Consider the explosion in the rate of C-sections and inductions. They satisfy the requirements of assurance behavior.Reducing adverse outcomes? Check. Deterring medical malpractice claims? Check. Pre-empting liability? Check.Consider the precipitous decline in the rate of VBAC. That's avoidance behavior: malpractice insurers have forced providers and hospitals to refuse to participate in VBACs.There's an important subtext that undergirds defensive medicine that often goes unrecognized and therefore unanalyzed. Defensive medicine is driven ...
July 2011
All Stories
Medical schools need to better recognize mental illness in students
At lunch recently, a few of us got into the topic of mental health in medical school. The conversation started when someone brought up the fact that a Harvard College senior and a Harvard Law School student had both recently committed suicide.We all worried that the medical school wasn’t doing an adequate job caring for students who may be suffering from mental illness. To be fair, University Health Services ...
What would an ACO would look like if it was truly patient centered?
Health care leaders are busy talking to attorneys and consultants about how to set up Accountable Care Organizations (ACOs). A recent Advisory Board survey found that 73 per cent of hospital finance executives said that creating such an organization was a top priority for their health system.
Last year my most popular keynote topic was patient-centered medical home creation; this year everyone wants a presentation on ACOs.However not ... 
Perfect is the enemy of good when it comes to work-life balance
Over the years, I have come to the painful realization that I am not perfect.Ok, all you other surgeons, close your eyes and ears, because to admit to being less than perfect is a sign of weakness (like asking for help). Don't read this, patients, because you wish even more than I do that I were perfect (especially when I'm operating on you). But it's true.Long ago, I remember feeling ...
Why healthcare is a responsibility, not a right
There is no "right" answer to the healthcare reform issue. There are facts, opinions, myths, politics and reality, all in no particular order of magnitude. Unfortunately, thus far and likely in the future, the reform will be political and thus costly and painful and will not address the core issues involved in fixing the inherent systemic problems.There have been many things written with regard to this topic and I ...
KevinMD keynotes PAINWeek 2011 in Las Vegas
I'm honored to be the keynote speaker for PAINWeek on Wednesday, September 7th, 2011 at The Cosmopolitan of Las Vegas.PAINWeek is the nation’s largest pain conference for frontline clinicians with an interest in pain management. Over 1500 physicians, nursing professionals, physician assistants, dentists, pharmacists, and psychologists are attending this year.My keynote, Medicine in the age of social media, will ...
Passing along the cost of health care to consumers won’t save money
Republican budget guru Paul Ryan had a plan to end Medicare as we know it to be replaced with a series of less-generous vouchers. The House of Representatives has voted to implement this plan. The political side of this has been written about a lot, and I am not going to rehash what has been better covered elsewhere. I do want to address what seems to be a persistent ...
A medical student’s first day of clinical training started on the bus
It happened on a bus on my way to work. I got on and sat in the only available seat, which I quickly realized was next to a disheveled looking man who smelled faintly of urine and had a dry hacking cough that could be heard throughout the entire bus. He was leaning against the window and did not seem to notice me. I was less than pleased with my ...
How to be a star intern, from a former nurse
This is another installment on how to ingratiate yourself with your new colleagues as a freshly minted MD intern (or medical student, for that matter). These are just observations on behavior that nurses tend to notice, which can really make a difference on how you'll be received. I hope some of my suggestions are helpful in making you appear like the Star Intern that you know you are.Introduce yourself. There is ...
If I could pick patients, they would be Native American Guatemalans
Spent a sweaty week operating in a hilltop Hospital Nacional in Guatemala a while back.A patient gave me a hat in thanks for her surgery. It’s a full-brimmed canvas safari number – I’m sure Hemingway shot a rhino in one. I’m just mature enough now to value sun protection and always grateful, sometimes to the point of pain, for gifts from those who have almost nothing. I was also ...
Can health coaches help fix our healthcare system?
Simply put, habits are hard to break and bad habits like smoking, drinking, sedentary lifestyle and overeating are making our population sick. Who in the healthcare system can tackle these issues before they manifest into chronic disease?Doctors are trained to diagnose and treat, but they aren’t trained to help people change their behavior, nor should they be since most physicians, particularly general practitioners, are already severely overloaded. Nurses provide ...
Executive compensation and the rising cost of health care
The revelations about the huge golden parachute given the outgoing CEO of ostensibly non-profit Massachusetts Blue Cross Blue Shield induced some public discussion about the disconnect between executive compensation and the mission of health care organizations.First, new proxy statements revealed the compensation of executives of two large for-profit health care insurers/managed care companies.CignaAs reported by the AP, via ABC News, the CEO got a big raise:
Cigna Corp. ...
Are psychiatrists rushed, uncaring, and in it only for the money?
Perhaps you've heard the news: psychiatrists no longer have time to listen to their patients. It's all about writing prescriptions for medications and the days of "tell me about your mother" are long gone, or so we're told. The current perception is that large volume practices where patients are seen in a matter of minutes are now standard and acceptable in psychiatry; that it's how many -- if not ...
Policy makers aren’t doctors, and why that’s a problem
Sometimes you just don't want to be right. Over the past 5 years, I have seen an alarming pattern arise in my profession. Many of my patients have heard me talk about Soylent Green, an old Charleton Heston movie. The premise of the movie seems absurd. Can you imagine the government of the United States providing for all the needs of its people including healthcare, food, clothing, and ...
Being a primary care doctor is an utter privilege
Being a primary care doctor is an utter privilege. Think of this post as part proclamation and part journal entry.Yesterday afternoon I sent out this tweet:
It was a spontaneous tweet in the middle of my 15 minute "lunch break" when I realized I still had hours to go in my clinical day. The motive was incredulity, not remorse or a ...
Why receptionists are integral to the health care team
Health care is a team sport, and one of the most important members is the office receptionist.Receptionists are often the first people patients see when the visit the clinic. And those first impressions count.In a recent piece from the New York Times, Pauline Chen notes a study of the responsibilities of the medical receptionist, and finds they ...
Options when your drug copays are too expensive
You have insurance and, supposedly, it covers your medicines. However, you still get stuck with a portion of the bill that the insurance company calls a "copay." In some cases these copays can run more than $150/ month per medication (e.g. Enbrel). If you are on more than one of these expensive, branded medications the copays can really add up. What are your options?
1. Generic alternative. Always ask your doc if there ...
The inevitability of AIDS and the presence of addiction
Jackson’s blood pressure was low, and this had the emergency room physician scrambling, barking orders. A nurse was busy at each arm, attempting to place large-bore IV’s so that fluids could be given rapidly and thus improve the low blood pressure. Other nurses were preparing strong antibiotics for immediate administration. An automated blood pressure cuff was attached to the left arm, inflating every 3-4 minutes with a characteristic grinding ...
The secret in caring for the patient is to care for the patient
Erik's wife had warned him many times, "Stay off ladders dear, leave it to someone younger." Erik though was a pretty spry 72 years old and had been cleaning the gutters for many years. He had a sturdy 25 foot extension ladder, had years of experience as an athlete, and wasn't about to slow down for no good reason.It was an unusually bright crisp November day in Seattle, when Erik ...
A Physician Family Office for high net worth families
As a middle-aged physician all too aware of the fact that we are all merely "passing through" life on our way to somewhere else, I am increasingly concerned with having a good work-life balance. Gone are the days of my residency when I was only able to catch a couple of hours of sleep here and there and be lucky to have the time to eat a fast food ...
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....
