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 ...

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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 ...

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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 ...

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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 an hour. It's ...

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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 ...

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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 ...

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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 gifted clinician, ...

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I recently wrote about the hidden dangers of physician social networks, and how private posts can potentially become public at a later date. With the recent controversy surrounding former Washington Post blogger Dave Weigel and Journalist in mind, I commented that,

passionate, controversial debate is frequent on Sermo, along with discussion of patient cases. Part of what makes the site so provocative and insightful is the fact that the conversations ...

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Say the words, "Patient-centered medical home," and you're bound to get a variety of opinions. On this blog alone, there are a variety of guest pieces critical of the effort, saying it does not increase patient satisfaction, nor does it save money. And that's not good news for its advocates, who are pinning primary care's last hopes on the model. Medical homes hit the mainstream media recently, ...

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As more students participate in social media, like Twitter, Facebook, and blogs, Bryan Vartabedian asks, "Does Twitter Belong on Your Medical School Application?" Great question. I'd say that the majority of doctors and medical schools fail to see the utility of social media, and are generally behind the curve.  Indeed, as Dr. Vartabedian writes, "some academics, after all, see social media as a waste of time." But that's going to change.  With sites ...

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Recently, JAMA published a study concluding that doctors are hesitant to report incompetent physicians or those who were impaired. According to the article,

more than a third of docs don't think they're responsible for reporting those who aren't fit to practice, according to the results just published in JAMA. And only 69 percent of the docs who knew about an impaired or incompetent colleague reported them.
To those who advocate that the medical ...

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Physician salaries are always a sensitive topic. A common view among health reforms is that doctors, in general, are paid too much. Various progressive pundits point to statistics showing that American doctors are the highest paid in the world. For many specialists, that may be true. But not for primary care. A recent Tweet by Ves Dimov pointed me to an article from the UK, stating that primary care doctors working in ...

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There's little question that medical school debt is rising rapidly, affecting the career choice of medical students. It's one of the main reasons why the disparity between the number of specialists and primary care doctors is widening. There have been a variety of proposed solutions -- most recent of which are medical schools completely subsidizing their tuition. I think that's a good step forward, but so far, has only been ...

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How effective is direct to consumer drug advertising? Some think that drug ads should be banned altogether, saying that it encourages patients to ask their doctors for expensive, brand name prescription drugs. It turns out, their fears may be overblown. NPR's Shots blogs about a recent study looking at the effectiveness of these ads. The numbers, for the pharmaceutical companies anyways, are not encouraging:

Overall, about 8 percent of the people who were ...

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Remember when I wrote, way back when, that expanding health coverage without a concurrent increase in primary care access will only worsen emergency room waits? For instance, consider this, from CNN.com:

What good is having health insurance if you can’t find a doctor to see you? ... ... The Massachusetts Medical Society reported that the average wait time for a new patient looking for a primary care doctor ranged from 36 to ...

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Should doctors face consequences if they run late? From the New York Times' health blog, Well, comes a story where a medical group promises, “same-day appointments and longer, more personalized visits that start on time.” Sounds good, right? But it comes with a caveat, namely, a $199 annual membership fee. A tremendous amount of primary care can be bought with that amount of money, and if patients were willing to pay that, ...

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The following op-ed was published on June 7th, 2010 in CNN.com. "I read all about my condition on the Internet," a recent patient proudly told me. Like other doctors, I'm seeing more patients research their symptoms thoroughly before setting foot in the exam room. Patients are using the Web in unprecedented ways for their own health empowerment. According to the Pew Internet & American Life Project, 61 percent of American adults ...

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Should drug and device makers fund continuing medical education courses? That's a question medical schools and academic medical centers have recently been grappling over. Now, the University of Michigan has taken the controversial step to completely divorce the industry from physician education. According to the New York Times,

the University of Michigan Medical School has become the first to decide that it will no longer take any money from drug and device makers ...

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It's well known that patients Google their doctors, a practice that's performed with increasing frequency. But what about doctors researching their patients on the web? It's an interesting idea that I hadn't thought of. I have never Googled a patient, and can't see any reason to in a primary care setting. But the context of the piece, which I first saw in the WSJ Health Blog, was in psychiatry. It would ...

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