In the wake of the Orlando shootings, the usual battle lines are drawn in the usual, predictable way. Urban liberals and many Democrats call for more regulations and enforcement to limit access to firearms (especially assault weapons); hunters and conservatives and many Republicans -- and especially the National Rifle Association (NRA) -- ...

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I’m feeling pretty good about myself today. My patient, recently admitted to home health care, was just not herself, low O2 sats, irregular heart rate with pain on inspiration and feeling a little clammy. While her recent surgery was a neck fusion, it still didn’t completely eliminate the possibility of a pulmonary embolism. Instead of spending 15 to 30 torturous minutes in her primary doctor’s voice mail hell, I made ...

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This is my 12th year as a physician in the United States. I was born in London, grew up in Berkshire, and decided to become a doctor when I was a teenager. I remember being asked what I thought about the National Health Service (or NHS, the UK’s government-run health system) during my medical school interview. That question is almost a rite of passage for anyone applying to medical school in ...

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It has now been confirmed that Prince’s untimely death resulted from an overdose of the drug fentanyl. It is unclear whether the lethal dose of fentanyl was a prescription medication or a counterfeit “analog” drug from the illicit market. Regardless, the facts are now clear enough to know that the U.S. health care system failed Prince in the same ways it is failing the 78 Americans who die every day ...

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In 2008, mental health advocates hailed the Mental Health Parity and Addiction Equity Act as “historic;” putting an end to what Sen. Edward Kennedy called “the senseless discrimination in health insurance coverage that plagues persons living with mental illness.” The law requires most group health plans to offer coverage for mental health and substance use disorders equal to that provided for medical problems. Two years later, the Affordable Care Act extended ...

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Three weeks ago, I changed jobs.  I left a high-tech, high-volume teaching hospital in one of the largest medical centers in the U.S. for the greener pastures of a small, private community hospital.  Why? I needed a less stressful position, lower acuity patients and to be rid of the madness of commuting. I am a registered nurse with experience in emergency and trauma nursing, critical care, electrophysiology and cardiovascular surgery. I ...

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“I need help with my colitis.” “Really? I thought we had things pretty well controlled.” I hadn’t seen her in the better part of a year. I remembered how hard it had been to get her ulcerative colitis into remission. How sick she had been, how miserable her life was. There was a bit of trial and error in the office, followed by a hospitalization for intravenous steroids, then a tapering dose ...

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Transparency -- or its absence -- continues to fascinate health care analysts and health care economists.  A study published in the Annals of Internal Medicine addresses the effects of public reporting of hospital mortality rates on outcomes.  Its senior author, Dr. Ashish Jha, offered his perspective on the study results and on the topic. According to the study investigators, mandatory public reporting of hospital mortality is not improving outcomes.  The result of their analysis surprised them ...

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Get a group of health policy experts together and you’ll find one area of near universal agreement: We need more transparency in health care. The notion behind transparency is straightforward; greater availability of data on provider performance helps consumers make better choices and motivates providers to improve. And there is some evidence to suggest it works.  In New York State, after cardiac surgery reporting went into effect, some ...

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I joined physicians nationwide last year in cheering when Congress passed the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). Not only did it eliminate the congressional budgetary fiction known as the Sustainable Growth Rate (SGR) formula, it also promised to simplify and improve Medicare’s costly and complex programs that purport to measure the quality of care we provide to our patients. Unfortunately, as we review the draft implementing rule, ...

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