I read an article in my local newspaper the other day that gave me reason to pause. The State of Florida intends to hand over 3 million Medicaid patients to managed care companies who will reduce payments to physicians and hospitals. In exchange for accepting these low payments for professional services, doctors are guaranteed through pending legislation that no matter what egregious errors they make, the patient will ...
August 2011
All Stories
How government can improve EMR usability
Government involvement in usability has been the talk recently. In case your not aware, EMR usability is such as problem the government is exploring ways to get involved. As you might imagine the topic is a very sticky subject, especially EMR vendors, as the topic conjures images of committee-centered design and EMRs being worse of then they already are now.However, when you think objectively about it, I believe the government ...
William Osler and the necessity of the exam
Osler said that exams were something of a menace to the true student of medicine:
“Perfect happiness for student and teacher will come with the abolition of examinations, which are stumbling blocks and rocks of offense in the pathway of the true student.” — William Osler, from Aequanimitas, 3rd edition, 1932.Perhaps this is because no examination can be passed by knowing the subject matter alone. One must also master the "hidden curriculum," ...
Family medicine needs to take advantage of buzzwords
I was driving into work recently listening to the radio and heard one of the fancy ads that our hospital has been airing over the last few years of it's "Good People, Great Medicine" campaign. The ad was talking about getting results for a patient recovering from a heart attack. Around central PA, this patient is far too common. And listening to the ad brag about how quickly this ...
Medical students spending time in a nursing home as a patient
An interview by Curaspan Health Group with Marilyn Gugliucci, PhD.Every summer, a handful of medical students spends two weeks in a nursing home as a patient. That’s part of what’s been called "the life-altering education" established by Marilyn Gugliucci, Ph.D., the director of geriatrics education and research at the University of New England College of Osteopathic Medicine.Gugliucci spoke with Curaspan Connections about the inspiration for her unique approach to elder-care ...
Physicians need to understand subtle marketing manipulation
There is do doubt that the way pharmaceutical companies market drugs to both doctors and consumers sways prescribing and drives up health costs. Prescription drug costs have outpaced other health care spending and are predicted to exceed the growth rates for hospital care and physician services going forward from 2010-2019.Two researchers (Howard Brody, MD, PHD, University of Texas Medical Galveston and Donald Wright, PhD, University of Medicine and Dentistry ...
Should patients be allowed to record their office visit?
Whether your office has wireless access or not, there will be patients texting, surfing the Internet, Facebooking, and otherwise engaging with the outside world on their smartphones while in your office.These smartphones have another function: the ability to record audio or video. It is understandably tempting for patients to record consent discussions, medication and follow-up instructions, and other physician or staff interactions.Recording a medical discussion via video or audio is ...
Treating fungal laryngitis in patients with asthma
It is a big bummer to be an asthmatic. Not only is breathing a problem, but even the treatment for asthma can cause problems.Take for example steroid inhalers like Advair, Symbicort, fluticasone, etc.All asthma patients know to rinse their mouth out after inhaler use due to risk of oral thrush, but what about from the back of the mouth down to the vocal cords? This nether region can't be ...
Properly delete electronic medical records, or face fines
Could a complete stranger receive your echocardiogram results in the mail?Could a homeless guy in Boston end up with your labs in his shopping cart?Is it possible that your medical records were sold on eBay?Yes. Yes. And yes.On February 24, 2011, Massachusetts General Hospital was fined $1 million dollars by the federal government when an employee inadvertently left a stack of papers on the subway. These documents contained the ...
A physician responsibility for the financial health of patients
Much as war begets both high-profile losses and the unsung wounded, two ranks of casualties lay fallen, rent financially by medical treatment.First are those of headlines, injured mortally, or nearly so, by insurmountable debt. Such wretched tragedy serves notice to all that a singular turn of fate may lead one swiftly to financial ruin.Less-celebrated are members of the second order, surviving but spending more than requisite for their care. In contrast to the ...
How a Google printout can strengthen your relationships with patients
If you are a practicing physician then it probably already happened to you more than once. Mature and responsible patients tend to Google their symptoms, medication and illnesses on the web – a phenomenon commonly referred to as cyberchondria. Nine out of ten women more or less decide which oral contraceptive they will take and not the doctor does. She will just let the doctor know whether his choice ...
Is the health quality bar set high enough?
Yesterday was no different than many other days in my life as a consultant. Two clients, three cities, and finally arriving late evening at the hotel. It had been a long day of travel and I was looking forward to getting into my room and off of my feet. As I got onto the elevator, for some reason, the inspection certificate caught my eye and I felt compelled to read ...
Obesity needs to be treated in primary care
Given the staggering prevalence of overweight and obesity in most developed countries, there is no other hope than to have general practitioners (and their allied health colleagues) take on the considerable burden of managing obesity in their practices.In fact, a recent example of a successful weight management program run in primary care just found considerable media attention in local newspapers.But research shows that most general practitioners (GPs) neither feel confident ...
Coronary CT screening is low value health care
Like many states, Texas is facing a fiscal crisis caused by decreased revenue from the economic recession and skyrocketing health care costs. Even without the expansion of publicly financed health insurance mandated by last year's health reform law, the percentage of the state budget devoted to Medicaid expenses is projected to rise from 28 percent to 46 percent by 2020, even faster if the law withstands current constitutional ...
How generational changes of physicians will affect oncology
Nothing makes a physician feel older (or should) than realizing that he/she just started a discussion with a younger colleague, fellow, resident or student with the sentence "When I was in training ... "In a recent article in the health section of the New York Times, Gardiner Harris skillfully depicts the culture gap between younger and older generations of physicians. Using a ...
