by Jeffrey L. Cohen In the 90s, physicians were told “The sky is falling. You have to find a tree to stand under or you will be crushed.” The “trees” were things like IPAs and PHOs. The future outlook was bleak. All patients were going to be part of some system with which the physician would have no input or control. Decisions would be made on purely ...
February 2011
All Stories
KevinMD posts of the week, ending February 13, 2011
Here are the top posts from this past week, based on the number of times they were viewed.1. Female physicians make less money than male doctors, here’s why. By spending more time with patients, female physicians are financially penalized by seeing less patients during the day.2. Pelvic exam by a medical student for the first time. They say you never forget your first “real” patient. Mine was ...
How to become a licensed, board certified doctor
I am licensed to practice medicine and surgery in Georgia. But that doesn’t mean I should, or that you ought to let me—at least not the surgery part. I’m actually pretty good at carving a turkey, but that’s pretty much the only kind of surgery that I’m qualified to do.Don’t let the license fool ya, I’m no surgeon. So what, exactly, does a doctor have ...
Why a patient waited 80 hours in the ER for placement
by erdoc85, MDWhen I arrived for my shift this am, I was passed off the following patient.EMS responded to a 50-year old guy laying alongside the Interstate. He had no idea who he was or how he got there. He complained of knee pain and shoulder pain. They were kind enough to tote him to my ER where his evaluation revealed that he had a fracture ...
Strategy and support is needed to quit smoking
Tobacco is the single biggest cause of preventable death and disability in the United States. But nicotine is highly addictive, and quitting the cigarette habit can be extremely tough.L.J., a 55 year old man who gave up smoking after 35 years, proves that it can be done. In L.J.'s words, he was "sick and tired of being sick and tired." But he didn't do it alone; his success depended on ...
Health records need to be online to improve health and save money
I exchange thoughts with healthcare IT people on a daily basis over at Twitter. So many of them seem perplexed at why we patients look at putting our medical records on the internet with trepidation.Then along comes this video from Elizabeth Cohen at CNN. In a matter of minutes, she was able to pull up one of her CNN colleague’s medical records, his kids’ ...
Medication lists need to be shared in a meaningful way
Recently, I spent a few days in California when both my parents ended up in the hospital with different issues. They're home, settled and doing well at this point.Just as when I first wrote about experiencing healthcare with my family, there are important lessons to learn about this trip.As we strive to achieve meaningful use and create health information exchange in the US, the ...
A $20 co-pay and the value of an office visit
‘Tis the season for upper respiratory infections, and since I couldn’t tell if what I had was garden-variety crud or crud that needed antibiotics, I went to the doctor. I handed over my $20 co-pay at the reception desk, where they have an electric candle burning, a tradition when a soldier is off to war. Their soldier is my family doctor, who’s in Afghanistan as a colonel with the Army ...
Should the FDA regulate medical apps?
by Chad HyettThere’s a storm brewing around the regulation of medical apps. The FDA has been skirting the issue for too long and it’s having detrimental effects on the potential for such apps. Recent FDA hearings have revealed that the agency is watching the apps stores for potential alarms and that they are drafting guidance. Whatever that means.The FDA needs to make a decision quickly if ...
Does screening and treating high cholesterol save money?
A commenter (I believe a physician) on one of my posts wrote the following: "I can prevent heart attacks and strokes (caused by atherosclerosis – "blockage") in people (minimal cost) who have no symptoms. If I wait for their heart attack or stroke – it costs a whole lot more."The implication is that screening and treating high cholesterol saves money in the long run. Unfortunately, the truth is the opposite. ...
Physicians’ voices heard through AMA advocacy activities in Washington, DC
A guest column by the American Medical Association, exclusive to KevinMD.com.by Ardis Dee Hoven, MD
This week, hundreds of physicians and medical students converged in Washington, D.C., for the AMA’s annual National Advocacy Conference. The current and future physicians learned about and discussed key legislative issues, including how new policy will impact physician practices, and heard from officials including CMS ...
What is job satisfaction for physicians?
"I can't get no satisfaction," sang the Rolling Stones. And so it goes for many of the physicians who contact me.I was struck by the fact that the word "satisfaction" in connection with work was used in two separate conversations with physicians recently.It got me curious. Just what is job satisfaction?How is it defined by the folks who study this kind of stuff?And why is it so hard to come ...
A person’s attitude toward their illness has a huge impact
In classic Aristotelian drama, there comes a moment when the main character is presented with an insurmountable obstacle, be it physical, psychological, spiritual, or otherwise. The nature of the obstacle forces the character to make a choice: a critical choice, an act of free will that determines the glide path of the rest of the story, irrevocably altering its arc.So it is with the arc of illness, a medical drama ...
Pelvic exam by a medical student for the first time
by Paul B. KubinThey say you never forget your first "real" patient. Mine was a woman who didn't need a pelvic exam, but who got one anyway.Next door, minutes later, my second patient provided another personal first: a male genital and rectal exam, also, without need. Medical students like me begin training by practicing the basics on one another–listening to heart sounds, and looking into each other’s ears and eyes—but eventually, every ...
How anchoring leads to misdiagnosis
Anchoring refers to the tendency to latch on, or anchor, to the first symptom or bit of data and fail to consider the full spectrum of information, leading to misdiagnosis. Recently, we have received several cases where an anchoring error was triggered by a mistake in translating the patient's words into clinical terms.Case study #1Henry Solomon, FACP, currently the medical director of Pfizer Global Pharmaceuticals, was for many years a ...
Ode to a family practice mentor
"Doctor Pete" was fifty-one when I started my residency in family medicine. "Family practice" we called it then, and I think I liked that name of our specialty better. It implies continued learning and brings to my mind visions of practicing a down-to-earth craft.I had interviewed with his predecessor the summer before and was really impressed with him and the program. I ranked it as my first choice in the ...
Build EMR functionality into the exam room
In 2003 our practice had a rare opportunity to build EMR functionality into the floor plan of our new office. I thought I had the perfect design for the EMR-based exam room.The spring-loaded, cantilevered arms used to hold monitors and keyboards in ICU rooms would be perfect. Fitting a touch screen monitor to a standard PC would allow the provider to work without a mouse. I could turn the screen ...
Tips to help patients save money on prescriptions
As a primary care doc, I have compiled several tips to help patients save money on prescriptions.All the prices quoted in the following examples are from Costco.1. Patient assistance programs (PAP). Try to get free meds from the pharmaceutical company that manufactures your medication. Most of the time this service is only offered if there is not a generic available for your medicine. I heartily recommend you check out NeedyMeds.org and ...
The golden hour and the difference between life and death
An excerpt from Surviving the Emergency Room.by Ron Clark, MDWith regard to emergency trauma care, a few minutes can mean the difference between life and death. This first hour of definitive medical care is called the "golden hour." It is usually this first hour where the patient’s medical fate is sealed. In general, the faster that medical care is rendered, the better the medical outcome will be.The old adage ...
Love is the secret ingredient to health
Last year's Mayo Transform 2010 symposium was a two-day excursion into the world of science, data, design, and the secret ingredient to health: love.Patch Adams, MD, kicked things off in grand style. If you’ve never seen him speak, treat yourself to a hit of his energy:In 1971, he and his compatriots opened a 24×7 hospital in a six-bedroom house to address every ...
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....
