New York Times op-ed entitled "In Cancer Care, Cost Matters,"  described what may be one of the earliest accounts where doctors at Sloan-Kettering decided not to use a new cancer drug because of its extra cost when they were already using equally-effective drugs for their cancer treatments.  The article piqued my interest.  These days for any doctor who uses expensive technologies, it is easy to see where this evaluation ...

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Decisions in medicine are supposed to rest on concrete observations and hard evidence. Often, hard evidence does not exist or when it does, it isn't used.  Why is this? Concrete observations, too, are increasingly missed as we stare at computer screens longer and patients less.  Yet we persist. Why? This is our reality now, our evolving medical world. But if we stop and think about it, medicine, by definition, is a world of technological ...

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As my head reels at the implications of the IRS scandal mushrooming in Washington, the IRS's recently disclosed ability to access emails without warrant, the intricacy of the NSA PRISM wiretap techiques that includes their ability to acquire tech firms' digital data, and even the Justice Department's ability to secretly acquire telephone toll records from the Associated Press, I wonder (as a doctor) what all this means for the privacy protections afforded ...

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Dear Graduating Class of 2013, I appreciate the opportunity to address such an impressive pool of medical school attendees.  From the first day of medical school when you were introduced to your cadaver, you have endured countless lectures and lab hours, physical examination and sensitivity training sessions, and ward rotations under the watchful eye of senior residents and attendings.   Today, you will hold something that few people are privileged to ...

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An interesting phenomenon is occurring in media circles these days.  No doubt others have seen it, too. Lately, doctors are being schooled by the media. From how to learn empathy, to improving communication with patients, the breadth and depth of what we should do for our patients is endless.  Why, some even have our own colleague experts tell us how we should really do things. These efforts, while probably well-intentioned, are patronizing.  ...

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Doctors are trying to rationalize our current story line:  the loss of autonomy and pay cuts are a necessary evil for the greater good.   We're taking one for the excess-health care cost team.  We're willing to take this personal sacrifice for our fellow man and woman.   It is the noble thing to do.   It will be good for America's healthcare system if we do our part, work harder ...

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The position paper from the American College of Physicians and the Federation of State Medical Boards, is a humbling reminder of the challenges that today's physicians face when entering the online space. Their recommendations for online medical professionalism, written by ethics committees for the two organizations, "provides recommendations about the influence of social media on the patient–physician relationship, the role of these media in public perception of physician behaviors, and strategies for physician–physician ...

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AliveCor-ECG With the announcement that the FDA granted 510(k) approval for the AliveCor EKG case for the iPhone 4/4S, the device became available to "licensed U.S. medical professionals and prescribed patients to record, display, store, and transfer single-channel electrocardiogram (ECG) rhythms." While this sounds nice, how, exactly, does one become a prescribed patient?  Once a doctor prescribes such a device, what are his responsibilities?  Does ...

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It’s been three years since the Patient Protection and Accountable Care Act (PPACA) became law.  There have been widely divergent opinions published by journalists on the impact of the law for Americans: from a rose-colored account from the New York Times, to a not-so-peachy account published at Reason.com.  Few doctors have ventured into this discussion. The need for health care cost reform I should start by saying that I am biased.  I grew up in ...

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"What's the most important finding on this chest x-ray?" There he was, standing before 5 ICU residents, each peering at a chest film on displayed on the over-sized computer screen. "Um, the pleural effusion?" whimpered a third-year resident. "No!" barked the attending. The others, standing dumbfounded in front of the computer display, searching for another finding but finding none, stood silently. "Come on, folks!  Look!" And try as they may, no one saw it. "The name, folks, ...

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A phone conference had been arranged.  They wanted to talk to me about a denial for payment on a portion of a patient's pre-authorized procedure after the fact.   Its participants: the regional medical director of a large insurance company, his female assistant administrator, and me. He cordially introduced himself as a pediatrician by trade from a large well-known (and highly respected) academic institution with impeccable credentials responsible for our region of the United States. ...

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My perspective on scientific publications has been greatly affected by my experience with this blog and social media in particular.  The ability to serve as author, reviewer, advertiser and marketer can be easily achieved in this space thanks to the power of self-publishing.  But with this new platform comes new responsibilities and for those of us who chose to work with people daily, perhaps none is as great as maintaining ...

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shutterstock_111665426 A collision is coming. Scratch that. The collision is here. I'm not quite sure how to describe this, but I'll try. Every day, I look at a computer screen for health care delivery with an increasing number of menu options.  I tried counting these menu options once and after scrolling through them, I never reached all of them after counting up to 275 items. Yes, there are ...

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The electronic medical record (EMR)'s promised contribution to health care cost savings got a second look recently, and the results were poor at best.  But what I found interesting was the "second look" was from the same organization that did the first look: the corporately-funded, non-profit think-tank called the RAND Corporation. From their second and more recent report:

A team of RAND Corporation researchers projected in 2005 that rapid ...

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"Doctor, could we have a copy of your most recent CV." "Sure," I said, realizing it hadn't been updated recently. It is interesting how I approach my academic pursuits now.  It used to be that it was "publish or perish" in the world of academic medicine.  Of course, even now the only "publishing" that counts to the academic world is that of conventional peer-reviewed journals with high impact factors (or grant applications that ...

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shutterstock_122493682 The implementation of the electronic medical record (EMR) in American medicine gained a powerful foothold in medical care with the passage of the American Reinvestment and Recovery Act (ARRA) in 2009. With the passage of this act came the promise of improved efficiencies, safety and ultimately reduced cost delivery for health care. Also, some $18 billion dollars in financial incentives were offered to physicians ...

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Medical journals aren't what they used to be. Just ten short years ago, medical journals were places to report scientific study, interesting cases or clinical updates and reviews. They were, for the most part, about science and discovery. Now, there is a dramatic shift of scientific content in our journals to politics and policy. No where is this more evident than the much-heralded and widely read New England Journal of ...

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I have used the electronic medical record (specifically EPIC) since 2004.  I have grown accustomed to its nuances, benefits and quirks.  There are parts about it I really like.  There are parts of it I'd like to do without but accept that they are necessary evils in our current health care climate.  I know that there will always be parts of any modified ...

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Diet and exercise: they were supposed to be the answer to all that ails America's obesity and health care cost problem. Signs of this Utopian vision are everywhere.  From entire government departments encouraging healthy lifestyles through fitness, sports and nutrition, government websites that encourage "healthy lifestyles," and entire community efforts to partner with health care organizations to fight obesity with the hope of cutting health care costs. What if, believe it ...

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There are so many changes in medicine these days, but it takes a bit of time away from the keyboard to appreciate them. So glued have I become to looking at computer screens, it's been hard to pull my head from them any more.  Doctors lives are spent staring at these damn screens now.  I wonder how many of my youngest colleagues know how to start an IV, a foley, place a central ...

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