Consider half life during drug detoxification
A young man on my sobriety-based detox program (only after showing positive for opiates) admitted to heroin-usage, but hedged the matter saying it was "5 days ago." His implicit presumption was that an isolated episode, days ago -- compared to continuous, more recent, heroin-usage -- would lessen the likelihood of his getting kicked off the program.Is his story of "no heroin [ingestion] in the last five days," likely, the whole ...
10 tips from 10 years sick
Ten years ago this summer, my husband and I flew from California to Paris, planning to immerse ourselves in Parisian culture for three weeks. The second day there, I got sick with what appeared to be an acute viral infection. I spent most of those three weeks in a Parisian bed. Ten years later—I’m still sick. I didn’t research what I should have learned the past 10 years. These are just 10 ...
The expensive progression of pill crushing technology
We have to crush pills sometimes. Either the patient (through aversion or physical limitation from stroke) can’t swallow whole pills so we crush them and put them in applesauce, or the patient gets their pills through a tube, so we crush them and dissolve them in water.When I started nursing, we had a mortar and pestle.
Anyway, this is what we used ...
Why medicine needs new schools to drive innovation and change
Let’s face it, medicine is slow to change – the profession has produced successful physicians for centuries using an education system based on grueling hours and unwavering dedication. Many established medical schools boast impressive Step 1 scores and match rates, so why should they modify what works?Change is necessary because our society needs the next generation of physicians to be technologically savvy and driven toward innovation. With the increasing prevalence ...
The secret to better patient care is time
Lets face it -- the system of primary care medicine in the United States is broken. Even in Boston, the mecca of medicine, patients struggle hard to find an accessible doctor. And when they finally land an appointment, their well-intentioned internist, pediatrician or family physician often seems overworked, rushing from patient to patient, with little time to really listen to details.As a primary care family physician for 20 years, ...
Kevin Pho, MD
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Why Priscilla Chan may become the country’s most influential doctor
Who has the potential to be the most influential physician of our generation? It's Priscilla Chan, who not only recently graduated from...
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Confused about prostate cancer screening? Make a shared decision
In a widely anticipated move, the USPSTF officially recommended against prostate cancer screening in healthy men. Case closed, right? Hardly. The prostate...
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When it comes to doctors and social media, hospitals fail miserably
When it comes to medicine and social media, much of the attention is negative. Doctors losing their hospital privileges because of Facebook....
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Warren Buffett’s prostate cancer choices aren’t right for every man
A version of this column was published on April 24, 2012 in USA Today. There has been a recent uptick of elderly men...
Physician
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Why test recalls should not be considered cheating
I was appalled recently by the coverage of radiology “test recalls” by CNN, amplified by Dr. Gary Becker of the American Board...
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Why physicians are susceptible to hardball tactics
I was invited to a medical staff leadership conference sponsored by our hospital. A company specializing in training physician leaders ran the...
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How we deliver bad news is critical to how families deal with grief
As a cardiac electrophysiologist, I have had to discuss bad news with patients and families more times than I would like during...
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His father’s suffering had already been too great
He looked dead. The paramedics brought him down the hall toward one of my critical care beds, and for a moment I...
Patient
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How death can be a beautiful experience
I was honored to be part of a beautiful experience in late January of 2011. It was the death of my mother-in-law...
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What meaningful encouragement can be given to someone who is dying?
Theirs is a lonely journey; to be moving towards the separation and end of all things known and loved. Being with a...
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Health care journalists have tendencies similar to those of doctors
As a patient who was asked to speak at the Association of Health Care Journalists 2012 conference, I felt a bit covert....
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Adaptation can be painful, but it can also be a gift
Nothing will force you to live life on your own terms faster than almost losing it. In 2008, I was on fire....
Policy
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What should America’s health care vision be?
America has this paradox of excellent biomedical science, innovative drug manufacturers and entrepreneurial device developers along with outstanding providers but at the...
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Hospitals around the world aim to remain relevant to patients
"It was the best of times, it was the worst of times ..." So begins a story called A Tale of Two...
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Repairing the tear in health care’s safety net with social media
The nation’s “safety net” hospitals are designed to ensure that uninsured, lower income and indigent populations receive adequate medical care – a...
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Look to technology to reduce health costs
Technology to lower costs rather than accelerate them. Smart phones to increase physician and other providers’ productivity. Fewer primary care physicians but...
Tech
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Mobile health apps don’t always follow conventional wisdom
Propaganda and non-truths abound all around the Internet saying that mobile health apps are everything from a threat to Big Pharma to...
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When patient care becomes secondary to filling out the medical record
The policeman was two cars in front of me. I meandered down the road cautiously adjusting my speed a few ticks above...
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Doctors, use Google to get more patients in less than 7 minutes
Every month, hundreds of thousands of people look for a doctor on Google. As an amazing practitioner, your site deserves to be...
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The user interface for EHRs should be uniform
The first thing I noticed when I walked into the physician’s office were the tall cabinets filled with manila folders, tabbed with...
Social Media
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We need to see the potential harm of social media
Prior to 1794, farms across the world could only pick cotton as fast as humanly possible. In the late 18th century, Eli Whitney...
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Why social media may not be worth it for doctors
Social media in healthcare is all the rage these days. You can’t visit even one physician-oriented website without someone breathlessly advising you...
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Transparency defines social media success for doctors
Want to understand social media? Physicians wanting to learn about social media must learn transparency. We must learn transparency on a personal...
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How Twitter was used in a potential mass casualty scenario
It was my first ER shift in charge of the resuscitation area. Needless to say, my adrenaline and nerves were firing like...
