Medical malpractice reform is one of the few health care policy issues where there is a real possibility of agreement between the White House and Congress. A common refrain is that the fear of lawsuits leads physicians to practice defensive medicine, ordering too many tests just to cover their behinds in case of a lawsuit. It drives up costs without creating benefits. There’s some truth to this argument, ...
July 2011
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KevinMD posts of the week, July 24, 2011
Here are the top posts from this past week, based on the number of times they were viewed.1. Using technology to completely rethink the patient encounter. It’s time that we rethink the doctor’s office encounter. It’s inefficient for doctor and patient, and doesn’t optimize care for those that need it most.2. 7 tips for students applying to medical school. Applying to medical school is really annoying, expensive, and ...
MKSAP: 52-year-old man with coronary artery disease
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.A 52-year-old man is evaluated regarding treatment of his coronary artery disease. He had a myocardial infarction 8 years ago and was treated with a coronary stent placed in his right coronary artery. Over the last 8 years he did well with medical therapy, with ...
Current psychiatric drugs are only marginally effective
The scientific journal Nature ran an editorial recently with a rather ominous headline: "Psychopharmacology in Crisis." What exactly is this "crisis" they speak of? Is it the fact that our current psychiatric drugs are only marginally effective for many patients? Is it the fact that they can often cause side effects that some patients complain are worse than the original disease? No, the “crisis” is that the ...
Reading body language to help navigate difficult patient interactions
When working with a patient population with chronic and terminal illnesses, very often, stressful and difficult conversations take place frequently. Often the news is not good or not what the person wants to hear. Having the assessment skills and knowledge about how to read body language and react accordingly to manage the interaction in a positive way are important skills to have.Here are 5 tips that can help you navigate difficult ...
The value of Accountable Care Organizations (ACOs)
Washington has been touting Accountable Care Organizations (ACOs) as the end-all solution to health care’s woes. Designed to reduce Medicare spending and increase care coordination across a large number of patients, members of an ACO – hospitals, primary care physicians, specialists – would be paid if and when their patient population received outstanding quality of care. However, as the Centers for Medicare and Medicaid Services (CMS) finalize their ACO ...
Should medical students be introduced as Doctor?
I recently saw a post in Yahoo questions entitled, "Is it illegal for a medical student to introduce themselves as 'Doctor' before they have received their MD?"One of the answers that was rated highly was "I think it is more unethical than illegal." Clearly, if a student is deliberately misrepresenting themselves as a ‘doctor’, it is grounds for disciplinary action. More often than not, this misrepresentation is not ...
Poor, illegible entries in medical notes can cost lives
I was present recently at a meeting between representatives of a hospital and the relatives of a recently deceased patient. The death had been the subject of an inquiry and in preparation for the inquest, the family had been given copies of the medical notes. A significant part of the meeting was spent, explaining the meaning and significance of various entries in the notes. Embarrassingly, some handwritten entries in ...
Are ACOs putting form ahead of function?
At UC Berkeley in the 70s, the secretary in the Department of Psychology pasted a bumper sticker on her desk positing the question: "… yes, but are we asking the right questions?"For some reason, this subtle invitation remains with me today, echoing amidst the ACO fervor of "… better care at lower costs."
… the good news is we’re making great time, the bad news is we don’t know where ...
The role of non-physician clinicians in primary care
With sixteen million more Americans expected to gain health care coverage in the coming years as a result of the Affordable Care Act, access to actual health care providers may become more difficult. This may be especially true for patients with marginal coverage such as Medicaid.The Kaiser Family Foundation recently explored the role of non-physician clinicians - specifically nurse practitioners (NPs) and physician assistants (PAs) – in ...
Neurotransmitters and the side effects of antidepressants
We certainly wish that antidepressants in particular, and all psychiatric medications in particular were free of side-effects. It would be a boon to our patients, and their families. Sadly, there is no such thing as a medication without any risk of side-effects. Even over-the-counter medications such as Tylenol, Benadryl an aspirin can have pretty serious side-effects.Some side-effects of medications are related to dose -- the higher the dose, the ...
How an allergy specialist reaches out to PCPs
Every chance I get, I do a grand rounds with pediatricians and other PCPs to promote what you might call Allergy & Asthma 201, and also welcome as many residents as is practical for rotations in my office. The reason is straightforward—I have plenty of new patients who need the specialty care that an allergist can provide -- both my accountant and I are happy to have them — but ...
How much medical care are doctors obliged to provide?
I couldn’t pass up the opportunity to comment on Dr. Karen Sibert's recent op-ed piece in the New York Times. She argues that, especially given the current shortage of primary care doctors in this country, being part of the medical profession confers one with the moral obligation to serve and, as such, conflicting interests, such as raising a family, should take lower priority. I worked with a ...
The benefits of successful patient self-management programs
The emerging literature on chronic disease management suggests that successful programs rely on patient self management skills. Having been in the primary care role for 20 years, that initially seemed self evident and a bit “so what?” to me, thinking it meant that we just need to teach our patients a bit more in the primary care office.However self-management skills refer to specific curricula of skills ...
Breast cancer screening guidelines confuse doctors and patients
The American College of Obstetricians and Gynecologists (ACOG) recently released their recommendations for breast cancer screening.Previously, they had recommended a mammogram every 1 to 2 years for women between the ages of 40 to 49.Now, they recommend more intensive screening:
Due to the high incidence of breast cancer in the US and the potential to reduce deaths from it when ...
Hidden meanings behind the chief complaint
Any primary care clinic has a schedule that lists the appointments of the day in incremental time slots. There is a column for the name of the patient, the patient's age, and always there is a place for the reason for the visit--the "chief complaint" according to medical parlance.A quick review of the "chief complaints" for the day gives the physician a sense of how clinic will flow. There are the seemingly "quick" concerns, ...
AMA: Health insurers’ denial rates are down, but error rates are up
A guest column by the American Medical Association, exclusive to KevinMD.com.Billions of dollars in administrative waste would be eliminated each year if health insurers sent a timely, accurate and specific response to each physician claim, and while this year’s AMA National Health Insurer Report Card shows promising improvements in denial rates, more work needs to be done.The AMA’s fourth annual ...
A model patient in physical exam class
In the New York Times article "18 Stethoscopes, 1 Heart Murmur and Many Missed Connections," Madeline Drexler tells her story of being a model patient. Not like a model citizen cooperative and pleasant but, a person with a medically interesting finding who is asked to help teach medical students. These "patients" are examined by small hoards of inexperienced medical students who have little knowledge, little skill and varying degrees ...
Why children need more unstructured play
The nature of an average child’s free time has changed. For the past 25 years kids have been spending decreasing amounts of time outdoors. The time that our kids do spend outdoors is frequently a part of an organized sports activity. Other activities taking up our children’s time include indoor lessons and organized events such as music, art and dance lessons. Another big indoor activity, taking up to 7.5 ...
How the landscape of physician hiring is changing
The majority of new job openings for physicians are now as hospital employees, not in private practice.This is the new reality for both residents facing the employment landscape and seasoned physicians looking for better opportunities. In their 2011 Review of Physician Recruiting Incentives, Texas-based national physician search firm Merritt Hawkins confirmed that private practice scenarios are giving way to doctors being directly employed by hospitals, large health systems, and medical groups.As ...
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....
