We hear a lot about the death of the independent physician practice. But perhaps the more important discussion is about the death of practicing medicine independently. That is, the days when individual physician groups could operate their businesses and treat patients independently and without regard to the surrounding network of other physicians, nursing facilities, health networks, social workers, case managers, and other support is over. It doesn’t matter whether the physician ...

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When I was a medical student, I worked with an non-government organization (NGO) in Rwanda to provide medical care to women with HIV. Nearly all had witnessed their family members murdered during the genocide, and many became afflicted with HIV as a result of rape. Our initial focus was on getting antiretroviral therapy to these women, but we quickly realized that while it was important for them to have access ...

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Not long ago, Tracy Hume, a freelance writer who lives in Greeley, Colorado, sent me an email posing this question: "Do ER-affiliated urgent care providers ever try to escalate patients to the ER when it is not medically necessary?" It seems that over the July 4th weekend, Tracy’s teenage son was complaining of a headache, nausea and abdominal pain, and was vomiting. He doesn't complain much, she said, so thinking that ...

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I thought the most important thing I had learned while working in the emergency department as a first-year medical student was to bop and weave.  The impeccable foot skills I harnessed as a youth lacrosse player were put to great use- to stay out of the way.  The quiet whisper of a nurse trying to slide behind me, and -- BAM -- back against the wall.  I can hear the ...

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In a recent posting Dr. Kaylan Baban mused about the ubiquity of scribes and some of the reasons behind this growing phenomenon. Among them were the usual suspects: increasing patient loads leading to decreased visit times with the provider, increasing non-clinical demands monopolizing time that would be better spent actually practicing medicine, and improved legibility of notes, which are now the patient's property and are used for a ...

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Emergency department directors measure value in their departments with a number of metrics that are tracked religiously: door-to-provider times, ambulance drop-off times, left without being seen rates, length of stay for discharged patients, diversion hours, and 72-hour returns all come to mind.

These  metrics clearly measure the performance of the emergency department, what to they do, if anything, to measure the value of care being provided? These metrics are often ...

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Ask almost any physician why they chose medicine, and they'll answer, "I wanted to make a difference in the lives of patients." But in today's high-pressure healthcare environment, it's easy to get caught up in performance metrics and obsessed with efficiency. We tell ourselves, "It's OK, as long as we're delivering great clinical care, we're delivering great care. After all, the massive heart attack was averted. The wound was stitched. What ...

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It’s easy to get frustrated in the ER. First, you’re at work. Second, most of your patients don’t want to be there. Third, many (if not most) of your patients don’t need to be there. Finally, by the time you see them, most of your patients are tired of being there. It’s easy to become jaded when you trudge through this never-ending mire of patient after patient, and indeed ER docs ...

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Top stories in health and medicine, July 22, 2014From MedPage Today:

  1. Error: You Have No Payments from Pharma. The federal government has a word for physicians who don't have financial relationships with pharmaceutical and medical device manufacturers: "Error."
  2. Do the Eyes Really Have it in Diabetes? Novartis and Google garnered much media attention last week when they announced their partnership ...

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In my past few shifts in the emergency department, I have seen the following patients who were seeking further care after being treated by other providers. One was a child who had been seen twice at an urgent care clinic. He had a fever of 103 degrees and wasn’t eating. The first time he went to the urgent care center, he was diagnosed with an ear infection. He was started on ...

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