I read an interesting link via Reuters about how students have developed a smart phone application with a microscope attachment to diagnose malaria.The article shows a picture of a child at risk somewhere in Africa.This is a great idea, and one that can go a long way to help people who really need it. But the last word from the project’s software engineer in the article was the one that was ...
April 2011
All Stories
Why denying ER care to patients is bad policy
It's commonly thought that rising emergency department expenditures could be curtailed if we could eliminate non-urgent visits.In Washington state, for instance, lawmakers are proposing limits to the number of times Medicaid recipients can go to the ER.But what, exactly, is a "non-urgent" visit? And how ...
A physician assistant writes to the doctors of America
by David Mittman, PAI’m a physician assistant, having graduated from PA school over thirty-six years ago. There is angst in my profession, but many PAs don’t openly voice it. I felt compelled to write to you because I still believe in my profession, and I believe in yours, as well. Sometimes I think it might be time to embrace a new belief system. I’d like ...
A market driven success story of participatory medicine
The United States does not have enough money to give all medical and healthcare products and services to everyone who wants them, whether or not they need them, right now, especially at the prices that those in the medical-industrial complex wish to be paid.Thus, we now have, and have always had, rationing.Anyone who does not agree is in some zone ...
Should a hospitalist be given more information on hospital costs?
In Today’s Hospitalist, Jeremy Graham, DO discusses implications of research he’s published about hospitalists and costs: How much is that bed on the ward? Hospitalists are clueless about patient charges.Not surprisingly, hospitalists, like almost everyone in the hospital, have no idea what anything costs.That’s no real shock, as Graham points out:
It’s often hard for hospitalists to know these charges, ...
An ACO must make the patient experience meaningful
Accountable Care Organizations (ACOs) are supposed to be provider-led (physician groups +/- hospitals) and, they are supposed to inject a new accountability, at the provider level, for the value of services delivered.You know the old equation. Value=Quality/Cost. Those of us inside the health policy “beltway” know this mantra well. We have been talking about it for years (decades, really).I spent almost ...
The exhaustion of emergency physicians, and its toll on patients and family
When I advise students about how to choose a specialty, I suggest that they seek out advice from physicians who are at least 10 years out of residency and leading the type of life they hope to have in the future.It is difficult, and perhaps impossible, to anticipate in your late 20s or early 30s what practicing a certain specialty will be like when you are 40, 50, or 60.Find ...
How to be heard by your psychiatrist
How do I get my concerns heard about the direction of my treatment?On the surface, it seems easy. Just tell your psychiatrist what you want him to pay attention to.On the other hand, there are many reasons why it not so simple.
- Many psychiatrists diagnose a patient's illness after a 45-50 minute interview, without doing any tests to rule out potential medical causes of ...
Arm amputation from a rare sarcoma
Harold was 51 years old and needed his left arm amputated. A year ago he noticed some swelling in his forearm and went to his primary care doctor.An MRI showed something. It was small and hard to define, hard to categorize, probably a collection of blood, but there was an outside chance it could be a sarcoma, a tumor originating from muscle ...
A moral imperative to address the costs of training our doctors
by Andrew M. Ibrahim and John A. BrockmanDespite the landmark progress of recent healthcare reform, it missed the mark on long term cost control by failing to address medical education.Radical changes are needed in the way we finance tuition and how we teach our students.While last month a new graduating class of medical students celebrated their A medical malpractice system that reduces errors and improves quality
The Affordable Care Act does very little to reform the medical malpractice system.It only allocates $50 million to various pilot projects around the country.A recent piece in the New England Journal of Medicine provides more detail. It appears that, instead of capping non-economic damages, many of the projects have a
How to discharge a patient from your practice
Occasionally, you may encounter patients who you no longer wish to treat. Reasons for ending the physician-patient relationship may include chronic non-compliance, rudeness to office staff, or non-payment of bills.While these patient behaviors can affect the interactive care-giving process, they may also identify patients with a propensity to file a claim against you. To help reduce the risk ...
Specialty hospitalists joining forces with the generalist hospitalists
I recall with fondness many meetings in 1996-98, when the hospitalist field was still in its infancy. We had invented a new medical specialty, and our gatherings were vibrant and purposeful.We were determined to remake the healthcare system, learn from each other’s triumphs and disasters, and chart a course that would improve the care of hospitalized patients. These ...
First, do no harm
by Alison BlockIt's one of my earliest memories: I'm wrestling with my brother, and I'm losing, because I'm five and he's seven, and he's bigger and stronger than I am. So I bite him, hard.Instantly I know I've crossed some sort of line, and I employ my most primitive defense mechanism, shouting out, "He bit me! Jon bit me!" I feel shame, because I am old ...
The future of primary care in Accountable Care Organizations
A recent blog post in Health Affairs proclaimed The End of Internal Medicine As We Know It. What the article is really asking is the future of primary care in the world of health care reform and the creation of Accountable Care Organizations (ACOs).While doctors should be naturally concerned about change, I don't completely agree with this ...
Primary care providers are needed to support health reform
by Vanessa HurleyLike many American patients, the American health care delivery system suffers not only from acute crises, but also from a chronic, poorly managed and debilitating disease.Primary care is in trouble. Not only are primary care physicians (PCPs) fleeing the profession in droves, but fewer and ...
Osteoporosis in patients with HIV
At the age of 56, Jules Levin felt pretty invincible, despite being HIV positive. He went to the gym regularly and controlled his disease well by taking his antiretroviral medicines every day.Then he slipped one day while on vacation and broke his wrist.He underwent an operation to insert pins in his bones and needed to wear a cast for a month, keep his arm ...
For physician asset protection, leverage qualified retirement plans
Medicine is a profession fraught with legal risk. According to an AMA survey for the period 2007-2008, for every 100 doctors, there were 95 lawsuits.The survey also reveals that physicians 55 years and older are eight times more likely to get sued than physicians 40 years and younger.Not that they make eight times more Much has been written on the death of private practice.A lion's share of the reason is economic. It's becoming financially unfeasible to run a private practice and practice medicine at the same time. The increasing bureaucracy and regulations will only get worse.And many doctors are responding by becoming employed by hospitals or by large, integrated health practices, and giving up some independence.Some will continue to resist this trend. But ...New doctors tend to become employed physicians
Integrating social media into everyday health care
The desire to be touched by and connected with others is among our most primal and, until recently, our most untapped qualities.There have always been powerful signs of it. Those of us who remember exchanging letters with distant friends and family know the palpable anticipation when a letter arrived.Years ago I visited the senior center at Pan American Hospital in Miami, an institution beloved by the “abuelos” (grandparents), mostly elderly ...
Kevin Pho, MD
-
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...
-
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...
-
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...
-
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
-
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...
-
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...
-
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...
-
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
-
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...
-
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...
-
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...
-
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
-
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...
-
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,...
-
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...
-
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
-
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....
-
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...
-
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...
-
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
-
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...
-
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...
-
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....
-
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...
