September 2011

All Stories

It is not easy being a patient-consumer, but it can be done

by | in Patient | 8 responses

I would like to share a story about my son’s recent surgery that, while only one simple case, reveals the foundational problem with the U.S. health care system.I write this story as a father of a 12 year old boy who has cerebral palsy. Jack is fortunate to be healthy and active with minor medical needs. As he has grown he experienced some issues with contractures in his right lower ...

If you need to say you’re all about the patient, you aren’t

by | in Physician | no responses

Sir William of Ockham has achieved a degree of mortality via the wide promulgation of an aphorism, now generally known at Occam's Razor (I'll use the more economical spelling). There are many iterations of the razor, but my favorite is this: "simpler explanations are, other things being equal, generally better than more complex ones." That trips off the tongue more easily than, say, "plurality should not be posited without necessity."In ...

Learning the hard way that there is an art to medicine

by | in Patient | 2 responses

In med school budding doctors are told: "When you hear hoof beats, think horse." The problem is that sometimes when you hear hoof beats, it’s a zebra, and when that "zebra" is a disease, your patient leaves your office misdiagnosed. I’m that patient.In 1998 I had my first abdominal attack. I vomited for days and walked hunched over like a frail octogenarian. (For reference, I was extremely fit and twenty-seven ...

How social media helped this medical student

by | in Social media | 8 responses

In the course of our work as doctors we will undoubtedly witness events that change lives, but coming into medical school I never realized how directly some of these events would change my life.Often in medicine we see people at the worst possible time. Patients are sick or grieving and rarely happy to be in our presence, no matter how great we might think we are. Usually, they are experiencing ...

Social networking has changed the landscape in health care

by | in Social media | 9 responses

In a recent Harvard Business Review Blog, David Armano writes about the six pillars of influence that leads to measurably favorable outcomes.To achieve measurably better health, the pillars Armano explains can certainly be adopted.He notes how the "social web can amplify signals, influence behavior and lead to action."Social networking has changed the landscape in health care.  Technology has paved the way for instant communication and feedback.While some ...

The threats to profit in academic medical centers

by | in Policy | 2 responses

My hospital, UCSF Medical Center, is thriving. Our profits this year will be nearly $200 million. We’re building a sparkling clinical complex – a combined women’s, children’s, and cancer hospital – adjacent to our new downtown biomedical research campus.We are installing a state-of-the-art computer system. US News & World Report calls us the 7th best hospital in the country. Our students, residents, and fellows have never been better.Yet angst is in the ...

A hundred shifts in, I have fine tuned my instincts as a physician

by | in Physician | 2 responses

I gather my belongings: stained white coat, stethoscope, pen light, black ballpoint. I stuff the last two granola bars into my canvas bag. I glance at the clock on the microwave, which is three minutes fast.Twenty-two minutes until my shift begins. One minute before I will lock the door to my apartment.Precision is critical: ER shifts change fast and blend together, from late nights to early mornings to mid-afternoons. Suns ...

How to predict which patients will be hospitalized

by | in Policy | one response

What’s the most effective way to predict which patients will be hospitalized in the coming year? The Heritage Provider Network, a managed care group in California, hopes to answer this question through its sponsorship of the Heritage Health Prize, a $3 million X Prize-like competition for health care. The contest invites participants to develop a prediction algorithm to identify patients who will spend time in the ...

Doctors can help patients make informed decisions and prevent overtreatment

by | in Patient | no responses

There are many tips to saving money on medical costs like asking your doctor only for generic medications, choosing an insurance plan with a high deductible and lower monthly premiums, going to an urgent care or retail clinic rather than the emergency room, and getting prescriptions mailed rather than go to a pharmacy.How about getting your old medical records and having them reviewed by a primary care doctor?  It ...

Patient transparency cannot be mandated by a federal agency

by | in Physician | 2 responses

Not long ago, when my father was about to undergo a heart procedure, I hinted to the cardiologist, a colleague, that I wanted to be there, too, not just to offer comfort but also to be present for the play-by-play that would lead to a critical decision: whether to open his blocked arteries with a stent or to perform bypass surgery. Draped in an X-ray-shielding body suit over his blue ...

