How do companies curb health care costs?Do healthier employees lead to increased productivity? Several progressive companies believe so and have committed to providing employees with programs to help engage them in a healthier lifestyle.As part of the incentives to lead a healthier lifestyle some employers have instituted a penalty and reward system tied to the companies’ benefits. For example, smokers may incur a significant surcharge to the cost of their ...
December 2011
All Stories
Dropping out of Medicare will break my heart
I met with my staff yesterday to discuss the effect of a 27% cut in Medicare reimbursement on our patients and our office. I had a really lousy day, explaining to my elders what would happen if Congress fails to act. One of my patients aptly pointed out that Congress has not acted responsibly in the last 20 years and that it would take a miracle for them to get their ...
Creating a practical, uniform policy on vein treatment
The general public, and much of the medical profession, has unfortunately little understanding of the connection between varicose veins and more serious manifestations of chronic venous disease, represented by higher CEAP classes. This is a fact that keeps many with vein disease from obtaining, or even considering, treatment. Fortunately, public education concerning venous disease and its potential complications, including chronic venous insufficiency and deep venous thrombosis, is growing.Organizations such ...
A good attitude is necessary when transitioning away from medicine
Do you feel like you have nothing to show for the efforts you’ve put into your career change?It’s easy to feel frustrated and lose motivation when nothing seems to be coming from all the work you put into things like LinkedIn, calling recruiters, revising your resume or networking.There are two possible reasons why things might not be working for you. Maybe you are doing the right things but you ...
Learning valuable public health lessons from influenza vaccination
In response to low immunization rates in my community, I served on a task force to develop a community-based pilot to increase influenza vaccination. We worked in collaboration with the NYC Department of Health and Mental Hygiene, Department for Aging, Visiting Nurse Services of New York (VNSNY) and a local church health ministry.On a Sunday morning in late November (during the CDC's National Influenza Vaccine Week) nearly 100 African-Americans received ...
My audacious goal for family medicine
I have a BHAG (Big Hairy Audacious Goal).I want people to hear "family medicine" and know that it refers to a medical specialty dedicated to providing relationship-based, patient-centered health care.I want people to know that family docs take care of a lot of complicated, challenging diseases - and not usually in isolation. Our patients have high blood pressure, complications from type 2 diabetes, congestive heart failure, depression, chronic kidney disease, ...
Autism is but one part of my son’s soul
Conversation with my lovable eight year old boy with autism.Me: Do you have autism?David: Yeah. (Pause.) I want some milk.Me: What do you like to play with?David: CalvinMe: Calvin is coming over today. He comes to see your sister. (David never plays with Calvin but does say hi to him).Me: Do you like school?David: YeahWhat do you do at school?No answerMe: Do you like to run marathons?David: Yeah (Pretty sure ...
Why I vaccinated my sons against HPV
I knew it was more than a tragic coincidence when two of my friends, middle-aged men without the usual risk factors of tobacco and alcohol use, developed late stage (IV) tongue cancer, reportedly the identical condition with which actor Michael Douglas was diagnosed last year. Cancers of the mouth and throat are growing so quickly that experts in the medical and scientific community are calling this an “epidemic,” for which ...
Isn’t it time for a patient rating system for doctors?
Here's a devil’s advocate position.Historically doctors have held power over patients as compensation for the responsibility of that position, and the epatient and other patient advocacy movements seek to address that imbalance with good reason, arguing that the doctor-patient relationship should be equal. I don’t mind that. But let’s be truly equal partners then.The patient’s right to choose a doctor and be informed of the best ones via doctor rating ...
The primary care doc fix is in
Matthew Mintz, MD recently shared how primary care doctors are set to lose more than half of their salary. It's well documented how primary care has faced a number of challenges with half of primary care physicians saying they'd leave medicine if they could as was mentioned in an earlier piece. There's talk of a "doc fix" as physicians believe the debt ceiling deal is ...
Vaccines, preventable disease, and the nature of risk
Two nights ago, I was watching, with my family, an old episode of Dr. Quinn, Medicine Woman, in which a young woman is bitten by a rabid wolf, develops rabies, and dies. That same night, I read a post on Facebook decrying the dangers of immunizations, with a link to an online “news” article blaming immunizations for everything from spreading cancer to HIV.My mother, as a girl, was bitten by ...
The fifties woman has many reasons to get better
"51-year old female presents today with ..."Funny, the vast majority of my clinical notes last week began with that phrase, give or take a year or two. Women in their fifties who saw me in the clinic, who I spoke to via television in my telepsychiatry practice, or who I interacted with in some other way. It struck me as odd that so many women of similar age came to ...
Show doctors the value when it comes to social media and EMRs
The common perception is that older doctors are more adverse to technology, especially when it comes to electronic medical records.Recent data, however, says that isn't true.According to a study cited in American Medical News, "physicians more than 10 years out of medical school and those with higher patient volumes were more likely than younger and less busy ...
Reduce sedation in critically ill patients
I sit here today, in this small, windowless call room with its low twin bed that is covered in untouched hospital blankets and sheets. Tonight is one of my last nights on a 30-hour call shift in the medical intensive care unit. Yet another mile-marker on this long journey of residency. My day began at the break of dawn, when I and another resident passed each other in the parking ...
