Who has the potential to be the most influential physician of our generation?It's Priscilla Chan, who not only recently graduated from medical school, but also married Facebook founder Mark Zuckerberg.When I brought this up on Twitter, someone responded that it was "disappointing at the same time. I'm certain her own merits and studies would have made waves alone."But ...
Pho
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 cancer screening debate has been raging for the past decade. Increasing amounts of evidence show that screening does not save lives, and increase the risk of complications like impotence and urinary incontinence that stem from invasive diagnostic tests and ...
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.Or other health care workers taking pictures of patients and posting them on the web.It's no wonder that many hospitals are taking a heavy handed approach when it comes to their doctors and social media.Consider this story,
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 in my primary care clinic asking about prostate cancer, perhaps because they heard of Warren Buffett’s recent prostate cancer diagnosis and his proposed treatment.Patients are wondering if they should also be screened. Other patients who already have ...
Many medical decisions require shared decision making
The following column was published on April 1, 2012 in USA Today.I recently saw a middle-age man in my primary care clinic who asked whether he should continue his cholesterol medication. He was reacting to new Food and Drug Administration warnings on statins, a class of drugs taken by more than 20 million Americans to lower their cholesterol. Though generally ...
Patients deserve a medical malpractice early offer
The following column was published on March 25, 2012 in the Nashua Telegraph.Medical malpractice historically has been a contentious issue. Doctors have argued that the system is broken, promotes multi-million dollar awards disproportionate to the injuries suffered, and encourages the ordering of unnecessary tests to avoid being sued, a practice known as defensive medicine. Trial attorneys, on the other ...
Discussing whether tests actually help patients or cause more harm
The following column was published on April 11, 2012 in CNN.When you visit the doctor, chances are you are given a prescription for a drug or an order for an X-ray or lab test. Before you leave, it's important to ask whether your doctor's recommendations are truly necessary.Even though much of what physicians do is meant to help patients, sometimes it's not always the case. Drugs may have harmful side ...
Conservatives should love the Affordable Care Act
And progressives should want health reform to fail.No, you read that right.Counter-intuitive? Let me explain. As the fate of the Affordable Care Act hangs in the balance in the Supreme Court, both progressive and conservative pundits have been working overtime to discern the future of health reform.The traditional thinking is that progressives direly want health reform to move forward, ...
The Affordable Care Act needs primary care to be effective
The following column was published on March 26, 2012 in CNN.With the Supreme Court set to hear oral arguments about the constitutionality of the President Obama's health care law, more patients than ever have been asking for my thoughts about health reform.I practice primary care in southern New Hampshire near the Massachusetts border, which gives me a firsthand look at how health reform has impacted my neighboring state. Despite flaws ...
Will patients accept focused networks in today’s economy?
In a bid to save money, health insurers are coming out with what's known as "focused networks," which typically exclude the highest cost hospitals.In the Boston area, one such plan comes from health insurer Harvard Pilgrim Health Care, whose plan excludes Partner's Health Care institutions. That's significant, since Partners includes the famed Massachusetts General Hospital as well as ...
Should doctors be forbidden to complain about money?
The Patient Centered Medical Home is supposed to be the solution to our primary care woes.Endorsed by both the American Academy of Family Physicians and the American College of Physicians, this new model of primary care creates a team-based approach to patient care, with a cadre of care managers and nurses assisting physicians to manage patients with chronic disease. ...
Why electronic medical records may not save money
A recent study from Health Affairs has been generating some buzz, as well as passionate rebuttals.According to the study, doctors who used electronic medical records actually ordered more tests, compared to those who used paper records.There was a 40% increase in ordering imaging tests, a number that increased to a whopping 70% when it came to advanced tests, ...
Reducing the emotional impact of medical malpractice
A version of this op-ed was published on January 17, 2012 in USA Today.Ask doctors about what concerns them the most, and chances are they'll say, "medical malpractice." Indeed, most physicians will be sued sometime during their careers. A recent New England Journal of Medicine study found that 75% of doctors who practice psychiatry, pediatrics or family medicine will ...
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 are under pressure from administrative executives to raise patient satisfaction scores.High scores are even used by hospitals as a powerful marketing tool.But, in the end, are patient satisfaction scores hurting patients?I wrote about the issue previously, saying that
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 is at an advanced stage. Tests to look for the disease, such as the transvaginal ultrasound or the CA-125 blood test, are not specific enough. That leads to false positive tests that necessitate more studies that may not ...
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 before. In fact, the rate almost doubled in the 10-year period between 1999 and 2009.This drives up the cost of care, as specialist consults tend to be more expensive than primary care visits. Furthermore, specialists tend ...
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.Do a search for "autism" and "vaccines," for instance, and you'll be greeted with a wealth of information linking the two, despite the fact that any connection has been scientifically disproven.A fascinating piece in Slate asks whether search ...
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 exam to become board certified in radiology have cheated by memorizing test questions, creating sophisticated banks of what are known as 'recalls,' ... The recall exams are meticulously compiled by radiology residents, who write down the ...
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 business and drug costs among the factors preventing them from keeping their practices afloat. But some experts counter that doctors' lack of business acumen is also to blame."That's all entirely true.Pressure on reimbursement, combined with a lack ...
Place the frustration of cost uncertainty on health insurers
As we enter 2012, many patients will be changing to new insurance plans.And for a few, deductibles will be rising.One thing that's emphasized in the Affordable Care Act, however, is that preventive services would remain "free."However, consider this story of a man, who thought he wouldn't have to pay for his screening colonoscopy, instead was charged over $1,000 for ...
