Why electronic medical records may not save moneyA 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, ...

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Reducing the emotional impact of medical malpracticeA 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 ...

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How patient satisfaction can killPatient 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
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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 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 ...

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Why more primary care doctors are referring patients to specialistsAccording 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 ...

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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. 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 ...

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Radiologists who cheat on their board exams: Whos 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 ...

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Doctors: Dont be ashamed about going bankruptAre 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 ...

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Place the frustration of cost uncertainty on health insurersAs 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 ...

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How much guidance do patients want with their medical decisions?The following column was published on November 10, 2011  in Medical Economics. I recently saw two patients in my primary care clinic, each with new-onset hypertension. The first, a middle-aged executive, brought printouts from the Internet and already had researched the various treatment options for high blood pressure. During the visit, we discussed this information, and I gave my thoughts on ...

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