Your staff members are your most important (and costliest) resource. Have you invested in them? Do they know what is expected of them? Have you asked them if they have what they need to do their jobs?Optimizing staff performance is a process. It starts with a plan, not the formal performance review.You can't do a successful performance evaluation without establishing accurate standards against which the employee's performance can be ...
June 2011
All Stories
How positive thinking affects patients with serious illnesses
I was sick the other day. A bout of gastroenteritis that had me vomiting with diarrhea for 24 hours and feeling weak for another 48. I felt rough for a while, but got over it pretty quickly. My family gave me just the right amount of care, and avoided me appropriately because I get grumpy when I am sick.Had they dared approach me with the suggestion that my state of ...
Surgeons with depression and suicidal thoughts don’t get the care they need
When you think of surgeons, you likely picture heroes deftly using scalpels to pull patients back from the brink. But sometimes, as much as surgeons want to save someone, they simply can't. A new survey finds that some of the men and women doing amazing feats of medicine in the OR don't think quite so highly of themselves.
Suicidal thoughts could be the result of depression and job burnout. ...
The challenge of pre-authorization for an elective procedure
by Grayson Wheatley, MDIt was supposed to be a routine office visit for my patient.Unexpectedly, it turned into a real-world health economics lesson for me, the treating physician. The old adage "listen to your patients; they will always give you the answer" became exceedingly true in this case, even when it dealt with an issue beyond a medical diagnosis, such as lack of transparency ...
A transparent process to allocate resources based on evidence
The New York Times reports on Washington state’s efforts to "to determine which medical devices and procedures Washington will cover for state employees, Medicaid patients and injured workers, about 750,000 people in all."An expert panel, appointed by the state, is getting national attention, writes the Times, "in part because its process is public and open. . . [and] provides a living laboratory of the complexities of applying evidence-based ...
Should doctors be scared of government mystery shoppers?
The government is going to find out about the primary care physician shortage for themselves.They're resorting to "mystery shoppers," used frequently in other industries, to see what the wait times really are for a new primary care doctor. As mentioned before, come 2014, there will be over 30 million newly insured patients looking for a doctor. This will further stress a system short of primary care resources.Doctors, as ...
One more thing: Works for Apple, but killed Google Health
Google Health is dead.There have been plenty of post-mortems as to why, ranging from the fact that it's not social enough (uh ... no), to the realization that only a minority of practices have electronic medical records, yet alone a patient portal that can incorporate PHRs like Google Health.I'll chip in with my own reason -- it suffered from "one more thing" syndrome.PHRs today aren't seamlessly incorporated ...
Closing the communication gap between patients and physicians
I lived in Japan in 1991. When I was having a conversation with someone, they would always nod their head as if they completely understood the message I was trying to convey.It turns out that was not the case. The nodding was a sign of respect. When I began to inquire if they understood what I was trying to say — it became clear that the answer was usually no.Many ...
Reasons why medical students burn out and become depressed
As I finished my 24-hour call recently, I was reminded of a 2009 study revealing a decline in empathy as medical students transition from their mostly-didactic second year to third year, which is essentially an apprenticeship in the hospital with lecture as an afterthought. I began my third year with what most would argue is the most difficult rotation, surgery, and my experiences over ...
How doctors can shape the health reform narrative
With the roll out of the Affordable Care Act and perhaps more significantly the approach of the 2012 elections, public discussions of healthcare reform has been drowning in an alphabet soup of ACOs (not to be confused with the above ACA), CMS, SCHIP, and RUVs, just to name a few.The challenge is twofold. Most of these plans/systems/agencies deal with how to better pay for a seriously flawed system. ...
ACS: The breast cancer screening debate continues
I am sitting here wringing my hands that so much has been made of some studies reported recently at a major radiology conference which suggest that the impact of the breast cancer screening guidelines released by the United States Preventive Services Task Force (USPSTF) in November 2009 has either been good or bad on doctor ...
When learning pathology, real color is difficult to forget
I'm starting to understand why graphic pictures on cigarette packs are so effective.We are studying pathology, which is the human body gone wrong. The photos--taken from autopsies--are gross, meaning their structures can be seen with the naked eye. Cirrhotic livers are littered with bumps and scars, the heart dies and leaves a band of black tissue behind, the lungs are stretched so far that they can't pull in the ...
MKSAP: 75-year-old man with a draining chronic ulcer on the foot
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 75-year-old man with type 2 diabetes mellitus is evaluated in the emergency department for a draining chronic ulcer on the left foot, erythema, and fever. Drainage initially began 3 weeks ago. Current medications include metformin and glyburide.On physical examination, he is not ill appearing. ...
Differences between obstructive and central sleep apnea
In sleep disorders, obstructive sleep apnea is the most common condition that’s seen, but a significant number of people with obstructive sleep apnea will also have central sleep apnea.Central sleep apnea is thought to be a condition that’s associated with a number of different neurologic problems, as well as heart or kidney failure. During the night, people with central sleep apnea stop breathing when signals in the brain that ...
KevinMD posts of the week, June 26, 2011
Here are the top posts from this past week, based on the number of times they were viewed.1. 5 strategic tools to solve our healthcare woes. The way things are going now—with the economy wheezing, doctors bailing, chronic disease rising fast, boomers sliding out of the Viagra years into the Depends years, reimbursements getting squeezed ever tighter, Medicaid sputtering on fumes, and 30 million or more new people soon ...
How a day in the emergency department is a microcosm of real life
I imagine the world as a vast, boundless frontier weathered by our swirling human emotions and complicated energies--hurricanes of intense heartbreak and tornadoes of joyous, unbridled celebrations, with every weather pattern in between. Sunshine and rain included.If I could gather this world, foolishly believing that I could sweep my arms and hands through the unsuspecting air to collect a smaller, more-contained version of reality, I know with absolute sureness that ...
Team based care in health reform needs patient involvement
The following op-ed was published on June 7, 2011 in USA Today.More than ever, I find myself fielding questions from patients about the health care reform law. The most common one is, "How will reform affect me?" It's a complicated question, with a different answer for each patient. But as the law's full effects unfold, one of the more significant changes will be in how patients interact with their ...
Frustration when a government does not provide the necessary health care
Year: 1988Setting: Electricite de France clinic at Daya Bay, China Position: Resident physicianA Japanese encephalitis epidemic has struck southern China and I am in its midst at Daya Bay where Electricite de France is building a nuclear plant for the Chinese government. As the resident physician for the company, I see the local employees and their families. They all get immunized against the disease with the inactivated virus Biken vaccine, ...
New fields in general surgery and the rise of the surgical hospitalist
As medicine adapts to the 21st century, new specialties arise.General surgery is seeing two new fields emerge. One is "Acute Care Surgery," which encompasses three facets of general surgery — emergency surgery, critical care and trauma care. The other is the concept of a surgical hospitalist. That is, a surgeon works only in a hospital and has no office or private practice. The idea is similar to the medical ...
Doctors are asking whether the physical exam is becoming a lost art
The physical exam – looking into the eyes and throat, taking the blood pressure, sounding the chest – is part of the process of medical diagnosis. It’s one way a physician attempts to determine the cause of a patient’s complaint.In recent times, doctors have asked themselves whether the physical exam is becoming a lost art. It’s been replaced by an array of laboratory tests and high tech machines that ...
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...
