No pediatrician can answer the question: "What’s the most important thing I can do to keep my child healthy?" without listing three of four things. I’m no different, but right now family dinners are at the top of my list. You could argue that immunizations, car seats, bike helmets, 9-1-1, sleep, or good hand washing are just as important, and I won’t disagree. But it’s hard to overlook the overwhelming ...
September 2011
All Stories
United States health care may need reverse innovation
The realization that the American health care system must simultaneously decrease per-capita cost and increase quality has created the opportunity for the United States to learn from low and middle-income countries. "Reverse innovation" describes the process whereby an inexpensive innovation is used first in countries with limited infrastructure and resources and then spreads to industrialized nations like the United States.The traditional model of innovation has involved the creation of ...
Patient safety in the elderly staying at home
As a geriatrician in a locale with many elderly retirees, I am frequently asked how long mom or dad (or both) can stay in their home and live safely and successfully. It is clearly a complicated issue even if the individuals involved are cognitively and mentally intact, physically capable and financially able to pay for support and help.There is much to consider. Are the patients physically able to maneuver within ...
AMA: A new opportunity to fix the SGR
A guest column by the American Medical Association, exclusive to KevinMD.com.Every year since 2001 the threat of severe physician payment cuts, imposed by Medicare’s failed sustainable growth rate formula (SGR), have jeopardized the stability of the Medicare system and compromised access to care for patients. And every year – sometimes several times a year – Congress has put in place short-term ...
Patients should care about physician stress and burnout
Physicians are human, like everyone else.And when things go wrong, like making a medical error or having a patient die, they suffer like most people would.Pauline Chen writes about Schwartz Rounds in the New York Times, where, in a confidential environment, doctors and other health professionals can discuss challenging cases.As Dr. Chen writes, "the discussions that ensue ...
How health reform is reshaping health care markets
The current reorganization of health care could make it better and cheaper for everyone, harnessing real creative and competitive energies to build the "next health care" —or it could lead to local monopolies, higher prices and less real competition where it matters. The many and various moves toward accountability, competition and transparency could defeat themselves.The theme of the reorganization is clear: new types of cooperation between physicians, hospitals and other ...
Using the emergency room for routine physicals
One of my patients thanked me for saving his life. Apparently, many years ago I had told him that most men’s first complete physical is in the emergency room in the midst of their heart attack or stroke. I have been in practice long enough to have forgotten many of the things I have told patients. I try to capture the pearls I have learned over the last 30 ...
Unexpected medical bills on a graduate student’s budget
Last July, I found myself needing to visit a doctor for an urgent medical issue. My period had started in April and never stopped. It was light, so it wasn’t too much of an annoyance, but after three months I figured I needed professional help.I had started graduate school in Michigan the year before and was back home in California for the summer. I wasn’t sure if the new insurance ...
Does longer physician training merit more pay?
One of the main considerations in physician pay under CMS’ relative value system is the training required to complete a task. This is generally thought to be well understood but is, in fact. a quagmire of controversy.Take for example the specialty of family medicine compared with dermatology, anesthesiology, or ophthalmology. Family physicians make between 1/2 and 1/3 of what these other specialties make, so one would think that there ...
Social gaming to engage patients and improve wellness
Social connectivity to engage patients has real the potential to impact health through improvements in lifestyle, the main driver of wellness. This is in increasingly shorter supply as we collectively increase pounds, cholesterol, and blood pressure readings.Many have written compellingly on why social matters for health. The best I’ve seen are a post by Jay Parkinson (of Hello Health and Fast Company fame) that borrows from ...
How to talk to teens about tanning beds
You’ve had the sex talk, the smoking talk, and the drugs and drinking talk. But have you talked to your kids about tanning beds?You should. Tanning bed use can cause skin cancer, including the deadliest form, melanoma. And, using tanning beds before age 30 increases a person’s risk of melanoma by 75%.Equally worrisome: tanning beds can become addictive. A recent study showed that 80% of college-age tanning beds users couldn’t kick the ...
Why this medical student doesn’t blog anonymously
I started writing a blog when I began medical school, knowing that even though I was close to home I might not have as much time for keeping in touch with family and friends as I was used to. Writing it anonymously, or under a pseudonym, was a possibility that never even crossed my mind – it seemed it would defeat the purpose of being able to share my ...
Andrea Mitchell breast cancer thoughts
For the past 24 hours I've squirmed about whether to or how to criticize NBC's Andrea Mitchell about her on-air announcement of her breast cancer diagnosis and treatment. How can you criticize someone who is dealing with what she - and so many other women - are dealing with? But it's now clear that some breast cancer survivors and others who know the science are critical of the message ...
Care costs a lot and it’s not straightforward what the cost is
Up until last May, my experience of medical costs was limited to the $100 per month premium I contributed towards my employer-sponsored insurance and the nominal co-pays associated with well-child checkups and generic prescriptions. There was never any hesitation in seeing a doctor or filling a prescription. That all changed when went I back to school.I blindly signed up for the school-recommended family insurance and naïvely assumed myself, my ...
Targeting physician salaries is a poor strategy for health care costs
A recent study from Health Affairs took aim at physician salaries.Well, not exactly their salaries, but fees. It's a subtle difference, but that nuance is lost in the mainstream media narrative.According to the study, "American primary care and orthopedic physicians are paid more for each service than are their counterparts in Australia, Canada, France, Germany and the United ...
To connect with patients is key
con·nect (from dictionary.com)verb (used with object)1.to join, link, or fasten together; unite or bind: to connect the two cities by a bridge; Communication satellites connect the local stations into a network.2.to establish communication between; put in communication:Operator, will you please connect me with Mr. Jones?To connect with your patients is truly the key solution.Connect takes on two meanings:
- Establish a relationship; develop, dig, pursue
- Maintain via all the tools now available: email, texting, Facebook, blog, etc.
All of us are role models, whether we see ourselves that way or not
All of us are role models, whether we see ourselves that way or not. Of course I love to imagine myself as a positive role model, but my eleven-year-old daughter has already informed me that things will be way different at her house when she’s a mama. However, we’re not going to focus on how uncool I am, instead, I’m going to share the stories of a couple of people ...
How hospitals can avoid readmissions
An interview by Curaspan Health Group with Stephen Jencks, MD, MPH.Stephen Jencks is lead author of the 2009 landmark study of the multibillion-dollar cost of readmissions, says there’s “been a great deal of movement” on readmissions since his work was published in The New England Journal of Medicine, but there’s more that hospitals and communities can do.Dr. Jencks, an independent consultant in health-care safety and quality, and ...
ACP: Current and future payment and practice trends in medicine
A guest column by the American College of Physicians, exclusive to KevinMD.com.In April 2011 I finished seven years on the Board of Regents of the American College of Physicians (ACP) including two years as Chair of the ACP Health and Public Policy Committee and serving during the last year as President. During that time I had the opportunity to ...
The problem of inadequate discussions of end of life wishes
The Annals of Internal Medicine occasionally reviews the articles and studies of note in a particular field of internal medicine for those of us who don't read all of the specialty journals. Recently, there was an update in pulmonary and critical care medicine, the internal medicine specialty that is most intimately involved with caring for the very ill and those people who are at the ends of their lives. ...
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....
