One of the big concerns about implementing an electronic health record (EHR) into a medical practice is the fear that it will slow you down. In fact, after cost, usability (and its effect on productivity) is the second-biggest perceived barrier to EHR adoption.Numerous studies have shown that EHR implementation actually ends up saving cost in a group practice, mainly because of reducing or eliminating the need for ...
September 2011
All Stories
MKSAP: 25-year-old man with swelling of the feet and legs
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.A 25-year-old man is evaluated in the emergency department for swelling of the feet and legs. He has a 5-year history of HIV infection for which he has refused treatment.On physical examination, temperature is normal, blood pressure is 128/74 mm Hg, pulse rate is 88/min, ...
The dual tragedy of suffering catastrophic illness and being uninsured
An estimated 60% of American bankruptcies result from overwhelming medical costs. My uncle’s tale illuminates the dual tragedy of suffering catastrophic illness and being uninsured.The 2008 recession claimed my uncle’s job, health benefits, and assets, except for a small inheritance. By 2009 he found work (but not health coverage) as a consultant.One day he noticed that his eyes were yellow. He emailed a photograph, and I immediately recognized jaundice. I ...
The growth of integrative medicine in academic institutions
The Atlantic published an article about the growth of quackademic medicine in our teaching institutions and it's celebratory more than critical. It profiles the integrative medicine clinic of Dr. Brian Berman. That's right, this Dr. Berman. I blogged about him four years ago and it seems his clinic at the University of Maryland is still going strong. Stronger, apparently.The article, like integrative medicine itself, is a mixture of quackery ...
The graveyard hidden in a surgeon’s mind
This is a difficult story to tell but if I am to be true to the complete experience of a surgeon, I do need to tell it.One of my seniors used to say that every surgeon has a graveyard hidden away somewhere in the dark recesses of his mind. He went on to say it was unfortunately normal, so long as you remember all the names engraved on the tombstones. ...
Human capital makes doctors special
If you’ve ever been sick, especially with anything serious, you quickly realize that doctors, nurses and their ilk are an unusual and precious resource.First you have to find smart people with personalities willing and able to put up with a lot of guff in the service of their fellow man. Then they have to be willing to (usually borrow, and) spend tens or hundreds of thousands of dollars for ...
Patients lose if physicians are expected to practice perfect medicine
I discussed whether or not ambulances should be required to add equipment costing $12,000 in order to be able to transport 850 pound patients recently, so I won’t belabor the point here. Providing medical care to morbidly obese patients presents multiple challenges.Then I read an article in the Florida Sun Sentinel about how some obstetrician-gynecologists in South Florida are refusing to provide medical care to obese women. ...
Defining what health truly is
I read an interesting article by Jason Luban, a licensed acupuncturist, on why so many patients flock to alternative practitioners. Mr. Luban brought up an interesting question, "What is health?"Is health simply the absence of disease? If it is, there certainly aren’t very many healthy patients in my neck of the woods. Most of the patients I take care of have something that’s not quite right. I only know one perfect ...
The threat of technology to proper patient care
Dr. Abraham Verghese wrote in the New York Times recently about the threat of technology to proper patient care. This is an excellent piece and although I do not disagree with the overall message, I think Dr. Verghese conflates different issues currently plaguing our health care system.Below, I provide some comments on a few of the major points Dr. Verghese writes about: "This computer record creates what I call an "iPatient" ...
A reminder of why doctors do what they do
Residency is hard. The hours are long, the work is grueling, and, simply put, hospital food is not good. Many days, we, as residents, walk the wards in a lifeless haze – coasting on the wings of our white coats, our fuel tanks pointing way past empty.During these times, we find ourselves sitting in wheelchairs that are stored in dark remote corners, questioning whether or not all of this is worth it. For years, ...
Asking patients about their health care financial concerns
I remember joking with Dad about how he'd outlive us all. He had gone vegetarian 10 years before I was born, never smoked, took vitamins, and asked for a designated driver after his annual Heineken at the neighbor's Christmas shin-dig. He flossed, wore a seat belt, and looked forward to annual physicals. If I tried leaving our Michigan house in the winter with more than 3 inches of skin exposed, ...
Can we control health costs without rationing?
Robert Brook, MD, health services researcher extraordinaire, wrote a provocative commentary in JAMA – as he is accustomed to doing – entitled “What If Physicians Actually Had to Control Medical Costs?” In his piece, Brook challenged physicians to take a lead role in addressing the cost dilemma and called on physicians to find alternative strategies to rationing.No matter how spot on Brook was in his call to physicians to ...
The specialty that makes doctors rich and happy
A long time ago, I was very close to becoming a cardiologist. Really.Even though my fascination with ID and microbiology started in medical school — and believe me, not much fascinated me in medical school — the fact that all the top residents in my program were going into cardiology made me feel that somehow I should be doing this too. Plus, the guy who was Chief ...
Telemedicine to augment the patient encounter
When I use the term "telemedicine," what does it mean to you?In current parlance, it usually refers to radiologists looking at digital images of x-rays and other scans from locations remote from the site of acquisition. Think "outsourcing" where the radiologist could even be as far away as India.But according to a recent conference I attended, telemedicine could mean so much more. It can range from synchronous video chat ...
Who are the most powerful people in American medicine?
Almost everyone I know considers the American healthcare system to be a horrible mess, although some that are deeply into it are quite happy with it. It serves their interests well.Many do have big-time power.There are lots of candidates for the "most powerful" title.How about Regina Benjamin, the Surgeon General of the United States Public Health Service?Maybe Kathleen Sebelius, the Secretary of Health and Human Services?Consider Howard Koh, the Assistant ...
