Until recently, I had but the vaguest idea of what hospice and palliative care and medicine (hpm) entailed.Until tuning into the #hpm Twitter group – hospice and palliative medicine – both words conjured a gloomy atmosphere of despair, grief, anger, pain en route to dying. I wondered at those working in the field: they must be a bit weird.I now know differently, ...
May 2011
All Stories
Why quality did not improve with hospital EHR implementation
The 2009 Health Information Technology for Economic and Clinical Health Act (HITECH) authorized incentive payments, potentially totaling some $27 billion over ten years, to clinicians and hospitals when they implement electronic health records in such a way as to achieve “meaningful use,” in terms of advances in health care processes and outcomes.But, are EHRs really "meaningfully useful" or are ...
Explaining why belief in pseudoscience is often evidence resistant
What links belief in tarot cards, UFOs and vaccine rejectionism? Yes, they are all forms of superstitious or magical thinking, but are there characteristics that predict who will believe in such nonsense? That's one of the questions that psychologists Marjaana Lindeman and Kia Aarnio seek to answer in their paper, Superstitious, magical, and paranormal beliefs: An integrative model.Lindeman and Aarnio postulate that believers in superstition, paranormal phenomena and ...
How skipping medical school lecture is preparing doctors for the future
by Chris ChenRecently in lecture, our professor wryly mentioned that in his many years of teaching, he had never seen so many laptops out as well as so many people taking advantage of the option to watch videos instead of attending class.That was fine with him, he commented, as long as people were learning—although he was skeptical that students on laptops would learn as much, ...
Direct primary care and a do it yourself health plan
Now that I'm well out of my reckless youth phase of my life, I try to preserve the efficacy of my brain. With my lifestyle, there's three actions I take to ensure the integrity of my brain.
- Always wear a bike helmet when I bike
- Avoid over-consumption of alcohol
- Avoid looking at doctor bills and insurance "statement of benefits"
The CME community is late to adopt social media
To my friends and colleagues in the CME community, I ask of you today a simple favor: involve yourself in social media.Immerse yourself in social media. Do what it takes to make social media a part of your, and your place of employment’s, daily routine.Do it.If you don’t know how ...
How the fear of SIDS keeps infant sleep positioners on the market
I hate infant sleep positioners. They are not safe or helpful. If you have one or know a family/friend who uses one for their infant, throw it out. Trash compact it. Stomp on it. Cut it up in bits. This is one rare thing you should feel good about putting in landfill.When I was first started in practice, I didn’t even know sleep positioners existed; I was shocked ...
End of life care is being influenced by politics
A version of this op-ed was published on April 12, 2011 in USA Today.
“Would you like to discuss your end-of-life plans today?”It’s a question that I ask my patients, although not as often as I would like. Talking about death may be uncomfortable, but it’s a conversation that needs to happen more often.We can never ...
Medicine’s paradigm shift is a microcosm of a trend occurring in society
In 1994 Jeff Bezos revolutionized how consumers shop. He founded Amazon.com.Shortly after, Ebay followed suit—solidifying a paradigm shift that has redefined shopping from an in-person to online experience. In 2004, Facebook capitalized on another trend: individuals were becoming more comfortable sharing personal information online. Interestingly, people did not wake up one morning and decide it would be convenient to shop from home, or that sharing pictures with their friends online ...
People feel anger and fear over our health care situation
by Aldebra Schroll, MDDuring the election season, the biggest loser appears to be civility. Anger, attack ads and name calling ruled the day. We are faced with enormous and complex challenges, issues not easily addressed in sound bites. Yet that is what we usually get from our representatives. I find myself asking are we not willing or able to do the hard work of examining ...
Does the Affordable Care Act give the American people what they want?
Now here's a novel idea. What if someone asked the American people, or a demographically representative group of it, what it wants from healthcare. That would be called "market research."Ask the public what it wants, listen carefully, and then give it to them.Turns out that the New York-based Commonwealth Fund has done just that.In brief they found:
- 72% of American adults believe that our healthcare system needs to be fundamentally ...
Dealing with a negative online review on a physician rating site
Whenever I speak about social media to doctors across the country, I often get asked, "How do I deal with a negative online review?"Here's one way not to handle it: sue the patient writing the review.There's a well publicized case in Minnesota, where a resident posted a screenshot of the situation ...
Physician responsibility and leadership is critical for ACO implementation
by Jeffrey L. CohenThe current fixation on Accountable Care Organizations (ACOs) is causing an enormous amount of two things: 1) talking, and 2) inactivity.Yes, the concept of delivering care in a manner that reduces or at least controls costs is important and interesting. Yet, the marketplace is replete with people and businesses that have adopted ...
Patient satisfaction should not influence how doctors are paid
Medicare is thinking of using patient satisfaction scores in part to determine bonuses to hospitals.According to Kaiser Health News,
... patient gripes soon will affect how much hospitals get paid by Medicare.The Centers for Medicare & Medicaid Services is finalizing details for the new reimbursement method, required by last year’s health care law. Consumer advocates say tying ...
How Twitter changed the life of this physician executive consultant
Every morning at 5:30 AM, I am at my computer scouring the Wall Street Journal, the New York Times, the Philadelphia Inquirer, and other news sources for articles about health care and wellness.These articles are then summarized in 140 characters with a link to the original article and tweeted. As of today there are 3700 followers of my informal aggregated health care news service, and I hear about it if ...
ACP: National immigration policy and health care
A guest column by the American College of Physicians, exclusive to KevinMD.com. by John Tooker, MD, MBA, MACP
There are over 11 million undocumented immigrants in the United States -- about 3.7% of the U.S. population -- according to a 2011 report from the Pew Hispanic Center.Although there are many reasons why immigrants elect to come to ...
The trend from drugs of value to medications of convenience
Pharmaceuticals are amazing stuff. You can bitch and moan about their costs, side effects, or the number of them you're taking, but what they've done to extend life and improve its quality is truly remarkable.And for all the bad raps they get, I salute the pharmaceutical industry, and those who work anonymously in labs around the world, to bring us these miracles.But ...
How a model of multidisciplinary team based care may save primary care
I didn’t expect to bump into "Max" on the streets."I was kicked out of the house by my wife," he sighed. Max shifted around on his feet, eyes puffy and cheeks pink."Did you start using again?" I asked.Max looked down and didn’t say anything. In the three years I had known Max, an alcoholic and former drug user, he had been clean. But recently he had started struggling. He lost his ...
A simpler coding system proposal with a focus on primary care
In a recent Wall Street Journal article, Barbara Levy, Chairwoman of the Relative Value Scale Update Committee (RUC), commented on the American Medical Association’s (AMA’s) decision to have minimal primary care participation on the RUC, saying the committee is an “expert panel” and not meant to be representative.Since the committee is made up of 27 specialists, one ...
Should nurses be fired for fatal medication errors?
Kimberly Hiatt was a pediatric critical care nurse who accidentally gave an infant a fatal overdose of calcium chloride last year.By accounts, it was a calculation error. A human mistake.After the incident, the hospital fired her.This past April, she took her own life.Although it cannot be concluded that the tragedy was directly responsible for her suicide, ...
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....
