I recently had some physical therapy for a minor injury. Since the office forgot to charge my co-pay the first time I went in I received a so-called Explanation of Benefits (EOB) from my insurance carrier, BlueCross BlueShield of Massachusetts. EOBs are a holdover from the mainframe era: arcane, inflexible reports that are hard to interpret. They may have done their job in the day when their only purpose was ...
October 2011
All Stories
The life of a medical resident in Mexico
The average week for a medical resident training in Mexico can easily exceed 90 work hours. Mexico is a country that takes pride in offering full health coverage for 100 million citizens. This is a new policy and free public medical care is being pushed to the limit. The situation is simple, the work load in outpatient clinics, operating rooms, the wards and emergency rooms across the country is ...
The United States lacks postpartum support for mothers
Last month, vegan couple Jade Sanders and Lamont Thomas’ appeal of their life in prison sentence was overturned. The couple reportedly starved their 6 week old to death by feeding him only soymilk and apple juice. When reading this, so many questions arise. How could they not know their child was starving? Where was their support? Were they truly negligent? And what happened to all the systems in place to protect ...
The impact of unnecessary testing and treatment on patients
Ask most patients, and they say their doctor has a good reason for ordering tests and prescribing treatments. Turns out their doctor may secretly disagree. That's the conclusion of a new study. The implications are more than a bit disturbing.Researchers from the Dartmouth Institute for Health Policy conducted a survey of more than six hundred physicians. Forty-two percent of family doctors admitted that patients in their own practice receive too much care - meaning ...
Our easy access to imaging has led to overutilization
With all the debate about cost control, it’s clear that we doctors will have to police ourselves – or else politicians and insurance companies will exert even more influence over our practices than they already do. The main question is:Are we willing to let our physician colleagues exert influence on our care decisions?Taking a case from my field: at a conference this past week I met a radiology resident ...
Hospital discharge summaries are a health literacy issue
A couple of years ago, a frail 88 year old Filipino woman came into the emergency department of my hospital complaining of confusion and weakness of her left arm. Her blood sugar level was extraordinarily low, so low that she would have died had she not received immediate treatment.The emergency room doctors treated her by injecting her with sugar, and then called the team of internists on call to admit ...
Prostate cancer screening requires patient input
Predictably, reactions to the USPSTF's prostate cancer screening guidelines are all over the map.Consider editorials from two national newspapers, the New York Times and USA Today.USA Today wants readers to ignore the recommendations: "Here's our suggestion for the 50-plus male: Get tested, then get smart. Information about prostate cancer and its treatment is readily available from the ...
Knowing the true name of a medical condition
There is a long tradition in folklore, one shared by shamans and occultists, that knowing the true name of something gives you power over it.Many years ago I had a very sick patient in the PICU who one morning, totally out of the blue, broke out in a bright, red rash all over his body. The boy had many critical problems already and, although the rash didn’t seem to be causing ...
Top 5 myths about empowered patients
Irrational exuberance was a term once used to describe the stock market before the last crash. It also seems an apt description for much of the talk these days about empowered health consumers.To be sure, patients today have unprecedented access to health information. Patient decision-support tool can be found on just about every provider, payer and self-insured employer website. Consumers can go to any number of websites to find ...
Whose responsibility is childhood obesity?
With the obesity crisis in America, one of the major reasons for increasing health costs, the issue of the causes inevitably arises.There seem to be two sets of causes postulated by a growing crowd of experts. Unfortunately, each set is aligned in our current polarized political climate with the right or the left. Each set of causes has some basis in reality, but neither fully explains the problem.On one ...
Stem cells, surgery free heart valve repair and nutraceuticals advance heart care
The last post in this series discussed new advances in cardiology – the two themes of genetically informed therapy and technical advances. I will continue with three additional themes – regenerative medicine, minimally invasive approaches and prevention.The third of the five themes is regenerative medicine. One major area of investigation is whether stem cells can heal the damaged heart. Perhaps the field is “more glamour than fact” just now ...
ACP: Relationships enhance patient care
A guest column by the American College of Physicians, exclusive to KevinMD.com.Up until 2001 I practiced medicine in the hospital where I was born. I still work in the hospital that was built to replace it. In our mobile society that is clearly the exception rather than the rule.I love what I am able to offer my patients as ...
Doctors who cross the line by protesting too much
Doctors are in the cross-hairs of the nation's politics more than ever. We're all being asked to achieve more with less. We must cope with nightmare scenarios precipitated by cracks in the social and healthcare infrastructure so often these days that medical schools insist students become effective patient advocates as well as healers. Practicing good medicine necessitates navigating a minefield of competing interests. Doctors are increasingly tempted to just walk ...
Are physician services to blame for high health costs?
Why does health care cost so much more in the United States than in other countries? The answer is exceedingly complex; pharmaceuticals, hospitals, and physician services (among others) comprise the multiple slices of the health care pie that in the United States is about twice the size of the next largest spender for health care services.A new study from one of President Obama’s appointees (note: this study was written ...
Three major cognitive errors physicians make
As physicians, we all dread missing a diagnosis: indigestion that turns out to be angina, back pain that signals an aortic aneurysm, migraine that proves to be a brain tumor. Although it is only an estimate, several studies in the medical literature indicate that misdiagnosis occurs in 15% to 20% of all cases, and in half of these, there is serious harm to the patient.Researchers have found that the vast ...
Transparency in health care preserves our ability to innovate and grow
Collaboration between medical professionals and the healthcare products industry has long been vital to advancing patient care and safety. Healthcare professionals help companies better understand unmet clinical needs, while companies invest in innovative research and product development that are squarely focused on improving patient care and enhancing patient safety.As a society, we should acknowledge the value of these bona fide relationships. Balanced provider input into corporate decision-making has broad ...
Shared decision making is impossible in a government run health system
The relationship between doctors and their patients has changed dramatically over the past few years. Medical beneficence became paternalism and is now near obsolete. Shared decision making is the new lofty ideal we should all be striving for. It is guiding new health policy both in the UK, with the new mantra "nothing about me without me," and in the US.We are at the start of the Century of the ...
Observing the Primatene Mist controversy as an asthma specialist
As the clock ticks away on Primatene Mist, the only over-the-counter asthma inhaler left on the market, it is being ginned up as an argument against regulatory overreach by the Obama administration. I have been observing the Primatene controversy for decades as an asthma specialist. I have to say that there’s blame enough on many sides of this discussion, not just pro and con government regulation, but both the pharmaceutical ...
Time to put a little bit of Disney into medicine
Why is a trip to the doctor’s office more like going to the DMV than going to Disney World? Both the DMV and Disney World involve waiting in long lines, but Disney has made the entire experience fun and exciting, while the DMV has made it cold and frustrating."But medicine is different," you may say. Seeing the doctor was never meant to be a fun or exciting experience, after all. ...
MKSAP: 72-year-old woman with fatigue and decreased exercise capacity
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.A 72-year-old woman is evaluated for fatigue and decreased exercise capacity. The patient has severe chronic obstructive pulmonary disease, which was first diagnosed 10 years ago, and was hospitalized for her second exacerbation 1 month ago. She is a former smoker, having stopped smoking 5 ...
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....
