My USA Today column was published this morning: Pain management: Education is key.I discuss the pain management conundrum in our country, explaining the no-win situations both chronic pain patients and doctors find themselves in: "Doctors face a conundrum. On the one hand, chronic pain drugs can lead to abuse, which could draw the attention of law enforcement. On the ...
September 2011
All Stories
You cannot treat a patient against his will
Year: 2002Setting: Gleneagles Hospital, Singapore Position: Private general practitionerI am the first and only non-Anglo-Saxon, foreign, private general practitioner in the city-state and the physician of reference for 14 embassies, consulates and a high commission from Europe, Asia, South America and Africa. One afternoon, a nurse comes into my consulting room saying that an ambassador from a European country has had an accident and that he insists on being seen immediately.I ...
Should Medicare pay for procedures that have no proven benefit?
"Doctors, with the consent of their patients, should be free to provide whatever care they agree is appropriate. But when the procedure arising from that judgment, however well intentioned, is not supported by evidence, the nation’s taxpayers should have no obligation to pay for it."So argues Dr. Rita Redberg, a cardiologist and professor of medicine at the University of California, in a provocative op-ed published in the New ...
When professional courtesy could get physicians in trouble
More likely than not, a physician or a dentist has at one point provided discounted or free healthcare services to some patients by waiving all or part of a fee or the copayment and/or coinsurance obligations as a "professional courtesy." According to the Office of Inspector General's (OIG) Compliance Program For Individual and Small Group Physician Practices guidelines, however, this practice may expose a physician to an investigation.To be sure, not all professional courtesy discounts or free ...
A PhD who’s no longer a doctor in medical school
I’m a doctor. My mail comes with the Dr. prefix and my checks have Dr. on them. People introduce me as Dr. and when I go to conferences I am Dr. SuFu. However as of a couple months ago I’m no longer a doctor. With the donning of the white coat I paradoxically lost a degree and became a first name or Mr. SuFu. My name badge makes no ...
False assumptions and clinical errors in modern medical practice
Here are 22 false assumptions, practice failures, and everyday clinical errors that we believe are common in modern medical practice:1. Lack of appreciation of the phenomenon of physician persuasion and its hidden power. The placebo effect is scientific, potent, and worthy of use.2. Lack of understanding of the power of prevalence or pretest probability in the diagnostic process, leading to frequent false positives and "overdiagnosis" of nonexistent diseases.3. Lack ...
Why health reform will not be repealed
It's pretty simple, really.Once people gain actual real-life experience with a government program, they abandon their fear of the unknown, see its benefits more clearly, and become invested in its future.We've seen that with Medicare, which consistently pleases its beneficiaries. Part D has similar traction, and now we've learned that the citizens of Massachusetts are increasingly happy with that state's health reform.I'm not arguing that Massachusetts, Part D or even ...
KevinMD posts of the week, September 18, 2011
Here are the top posts from this past week, based on the number of times they were viewed.1. How Jenny McCarthy became a medical thought leader. The mere mention of Jenny McCarthy gets an immediate eye roll from many physicians. The closer their practice is to autism or immunology, the more likely the eye roll turns into a lecture on why Ms. Playboy should focus on what she knows.2. ...
How your physician is like a chef
I wear lots of hats. Over the years, I have developed analogies for most of the things I do and for the things I want my patients to do. Analogies help people conceptualize the complexities of medicine in a way that makes sense.Today, I had my chef’s hat on. I was actually treating a young chef and found myself talking about food and medicine. There is a direct correlation. My ...
How our resuscitation efforts would be interpreted by fate
I walked up to the closed door and paused , exhaling a deep breath weighted with disappointment, trying to clear my thoughts for the conversation about to come. My clenched fist was briefly suspended, mid-air, ready to knock. Beyond the door, I could hear muffled conversation and movement.A calm, pretty woman stood beside me. An emergency department case manager. She held a notebook and pen, ready to jot down any ...
