Physician

Do patient demands drive up health care costs?

According to recent data from the Pew Internet & American Life Project, upwards of 60 percent of patients first consult the internet for their health issues.

This is leading to more educated patients, taking an increasing role in their own health care. And that’s a good thing. I’d rather be seeing patients who are interested in staying healthy and conscientious about their conditions.

But it’s unfortunate that the incentives within …

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Op-ed: Injured patients deserve medical malpractice reform

A version of this op-ed was published on October 26th, 2009 in the USA Today.

President Obama has acknowledged that changes in the medical malpractice system must be considered with other health reforms, and recently ordered that pilot projects to improve the way we compensate injured patients be implemented.

Reforming medical liability has historically been a source of major contention. Physicians argue that the system is expensive, promotes multi-million dollar awards …

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Does the tort-based medical malpractice system improve patient care?

by Michael Kirsch, MD

Physicians and plaintiff attorneys have philosophically divergent views on our tort system. I know the attorneys’ views on this issue well. There are lawyers in my family who have prosecuted physicians for alleged medical malpractice. Sometimes, there hasn’t been enough antacids in our house to douse my flaming heartburn after some of our discussions.

Obviously, one reason that lawyers support the current system is because it enriches them. …

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Who’s most likely to spread infection in the hospital?

Originally published in MedPage Today

by Michael Smith, MedPage Today North American Correspondent

Good hand hygiene among healthcare workers is an important factor in preventing the spread of disease, but exactly how important depends on an individual’s job, researchers said.

In a mathematical model, so-called “peripatetic” workers — such as therapists or radiologists — were most likely to spread pathogens if they …

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ACP: How to fix the primary care problem in health care

The following is part of a series of original guest columns by the American College of Physicians.

by Steven Weinberger, MD, FACP

Many would argue that lack of universal coverage is the primary problem with health care in the United States, accompanied by the logistical and financial difficulties of obtaining coverage for someone with a pre-existing medical condition. Others would argue …

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An obsession with making money can be a sign of physician burnout

Originally published in HCPLive.com

by Jeff Brown, MD

Physician burnout has a tremendous effect on the financial bottom line and is far more common than docs want to talk about.

When I say the bottom line, I am referencing studies that have been done on “workaholics,” another softly defined term, that show in spite of increased hours and apparently focused activity, productivity in …

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Medscape op-ed on how to help today’s tense, frustrated doctors

My latest opinion piece, co-written with Placebo Journal’s Doug Farrago, was published in Medscape today.

medscape logo Entitled, Help for Today’s Tense, Frustrated Doctors (registration required), we discuss how doctors benefit from finding a ray of humor, despite the glum practice environment many physicians find themselves in:

Patients also can benefit from some levity during their doctor’s visit. We’ve heard from many …

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Incentives promote unnecessary, excessive tests in the ER

A professor of medicine visits the emergency department with a seemingly routine case of shingles, and gets the million dollar workup.

Writing in the Washington Post, Jack Coulehan describes how he was subjected to neurology and ophthalmology consults, several MRIs, and a CT scan. All for shingles, a disease that is diagnosed clinically, and treated with an anti-viral medication, pain relievers, and in some cases, steroids.

Soured from the experience, …

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The high cost of hiring, and firing, a doctor

Originally published in HCPLive.com

by Jeff Brown, MD

One area we need to look at is the surprisingly high costs of hiring and firing people who work with us. And as always, I rebuke our training programs for their ostrich-like attitudes, ignoring how important managerial and organizational competence is to the quality of medicine that we practice.

We know that recruiting a …

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My USA Today column on why medical malpractice reform is needed

My latest USA Today column was published this morning: Any malpractice reforms should put patients first.

I discuss how the our medical malpractice system poorly compensates injured patients and is ineffective at improving medical practice. These are the most important reasons why malpractice reform is needed. And capping awards is not the answer:

Researchers found that the impact of frivolous lawsuits …

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Doctors spend more time on social work than medicine

Originally published in HCPLive.com

by Alan Berkenwald, MD

William Osler is known as the Father of American Medicine. He was a world class physician, the “Doctor’s Doctor” – as physicians all along the Atlantic seaboard would sent their family members to him.

He wrote the first American medical textbook. He was so good, he was recruited from Johns Hopkins (which he had turned …

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Is emergency department boarding associated with undesirable events?

Originally published in Journal Watch Emergency Medicine

by Richard D. Zane, MD, FAAEM

Nearly 30% of ED boarders at a single tertiary care hospital experienced undesirable events.

Emergency department boarding — inpatients in the ED awaiting a hospital bed assignment — is common across the U.S. Although boarding is inconvenient and demoralizing for both patients and providers, few studies have examined outcomes of boarding.

In …

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Unnecessary hospital admissions cost money and can harm patients

When the elderly go to the emergency room, more often than not, they are admitted to the hospital.

Stuart Turkewitz, a geriatrician posting at his platintiff attorney brother’s malpractice law blog, explains why. Often times, it’s because emergency doctors aren’t familiar with the baseline state of his elderly patients. Subsequently, “the urge to recommend admission is overwhelming,” and the “attending physician often at the other end of the phone, …

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Two nurses face jail time for reporting a doctor to the Texas Medical Board

There’s a disturbing case in Texas, involving two whistle-blowing nurses who reported a physician to the Texas Medical Board (TMB).

Apparently, they took offense at the physician who was peddling herbal medications in the emergency room, among other deeds. Unable to convince hospital administration to discipline him, they reported him to the Board.

And here’s where it gets disturbing.

Angered by the action, the physician then filed a criminal complaint, …

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Do HMOs drive blacks to the emergency room?

Originally published in MedPage Today

by John Gever, MedPage Today Senior Editor

Many African-Americans in California enrolled in health maintenance organizations (HMOs) appear to prefer getting medical treatment in emergency rooms, researchers said.

One-quarter of African-Americans enrolled in Kaiser Permanente or other commercial HMOs in California, who would therefore have a range of treatment options, sought treatment in emergency rooms in 2007, …

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Why rapid viral testing for kids with URIs may not help in the ER

Originally published in MedPage Today

by Todd Neale, MedPage Today Staff Writer

Rapid viral diagnostic testing did not reduce the burden of treating children with respiratory symptoms and fever in the emergency department, according to a Cochrane Review meta-analysis.

Pooling the results of four trials, researchers found a significant reduction in the use of chest radiography (RR 0.77, 95% CI 0.65 to …

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