One of the more notable findings from the special report on the TransforMED National Medical Home Demonstration project was that “patient satisfaction doesn’t automatically go up.” Terry McGeeney, CEO of TransforMED, attributed the lack of increased patient satisfaction experienced by the 18 participating physician practices to a variety of factors, chief of which “was the turmoil of change experienced by patients as practices implemented after-hours access, quick access to laboratory results ...

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“Hey doc, all I need is this referral.” I’ve been encountering more of this lately. A patient who has not been seen in the office for months to years (well beyond when they were supposed to come back for a follow up visit) walks in and requests a “referral” for a specialist visit but they can’t be bothered with actually being seen and evaluated in the office or to be compliant ...

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It's worth your while to browse through Sid Schwab's sampler one rainy Saturday afternoon when you get a chance. The old man can write. I was reading through a couple of his old posts the other day when I stumbled upon this one. It's a shorter post (for him) but very powerful and moving. He describes what it's like to enter an abdominal cavity of a patient, with all its ...

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Emergency physicians are in a dilemma.  Risk missing a diagnosis and be sued, or be criticized for overtesting. Regular readers of this blog, along with many other physicians', are familiar with the difficult choices facing doctors in the emergency department. The Associated Press, continuing its excellent series on overtesting, discusses how lawsuit fears is a leading driver of unnecessary tests. Consider chest pain, one of the most common presenting symptoms in the ...

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by James Baker, MD In public mental health care, “local control” is the mantra that describes the desire to assure that mental health policy is dictated by local communities rather than by state or federal government. I hope that folks who insist upon this are mindful that power-hoarding in the form of “local control” is no blessing in itself, except when it is used, in turn, to empower the people we serve. I ...

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When I was a second-year medical student I remember thinking, after meeting with an attending physician in a physical diagnosis class, how impossible it seemed that my brain would ever contain as much medical knowledge as his. And even if somehow one day it did, how would I ever be able to call on it, manipulate it, twist it, bend it, and turn it upside down with the same apparent ease ...

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Obesity is a huge healthcare problem in the United States. It has reached the proportions of an epidemic and continues to get worse. Multiple medical problems including heart disease, hypertension, diabetes, sleep apnea and cancer are closely associated with obesity. The patients with extreme obesity can reach a body weight of five, six or seven hundred pounds and even higher. Riddled with chronic medical conditions, these patients often end up in ...

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It's time to ask patients whether they text and drive. An important perspective piece from the New England Journal of Medicine urges doctors to include that question during preventive health exams. The data surrounding texting and driving is grim:

Although there are many possible distractions for drivers, more than 275 million Americans own cell phones, and 81% of them talk on those phones while driving. The adverse consequences have reached epidemic proportions. ...

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by Chris Emery Nurses and other healthcare providers complied with hand hygiene guidelines less than half of the time before participating in medical procedures, results of a new study showed. Compliance was better after procedures, with 72% following guidelines after procedures compared with 41.7% before procedures, according to a report published in the May issue of Applied Nursing Research. Overall compliance with hand hygiene guidelines was just 34.3%. "It is important to note that ...

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During my entire career I have seen unwarranted and unseemly squabbling between town and gown. I often hear the gown side insult the town side. While I went straight into academic medicine, I did moonlight in community hospitals. For the past 6 years I have taught part time in a community hospital and part time in an academic VA hospital. I find recent negative comments about academic medicine unfortunate just like ...

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