In a recent New England Journal of Medicine, a perspective piece on what to do with fatigued surgeons is generating debate.The issue of work-hour restrictions has been a controversial issue when it comes to doctors in training, something that I wrote about earlier in the year in USA Today. But once doctors graduate and practice in the real world, there are no rules.As summarized in the WSJ's Health Blog, ...
Pho
Why an EMR doesn’t necessarily deliver better patient care
Regular readers of this blog know that the mere introduction of an electronic medical record doesn't necessarily guarantee better patient care.There are multiple reasons for that, including the fact that many systems are archaic in nature, counter-intuitive, and doctors are forced to learn multiple systems.Yesterday, the WSJ's Health Blog posted a study showing that hospitals with an EMR don't necessarily have better quality measures.Shocker.According Rand Corp.,
trying to ...
How false positives can kill patients
I've written in the past that more medicine and tests do not necessarily reflect better care.There is no test that is 100% specific or sensitive. That means tests may be positive, when, in fact, there is no disease ("false positive"), or tests may be negative in the presence of disease ("false negative").It's the latter that often gets the most media attention, often trumpeted as missed diagnoses, but false positives ...
Patient complaints do not fit the primary care office visit
Primary care physicians often have to see patients with a litany of issues. Often within a span of a 15-minute office visit.This places the doctor in the middle of a tension -- spend more time with the patient to address all of the concerns, but risk the wrath of patients scheduled afterwards, who are then forced to wait.And, in some cases, it's simply impossible to adequately address every patient question ...
Why doctors should embrace mediation for medical malpractice
Mediation has been cited as a way to lower the cost of litigation and compensate injured patients without going through the ordeal of a trial.In post from the WSJ Health Blog, the problem is few doctors are participating.That's a problem.A study from a law journal looked at 31 cases that went to mediation, and found that,
of those cases, 16 were settled at mediation, 5 settled afterward and 10 weren’t ...
Health reform repeal should make conservatives nervous
Early last year, I wrote that conservatives should have been happy with health reform.Maybe they just didn't realize it yet, because they're rejoicing after yesterday's news of a federal judge ruling the individual mandate unconstitutional.But by supporting repeal, conservatives should be careful what they wish for.The fact is, the Affordable Care Act is a moderate piece of legislation. There's no public option. It leaves private insurers intact. There is ...
Lifestyle matters for specialties that want to survive
Medical students today consider lifestyle an essential criteria when choosing a specialty.It's become a cliche that most are looking towards the ROAD (radiology, ophthalmology, anesthesiology and dermatology) to happiness.There's been some recent media attention at how women are lured to specialties that offer a greater balance between their family lifestyle and professional demands.Claudia Golden, a Harvard economics professor, recently noted that,
high-paying careers that offer more help in balancing work ...
The reassurance of a CT scan in the emergency department
There's little question that CT scans are on the rise, especially in the emergency department.A recent paper from Radiology put a number to the increased frequency of the test, concluding,
CT, a radiology tool that once took nine days to finish, was used 16.2 million times in 2007 to diagnose headaches, stomach aches, back pain, chest pain and the like. That was a huge increase from 1995 when it was ...
The malpractice system doesn’t improve patient safety
There has been significant media attention on a New England Journal of Medicine case report where a surgeon, Massachusetts General Hospital's David Ring, described how he operated on the wrong hand of a patient.Here's a summary of the case:
Ring, along with colleagues at Massachusetts General and Harvard Medical School, detailed the series of missteps that led to the wrong operation in the patient whose ring finger on her ...
Do online physician rating sites help patients to choose a good doctor?
The following op-ed was published on October 27th, 2010 in USA Today.When I ask new patients how they found me, frequently they say on the Internet through search engines such as Google.Out of curiosity, I recently Googled myself. Numerous ads appeared, promising readers a "detailed background report" or a "profile" of me. Among the search results was information about my practice, whether I was board certified, had any lawsuits against ...
