Why do you need a population health management (PHM) IT system? In our last column we discussed the fact that reimbursement tied to outcomes will demand a greater level of patient management. Greater, perhaps, than your EHR can deliver. The early focus of new pay-for-performance and bundled payment systems is on preventive care for top chronic illnesses. The 15 most expensive health conditions account for 44% of total ...

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An apology can be a powerful statement that influences how another responds to a perceived wrong. This can be especially true within the context of a doctor-patient relationship. Yet, most physicians have been conditioned to employ a “deny-and-defend” approach to adverse medical outcomes, avoiding apologies because they believe it could imply an admission of guilt or ultimately initiate a lawsuit. Apology in medicine is neither new or a fringe concept (currently ...

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shutterstock_74641645 Just as Sherry Gorman describes in her compelling post, being sued for malpractice can launch a complicated mix of often overwhelming emotions so debilitating that personal and professional lives are never the same. Since so many physicians are sued at some point during their career—some estimates say as many as 9 out of 10 —becoming educated about the malpractice process may ...

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Politicians, financial experts, pundits and main street America would love to predict what’s going to happen to America in the next five years. But we don’t have to dust off the Dow Jones or the S&P, or even wonder what the Feds are going to do about Medicare, taxes, the debt ceiling or Afghanistan. All we have to is understand the five stages of grief first developed by Dr. Elizabeth Kubler-Ross. Elizabeth ...

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I inherited motion sickness from my father's side of the family.  I can't sit in the back seat of a car for more than 10 minutes without becoming sick.  I take meclizine before every plane flight. I inherited asthma from my mother's side of the family.  Exposure to perfume, 90+ degree temps with 90+% humidity, or even a good laugh will all prompt me to cough. These two maladies of mine have ...

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The more I try to help people in this field of mine, the more I realize that it doesn't take a village. It takes a huge industrialized city, all its wires and arteries humming with constant activity, just to try and make one woman better. In this case, one smiling woman in her 50s, ethnicity I couldn't figure and of dubious relevance, who came to our clinic seeking advice about ...

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shutterstock_128247605 Academic Medicine, a journal of the American Association of Medical Colleges, has sent out a recent call for articles addressing the 2013 question of the year: “What is a doctor?  What is a nurse?”  Thirty years ago this would have been an absurd question.  Not only would it have been absurd for doctors and nurses, but for patients too.  Roles were ...

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My husband likes to say, “No good deed goes unpunished.” I don’t always agree, but sometimes you just can’t argue that concept.  One of my favorite patients, a forty nine year old woman who I treated for head and neck cancer a year ago is a good case in point. Head and neck cancer is on the rise, and is linked, like cervical cancer, to infection with human papilloma virus which ...

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As healthcare providers we are focused on life.  We are committed to healing.  We measure success by lives saved.  Unfortunately, many diseases remain incurable.  Some diagnoses do carry with them a death sentence in spite of the best that modern medicine has to offer.  Even in theses extremely devastating cases, We can still make a huge difference in the lives of our patients in the way in which we help ...

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“We’re doing everything we can,” I said as I put my hand on the sobbing woman’s shoulder. “We’re going to keep trying for about 10 more minutes, but I don’t know if we’re going to be successful with this.” These are the moments that are truly difficult in my job. Telling people their loved ones have passed away, or preparing them for what seems inevitable. “You can do it!” the woman said ...

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