With my extensive health care background, many people have asked for my opinion during the health reform debate. My response has been that the only way to really "reform" the system is to blow it up and start over, which isn't politically feasible.After delving deeper into the current legislation, I believe that we are going to see something ...
April 2011
All Stories
Overuse of heart stents and the response of Abbott Labs
"Someone needs to take this writer out and kick his ass."The quote leaped out at me from a New York Times article.Now, maybe I’m a little sensitive about using physical threats to try to silence writers, since I am a writer. Maybe I am especially sensitive about threatening to kick someone’s ass for writing about healthcare. To my eyes, the quote stood out as emblematic of the tumor ...
A confident, independent, empowered woman is a force to be reckoned with
I am infinitely blessed by The Girl Effect. As I look back through the generations of my family, I see it rolling toward me, through me like a wave.I am sure it started even before my grandmother stole her parents’ car with intent to drive by herself from Austin to Chicago to see the World’s Fair in 1924; I just don’t have much history to work with prior ...
A medical student goes back to the anatomy lab before residency
by Christopher BayneI still remember the first time I entered the anatomy lab. Heck, I remember the first time I entered the hallway leading to the anatomy lab.I wouldn't say an anatomy lab "smells." That is, an anatomy lab doesn't smell "bad": the odor can't be defined as good or bad. Really, it's neither. But the scent is distinctive. If you've been ...
The Relative Value Scale Update Committee (or RUC) impact on health care
On Kaiser Health News, Barbara Levy MD, the Chair of the AMA’s Relative Value Scale Update Committee (or RUC), published a glowing defense of the RUC’s activities.Her article extols the work of the 29 physician volunteers who, "at no cost to taxpayers ... generously volunteer their time, supported by advisers and staff from more than 100 national medical specialty societies and health care professional organizations."She fails to mention that the ...
Patients can lift doctors up during a challenging day
I will be leaving my current practice in a couple months and starting work at a different clinic in a different city. This type of transition really brings to light how much I had really gotten to know patients on a personal level. This became surprisingly clear not too long ago.One day, I saw a patient on my schedule that had historically required more of my emotional energy. We often ...
After the ACO regulations: Accountable care organization answers
by Jeffrey L. CohenPatient centeredness, fragmentation and value based purchasing are just a few of the terms that are peppered throughout the newly proposed regulations for accountable care organizations (ACOs).The healthcare reform law established the Medicare Shared Savings Program for It was a dimly lit room, up on the sixth floor. I am not sure why they would not fix the light in that corridor. Even during the day, I would find this area poorly lit.Maybe it was not the light but the grim atmosphere of oncology floor. Some of the patients there had terminal illnesses but they would still act like they had decades to live. You would be ...Doctors are trained to prevent death, but not deal with death
Treatment of chronic pain puts doctors in a no win situation
First do no harm.Treat every patient with respect and dignity.These are values I try to live by and incorporate into my daily work. Treatment of chronic pain is the scenario that puts me and every practicing primary care physician in a no-win situation regularly in the office. To try to make physicians feel more comfortable treating pain most states have tried ...
Real life example of medical school debt
by Pierce HibmaWant to really understand the reality of US medical education debt? Then allow me to pull back the curtains to expose the financial monster that awaits me after I earn my MD.I am a third medical student at a private medical school in the Midwest. Fortunately, I was able to graduate from college without any financial debt ...
Cyberchondria repackaged as new local TV health news
So I'm watching the 6 pm local news last night and see a piece on KARE-11, my local NBC affiliate, about "a new buzzword called 'cyberchonrdria'" -- used to describe people who "Google their symptoms online and then worry over the multitude of results and possible diagnosis ..."But it's clear from what they posted online that this ...
How to make money off the mentally ill
by Dennis GraceRecognize the title? It’s from Steve Martin’s 1978 stand-up album, Wild and Crazy Guy. Martin lists How to Make Money Off the Mentally Ill as one of the many books he’s written. The joke is supposed to be on Martin himself, inviting us to ask, "What kind of disreputable jerk takes advantage of the mentally ill?"
But it’s just a ...
How academic physicians are being used as live bait for journalists
Here’s something little known outside of the small circle of industry marketers, academic docs, PR flacks, and medical journalists: pharmaceutical and device companies (or their PR agencies) regularly offer to arrange interviews with well-known academic physicians to talk about new trials, drug approvals, and other items of obvious interest to the companies involved.I receive these sort of invitations all ...
KevinMD posts of the week, ending April 3, 2011
Here are the top posts from this past week, based on the number of times they were viewed.1. Treatment for plantar fasciitis is expensive and ineffective. There are nearly 2 million cases of plantar fasciitis in the United States every year.2. Why some EMR programmers think physicians are stupid. Every major industry is now computerized with one glaring exception; health care delivery.3. Wimpy Parent Syndrome, and allowing ...
Can ACOs curb health costs and improve quality of care?
Accountable Care Organizations (ACOs) have received considerable attention recently, and are the new "hot topic" in healthcare delivery policy circles. They are the latest response to the need to do something to stem the runaway inflation of healthcare costs, while maintaining or improving measurable health care quality.According to a ...
MKSAP: 28 year old woman with easy bruising and bleeding gums
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 28-year-old woman has a 3-month history of easy bruising and bleeding gums. She feels otherwise well. Medical and family histories are unremarkable, and she takes no medications.On physical examination, temperature is normal, blood pressure is 110/70 mm Hg, pulse rate is 64/min, and respiration ...
The futility of prolonging life and the benefit to patients
In case you have not heard about it, there is a very gut wrenching court case St Louis Park, MN. A doctor in the hospital system is going to court to replace a patient’s wife, Lana Barnes, with a substitute decision maker, claiming that she is making futile and reckless decisions to prolong her near-vegetative husband's life.He has ...
Patients using Facebook for health information
Do you use Facebook to look for health information?If you said "yes," and use social networking sites to research your health, you could be in the minority, or majority, depending on which study you read.Recently, a survey released by the ...
Debt prevents health insurance from providing more health care access
I read an article in the New York Times that underscores my argument that health care insurance does not and never will equal health care access.Our federal and state governments are being crushed by debt. There are many reasons for that debt, and addressing the reasons for the debt are a necessary aspect of decreasing the debt. For example, if a family household had overdrawn its checking account by ...
Dangers of strict adherence to clinical guidelines
Medical guidelines are well on their way to becoming the Law of the Land. Dr. Rich over at The Covert Rationing Blog featured a recent post that highlighted this point.When a study published in the Journal of the American Medical Association showed that nearly 23% of patients receiving implantable cardioverter-defibrillators (ICDs) received them under circumstances that did not match up with the recommended “guidelines” for doing so, this ...
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....