See more patients with same day appointments

by | in Physician | 5 responses

No one knows for certain what the future holds for American medicine. With cutbacks again on the horizon, we do know that reimbursements are going to decrease in the near future resulting in a decrease in income.   An effective way to maintain our incomes is to increase the volume of patients seen but also to increase the income per patient that is seen in our offices.  One of the best ...

Why medicine is not health

by | in Meds | 9 responses

Being a physician certainly biases how I view the world around me. I can't help but think in terms of problem solving and healing. But have you noticed how medicalized our society has become? The other night watching television, we watched at least four drug commercials and one health insurance commercial -- during a half hour show! I believe we are in the middle of the medicalization of America, and ...

Few doctors will meet meaningful use in 2011, and that’s ok

by | in Tech | one response

2011 will be a disappointing year for the Centers for Medicare and Medicaid Services and the Office of the National Coordinator’s electronic health record incentive programs. We predict that few doctors and hospitals will meet the objectives set for the "meaningful use" of certified EHR technology. Meaningful use is, of course, the term that describes the objectives and measures providers and hospitals must meet in order to receive financial bonuses ...

Why deferral of emergency care is risky and unethical

by | in Policy | 5 responses

Boondoggle – a scheme that wastes time and money. Perhaps this is not the best way to describe the many efforts that are being made to try to keep patients with non-urgent problems from using the emergency department, but from where I sit, deferral of ED care is a cost-saving tactic that not only fails to deliver much in the way of cost savings, it also is a strategy that ...

Social media and the modern day House of God

by | in Social media | 4 responses

In 1978, as I neared the end of high school and readied myself for medical training, a book called House of God was published by a doctor under the pseudonym Samuel Shem.  By the time I read it as an intern eight years later it had become a cult classic among doctors.  Everyone I knew in my hospital read it, passing around the single copy we had, writing our names in ...

Why do doctors cling to continuous fetal heart monitoring?

by | in Physician | 10 responses

My patient needed to be delivered. She had just developed eclampsia, a potentially fatal disease that afflicts women in the second half of pregnancy. She had suffered a seizure and dangerously high blood pressure, and was at risk for far worse, including a stroke. No one knows why this condition arises, but delivery sure clears it up in a hurry.So we gave medication to start labor, and the nurses placed ...

My good intentions had helped start a reaction

by | in Patient | no responses

If death was the end zone, George had been on the one yard line twice in the last five years. And I, as part of his team of doctors, watched as he stubbornly maintained his goal line stand. Miracles rarely happen in medicine. They certainly don't happen to the same person more then once.Yesterday as George glided into my office you would have never known that eternity's grip had been ...

Why I left a top children’s hospital for a private office

by | in Physician | 7 responses

All medical students and residents, those with any sense of introspection anyway, wonder if we (they) should be on the front lines. We wonder if we should be meeting, examining, trying to diagnose and treat families and children when we know that an experienced clinician just around the corner or in the next room could see the patient, perform the procedure faster and with more panache than our feeble ...

Divorce after the diagnosis of Alzheimer’s disease

by | in Conditions | 13 responses

I was tempted to avoid venturing into this topic, only because I strive to keep my website and blog away from politics and religion. In that light, I am going to stay away from the politics and religion of this topic and just stick with the main theme of the story and respond based on my own experiences, which includes assessing patients who are known to have or are suspected ...

Why a physician recruiter needs to consider the spouse of a doctor

by | in Physician | 2 responses

Whether you are a physician saddled with the task of spearheading the recruitment efforts of your practice, a group practice administrator, an in-house physician recruiter, or an agency recruiter like myself, you have probably heard the following at least once (if not several times, as in my case) in your career from a prospective physician candidate you are seeking to recruit:"You know, I just wanted to say that I really ...

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