Health insurance companies seem to be pretty happy with the Affordable Care Act. And why not? Health reform has left the private insurance industry in place, albeit with stricter regulations.Family physician and editor of Placebo Journal Doug Farrago, profiled last year in the New York Times, gives his take on the situation, with his regularly scheduled Placebo Television's Medical ...
March 2011
All Stories
How astroturfing disease affects patients
One of the top hits that comes up on the Oracle of Googlius for "astroturf" is for the original company, now renamed SYNLawn, but still proudly stating, "We invented synthetic grass," which is what astroturf is. More recently, this already synthetic term has become a verb, as in "astroturfing."My favorite of all credible information sources on the web, Wikipedia, has this to say about it:
Astroturfing denotes political, advertising, or public relations campaigns that are formally ...
ACP: Benefits, harms, and quality in high value, cost conscious care
A guest column by the American College of Physicians, exclusive to KevinMD.com.by John Tooker, MD, MBA, MACP
Last month, my KevinMD.com column introduced a concept paper published in the Annals of Internal Medicine by Owens and colleagues titled High-Value, Cost-Conscious Health Care: Concepts for Clinicians to Evaluate the Benefits, Harms, and Costs of Medical Interventions. This ...
Reductionism and daily medical practice
The results of the application of reductionism in modern biomedical research and practice has been nothing short of miraculous, but while wondrous for some things, reductionism alone is incomplete.The basic premise of reductionism is that by breaking down (or "reducing") complex biological or medical phenomena into their many parts, one is much more likely to understand a single cause and devise a cure.Historically, the invention of the microscope, the defining ...
Life at a needle exchange
I went to needle exchange to hang out. You may be asking yourself what a soccer mom from the burbs is doing perched on a folding chair in the parking garage of 101 Grove on a dark November night, surrounded by syringes.I was there as a guest observer because I’m working on a series of articles about mortality and homelessness, as part of an Annenberg California Health Journalism Fellowship I ...
Overeating is a behavioral problem, not a surgical one
Overeating is not a surgical problem.This may seem to be a statement of the obvious, but the solution to a behavioral problem is not surgery. Overeating is not a surgical problem -- it is a behavioral one. The problem is not because the stomach is too big and needs to be made smaller. It is a function of how ...
KevinMD posts of the week, ending March 27, 2011
Here are the top posts from this past week, based on the number of times they were viewed.1. A surgeon on those who understand murderers, rapists and child molesters. Recently I was involved in a discussion with a guy that was explaining how we should understand criminals.2. Being a physician is not just about medicine. I hope that physicians will band together, tear down these economic barriers, devise ...
Reduce variations in cancer care that do not improve outcomes
Here are a few facts to enliven the next public discussion about death panels.An analysis of Medicare claims by researchers at Dartmouth University found that nationwide nearly one in three cancer patients died in hospitals or in intensive care, the most expensive form of end-of-life care and contrary to most patients’ wishes. Nearly half are not ...
Screening for Alzheimer’s is a diagnostic bridge to nowhere
Doctor, do you really want to know if your patient has a chronic, slowly progressive, fatal, debilitating disease for which you have no effective intervention?Patient, do you really want to know if you have a chronic, slowly progressive, fatal, debilitating disease for which medicine has no effective intervention?If you two together (along with family members) answer yes to that question, then the florbetapir-assisted PET scan of the brain for amyloid ...
Vaccination and the killers of yesterday now overcome by modern medicine
It’s only been a little over fifty years since vaccinations became routine for the childhood killers like polio, measles, mumps and whooping cough. People my age and older had no choice but to suffer through childhood infectious diseases given how effectively and quickly they spread through a community.Most of us survived, subsequently blessed with life long natural immunity. Some did not survive. ...
Guiding patients online is a new physician responsibility for the digital age
The following op-ed was published on February 22nd, 2011 in AOL News.If you woke up one day with an earache, you could call your doctor's office for help. Or you could do what the majority of patients do today and Google what to do first.Type "earache" into your Web browser and the results can vary wildly. Search engines can return results saying that an earache can be from the common ...
Food
by Joanne Wilkinson, MDI have a stress test nearly every year. I do this because my mother dropped dead of a heart attack when she was thirty-six, and now I am thirty-five.They stick EKG leads on me, and for weeks I have blotchy red circles on my skin where it's reacted to the adhesive. I run on ...
3 resident interviews for family medicine
I interview approximately 60 prospective physicians for medical school over the course of the year and 40 physicians who are applying for the residency program. The pre-med students (almost all of whom are the age of my children) tend to have pretty good interview skills and are trying very hard to get into medical school ("I've wanted to be a doctor for as long ...
EHR and the solo primary care physician
Recently, I went to see a doctor about an EHR. Dr. Greene (not his real name) is a typical solo primary care physician in a typical small town in the typical middle of nowhere. Four hours from the closest airport and miles and miles of winding roads, cow pastures and corn ...
Developing innovative solutions to battle cancer and disease
There isn’t a country on this planet where there isn’t someone dreaming of curing cancer. What if there was something even more spectacular than curing cancer? What if you could stop cancer right in its tracks and eliminate its existence. Prevent it. Squash it before it starts.Vincent Tuohy, PhD, an immunologist at Cleveland Clinic, may be on a path toward ...
