"Doc, do I really need the colonoscopy? It’s going to cost me $1500. I have a $750 deductible."That’s a tough question to answer. In reality, I’ll know the answer after the test is done.If the colonoscopy is completely normal, then the answer is no, you did not need the test. It’s not a complete loss. You have the peace of mind of knowing that you don’t have ...
June 2011
All Stories
The tragic irony of pharmaceutical coupons
As a primary care physician in private practice, I have my own little taste of celebrity.Every day attractive people come to my office seeking time to speak with me and collect my autograph. They fawn over my partners and I, and bring us food for lunch, and will invite us to the nicest restaurants in town for dinner. These people also used to bring gifts, until they were barred from ...
Reasons why your doctor is running late
It may not be rabbit season or duck season but it definitely seems to be doctor season.Physicians are lined up squarely in the gun sights of the media, government agencies and legislators, our health care industry employers and coworkers, not to mention our own dissatisfied patients, all happily acquiring hunting licenses in order to trade off taking aim. It’s not enough any more to wear a bullet proof white coat. ...
Tips to make the most out of your national medical meeting
Here is the latest edition of Handy Hints for a National Meeting. The original version was written in 2005 (editions have been more often than yearly).My first national medical conference was a whirlwind of new ideas and experiences some of which I was not necessarily prepared for.General
- If you are bringing family or a significant other, spend some time with them.
- If you don't bring family or a significant other, leave something nice for ...
Resident responsibility at a Level 1 trauma center
Debates over resident autonomy are nothing new. Informed patients are sometimes reasonably concerned about just how much responsibility for their care will be delegated to their doctor's trainees. Care within academic medicine, especially acute inpatient care in a public system, can and does sometimes mean going a whole admission without meeting the attending physician presumably responsible for your care as a patient. At least in my limited experience. This as ...
Physician consolidation places health reformers in an ironic dilemma
One of the major efforts of the Affordable Care Act is to consolidate physician groups, so they can be modeled after integrated health systems like the Minnesota's Mayo Clinic or California's Kaiser Permanente.According to health reformers, these integrated systems can reduce variation in care, which improves quality, and potentially reduces costs.There's been a major effort to re-organize hospitals and physicians under guises of Patient Centered Medical Homes and
ACP: ACOs – On to the final rule
A guest column by the American College of Physicians, exclusive to KevinMD.com. by John Tooker, MD, MBA, MACP
Recently, I commented on cost saving, quality, and care coordination requirements in the proposed rule that physician practices will likely need to meet to be eligible for additional Medicare payments.The public comment period on the proposed rule for the ...
Bias in top tier academic journals
Venture-capital guy Bruce Booth has a provocative post, based on experience, about how reproducible those papers are that make you say, "Someone should try to start a company around that stuff":
The unspoken rule is that at least 50% of the studies published even in top tier academic journals – Science, Nature, Cell, PNAS, etc… – can’t be repeated with the same conclusions by an industrial lab. In particular, ...
2 changes to cut Federal health care expenditures
If we're serious about cutting Federal health care expenditures over the long term, here are two changes that will do just that.1. Requiring HHS to negotiate with pharma for Part D drug costs would reduce annual expenditures by over $20 billion.As I've noted repeatedly(but unfortunately few in the mass media have), Part D's perhaps the biggest deficit problem we have - the ultimate unfunded liability is now over $20 ...
The future of vaccines for infectious diseases
In concert with sanitation and clean water supplies, vaccination has been the most cost effective means of preventing infectious diseases.Most vaccines have been inexpensive, easy to administer (albeit objected to by the recipient’s arm!), safe and effective. From when I was a child until today the number of new vaccines has multiplied dramatically. This will only continue at an accelerated pace in the coming years. In the future many ...
Why your medical practice should adopt social media
"Twitter? I don’t have time for that, besides, my life is boring; nobody wants to hear about my boring life." This is a common response when I talk to people about social media.One of the reasons I think many have a hard time persuading docs to adopt social media, is because docs don’t understand what they can do with social media or how they can use it for ...
Matters of the heart
She whispered to me with bulging eyes of urgency, "something is not right, I’ve been in pain all night."Her chief complaint was chest pain. She had a routine work-up and some care with little relief. The news came that all of her test results were normal. Her body appeared tense, she looked panicked and afraid. At bedside, the attending suggested endoscopy offering that her pain ...
Why the annual physical exam is essential to both doctors and patients
I have listened to health economists debate the value of an annual physical exam. Is it cost effective? Does it prevent disease? It doesn’t matter. It is an essential part of the development and continuation of the doctor patient relationship.The annual physical exam is a form of benchmarking. It allows the doctor and patient to review all the pertinent aspects of your health history ...
A new organization for primary care
Recently, the Board of the American Academy of Family Physicians (AAFP) announced that, for now, it would continue participating in the Relative Value Scale Update Committee (RUC), the secretive American Medical Association committee that, through a longstanding relationship with the Centers for Medicare and Medicaid Services (CMS), has heavily influenced physician reimbursement.At nearly the same time, Medicare announced that it will go broke in 2024, a decade ...
Difficult testing decisions for parents with premature babies
Many people think that tests (blood work, x-rays, scans, etc.) mean their doctor is doing something constructive and working hard to figure out what is wrong. But tests are a double-edged sword.When I trained most diagnoses were derived from careful history and a physical exam. Perhaps because our province did not have funds to have enough CT scanners and we didn’t have an MRI, those tests were on a ...
5 strategic tools to solve our healthcare woes
It’s getting scary.We are facing, before the end of this decade, a bifurcated future. 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 swarming our doors with insurance cards—if we don’t pull a rabbit out ...
A medical student doing clinical rotations at the VA
I do my clinical training at the VA. It is an interesting population because the people are all pretty similar (this will likely change as the army changes, but for now, its just a lot of old guys, and a lot of heart problems).In our last few weeks, we finally switched to doing histories and physicals on patients (this really just means that we ...
Using video games to fight childhood obesity
"I don't study because it gets in the way of my video game time"-15 year old patient.Sorry mom and dad, video games are here to stay. In my clinic, this is a topic of discussion every day:
"How many hours of screen time does Mikey get every day?" I ask. "Tell the truth", Mom says looking at Mikey. "brmfbr mbbrm," says Mikey looking away. Mother turns to me with the familiar look that ...
Make the most of the time spent with a doctor to minimize patient frustration
A lot of people express frustration when visiting their doctor’s office. They don’t feel they are listened to, cared about, or have their issues adequately addressed. If this sounds familiar, it could be that your doctor is evil, or what’s more likely, he’s trying to practice medicine within a difficult system.Due to decreasing reimbursement and increasing expenses, many doctors are forced to see more patients just to keep their ...
When TV news departments partner with local medical centers
It's not a new phenomenon. In fact, it's troubling how old and widespread it is.But when TV news departments partner with, and sell news time to local medical centers, you can take the Radio-Television Digital News Association's code of ethics and throw it out the window.Blythe Bernhard reports in the St. Louis Post-Dispatch: "In St. Louis, the latest media/hospital partnership is a campaign from Barnes-Jewish Hospital and local ...
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....
