Until recently, there was a financial difference between performing a "consultation" and a "new patient visit" for office visits (Medicare stopped paying for consultations at a higher rate than new patient visits in 2010).In specialists’ offices, patients often got billed for the more expensive “consults” when in fact the visit was not a consultation at all. Let’s just use this understanding as the brief background for what I’m about to say.I ...
November 2011
All Stories
KevinMD media mentions, November 2011
I’d like to thank various media outlets for recently citing KevinMD.com.1. Ethics Forum Speaker KevinMD: Social Media Gives Doctors a Voice, Massachusetts Medical Society. We recently caught up with Dr. Kevin Pho, MD, a Boston University-trained internist now practicing in Nashua, NH. His website, KevinMD.com, is one of the Internet’s top sites for physician commentary and news.2. Defensive medicine adds billions to healthcare costs, Healthcare Finance News. “There is a ...
Gallows humor is only a temporary release from a traumatic situation
Cheryl and Susan arrived at the hospital at 6:30 AM. As was their routine, they stopped for their Starbuck's latte and shared family stories as they walked toward the ICU. The two were well known pranksters but were widely respected for being top notch ICU nurses. The whole crew there was like a family. They went to baseball games, picnics, and vacations together. Today was like most other days. They ...
Why do non-profit hospitals compete with each other?
While we are talking about things that drive health care costs up, this one has bothered me since I was in practice years ago. I am a believer in competition, I think it forces us to be creative and provide better, cheaper, more efficient products and services.But there is the mindset of leadership at play as well. Are we competing to provide better patient services to improve patient care, or ...
How the crises of healthcare and education are related
There are two crises in America, both of which have a profound effect on the economy. The cost of healthcare is eating away at our ability to finance other needy areas. Poor performance of our educational system is weakening our international competitiveness. Both healthcare and education are at the precipice of complete collapse. They both deliver glaringly inferior results with prohibitive expenditures. The performance of our healthcare system relative to ...
It is natural for medical students to feel long white coat envy
As a current fourth year medical student, one of the main things I look forward to after I graduate is trading in my white coat. For medical students everywhere, it’s a huge sign of accomplishment to shed the short coat and don the long one. It means you are now a real doctor.Medical students are required to wear short white coats that might reach to their fingertips, if they’re lucky. ...
When easy familiarity blurs the boundaries
When the patient jokingly touched my nose, I knew I had muddied the boundaries between us too much and it was too late to go back.(Note: Except for the aforementioned sentence, all of the patient’s details and quotations have been fabricated. Events from the interview and exam have been drawn from a conglomeration of patients and scrambled to illustrate a general theme.)It didn’t happen until the end of the interview, ...
How pain as a vital sign contributed to prescription pill mills
At this point, few would argue against the need for increased oversight of the legions of so-called pain management clinics that have sprung up in the past decade.After all, an annually increasing majority of them are nothing more than lucrative cash and carries for the legal sale of prescription narcotics to anyone with a need or want -- and the cash in hand. They have become a public mental health ...
Why Steve Jobs was the ultimate physician
The release of Steve Jobs's biography launched a second round of well-considered articles about Jobs and his legacy. It has launched a rich, detailed, almost “too soon” debate about Jobs as a man and how we have come to define genius in this day and age. Here at Doximity (an Apple fanboy shop if there ever were one), our head of design has already joked that after reading Isaacson’s biography, ...
Life expectancy is a simple number with immense ramifications
The milestone of the world's population reaching 7 billion is a fitting time to reflect upon life expectancy. Life expectancy is a rough marker of humanity and medicine's progress in the age-old battle to attain old age.Those born in the US this year are expected to live until 78.37 years of age if current mortality rates persist. This puts us at a sobering 50th in the world.How long is ...
Is preventive health really preventative?
Lately, there has been increased emphasis on "preventative" care in the US now that there are some mandates under the Affordable Care Act. The U.S. Preventative Services Task Force (USPSTF) exists, which is a panel of private sector experts who recommend evidence-based preventative screenings for certain conditions based on factors such as age and gender.As a family nurse practitioner, I base a large part of my practice on ...
When FDA fines become the cost of doing business
A recent $3 billion settlement between drug giant GlaxoSmithKline and the FDA really got me thinking. On one hand, it’s a breathtakingly huge number, breaking the old record of $2.3 billion set by Pfizer a couple years back. And there are some initial indications that the pharmas may be cleaning up their act a bit, expanding their compliance departments and reining in their sales forces in order to avoid ...
In both my driving habits and my surgical practice, I look both ways
I noticed something different about my driving habits lately. At a traffic light I used to accept the green as an open invitation to drive through unconcerned, confident that other drivers would see the red and do what they are supposed to do: stop.I don’t do that anymore. I always look to see if the road is clear, and other drivers have indeed stopped. And then I go. I have ...
Why patients with irritable bowel syndrome are angry at their doctors
I've had irritable bowel syndrome for 20 years, and I'm angry. About the pain, and the suffering, and the limited diet, and the huge impact that it has had on my life. But mostly, I'm angry at my doctors. No, they didn't misdiagnose me. No, they didn't harm me. No, they didn't treat me like dirt. But they still made me angry.Before we go any further, let's get one thing straight: I know ...
Lives focused through the lens of medicine will burn your eyes
I am a writer as well as a doctor. My heroes are Keats, Chekhov, Williams, Coulehan, Coles, and other physician writers. And those greats of medicine too, known and unknown, who have spent their lives caring for people.My writing is short. Really short. If it isn’t poetry, it scans like poetry. And one act plays. As in The Ride, my latest collection. Someone said if you can’t write poetry, ...
New approaches to cancer screening and diagnosis
I see five major themes in cancer care advances: new approaches to screening and diagnosis, better understanding of the role of viruses as causative agents, targeted therapies, new technologies and improved approaches to ensuring better quality of life.Screening for the most common major cancers has been straight forward for years – women should get an annual mammogram and Pap smear, men should get a PSA test annually, both should get ...
Legislating the duties that can be performed by a nurse
Recently the Michigan Task Force on Nursing Practice hosted a regional forum in my area. I was fortunate enough to attend and hear from the RN’s there the many issues that they face, which are varied and challenging. The state wanted to hear from this forum of RN’s what changes were needed in the state’s nursing regulations so that certification could be updated to reflect the current nursing environment. It ...
The new definition for a medical emergency
The recent budget crisis in many state Medicaid programs has led the directors of these health care programs for the poor to cast about for ways to cut their costs, and many have landed on a ‘solution’ that puts lives at risk and undermine the financial viability of an emergency care safety net that is already severely underfunded and overwhelmed. Some 21 states use a variation of the old definition ...
Including communication as a system in work rounds
When patients are sick enough to require hospitalization, medical decisions often involve nontrivial tradeoffs between risks and benefits. They require discussions with patients and families from a variety of cultures and backgrounds. And sometimes these discussions break down.Patient-clinician communication is increasingly recognized as an integral part of clinician competency. Indeed, family-centered rounding, increasingly practiced at Children’s Hospital Boston, is a critical step in this direction. Fully adopting this practice ...
Why more cancer screening may not be productive
The longer I continue in practice, the more complex it becomes. I thought advances in our understanding of the molecular basis of cancer would clarify decision making ; instead answers have led to more questions. In the spirit of the immortal Henny Youngman: Take the issue of cancer screening, please.The story of screening for colorectal cancer (CRC) and prostate cancer has many similarities. The primary screening and diagnostic tool during ...
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....
