July is the month that new resident physicians begin their training all across the United States.Our future family physicians and pediatricians, neurosurgeons and emergency physicians, plastic surgeons and laser tattoo removal specialists (ok, not really a specialty, just a side-line) will begin learning how to be physicians, having completed four years of expensive college and four years of even more expensive medical school.Anxiety-filled and debt-ridden, they will embark on ...
July 2011
All Stories
Finding job opportunities by networking with other physicians online
Many physicians intentionally choose to avoid online social networking websites like LinkedIn, Facebook, and Twitter. Physicians want to maintain their privacy and they don’t want patients “finding” them on these public sites.If you’re thinking about a career transition or if you’re looking for non-clinical jobs that may provide supplemental income, it is very important to expand your social network by engaging others on social networking websites. There are ...
Patients who bill their doctor for being late
Meet Elaine.We lost touch for a while, but caught up with each other recently.Like most girlfriends, we shared adventures of love, travel, and work. I told Elaine that I left assembly-line medicine. Now I host town hall meetings-inspiring citizens nationwide to design ideal clinics and hospitals.Elaine shared: "If I’m kept waiting, I bill the doctor. At the twenty minute mark, I politely tell the receptionist that the doctor has missed my appointment ...
Consumer driven health care will only shift costs if implemented poorly
The creation of consumer-driven health plans (CDHPs), health insurance policies with high deductibles linked to a savings option and with more financial responsibility shouldered by patients and employees and less by employers, was completely inevitable.The American public likes to have everything, whether consumer electronics or other services, as cheap as possible. With escalating health care expenses rising far more rapidly than wages or inflation, it's not surprising employers ...
How might we think about EHRs globally while acting locally?
American health care information technology is undergoing two enormous leaps.First, it is moving onto Web-based and mobile platforms – which are less expensive and facilitate information exchange – and away from client-server enterprise-centric technologies, which are more expensive and have limited interoperability. In addition, more EHR development activity is headed into the cloud, driven by large consumer-based firms with the technological depth to take it there. Both these trends ...
Cost containment strategies for emergency care
It strikes me that in developing payment reform related, compensation driven cost-containment strategies aimed at constraining the cost of emergency care, policy makers, emergency physicians, and health insurers should adhere to certain principles.The American College of Emergency Physicians should be at the forefront when it comes to establishing these principles, which I hope will be focused on protecting our patients first, and our specialty second.The concept and practice of ...
When the parent becomes child and child becomes parent
I bet you didn’t know that the war for independence is being fought on a daily basis throughout our glorious country. From the time we are born until the time we die, each of us strives to assert our independence. Once the toddler learns to run, he insists on running wherever he wants to. As he ages, we foster his need to be independent and teach him ...
Why Jack Kevorkian had a profoundly correct message
Although Jack Kevorkian was only a few years older than I was, and we both practiced pathology in southern California for many of the same years, I never met Dr. Kevorkian.I found him from a distance to be a deeply odd character, and a profoundly flawed messenger but with a profoundly correct message.I can't improve on the quick summary of Jack Kevorkian by an unnamed author that the New ...
USA Today column: Do new cancer drugs deserve their flashy headlines?
My USA Today column ran in this morning's paper: New cancer drugs often get flashy headlines.
I discuss two cancer stories, reported the same day this past June. One included highly publicized drugs used to treat metastatic melanoma. The other was much less heralded, and involved the lack of efficacy in ovarian cancer screening.Despite the difference in coverage, ...
The older generation of physicians may disapprove of social media
In the last three years, less than fifteen minutes of the formal medical school curriculum at my school has been dedicated to social media.During our orientation, a faculty member showed us a series of images that she had found online, publicly available on Facebook, that showed what she considered to be inappropriate behavior: students drinking, dancing and in revealing clothing. She warned us about the impact that images ...