The shortage of general surgeons demands attention
There is much hand-wringing about the shortage of primary care physicians. But primary care not the only specialty with deficits. In a few years, all surgical specialties will experience significant decreases in availability. Here is what will be happening with general surgery.Demand-side factsThe current population of the United States is about 311 million people. Estimates are that by 2020, it will rise to over 340 million.As baby ...
For doctors who suffer from burnout, the ultimate tragedy is suicide
The British medical journal The Lancet surveyed a number of studies that discuss troubling statistics on suicide and depression among American physicians. The subject is not new, but the studies attempt to provide a few new insights.A 2004 analysis in The American Journal of Psychiatry found that male doctors were 1.41 times more likely to commit suicide than other men. The statistic for female doctors was significantly ...
MKSAP: 81-year-old man is evaluated for the gradual onset and progression of memory loss
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.An 81-year-old man is evaluated for the gradual onset and progression of memory loss over the past year. He says he has difficulty recalling the names of familiar people, has misplaced his wallet on numerous occasions, and is slower to find his car in large, ...
Large American pharmaceutical companies cannot have it both ways
Large American pharmaceutical companies must decide which end of the drug development / delivery to patent pipeline they wish the American taxpayer to subsidize. They cannot have it both ways.First, let me say that there has been a free-for all demonization of the drug companies or the more pernicious appellation Big Pharma. Large pharmaceutical companies provide jobs, support community services and charities. They provide the drugs and treatments that ...
The root cause of why our health system is unsustainable
An excerpt from Balancing The Budget is a Progressive Priority.It is our cultural fear of death and inability to discuss the limits of medicine to forestall death that enables the politics of health reform to be so potent.When I did a post-doctoral fellowship in England in the mid-1990s, a professor I met who had lived in the U.S. explained to me why he thought health policy discussions in that ...
How to use Twitter at your next medical conference
I thought I would give a quick overview of good ways for you to make use of Twitter at a medical conference. The growing field of palliative medicine has had a strong social media presence and the addition of more people into our online network helps get important information to people far beyond the patients and families we see each day in our work.Twitter can be a great way to capture the small ...
Free medical school may not help the future of primary care
In an op-ed appearing in the New York Times on May 29th, Drs. Bach and Kocher lay out a plan for making primary care more attractive to medical students. They propose the following: "Under our plan, medical school tuition, which averages $38,000 per year, would be waived. Doctors choosing training in primary care, whether they plan to go on later to specialize or not, would continue to receive the ...
The inability to locate price anywhere in the hospital
A torn meniscus. It did not disable but it impaired, and unpredictably. My stomach learned quickly to tighten at the sound of A.’s peculiar whimper in response to a crippling pain that would shoot through her at seemingly innocuous movements of the afflicted leg. We have health insurance of sorts, the type that will help you keep your home if tragedy strikes, but that does not shield you from the ...
The value of new drugs depends on your perspective
Here is an interesting survey from Quintiles, the large clinical outsourcing company, on how different groups perceive the value of new drugs.The first problem is that not everyone can agree on what's valuable. Surveying managed-care people and physicians, the number one factor mentioned is cost. Biopharma respondents mentioned cost, but were more weighted toward outcomes (which, for example, was a factor in only 10% of the physician responses). ...
Primary care gets caught in the physician pay crossfire
Major journals have slipped in another article that apparently was designed for controversy and for widespread distribution to media outlets. The New York Times rapidly picked it up. As the nation enters the final months before 29.5% fee cuts for Medicare physician services, there will be many more of these that reach the light of day - too many if this is an indication.What is common to major journals, media ...
Kevin Pho, MD
-
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...
-
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....
-
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...
-
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
-
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....
-
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...
-
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...
-
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
-
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...
-
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...
-
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...
-
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
-
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...
-
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...
-
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...
-
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
-
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...
-
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...
-
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...
-
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
-
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...
-
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...
-
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...
-
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....
