In a guest post last year, physician-author Richard Reece commented that the individual mandate may collapse health reform. Those words came to mind as Judge Vinson not only ruled the individual mandate unconstitutional, but the entire Affordable Care Act, as well. Nobody likes to be mandated to do anything, least of all purchase health insurance, and this was always the sticking point with the current iteration of health reform. So, what ...

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I recently pointed to a BMJ study concluding that pay for performance doesn't seem to motivate doctors.  It has been picking up steam in major media with TIME, for instance, saying, "Money isn't everything, even to doctors." So much is riding on the concept of pay for performance, that it's hard to fathom what other options there are should it fail.  And there's mounting evidence that it will. Aaron Carroll, a ...

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Electronic medical records and pay for performance are among the ways health reformers are going to improve patient care. It's a fundamental shift in how doctors practice, with more practices adopting expensive EMRs. And with the advent of Accountable Care Organizations, doctors will soon be compensated in part by quality measures. But will they work? Well, the jury's still out. Two articles caught my eye recently. The first, from the WSJ's Health Blog, reports ...

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Did you know that one-third of the country's physicians are over the age of 65? That's right, there's a good chance that your doctor is on Medicare.  That's a concern, because physicians aren't immune to the ails of aging, and are just as prone as patients to succumb to the effects of Parkinson's or various types of dementias. Not comforting if you're about to undergo an operation, for instance.  And absolutely frightening when ...

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Many doctors roll their eyes whenever patients bring in a stack of research they printed out, stemming from a Google search of their symptoms. A piece by Zachary Meisel in TIME.com describes a familiar scenario:

The medical intern started her presentation with an eye roll. "The patient in Room 3 had some blood in the toilet bowl this morning and is ...

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I wrote last year in USA Today about the impact of physician burnout.  Not only do doctors suffer, but so do their patients. Burnout starts early in residency, with entering interns having a depression rate of 4%, similar to the general public.  But after the first year of residency, that number balloons to 25%. Now, another study adds fuel to this disturbing trend. A paper published in the Archives of General Surgery ...

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Whenever I refer a patient to a specialist, a copy of the patient's recent notes, labs and diagnostic tests is  faxed to the specialist -- in many cases, prior to their visit. And most of the time, after they see the specialist, I receive a fax back describing what happened. You'd think this is standard procedure, but it doesn't happen as often as it should. A study from the Archives of Internal Medicine ...

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There are plenty of instructional videos on YouTube -- in fact, I use them not infrequently to show patients educational videos. But who uploads them, and are they medically reputable? Like most social media sites, YouTube's quality of information is variable.  And no where is that more apparent than in CPR videos. There are videos that use sex to teach CPR (a facetious take), or rap (a legitimate educational video ...

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Radiation from CT scans needs to be better taught to patients, as their risks are real. It's the best way to help curb the rampant ordering of these tests.  Unfortunately, we aren't doing a very good job. In a study from the Annals of Emergency Medicine, most patients underestimate their risk from radiation. When asked to compare the amount of radiation from a CT scan to the amount that Hiroshima ...

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Doctors today are wary about treating chronic pain. One of the main worries is precipitating fatal opioid overdoses.  Indeed, according to the CDC, and reported by American Medical News, "fatal opioid overdoses tripled to nearly 14,000 from 1999 to 2006 ... [and] emergency department visits involving opioids more than doubled to nearly 306,000 between 2004 and 2008." Requiring chronic pain patients to sign pain contracts is a way to mitigate this ...

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