American medicine overuses its technologies and innovation triumphs and way underutilizes old fashioned compassion, discussion and good common sense.Over the past twelve weeks I have given weekly updates of medical megatrends in the fields of genomics, stem cells, transplantation and vaccines. These advances are the representation of innovations and entrepreneurship in biological, computer and engineering science. They are exciting advances and offer promise of hope ...
July 2011
All Stories
Medical education cost is a health policy imperative
Whenever I talk about the cost of medical education, I like to bring up this chart. It starkly illustrates just how expensive it is to train a doctor in the United States, compared to Canada and France.
New York Times contributor Pauline Chen wrote a column on the issue recently. Most doctors graduate with a debt exceeding $150,000, and ...
How dabigatran is an atrial fibrillation paradigm shift
My iPhone vibrated with an urgent message that read: "Please call … the INR on your atrial fibrillation patient scheduled for cardioversion is too low. He is on that new blood thinner, Pradaxa. What do you want to do?"I responded, sounding like an expert: "It’s ok. Pradaxa thins the blood adequately, it just doesn’t change the INR."She astutely responded, "How do know the blood is thin? What if ...
A dermatologist take on the Facebook Kawasaki diagnosis story
The Facebook Kawasaki diagnosis story is a wonderful one. In case you’ve not heard, a 4-year-old boy with a fever and facial swelling was misdiagnosed by his pediatrician. When his mother went to Facebook to share photos of the poor, pumpkin-headed child, three of the mom’s Facebook friends told her that he had Kawasaki disease. They implored her to take him to the ER. She acquiesced and took her ...
How health care will change in community health centers after reform
37 years ago, at the very tail of the civil rights movement, my community health center (CHC) was established in Oakland to fill an unmet and urgent need. A growing population of immigrants were settling in downtown Oakland and had few choices for health care. Community surveys conducted by local leaders confirmed that residents received significantly less health care than the rest of the population largely due to a ...
People accuse doctors of not doing enough, or doing too much
Medicine is never an easy field. People accuse doctors of not doing enough, or doing too much.There are no easy answers. We're caught between doing what's best, without putting the patient through too much, and doing what's needed to protect ourselves from legal action.Let's take Mrs. Summer. She's a nice 78 year-old lady I saw in the office last week.Earlier this month she hurt her back. So she saw ...
Why primary care is due for a renaissance
At a time when half of primary care doctors say they'd leave medicine if they had an alternative and the NY Times reports on a family physician who can't give away his practice this hardly seems like the obvious time to claim that primary care is positioned for a renaissance. However, if there's one thing savvy investors have demonstrated, when everyone says to invest in something that is usually the time to ...
Political approaches on how to slow Medicare’s escalating costs
How to slow Medicare’s escalating costs has been the big health care policy issue recently, with Republicans and Democrats offering competing proposals, each part of broader plans for reducing the federal deficit—projected to be $1.5 trillion this year, with the government borrowing 40 cents for every dollar it spends.Unfortunately, neither the Medicare proposal of Representative Paul Ryan’s House Budget Committee, nor that offered in response by President Obama, can ...
How telemedicine helped a stroke patient
My attending doctor (a neurologist) and I were sitting at the nurses' station discussing a patient who had presented with a seizure when his pager beeped."Hold on, I have to call this in", he said. I listened to snippets of the conversation. "How long has he been like that?" "How far away is the helicopter?" "Alright, let me run to my office and set up my equipment."He hung up ...
Suggestions for physicians trying to determine the value of Twitter
Twitter, like most social media, is evolving rapidly. Even though most physicians are not directly familiar with Twitter, more are building an awareness and curiosity each month. This post is written mostly for those of you new to this tool or giving it consideration.The AMA recently posted an article entitled Physicians on Twitter and here is a synopsis of their study: "The study focused on 5,156 tweets ...
Speed dating techniques to screen medical students
Speed dating to find the next generation of doctors? Well, yes, in a way.The New York Times recently wrote about the admissions process at Virginia Tech Carilion, where students are chosen as much for their interpersonal qualities as their academic aptitude.Using the so-called "multiple mini interview," prospective medical students are ushered in a series of 9 interviews, each designed to ...
Physicians on the debt ceiling: Not a bang, but a whimper
Living in Washington, DC, I can not help but notice that many interest groups are up in arms about the debt ceiling debate (or more aptly, brinksmanship) going on between the Congress and the President.AARP is running a full-length TV ad that carries a stern warning to politicians: hands off Social Security and Medicare, or else.The energy lobby has a radio ad that direly warns: raising taxes on them would ...
Implications of Nebraska’s ill-conceived fetal pain law
Danielle and Robb Deaver are living proof of the awful reality of Nebraska’s ill-conceived “fetal pain” law. The law, which took effect last October and is the only one of its kind in America, prohibits abortions in the state after the 20th week of pregnancy. It is based on the discredited notion that a fetus may feel pain at that stage of development. Physicians who break the law face ...
Celebrity endorsements of prescription drugs
Boniva continues to use Sally Field as a celebrity spokesperson for their product but as John Mack pointed out, should any prescription drugs be paying celebrities to endorse their products? Well, according to an Ace Metrix study the answer to that is "probably no."The Ace Metrix study found of more than 2,600 ads that celebrity ads do not perform any better than non-celebrity ads and in some case ...
How a doctor learned how to suture
One of the skills I really wanted to learn in med school was how to suture. It’s just one of those things that I felt like you’re supposed to know if you’re a doctor. How can you be a doctor if you don’t know how to suture?Anyway, by fourth year of med school, I had totally failed at my goal. I had already done a surgery rotation, but while ...
How secure messaging helps this doctor connect with patients
I commented on a blog post recently that cited a recent study called "Secure web messaging between patients and doctors: Not well received." I was pleased to see that other professionals who left comments had the same reaction I did to the study: it is simply not accurate. I have 4,900 patients and five other physicians in our practice who can attest that secure messaging, when used the right ...
What is your expectation when you visit a physician?
As a physician, and as an interventional radiologist, I consult with many patients. Similar to anyone who sees and talks with many people, I encounter a significant diversity of personality types, cultures and attitudes. One thing I have noticed is that each person has a certain level of expectation regarding their care, illness, and our potential interaction.I have visited with many people who are simply happy to have someone ...
What a hospital can do to be more comfortable for patients
Although filled to the brim with patients, hospitals were created to support doctors, not us patients. Historically, their organizational structure focused on doctors’ needs and doctors’ requirements. The concept of centering hospital care on patient needs and requirements is a relatively recent development.How can a hospital switch from being provider-centered to patient-centered? Shifting such a complicated and cumbersome behemoth a full 180 degrees is a huge undertaking.I believe it ...
Screening for mental disorders in children and adolescents
For many academics and researchers, the debate is over: The use of mental health screening questionnaires in a routine fashion in primary care offices greatly increases the detection of mental disorders among children and adolescents. With such information, the American Academy of Pediatrics, Bright Futures, the US Preventive Services Task Force and others have weighed in. Screening is the order of the day, at least for adolescent depression. ...
ASCO: Making e-visits work for cancer patients
In early February, my new patient was a middle-aged woman from here in Silicon Valley with a self-discovered 2 cm right breast mass. Her internist was all over this. She quickly had a core needle biopsy, was evaluated by one of our breast surgeons, and was referred to me for an opinion regarding pre-operative (neo-adjuvant) chemotherapy. I saw her ...
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...
