American Medical News published an informative essay by Kevin B. O’Reilly on December 13, 2010, about errors in diagnosis and why doctors make them.According to Gordon Schiff, MD, associate director of the Center for Patient Safety Research and Practice at Brigham and Women’s Hospital, “The problem of diagnostic errors has gotten short shrift in the broader patient safety movement.” The article ...
March 2011
All Stories
How an EMR can be shockingly inconvenient for prescription refills
Let me start by confessing I’m something of a gadget freak. I was an early Palm Pilot adoptor, loved the iPod from the get-go, and need to avoid CNET, Engadget, Gizmodo, and David Pogue’s columns for the New York Times when deadlines loom.Not surprisingly, I embraced the shift to electronic medical records (EMRs) enthusiastically. While I acknowledge that sometimes EMRs ...
How social media will change mental health care
Social media is changing how we communicate and how we define "relationship." I was speaking to someone last week who said to me, "Social media isn’t coming it’s here!" He’s right.And while many voices in our professional communities are wary about social media, I see positive opportunities at every turn. Here are just 5 ways social media will change ...
How primary care will play a central role with health care reform
by Jeffrey L. CohenHealthcare reform used to imply just regulatory change. As time marches on, it also implies market change. Most pundits agree that, whatever happens to the healthcare reform law, whether or not it is found to be unconstitutional, the healthcare business community is unleashed. Change is afoot!If you follow my nahsaying on the ...
Medical professionalism affect how hospitals perform
In my estimation, professionalism has a lot to do with personal values. Thus, when individuals or clinicians are aggregated into groups, their personal values form the base of their organization’s values and culture.It’s not surprising to this sociological-thinking individual when studies show that the differentiating factors between low- and high–performing institutional and ambulatory clinical practices are an organization’s values, ...
Residents assisting with your surgery can save lives, but at a cost
When undergoing surgery, would you want interns and residents present, and perhaps, assisting in the operation?That's a question patients face when going to an academic medical center. Some won't mind the presence of house staff. Some will.A recent study provides some details on the outcomes.In a column by ...
Why medical students should be passionate about health reform
by Chris ChenRecently, I stood in the back of a boisterous, packed auditorium as each of our school’s fourth-years received their match letters and proudly announced in front of friends, family, and classmates where they would be headed for residency.As peers enthusiastically cheered each other, significant ...
Wimpy Parent Syndrome, and allowing your child to get mad and cry
I woke up in the middle of the night last night and I could not fall back asleep. I had a moment of brilliance laying there in bed. I had discovered a new medical disorder, Wimpy Parent Syndrome (WPS).For years I have been seeing it in clinical practice, but have been unable to put my finger on exactly what was taking place. Then the idea of WPS came to me and everything ...
Medical ethics at hospitals and medical schools in China
One of the topics I went to China to discuss was our medical school’s approach to teaching medical ethics.At Wuhan University they have a first-year course, but I was told by both the school administrators and some of the students that the material is dry and not seen of immediate importance, so students often skip the class.Here’s how ...
How much empathy is too much?
If you're sick, you need people to empathize with you, right? Maybe not.
Empathy is one of those words with a wide variety of definitions, especially in academic settings.From Wikipedia: "Empathy ... cover[s] a broad spectrum, ranging from feeling a concern for other people that creates a desire to help them, experiencing emotions that match another person's emotions, knowing what the other person is ...
A boxing fight physician experience
I received a phone call from the Broward Sheriff’s Office Police Athletic League Youth Boxing Program asking if I would help them out and be the fight physician at their upcoming youth boxing tournament.Their usual physician, a member of the Boxing Hall of Fame, had another commitment. However, he was willing to train me in advance and show me the ropes on the day of the event.State law and the ...
Accountable Care Organizations and the need to innovate
There is a lot of buzz over the creation of Accountable Care Organizations (ACOs) under the Patient Protection and Affordable Care Act (PPACA).An ACO is a network of health care providers and hospitals that collaboratively manage patient care and prospective budgets. Perhaps the biggest draw of ACOs is the potential to create innovative ways to improve quality and decrease costs. To ...
Why some EMR programmers think physicians are stupid
Every major industry is now computerized with one glaring exception; health care delivery. Thirty years after Steve Jobs began selling personal computers out of his garage, far less than 50% of physician practices and hospitals have converted to any form of electronic medical record.The vast majority of medical documentation is still done via paper and writing utensil just as it ...
How physician practices can compete with retail clinics
A reader recently wrote to me: "Brandon, in our area, we’ve seen a few retail clinics pop up. What can we do as a practice to let patients know that visiting retail clinics is not in their best interest?"We had along discussion. So I put together a summary of our conversation. Below is a rundown, more of less, of what I ...
What is stuttering, how is it treated, and The King’s Speech
One of the "Crown Jewels" of the 2010 holiday movie season may be The King’s Speech. The film centers on Colin Firth, who plays King George VI of Britain, and Geoffrey Rush as Lionel Logue, the speech therapist who helps the king deal with his stutter.Born Albert Frederick Arthur George, the second son of King George V, he spent most of his early years out of the spotlight, which centered ...
Does empathy mean giving patients what they want?
Recently, KevinMD.com picked up my post on empathy or should I say the lack of it. I received some engaging comments.One comment in particular caught my attention.The contributor for some reason equated “being empathetic” with “giving in” to patient requests presumably during routine office visits. Here’s a direct quote:
Give the patients what they want! Antibiotics are OK for colds. The patients want them. So ...
Why medical education needs to be more affordable
I was talking to a young man who is starting medical school this fall. His tuition at one of South Carolina’s newer schools will be $40,000 per year. That’s admittedly on the high end. On the low end, it runs a paltry $33,000 per year.And this is all after college, of course. He and others like him are taking out loans to the tune of $240,000 to pay for their ...
Implications of the surgical buy in when discussing informed consent
Pauline Chen had a post in the New York Times recently about surgical informed consent. Informed consent is an important part of the surgeon/patient communication transaction.Surgeon reviews the proposed operation, the rationale behind it, and the possible complications. For example--- a patient comes in with biliary colic. We describe the anatomy and pathology. We aver that surgical resection will lead to ...
Treatment for plantar fasciitis is expensive and ineffective
There are nearly 2 million cases of plantar fasciitis in the United States every year. As an orthopaedic surgeon, I’m quite familiar with this issue since nearly 20 percent of my patients come to me about plantar fasciitis.Although there is a surefire way to fix the problem, the current treatments aren’t really addressing the issue, and they are costing millions for those who suffer from the heel pain. Many are ...
Calling in sick serves as a reminder for compassion for this doctor
One of my Facebook updates on my private account was that I "have a love-hate relationship with interleukin-6. Yes, macrophages and T cells, I know you are doing your job, but how many proinflammatory cytokines does it really take to fight this thing? What's that? Be grateful you guys are even working? Oh, all right. I'll shut up and eat my soup now."Yes, I've been sick this week. It started ...
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....
