Great doctors listen to their patients. They start out by asking open-ended questions, and unless patients get too far off-track, they don’t typically interrupt them. Despite having limited time for appointments, they have an unhurried manner. They make eye contact with their patients and do not bury their heads in charts and computer screens. Their patients leave their appointments feeling respected and heard. Of course no doctor is likely to be able ...

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Recently, the 21 percent cut in Medicare physician reimbursements was replaced with a 2.2 percent pay hike. Later this year, Congress will have to consider the matter once again, just as it has ever year since 2003. This is the third time this year that Congress has averted Draconian cuts to physician’s payments. What, you might wonder, is going on? Here is the back-story.  In 1997, Congress enacted a so-called "sustainable growth ...

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As might be expected of reform legislation, the Patient Protection and Affordable Care Act (PPACA) places a lot of emphasis on innovation. Reasonably enough, most of the potential changes—at least in Medicare—are to be preceded by pilot or demonstration projects designed to test their feasibility. In fact, according to one health care blogger with time on his hands, PPACA includes no less than 312 mentions of demonstrations and 80 mentions of ...

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For years, I have been progressively beating a louder and louder drum -- one where my colleagues know that I liken radiology to McDonald's. Most of the bad press out there, it seems to me, has to do with poor customer service. Our health care system is often inefficient, and delivers limited, incomplete care. The root of the problem, in my opinion, is that there aren't enough doctors or hours in ...

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At the recent AAMC meeting on how to integrate quality into teaching hospitals, the question that kept popping up from speaker after speaker was how to address the fact that doctors in teaching hospitals don’t get along. Unfortunately, all the specialty bashing that takes place prevents the adoption of a team based culture necessary to advance quality and safety.  As one speaker highlighted, how can we really start to address this ...

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shutterstock_131909891 Since the subtext of the natural childbirth and attachment parenting movements is the notion of the good mother, it's worth asking what makes a good mother. My whole approach to writing about childbirth and mothering choices is based my rejection of currently popular beliefs about good mothering. Simply put, I believe that good mothering is about choosing mothering and not about mothering ...

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Raising children in a world full of accessible opinion is a funny thing. Everyone seems to have an idea about how to do this right. Stay home, work full time, work part time, return to work, cry to sleep, not cry to sleep, pacifier, no pacifier … the recipe for each of us is different, of course. Often we’re all right in what we’re doing from picking out baby food to ...

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A couple of months before my son was born 2 1/2 years ago, we were notified that my husband, an active duty member of the Navy, was getting deployed to Iraq. His date of departure was exactly one week after my due date. To any wife or family member of a service member, this would be difficult news -- a loved one going into a war zone. But, to me, 8-months ...

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I often find, when I talk with patients and families about hospice care, there is a palpable sense of relief; relief that there is another option when facing a terminal diagnosis or end stage disease process. Families who have participated in caring for their loved one at the end of life are grateful for the guidance provided in hospice care. Patients in turn are grateful to spend their last days at ...

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Recently, I was lucky to be invited to a New England Healthcare Institute discussion entitled "From Evidence to Practice: Making CER Findings Work for Providers and Patients" in Washington, DC. How to disseminate and implement Comparative Effectiveness Research (CER) so that patient care is really improved was the first topic tackled by the expert panel and the moderator, Clifford Goodman of The Lewin Group. The target audiences for CER findings include: patients, ...

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by Felasfa Wodajo, MD Recently, we had the chance to check in with Dr. Henry Feldman. He had posted a detailed summary of his experiences using the iPad as his main interface while rotating on service for a week as a hospitalist at Beth Israel Deaconess hospital (BIDMC) in Boston. Dr. Feldman is also Chief Information Architect for the Harvard Medical Faculty Physicians. The summary of the ...

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In 2005, we entitled a post, "How Can a $124.8 Million a Year CEO Make Health Care More Affordable?" At that time, we contrasted the enormous compensation given to the then CEO of UnitedHealth, Dr. William McGuire, with the stated mission of his corporation.  Since then, we have traced the travails of UnitedHealth and its leadership.  Dr. McGuire was eventually accused of receiving backdated stock options (which at one time ...

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One of the mantras of performance improvement is that caregivers and provider organizations should learn from their experiences. That’s all well and good, but how about policy-setting organizations? Recently, in the New England Journal of Medicine, two of the Biggest Kahunas in the safety and quality worlds – the Joint Commission (TJC) and the Accreditation Council for Graduate Medical Education (ACGME) – announced bold new policies. To their credit, both organizations ...

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by John Gever Elderly people who are depressed may be at twice the risk of developing dementia or Alzheimer's disease over time -- but it's unclear whether depression causes dementia or vice versa, researchers said. Among more than 900 participants in the original Framingham Heart Study, almost 22% of those who were depressed when screened between 1990 to 1994 were diagnosed with dementia over 17 years of follow-up, compared with 16.6% of ...

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I was in a room full of Family Doctors – who call themselves everything but Family Docs: Family Physicians (FPs) Primary Care Physicians (PCPs) General Practitioners (GPs). It was the Society of Teachers of Family Medicine (STFM) Spring Conference, at a session entitled: "Language Matters: Women-centered talk during pelvic exams." Two men amongst 20 women, all interested in learning more about being Politically Correct (PC) whilst conducting a pelvic exam. Session leaders Drs ...

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Top of mind positioning has been replaced with top of page positioning.  The old ad model of informing, persuading and reminding are being replaced by involvement, community and empowerment.  So why are the nightly network newscasts still being subsidized by drug direct to consumer (DTC) ads? From all the latest research that I have done, coupled with the research from other sources like Manhattan Research, Pew and Rodale, it’s quite clear ...

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How many hours can a doctor work? The residency regulators are back. About ten years ago, the national organization that accredits residency programs (ACGME) set out its first guidelines about how many hours a doctor-in-training can work. Interns and residents finally achieved the vaunted 80-hour workweek. New York State was 15 years ahead on this, having mandated an 80-hour work week in 1989, stemming from the Libby Zion case. Every patient wants ...

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One of the big complaints about the recently enacted health care reform law is that it does little to control costs. There is some truth to that because the major focus is on increasing access to insurance. And yet there is reason for optimism on a couple of fronts:

  • First, with many of the access issues settled, stakeholders can focus directly on cost matters rather than cost-shifting and finger pointing
  • Second, health ...

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by Nancy Walsh Patients admitted to an intensive care unit (ICU) over the weekend face a greater likelihood of dying compared with those admitted on a weekday, a meta-analysis suggested. The meta-analysis, encompassing more than 180,000 weekend and weekday ICU admissions, found that even after adjusting for disease severity, the odds ratio for death among those admitted to an ICU over a weekend was 1.08 (95% CI 1.04 to 1.13, P<0.001), according ...

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by Leonard R. Friedman, MD In diagnosing areas of chronic pain for adult pain management, I have come across a helpful test which I have unable to peer review. It is the Draw a Person test.  Pain management physicians have not used this easily identifiable test to evaluate the subconscious of the patient.  This is done by asking the patient to draw a male and a female, with ...

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