How a doctor reviews cases for both plaintiff and defense attorneys
Early in my career, a local defense attorney working with my hospital would occasionally ask me to review a case in which another physician client of her firm was the defendant. As Medical Director of Evergreen Hospital Emergency Department, I was comfortable with hospital records, knowing where to look in a record for information – both recorded and not recorded – that either helps or hurts a case. I found ...
An incorrectly coded $1,000 billing error
As a graduate student in the health field I often get phone calls from various family members and friends asking what I happen to know about different drugs, procedures, and devices. I was having one such conversation with my younger sister last spring. She had just completed her undergraduate education, started a new job, and was very proudly financially self-sufficient for the first time.We were talking about birth control. Her ...
5 signs for health care social media success
I sense a movement in health care circles from, "no way we’re doing that social media," to "ok, we get it social media is important, now what?"This is good to see. But like all things new, we’re experiencing some growing pains. Some health care providers take to social media easily and find ways to leverage it to educate, inform and grow practices, while others make efforts but can’t seem ...
When is the right time to introduce solid foods to an infant’s diet?
Parents often wonder when is the appropriate time to introduce solid foods to their infant's diet. It seems like a simple question. So simple that the American Academy of Pediatrics (AAP) cannot agree on the answer. The AAP Committee on Breastfeeding recommends starting complementary foods (rice cereal and baby foods) after six months of age and the Committee on Nutrition recommends the introduction of complementary foods between four to six ...
Promoting a rational approach for the reduction of cardiovascular risk
It is a rare occasion nowadays when academic journals treat us to an editorial debate of some substance. The staff at the Journal of the American College of Cardiology can be applauded for publishing last summer two articles representing fundamentally opposed viewpoints on the best strategy to avoid cardiovascular illness. Amusingly, both claimed in the title of their piece the distinction of promoting a "rational approach" for the reduction ...
Kevin Pho, MD
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Why Priscilla Chan may become the country’s most influential doctor
Who has the potential to be the most influential physician of our generation? It's Priscilla Chan, who not only recently graduated from...
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Confused about prostate cancer screening? Make a shared decision
In a widely anticipated move, the USPSTF officially recommended against prostate cancer screening in healthy men. Case closed, right? Hardly. The prostate...
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When it comes to doctors and social media, hospitals fail miserably
When it comes to medicine and social media, much of the attention is negative. Doctors losing their hospital privileges because of Facebook....
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Warren Buffett’s prostate cancer choices aren’t right for every man
A version of this column was published on April 24, 2012 in USA Today. There has been a recent uptick of elderly men...
Physician
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Why test recalls should not be considered cheating
I was appalled recently by the coverage of radiology “test recalls” by CNN, amplified by Dr. Gary Becker of the American Board...
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Why physicians are susceptible to hardball tactics
I was invited to a medical staff leadership conference sponsored by our hospital. A company specializing in training physician leaders ran the...
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How we deliver bad news is critical to how families deal with grief
As a cardiac electrophysiologist, I have had to discuss bad news with patients and families more times than I would like during...
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His father’s suffering had already been too great
He looked dead. The paramedics brought him down the hall toward one of my critical care beds, and for a moment I...
Patient
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How death can be a beautiful experience
I was honored to be part of a beautiful experience in late January of 2011. It was the death of my mother-in-law...
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What meaningful encouragement can be given to someone who is dying?
Theirs is a lonely journey; to be moving towards the separation and end of all things known and loved. Being with a...
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Health care journalists have tendencies similar to those of doctors
As a patient who was asked to speak at the Association of Health Care Journalists 2012 conference, I felt a bit covert....
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Adaptation can be painful, but it can also be a gift
Nothing will force you to live life on your own terms faster than almost losing it. In 2008, I was on fire....
Policy
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What should America’s health care vision be?
America has this paradox of excellent biomedical science, innovative drug manufacturers and entrepreneurial device developers along with outstanding providers but at the...
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Hospitals around the world aim to remain relevant to patients
"It was the best of times, it was the worst of times ..." So begins a story called A Tale of Two...
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Repairing the tear in health care’s safety net with social media
The nation’s “safety net” hospitals are designed to ensure that uninsured, lower income and indigent populations receive adequate medical care – a...
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Look to technology to reduce health costs
Technology to lower costs rather than accelerate them. Smart phones to increase physician and other providers’ productivity. Fewer primary care physicians but...
Tech
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Mobile health apps don’t always follow conventional wisdom
Propaganda and non-truths abound all around the Internet saying that mobile health apps are everything from a threat to Big Pharma to...
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When patient care becomes secondary to filling out the medical record
The policeman was two cars in front of me. I meandered down the road cautiously adjusting my speed a few ticks above...
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Doctors, use Google to get more patients in less than 7 minutes
Every month, hundreds of thousands of people look for a doctor on Google. As an amazing practitioner, your site deserves to be...
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The user interface for EHRs should be uniform
The first thing I noticed when I walked into the physician’s office were the tall cabinets filled with manila folders, tabbed with...
Social Media
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We need to see the potential harm of social media
Prior to 1794, farms across the world could only pick cotton as fast as humanly possible. In the late 18th century, Eli Whitney...
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Why social media may not be worth it for doctors
Social media in healthcare is all the rage these days. You can’t visit even one physician-oriented website without someone breathlessly advising you...
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Transparency defines social media success for doctors
Want to understand social media? Physicians wanting to learn about social media must learn transparency. We must learn transparency on a personal...
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How Twitter was used in a potential mass casualty scenario
It was my first ER shift in charge of the resuscitation area. Needless to say, my adrenaline and nerves were firing like...
