Are you paid fairly for what you do?How much are your services actually worth?Of course you are worth more than you are paid. Enough money is never enough."The market decides."But, in medicine, there is no way that it is a "free market"; the American medical marketplace is historically rigged by innumerable visible and, to the average person, invisible factors.We live in one world. Ask Detroit about wages for making American ...
September 2011
All Stories
A social media background is an asset in medicine
I have a confession to make. Lately I've been doing some soul-searching regarding the future of my social media presence. It started at a lecture I attended a few weeks ago, where students and residents were cautioned to avoid public social media profiles and blogging. It came up again one morning while I was discussing some current events with other students, and was mentioned most recently at a professionalism ...
The empowered patient is a relief for physician practice
Patients may soon be universally able to view their lab results thanks to a new rule proposed by the Department of Health and Human Services. This means patients may access without permission or release by their providers. This is a victory toward patient empowerment and a step in the right direction.Classically patients do not see their lab results. The busy primary doctors are often left with nothing more than ...
Physicians lack harmony in this age of health reform
At every turn, we in health care are being told we must fundamentally change the way we deliver care to the patients who come to us for assistance, advice, and decisions as to how they can, if not maintain health, at least survive in an increasingly burdensome world. Whether referenced as medical home, health care home, advanced primary care, patient-centered approaches, or accountable care organizations, it all sounds the same ...
Bias in CME due to the presence of commercial support is overrated
So I missed out on the whole CME outrage that came up earlier this year in a Archives of Internal Medicine study, but I do have a theory about it that I’d like to try out.I’m not interested in getting into the “perceived potential bias” vs “actual bias” argument – which is a good one and one Tom Sullivan wrote about extensively – but would rather take a look ...
Doctors should not treat every patient like their mother
Physicians recommend different treatments for patients than they would choose for themselves. The preceding statement is true according to a similarly titled article recently published in the Archives of Internal Medicine, and has, I will argue, important implications for how we view the doctor-patient relationship.In the study, one group of physicians was asked to choose between two hypothetical treatment alternatives for either avian flu or colon cancer as if they ...
Is medical tourism a dire threat to American surgeons?
In an earlier post, DrRich offered several potential strategies for doctors and patients to consider should healthcare reformers ultimately succeed in their efforts to make it illegal for Americans to seek medical care outside the auspices of Obamacare. To those readers who persist in thinking that DrRich is particularly paranoid in worrying about such a thing, he refers you to his prior work carefully documenting the efforts the Central ...
How to isolate problems in your scheduling system
Though there will always be times when an emergency disrupts your schedule, there is usually little reason for patients to wait more than 20 minutes for their visit. You will also find that continually double booking, arriving late, or having general mayhem in your office will inevitably result in everyone having to stay later than expected. Rather than experiencing all of these problems, you will be well served by isolating ...
The only anesthesiologist in this vast hospital
His blood pressure disappeared. The arterial tracing, a red line on the monitor reassuringly undulating with every beat of his heart, falling from 122/83, 99/64, 80/50, 67/42, then a flat line at 48.I had just come off the elevator, ushered in by the surgery resident who found me in the hallway searching for the right room.Epinephrine. Get the code cart. Check for a pulse. The nurse screwed the two halves ...
America’s broken disability system
I once asked a man in his 30’s why he was on disability. He had fallen attempting to ford a swift stream while fishing. He replied: "Well, the judge said I have a bad attitude, I don’t like people and I can’t hold a job." Shocking as it sounds, it wasn’t very different from other reasons I’ve heard. "I don’t remember, my Dad put me on it." "I have anxiety." ...
A hospital board needs to understand generative thinking
Hospital systems and physician groups are faced with unprecedented change demanding decreased per-capita cost and increased quality in American health care. Boards of directors are underutilized resources that must be tapped more effectively in order for such organizations to survive in a time of industry consolidation. Generative thinking is a tool that can help organizations innovate in order to improve patient care and the financial bottom line.Generative thinking is ...
Lethal injections are not good medicine
Recently, two executions by lethal injections were carried out in America. One ended the life of Troy Davis in Georgia, the other with too much hate Lawrence Russell Brewer in Texas. Death and dying offer complexity and complications in the profession medicine bound by policies, mandates and laws driven by internal (e.g. professional associations, medical boards) and external (e.g. federal, state, medical center) forces.Lethal injections involve delivering a fatal dose ...
An MRI for back pain may only confuse the diagnosis
"Doc, my back is killing me! I think I need an MRI."I don't know if you've ever uttered those words, but I can tell you I've sure heard them ... more times than I can count. And believe me, I get it. When you're in pain, all you care about is finding out what's causing it as soon as possible so you can get rid of it as soon as possible. It’s quite tempting to ...
It is a rare medical news story that gets high marks
Like you, I receive a whole bunch of breaking medical news every day, from television, radio, newspapers, direct mail, email alerts, press releases, and multiple websites.Is any of it worth my time, my attention, or even a change in my knowledge, attitude, behavior, or medical practice? How can I quickly tell?A medical journalist from Minnesota named Gary Schwitzer recognized this problem many years ago and created a service that ...
Patients generally seek attorneys out of anger rather than greed
Patients often pursue litigation simply to obtain information that has not been forthcoming. Research shows that the three things patients want most in the face of medical error are: information about what happened; a sincere apology; and measures to prevent the error from happening to someone else. Financial compensation is lower on the list. Patients generally seek attorneys out of anger rather than greed. When unanticipated adverse outcomes occur, error ...
A bride who wants to register at the Mayo Clinic
I’m getting married in November and am not "registered" anywhere. Doing so hadn’t even occurred to me until people started asking, "where are you registered?"At first, I simply laughed. Dan and I have enough for two households. Now I’m re-thinking the bridal registry thing.Here comes the under-insured, chronically-ill bride going on two years without primary medical care ... and I want to register at the Mayo Clinic.My bridal registry wish list ...
Physicians need to be part of the overall wellness process
After nearing the brink of political collapse, Congress and the President reached agreement on a plan for deficit reduction. Part of the agreement is that a "super committee"will cut an additional $1.5 trillion from the federal budget. Cuts are being considered for a range of programs, including Medicare. As director of a wellness program for retirees, however, I remain acutely concerned about the impact Medicare cuts will have on ...
Doctors with great bedside manner can also provide great clinical care
The New York Times recently published an article titled, Finding a Quality Doctor, Dr. Danielle Ofri an internist at NYU, laments how she was unable to perform as well as expected in the areas of patient care as it related to diabetes. From a New England Journal of Medicine article, Dr. Ofri notes that her report card showed the following - 33% of patients with diabetes have glycated hemoglobin ...
Honesty between doctors and patients goes both ways
Yesterday, someone asked me, "Can I be perfectly honest with you?" I wanted to reply, "No, just be dishonest, I like it better that way!" "Can I be" implies that, in past conversations, my patient has been dishonest. Dishonesty is a relationship breaker. Dishonesty leads to distrust and if I cannot trust what a patient is telling me, I cannot be effective; the doctor-patient relationship is terminated.Am I being too ...
Father and son, doctor and grieving family member
The edges of Cameron's lips rise undeniably toward the clear blue sky. His legs move methodically. One motionless on the scooter and the other periodically kicking to propel himself forward. He weaves in and out dodging my shadow as I jog beside him.I struggle to keep pace. My breathing unsteady and labored. My joints aching. And my brain foggy from lack of sleep and replaying the events of the day.***The ...
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....
