Authors of a recent study from the Archives of Internal Medicine are unlikely to endear themselves to specialists.As reported by Reuters, and provocatively titled, Do specialist doctors make too much money?, the study gives a per-hour breakdown of how much doctors make.I think this is a good approach, since annual salary figures do not account for the number of hours doctors work -- and in the case of primary ...
Kevin Pho, MD
Public health fears will not sway parent opinion on vaccines
Dr. Robert Sears' The Vaccine Book, is, as Rahul Parikh puts it, "a nightmare for pediatricians like me."In a piece from Salon, Dr. Parikh brings his issues to the author. The controversy of the book is the so-called "alternative vaccine schedule," which, as vaccine developer Paul Offit puts it,
is "misrepresentation of vaccine science" that "misinforms parents trying to make the right decision for their children" in the Journal of ...
Are social networks competitive or compatible with the medical blogosphere?
I'm back from my whirlwind trip to Las Vegas, and I want to think those who followed our panel at BlogWorld 2010.I was joined by Bryan Vartabedian of 33 Charts, and Kerri Morrone Sparling of six until me in a panel moderated by Kim McAllister of Emergiblog.A few thoughts from my end.
Too much data can overwhelm physicians and harm patients
One of the supposed strengths of electronic medical records is better tracking of test data.In theory, when using more sophisticated digital systems, doctors can better follow the mountains of test results that they encounter daily.But a recent study, as written in the WSJ Health Blog, says otherwise.Apparently, a study performed in 2007 found,
VA doctors failed to acknowledge receipt of 368 electronically transmitted alerts about abnormal imaging tests, or one third ...
Doctors should work weekends, and how reformers alienate physicians
Peter Orszag wants doctors to work weekends.The former director of the White House Office of Management and Budget wrote as much in this past weekend's New York Times:
Doctors, like most people, don’t love to work weekends, and they probably don’t enjoy being evaluated against their peers. But their industry can no longer afford to protect them from the inevitable. Imagine a drugstore open only five days a week, or ...
Boston Medical Center gets screwed by the Massachusetts government
Boston Medical Center has provided care to the underserved and Medicaid population in Boston for almost 150 years. And what's happening to the venerable institution is gut-wrenching to read.I trained at Boston Medical Center (BMC), completing my internal medicine residency there in 2002. A recent write-up in Boston Magazine highlights the financial trouble the hospital is going through:
Boston Medical Center is almost broke, perilously close to ...
Relationship advice for those dating American medical students
The average medical school debt today, according to the Association of American Medical Colleges, is $156,456.The United States is the only country in the world were future doctors have to bear such a financial burden of their education. That places significant strain on any relationship involving an American medical student.Recently, there was an interesting piece in the New York Times discussing this very issue. The article profiled a female ...
Preoperative evaluation can lead to unnecessary tests and may waste money
What's one of the biggest culprits for the rise of unnecessary medical testing?Preoperative evaluation.Before most patients undergo surgery or an invasive procedure, they are normally sent to their primary care physicians for a "preoperative evaluation." This is a visit to determine if they are medically stable enough to undergo the operation.Tests like bloodwork, an EKG, or a chest x-ray are frequently ordered. For those with suspicion of coronary artery ...
Mayo Clinic Center for Health Care Social Media disses physicians
The Mayo Clinic has always been at the forefront of the social media and health care intersection, and is the first institution to have an official Center for Social Media.When they recently announced the invited first 13 members of their Advisory Board for the Mayo Clinic Center for Health Care Social Media, the first thing I noticed that there were zero physicians, and few with clinical experience.What a slap ...
Patients need more accurate information on their prognosis
Why are doctors so bad at predicting how long a patient has to live?That's the interesting question posed by John Schumann, an internal medicine physician who blogs at GlassHospital, recently in Slate.There are many reasons why doctors evade the question of prognosis:
We don't like to be wrong; we don't want to take away hope for survival or good quality of life in the time that remains; and we just ...