Use the National Cancer Institute’s Cancer Information Service
Brenda Bryant learned she had breast cancer while she was sitting alone in her car in the parking lot of her grandson's day care center. It was early evening on a Friday two years ago, and her surgeon called to tell her the results of a biopsy. "He just gave me my results and that was it," says Bryant, who lives in Northern Virginia. "It was like there was ...
Cost of care is related to the advancements in medicine
Much is being written about the ever increasing cost of health care in the US, especially compared to the rest of the developed world.As a nation, we spend nearly 16% of our GDP on health care. All estimates predict that this amount will continue increasing unless costs can be controlled now. Hence the passage of the Affordable Care Act. Not only was it designed to extend coverage to ...
Using genomic data to understand disease entities
Three recent studies point to the continued presence and increasing importance of genomic information to improving health care.We have discussed the power of personalized medicine in multiple posts and highlighted the potential of genomics and though this movement is really still in its infancy it is a burgeoning component of medicine.The first study, published in the American Journal of Gastroenterology, explores Helicobacter pylori, a common ...
Vaccines to prevent or treat non-infectious chronic illnesses
A major megatrend in medicine will be the use of vaccines to prevent or treat (non infectious) chronic illnesses.Although we tend to think of vaccines for preventing infections there are now two vaccines that prevent cancer (via preventing the infections that are in part causative), one vaccine on the market to treat residual cancer and many vaccines in development to prevent or treat other cancers ...
Why HB 155 undermines the trust doctors have with patients
Do doctors have any business asking patients about whether or not they own a handgun?Like many other paternalistic inquiries with which doctors routinely harass their patients (car seats, bicycle helmets, smoke alarms, etc), my answer to this question is "no.’"There is a fairly well delineated sphere of knowledge which is medical in nature and in which I have some expertise and other topics which are purely personal, moral, or lifestyle considerations and in ...
Death is inevitable, but it is almost always seen as tragic
Everyone liked him. Though his later years (the only ones in which I knew him) took away his ability to do most things, and though he was in great pain every day, it was easy to see the mischief in his eyes. The subtle humor was still there, coming out of a man who was weak, in pain, dying.She lived for him. She was always telling me of his pain, ...
Not engaging in end of life discussions is grounds for malpractice
by Barry Massie, MDIt’s not that I am fixated on death, but recently, the CMS (Medicare) has decided not to pay for discussions with patients about prognosis and planning end of life care.Reimbursement for such discussions was a key aspect of the health care reform legislation passed this year, and was widely mischaracterized as establishing "death panels." I cannot imagine a legitimate justification ...
Medicare should stop paying for prostate cancer screening in men over age 75
The following op-ed was published on June 1st, 2011 in the New York Times’ Room for Debate blog.Medicare should stop paying for prostate cancer screening in men over the age of 75.You may be surprised to hear that, especially coming from a primary care doctor. But evidence is mounting that screening for prostate cancer is not only ineffective in older men, but may actually be harmful.The cornerstone of ...
Medicine and the examples of unintended effects of technology
The interaction of humans and technology will always be unpredictable. A few months ago this thought was driven home to me in a rather malodorous manner.I have obstructive sleep apnea (OSA) and use a CPAP machine every night to sleep comfortably. With OSA your airway collapses when you fall asleep. A CPAP machine is a small technological marvel, quietly delivering heated, humidified air under gentle pressure through a ...
KevinMD posts of the week, July 3, 2011
Here are the top posts from this past week, based on the number of times they were viewed.1. Reasons why medical students burn out and become depressed. I began my third year with what most would argue is the most difficult rotation, surgery, and my experiences over the past 5 weeks have sparked introspection on the things that cause medical students to burn out and wall themselves off during ...
Kevin Pho, MD
-
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...
-
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....
-
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...
-
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
-
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....
-
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...
-
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...
-
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
-
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...
-
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...
-
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...
-
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
-
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...
-
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...
-
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...
-
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
-
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...
-
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...
-
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...
-
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
-
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...
-
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...
-
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...
-
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....