Salaried doctors are less engaged in the health reform debate
The Disease Management Care Blog would like to introduce you to two alternate realities.In the first reality, physicians own the bricks and the equipment that make up their clinics. They hire and fire their office staff members. They don't mind fee-for-service payment systems, because the harder they work, the greater the reward." Recently, as I listened to leading researchers grapple with the question of how to design a feasible study of intervention for postpartum depression, I held in my mind an image of a particular moment in my office.I was sitting on the floor with 10 month old Madison and her mother Nancy, who was struggling with postpartum depression. Nancy spoke of the strain Madison's refusal to take a bottle and her ...How can research capture the complexity of tiny moments?
Giving the patient and family precious minutes to say goodbye
An excerpt from Doctor Confidential: Secrets Behind the Veil. by Richard Sheff, MDDorothy suffered a second heart attack, leaving more of her heart muscle damaged and causing her to slip into congestive heart failure. There was not much we could do to reverse the many blockages in her arteries. Yet she was cheerful, as were her four children.One morning Mary came to find me. “Dorothy says ...
Expand health care systems in a way that is professionally satisfying
You try to do the right things to sustain your business. You set high standards for delivery of quality care, follow the basic tenets of marketing, align your organization so that everyone in your firm "gets it," avoid unnecessary expenses but identify important growth opportunities and prudently invest so that you remain competitive and serve your patients well. But can you afford investing in the assets you require to become or ...
Restricting nuclear cardiac stress testing in favor of stress echocardiography
Dr. William Follansbee is the chairman of the American College of Cardiology/American Society of Nuclear Cardiology (ACC/ASNC) task force on non-invasive cardiac imaging and the director of nuclear cardiology at the University of Pittsburgh Medical Center Cardiovascular Institute.He recently published an editorial in the Pittsburgh Post Gazette in which he criticized the local Blue Cross/Blue Shield carrier, Highmark, for restricting the use of nuclear cardiac stress testing in ...
Kevin Pho, MD
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How patient satisfaction can kill
Patient satisfaction is all the rage. Medicare is beginning to tie patient satisfaction scores with hospital reimbursement, and doctors across the country...
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How I approach ovarian cancer screening with patients
Ovarian cancer screening clearly touches a nerve. No one doubts that ovarian cancer is a devastating diagnosis, often found when the disease...
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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....
Physician
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The analogy between baseball hierarchy and medical systems
From age six through high school, I played baseball. Playing baseball ended, rather abruptly it seemed, when I went to college, but...
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Saving patients from Internet health information
Lately, I get the feeling that I’m doing something wrong. I’m supposed to form a partnership with my patients. My patients are...
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Understanding what patient centered care really means
There was nothing the professor despised more then the syrup that oozed out of his partner's lips when dealing with patients. He...
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A letter of thanks to my organ donor
I have tried to write a letter of thanks but don't know what to say or even how to begin. I don't...
Patient
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Why patient engagement is reciprocal
It is said that "turn around is fair play." So if providers (physicians, hospitals and other health care professionals) expect patients to...
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Question the price of drugs and medical procedures
Hypertension was the trigger that forced medical cost awareness to the forefront. My doctor decided that with my rise in blood pressure...
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In love there is a life giving force
Here is a toast to the miracle of love. Not to the romantic, chocolate, dance club nightlife type of love. Not warm...
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How to get ready for death
No one wants to die. Even people who want to go to heaven don't want to die to get there. And yet...
Policy
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America has a medical care system not a health care system
As Americans we believe we have the best healthcare system in the world. But think again, it’s really not the truth. We...
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Reading between the lines of breast cancer treatment studies
Between the Susan G. Komen-Planned Parenthood debate and the study on treatments released by the Journal of the American Medical Association recently,...
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Why are labor and deliveries closing?
Labor and deliveries are slowly closing across the United States: California, Pennsylvania, and Ohio. In regional areas where there have been no...
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America has a health care paradox
We have a real paradox in American healthcare. On the one hand we have exceptionally well educated and well trained providers who...
Tech
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Why physicians don’t want patients to have their cardiac device data
There is a groundswell of discussion concerning patients demanding to have direct access to data derived from their implantable defibrillators and pacemakers....
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Impersonal communication on the Internet fuels cyberbullying
In the old days, bullying used to consist of name calling or physical aggression from someone in a position of power over...
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Health IT and doctors: A framework for successful partnerships
We are on the front lines of the healthcare revolution along side our patients and our colleagues in technology. We have firsthand...
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Break out of the prison of the American health care delivery system
Speaker after speaker at the recent Care Innovations Summit in Washington, DC concluded that increasing the quality and decreasing the per-capita cost...
Social Media
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Why doctors should embrace Google+
Lots of pressure out there for you to be on Facebook and Twitter, right? The ultimate question, though, is how are you...
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Using Twitter to deliver health improvement messages
I have decided to spam for public health. Phone calls, text messaging, and even apps have been shown to help improve health...
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Addressing comments on your medical practice’s Facebook page
Does your medical practice allow anybody to post links and comments on your Facebook page? The short answer is yes. We do....
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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...
