When physician blogger Kevin Pho wrote about involving patients in healthcare reform in a recent article in USA Today, one thing he failed to mention is a novel government initiative that has been flying below most of our radar screens -- the "Partnership for Patients: Better Care -- Lower Costs."Why was it necessary to call out patient centeredness as a separate initiative?Although no one disputes that those of us ...
August 2011
All Stories
Patients lose when insurers cut reimbursement for immunizations
I recently received a declaration of war from one of the major healthcare insurers. Not happy with its current record profits, this insurer has decided to reduce its reimbursement on immunizations and injectable medications by 40%. I do not have a 40% margin on immunizations and injectable medications. My margin is at most 10%. This means that with a 40% reduction, I will have to pay at least 30% ...
Can Medicaid be saved with better care coordination?
Recently, we marked the 66th birthday of Medicaid, the jointly funded but State-run program that supports health care for the poor. Medicaid plays a huge role in selected populations: 70% of nursing home inhabitants, 56% of low-income children and 42% of adults, and 44% of people living with HIV/AIDS all have their health care paid for by Medicaid. Medicaid is much talked about these days, and the reason is ...
Medical school debt only partly explains the primary care shortage
Pauline Chen had a compelling piece in the New York Times recently about medical student debt and it’s unappreciated costs. It draws on a recent publication in Academic Medicine which highlights the diverse drivers of medical student indebtedness. These include an expansion of the medical school’s research enterprise, a lack of accountability on the part of medical school administrators, who can increase tuition to support the research mission, ...
The different ways hysterectomy can be performed
When you and your gynecologist have decided on hysterectomy as the treatment of choice for your gynecologic diagnosis, there are several routes by which a hysterectomy may be accomplished. A total hysterectomy is the surgical removal of the uterus, and when indicated, the additional removal of the fallopian tubes and ovaries (termed salpingoophorectomy) may be recommended.There are several routes by which a hysterectomy can be performed. You and your gynecologist ...
What a psychiatrist learned during therapy sessions with mothers
I've noticed a certain dilemma that enters into therapy sessions with mothers over the years. Mothers often feel in a bind and sometimes this bind distorts the way they think about their lives ... or is it that their thinking distorts the way they feel? The sequence of events generally runs like this - the strong urge to have a family - the joy of being pregnant - the horror ...
The choices after getting diagnosed with breast cancer can be overwhelming
One of the many things I didn’t know about breast cancer before I got a front-row seat was just how many choices it entails. I didn’t realize that so much of the experience wouldn’t have clear-cut, yes/no answers.You’re confronted by your first choice before you even know you have cancer. When my mammogram revealed suspicious specks, I was presented the choice of a stereotactic or surgical biopsy. I opted for the ...
Pay for performance doesn’t work in difficult patient populations
Pay for performance. It’s a lovely sounding concept. If you’re a good doctor, defined by having healthy patients who meet predetermined quality indicators, then you get paid more.What could be simpler, right?Wrong.Not all patients are created equal. Some are highly educated, highly literate, highly motivated to prioritize health. They have good jobs with health insurance, so critical medical care isn’t prohibitively expensive. They don’t need to choose between paying ...
To help patients, physicians must rely on systems
I recently spoke with some people about medical systems—the actual processes involved in providing health care to patients. Story ideas involving systems sparked in my head: What about the guy who makes your sandwich at the deli? What if he had to grow the tomatoes? and cure the meats? and chop down trees to fashion the cutting boards? and weld the freezer parts together? etc.All the ideas looked much better ...
The benefit of prostate cancer screening is controversial
A good screening test is relatively inexpensive and noninvasive. In addition, effective treatment should be available if the disease being screened for is confirmed. Lastly, detecting the disease before a patient becomes symptomatic must be more beneficial than detection after the patient experiences signs or symptoms.The latter point is often debated in prostate cancer screening, which is done by obtaining a serum prostate specific antigen (PSA) and performing a ...
Sports physicals often includes no provisions for privacy
Sports physicals are universally required in the U.S. on an annual or seasonal basis for students wishing to participate in sports. All states have requirements covering public schools. The reason for the exams is to ensure that the athletes can participate safely. These exams are not intended to replace a regular physical. There are no absolute standards for what should be included in these exams. Most would agree that ...
Is the iPad too big for medicine?
The iPad has been a mind-blowing success, and we’ve been regularly covering the excitement about the potential it offers to doctors and hospitals.However, it’s important to continue innovating, and I propose that a 7 or 8 inch iPad Mini (Or Nano, if you prefer) would be the next logical step for Apple, as it offers an ideal blend of screen real estate and portability that both the iPhone and ...
Google+: Physicians can optimize their online footprint
Google+ has launched in beta stages and social networking for physicians has the potential for significant evolution. The challenge for physicians of balancing personal and professional online is not easy to solve. The dual citizenship approach provides recommendations for physicians to manage their profiles online. It is suggested that separate personal and professional profiles are created, with the hope that the latter will rank higher in searches. They ...
The loss of eloquence in EMR notes
Much has been made of the downside of the increasing use of EMR systems by physicians. But I am not going to dwell on those pervasive complaints concerning the cost and complexity of setting up the systems. Nor shall I rehash the well known issue of what I call "doc blocking" ... wherein a computer (or other entity) stands between the patient and physician, slowing the exchange of information to however many words can be typed per ...
Why the debt ceiling deal is a horrific outcome for physicians
If you're a physician or hospital that relies on Medicare payments, grim times are ahead. Yes, even worse than the scheduled 29% payment cut that's scheduled to go into effect in 2013. Emergency physician Shadowfax calls the debt deal "a terrible deal for health care providers."Under the contentious debt ceiling agreement, significant cuts in Medicare dollars will be ...
Showing me how much medicine I’ve never even known existed
This is Lokin. Every morning as I enter the hospital, Lokin sits in the same spot. Last week he was covered in gasoline and set aflame by a man in his village -- a dispute over gambling debts.For the past five days I've walked silently past this man, torn apart by not knowing what to do. I could tell him all ...
Decision aids need to be used for angioplasty and stents
For those who have been following the back and forth over the Less is More blog I posted last week, here's the poster that upset some cardiologists when it was up on the Parsemus Foundation's site.Over the top? Of course it is -- it's satire! And like all good satire, it contains a few grains of truth mixed with a hefty dose of exaggeration.Still, it's only fair ...
With cancer, sometimes there is no right answer
Medically speaking, what’s a guy to do when there is no right answer? My patient’s solution is often to ask me what I would do given his particular circumstance. He isn’t happy when I respond with, "I truthfully don’t know."In reality, I always know what I would do. I’d gather knowledge, see consultants, and explore every possible option to its fullest. Then, most probably, I would still not be ...
Improving the relationship between intern and nurse
One of my readers astutely pointed out in the comments section of my blog that "nurses will make your life a living hell" if you treat them badly. Some will make your life a living hell, no matter what. As in every profession, there are nurses with a chip on the shoulder, as well as those who are simply counting down to retirement. But for the most part, nurses ...
Psychiatry residents need to learn psychotherapy
For years, I supervised residents. They would come in each week and tell me about a patient in crisis. If no one was in crisis, they’d say all their patients were fine and they didn’t know what to talk about, even though I had told them to pick a patient they saw weekly and either audio-record the sessions or take detailed process notes. Psychotherapy, I would say, is a ...
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....