Balancing infection control with the patient experience
Hospitals have recently been stepping up their infection control procedures, in the wake of news about iatrogenic infections afflicting patients when they are admitted.Doctors are increasingly wearing a variety of protective garb -- gowns, gloves and masks -- while seeing patients.In an interesting New York Times column, Pauline Chen wonders how this affects the doctor-patient relationship.She cites a study from the Annals of Family Medicine, which concluded that,
fear of ...
Medical malpractice reform in exchange for paying doctors less
The bipartisan debt commission appointed by President Obama recently released its recommendations on how to pare the country's debt.Of interest to doctors is the suggestion to change the way doctors are paid. Physician lobbies have been advocating for removal of the Sustainable Growth Rate formula -- the flawed method by which Medicare, and subsequently private insurers, pays doctors.According to this method, physicians are due for a pay cut of ...
Cancer screening and treatment cannot focus on mortality alone
When patients undergo medical treatment -- like radiation therapy for prostate cancer, for instance -- little is reported about the lifelong side effects that can arise.That's because outcomes have disproportionally focused on survival. Whether a patient has incontinence, impotent, or blood in the urine stemming from prostate cancer therapy has largely been overshadowed.In a recent New York Times' column, Pauline Chen highlights the Patient-Centered Outcomes Research Institute. According to ...
Primary care private practice will die, will patients benefit?
Having more primary care physicians doesn't necessarily improve the quality of care.That may come as a surprise to regular readers of this blog, but that's one of the findings that came from a recent analysis of the Dartmouth Atlas.As reported by the WSJ's Health Blog,
having regular primary-care visits isn’t a guarantee of receiving recommended care. There was “no relationship” between rates of breast cancer screening for women age 67-69 ...
Can a social media manager convince doctors to get online?
A social media manager is becoming an imperative position for hospitals.Medical institutions are waking up to the fact that they need to engage their patients and physicians online. No where is there more fertile growth than in the various social media platforms that are prevalent today -- like Facebook, Twitter, and YouTube.American Medical News recently profiled the phenomenon, highlighting the position of social media manager, which some institutions pay ...
Screening for lung cancer with a CT scan: What the NLST results mean
Lung cancer screening has been an area of considerable controversy. Before today, there had been no evidence that screening patients for lung cancer, either with a CT scan or chest x-ray, saved lives.For years, doctors have been waiting for the results of the large, randomized National Lung Screening Trial (NLST), conducted by the National Cancer Institute.This morning, it was announced that the trial was stopped early, with a ...
Health IT will provide job security for the foreseeable future
Hospitals nationwide are racing against the clock to ensure their health IT systems meet meaningful use guidelines.The incentive? Money, of course. Systems that meet certain criteria make doctors eligible for up to $44,000 in bonus money from the government.As mentioned on this blog previously, implementing an electronic health system is difficult. The usability of the current generation of EHRs is still relatively primitive, especially when compared to other industries, and ...
Sick doctors who work are doing more harm to their patients than good
Doctors: if you're sick, don't go to work.The stereotype of doctors is that they go to work, despite whatever symptoms ail them. Calling in sick places strain on colleagues. Especially in residency, where team members are expected to pick up the slack.In a recent column, the New York Times' Pauline Chen discusses the image of self-sacrifice that a sick doctor going to work portrays:
Hacking, febrile or racked with the ...
The doctor patient relationship in team-based patient care
Is the doctor-patient relationship really more sacrosanct than the nurse-patient relationship?That's the provocative question asked by Theresa Brown in a recent column from Well, the New York Times' health blog.She discusses an instance when she had a disagreement with a physician over a patient care issue.
I couldn’t believe that this doctor, who had always worked well with the nurses on my floor, had just suggested, at least in my ...
Medical malpractice immunity from clinical practice guidelines
Ezra Klein calls Peter Orszag's proposal in a recent New York Times column a "new idea on medical malpractice reform."Except it's really not.The idea of immunizing doctors who follow strict clinical practice guidelines was floated by the AMA back in May of 2009. I supported the idea back then, saying the AMA is
acknowledging and embracing the data that is very influential in the White House, as well ...
