your practice. Physicians attempt to sell their practices for various reasons. Some physicians are reaching the age of retirement, while others are looking to add a partner, who, in time will take over the practice as a whole. Whatever the reason, attempting to get a quality price for the practice can, at times, be a challenge in this current ...
Insurance status when arranging follow-up from the ED
by Katherine Fullerton, MDAs a pediatric emergency physician in Northern Virginia, I have the good fortune to work with an amazing staff in a busy pediatric emergency department (ED) that sees a wide range of patients with both minor and life-threatening illnesses. Of note, we have a wonderful electronic medical record (EMR) that allows us to see past visits, lab tests, and medical problems.My last shift was an overnight ...
Shared decision making to determine implantable defibrillator need
Implantable defibrillators are truly life saving devices that have prevented sudden death in thousands of patients. No bigger than an iPod nano, the device can sense when the heart is beating irregularly and deliver an electrical jolt that kicks it back into proper rhythm. But like so many of medicine’s miracles, defibrillators are not always used on the right patients. According to a study published recently in the ...
Your physician may be thinking about suicide
by Heather Fork, MDVery few of us are untouched by the tragedy of suicide. Whether in our own family, through friends, or one of our colleagues, most of us have been affected by suicide. We are often left alone, with the painful questions,"Why?""What could we have done differently?"Now we learn from a study by Shanafelt et. al, in the Achieves of Surgery, that one in 16 surgeons had suicidal ...
Why this doctor loves electronic medical records
A recent post in the Wall Street Journal's Health Blog noted that a study found electronic medical records don't improve outpatient quality. The authors of the Archives of Internal Medicine article, Electronic Health Records and Clinical Decision Support Systems, correctly points out that we should be skeptical and "doubt [the] argument that the use of EHRs is a "magic bullet" for health care quality improvement, as some advocates ...
The hysterical patient during a busy ER shift
by VeronicaB, MDWe’ve all had that hysterical patient. The one that comes in during a busy shift. Grabbing at their head, their chest, their abdomen. Yelling out that they are in pain.You know the one. They makes the nurses’ eyes roll. They add to an already chaotic scene. Other patients stop to watch as the gurney rolls by.You debate how long you’re going to wait to ...
ASA: Patients demand physicians provide anesthesia care
A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com.by John F. Dombrowski, MD
When it comes to receiving anesthesia or pain-related care, patients overwhelmingly demand the care of a physician anesthesiologist over other non-physician providers. In a recent survey conducted by AMA, 70 percent of public respondents believed only a physician should administer and ...
When in the ER with abdominal pain, adjust your expectations
Abdominal pain is the bane of many emergency physicians.Recently, I wrote how CT scans are on the rise in the ER. Much of those scans look for potential causes of abdominal pain.In an essay from TIME, Zachary Meisel discusses why abdominal pain, in his words, is the doctor's "booby prize." And when you consider that there are 7 million visits annually by people who report abdominal pain, that's ...
ZDoggMD: Hard Doc’s Life (Hospitalist Anthem)
Hospitalist, comedian and rapper ZDoggMD recently released his latest, Hard Doc’s Life (Hospitalist Anthem). Enjoy.
Our health is worsening at a time when medicine has never been better
With little notice, UnitedHealth released a major paper recently considering diabetes in America.First the bad news: a large portion of our population either has the disease or is pre-diabetic.Now, the really bad news: diabetes and pre-diabetes rates are going to soar in the coming decade, according to the analysis, in part driven by the obesity crisis.I’ll return back to the study in a moment, but it underscores a ...
Smart money tips for young doctors and medical students
Adapted from Generation Earn: The Young Professional’s Guide to Spending, Investing, and Giving Back.by Kimberly PalmerYoung professionals today aren’t exactly known for our financial expertise. Dubbed "generation debt," we’re stereotyped as over-spending shopaholics, easily enticed by credit cards, lattes, and the latest smartphone. But that reputation, it turns out, isn’t fair.Yes, we have more student loan debt than previous generations, and average credit card debt among twenty-five- to thirty-four-year-olds ...
Why your doctor’s education is unique
What makes your doctor’s education unique from that of other health care providers?Recently, I was sitting in on a lecture by one of my favorite physician-teachers (certainly my favorite neurologist). I’ll call him Dr. Deeds (for his resemblance to a character from the movie, Mr. Deeds). He was giving a sort of broad, generalized lecture to prepare us for a series of lectures on neurodegenerative diseases ...
Onsite clinics within a competitive health care marketplace
The recent explosion of interest in onsite clinics – not just by employers, but by health plans, hospital systems, public health programs, and others – is anything but just another health care fad. At once, clinics’ growing popularity signals purchasers’ weariness with an intransigent, self-interested health system, as well as their guarded optimism about a better way.Today’s best clinics are single-mindedly focused on what works best for the patient and ...
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....
