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 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....