Defensive medicine costs less money than physicians think
Nothing polarizes the heath care debate more than defensive medicine. A recent study from Health Affairs will only add more fuel to the fire.Here's what I wrote a couple of years ago in USA Today: "When you consider that rampant testing is a major driver of escalating health care dollars, addressing defensive medicine should be a primary goal of cost containment."Is that still true?Well, yes and no.MedPage Today summarizes ...
Traditional primary care needs concierge care to survive
Concierge care is often discussed as a way for primary care to survive in the United States.Pauline Chen talks about the concept in her recent New York Times column, discussing the well-known issues involving "two-tiered" care that boutique practices inevitably bring.But what I found fascinating was how Tufts University utilized the concept.Here's how it works:
Since 2004, the primary care physicians at Tufts Medical Center have offered patients the option ...
iPad health care use by doctors, a comprehensive infographic
MobiHealthNews released a comprehensive infographic on physician use of the iPad, a distillation of their report on the issue.The iPad has been covered previously on this site. The form factor holds tremendous potential, as this Dartmouth physician noted, "the iPad offers a 'low profile' that doesn't seem intimidating to patients during exams." That's especially important as it can allow doctors to maintain eye contact with their ...
Burnout in doctors and stressed physicians hurt patients
The following op-ed was published on July 18th, 2010 in USA Today.A new patient recently said he was referred to me after his last doctor had left medicine. His old doctor always looked unhappy and burned out, he noted.Burnout affects more than half of doctors, according to researchers at the University of Rochester School of Medicine. Beyond mere job dissatisfaction, these doctors are emotionally exhausted to the point ...
International medical graduates and their patient outcomes
Did you know that international medical graduates account for 30% of primary care doctors in the United States?And with American medical graduates continuing to shy away from the field, that number will undoubtedly go up.But that's not necessarily a bad thing.Recent news stories, like Pauline Chen's New York Times column, have focused on a landmark study comparing patient outcomes of doctors educated in the United States versus those ...
Rewarding primary care physicians for time spent with the patient
Abraham Verghese is a professor of medicine at Stanford University, and one of the most articulate physician-writers today.He recently wrote an op-ed highlighting primary care's plight, and focuses on the scarcity of time:
The science of medicine has never been more potent - incredible advances and great benefits realized in the treatment of individual diseases - yet the public perception of us physicians is often one of a harried individual more ...
Alarm fatigue can cause mistakes and harm patients
The hospital is never a quiet place.Walk through the wards on a typical day, and you'll hear a cacophony of alarms, bells, and other tones coming from both computers and medical equipment.American Medical News recently discussed so-called "alarm fatigue." They cite a study showing find that "16,934 alarms sounded in [a medical] unit during an 18-day period."That's astounding, and for those who are wondering, that's about 40 alarms ...
Touch humanizes the doctor patient relationship
I've written previously that many doctors are finding the physical exam obsolete, and are favoring more technologically advanced, and expensive, tests.In fact, I alluded to traditional physical exam advocates as "arguing for staying with a horse and buggy when cars are rapidly becoming available."In a recent piece from the New York Times, internist Danielle Ofri says we need to look past the lack of evidence supporting ...
Reducing hospital re-admissions and bouncebacks isn’t easy
In their most recent piece at Slate, emergency physicians Zachary F. Meisel and Jesse M. Pines tackle the issue of bouncebacks. That is, the re-admission of recently discharged hospitalized patients.They bring up good some good points, and point out that, until recently, hospitals really didn't have any incentive to reduce bouncebacks:
... hospitals have never had a compelling reason to try to prevent bouncebacks. Hospitals are typically paid a flat sum ...
Doctors ignore social factors when making a patient diagnosis
A recent study from the Annals of Internal Medicine found that doctors often discounted a patient's social situation when making a medical diagnosis.Lead researcher Saul Weiner "arranged to send actors playing patients into physicians' offices and discovered that errors occurred in 78 percent of cases when socioeconomic concerns were a significant factor."Evan Falchuk, commenting on the results, provides some context:
It’s hard to expect even the most ...