Quality indicators can harm the elderly
Quality indicators are used to measure the quality of health care delivered to patients. Quality indicators are used extensively in the VA health system, and efforts are underway in Medicare to tie reimbursement levels to performance on quality indicators.The motivations for using quality indicators are guided by the best of intentions. There are many problems with the quality of health care in the US, and quality indicators aim to improve ...
A culture of fear permeates the healthcare system
The culture of fear that led to dozens of fatal plane crashes in Korea, the molestation of young boys at Penn State University, and the tens of thousands of deaths of patients in our health care system are all a consequence of unresolved organizational conflict arising from a culture a fear. Unless, we replace fear with trust, conflict won’t be resolved.In Korean culture, questioning authority is unacceptable and led to ...
Conflict between physician and nurse
When it comes to doctor- nurse interactions, when is enough, enough?Recently, I dealt with an upsetting situation involving a physician and nurse. A little background: The nurse has been working on our unit for years (since it first opened). She is very smart and savvy when it comes to nursing. She constantly gets feedback from the patients as being one of the kindest, most thorough nurses. I look up to ...
Let physician assistants be part of the primary care answer
There has been so much change in medicine, physicians are leaving primary care, and new ideas are being bantered about such as patient centered medical homes (PCMH) and accountable care organizations (ACO), in an attempt to try to address the problem. To add to this strain, is the knowledge that medicine is going to have to be ready to absorb thousands of additional patients in the near future ...
Advance planning should be a public health issue
"Medical training rarely deals with helping the dying patient find peace and comfort. In fact, most physicians are uncomfortable with the entire subject. I believe it is one of the most neglected aspects of medical care. I have spent my career as a pulmonary and critical care physician, and I have cared for thousands of dying patients. In many cases, both the patients and I knew that they were dying. ...
Making tailored health education standard of care
The recently instituted 30-hour-shift work restrictions placed on medical residents have created a need for "dayfloat" services to safeguard potentially unsafe handoffs in patient care and help residents adhere to duty hour limits. The past two weeks I’ve been the dayfloat resident for the cardiology inpatient service. My job is to round with the post-call team, help them get out of the hospital on time, and then take care of their ...
Kevin Pho, MD
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How patient satisfaction can kill
Patient satisfaction is all the rage. Medicare is beginning to tie patient satisfaction scores with hospital reimbursement, and doctors across the country...
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How I approach ovarian cancer screening with patients
Ovarian cancer screening clearly touches a nerve. No one doubts that ovarian cancer is a devastating diagnosis, often found when the disease...
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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....
Physician
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The analogy between baseball hierarchy and medical systems
From age six through high school, I played baseball. Playing baseball ended, rather abruptly it seemed, when I went to college, but...
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Saving patients from Internet health information
Lately, I get the feeling that I’m doing something wrong. I’m supposed to form a partnership with my patients. My patients are...
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Understanding what patient centered care really means
There was nothing the professor despised more then the syrup that oozed out of his partner's lips when dealing with patients. He...
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A letter of thanks to my organ donor
I have tried to write a letter of thanks but don't know what to say or even how to begin. I don't...
Patient
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Why patient engagement is reciprocal
It is said that "turn around is fair play." So if providers (physicians, hospitals and other health care professionals) expect patients to...
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Question the price of drugs and medical procedures
Hypertension was the trigger that forced medical cost awareness to the forefront. My doctor decided that with my rise in blood pressure...
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In love there is a life giving force
Here is a toast to the miracle of love. Not to the romantic, chocolate, dance club nightlife type of love. Not warm...
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How to get ready for death
No one wants to die. Even people who want to go to heaven don't want to die to get there. And yet...
Policy
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America has a medical care system not a health care system
As Americans we believe we have the best healthcare system in the world. But think again, it’s really not the truth. We...
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Reading between the lines of breast cancer treatment studies
Between the Susan G. Komen-Planned Parenthood debate and the study on treatments released by the Journal of the American Medical Association recently,...
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Why are labor and deliveries closing?
Labor and deliveries are slowly closing across the United States: California, Pennsylvania, and Ohio. In regional areas where there have been no...
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America has a health care paradox
We have a real paradox in American healthcare. On the one hand we have exceptionally well educated and well trained providers who...
Tech
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Why physicians don’t want patients to have their cardiac device data
There is a groundswell of discussion concerning patients demanding to have direct access to data derived from their implantable defibrillators and pacemakers....
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Impersonal communication on the Internet fuels cyberbullying
In the old days, bullying used to consist of name calling or physical aggression from someone in a position of power over...
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Health IT and doctors: A framework for successful partnerships
We are on the front lines of the healthcare revolution along side our patients and our colleagues in technology. We have firsthand...
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Break out of the prison of the American health care delivery system
Speaker after speaker at the recent Care Innovations Summit in Washington, DC concluded that increasing the quality and decreasing the per-capita cost...
Social Media
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Why doctors should embrace Google+
Lots of pressure out there for you to be on Facebook and Twitter, right? The ultimate question, though, is how are you...
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Using Twitter to deliver health improvement messages
I have decided to spam for public health. Phone calls, text messaging, and even apps have been shown to help improve health...
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Addressing comments on your medical practice’s Facebook page
Does your medical practice allow anybody to post links and comments on your Facebook page? The short answer is yes. We do....
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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...
