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Positive reinforcement can motivate preventive behaviors

Physician

August 24, 2010

Eating right, exercising, avoiding the sun or using sunscreen, moderating alcohol consumption, abstaining from tobacco use, getting mammograms, Pap smears, colonoscopies—almost every measure we’re asked to take to safeguard our future health is difficult. It’s a strange paradox that we have to work in some way, to expend energy, and experience discomfort of some kind in order to gain benefit in life.

Wouldn’t it be nice if the most pleasurable things …

Why OpenNotes and access to the medical chart is important

Wendy S. Harpham, MD

Patient

August 24, 2010

Have you ever read what your physicians and nurses have written in your medical chart? If not, would you want to?

The OpenNotes project is a recently launched observational research study that involves 100 primary care doctors and about 25,000 patients. Lead author Dr. Tom Delbacoa, a primary care physician at the Beth Israel Deaconess Medical Center, poses the research question succinctly: “After a year, will the patients and doctors still want to continue sharing notes?”

In the study, …

Adults living with dementia and disability need research funding

Alex Smith, MD

Patient

August 23, 2010

I heard a prominent speaker talk about studies at the National Institute of Aging. The speaker described several new large and well funded trials aimed at preventing illnesses associated with aging, such as dementia and disability. These studies are terrific, and worthy of funding.

I was disappointed, however, that little was said about funding for studies of older adults already living with dementia and disability. Research in prevention will not help these patients. I asked: where is the …

How patients can stop doctors from blaming them for their health

WarmSocks

Patient

August 23, 2010

If doctors need to listen to patients to figure out what’s going on, patients need to tell doctors what’s going on. Why is that so hard sometimes? It’s hard to speak up when you feel rushed, but have doctors ever done other things that made it harder for me to talk to them?

Sometimes doctors blame the patient

Years ago I got a terrible abdominal pain. I could only explain that it felt like …

Insurance does not have incentives to lower costs or improve quality

Stephen C. Schimpff, MD

Health Policy

August 23, 2010

Whether we have commercial insurance through our employer or Medicare, the incentives are poorly aligned to lower costs and improve quality.

In fact, they actually encourage greater and greater expenditures. In most instances, our insurance covers everything from prevention to basic routine care to complex care of serious illness. Coverage may not be all that good for some things like preventive care and our primary care …

Is placebo a therapy, like surgery or medication?

PalMD

Conditions and Diseases

August 23, 2010

The New England Journal of Medicine recently published a troubling article on acupuncture, which was ably deconstructed by Dr. Mark Crislip. This incident has reignited a discussion of what, exactly, “placebo” is.

A common argument is that placebo is like any other intervention, something that can be intentionally harnessed for the benefit of patients. This is both true and overly simplistic.

First, we must review what “placebo” …

Fetal heart rate monitoring is given too much importance

Nicholas Fogelson, MD

Conditions and Diseases

August 23, 2010

Continuous fetal heart rate monitoring is at its core an almost laughable idea.

We are checking a single vital sign and using that vital sign to extrapolate a host of ideas and meanings. OBs that have read strips for years can make some sense of them, but would we give so much meaning to any other single vital sign? Would we do it with an adult? Of course not, but there …

Medicine is an old profession, but not the oldest profession

Lucy Hornstein, MD

Physician

August 22, 2010

Medicine is a very old profession. Ancient and honorable. Sadly, for the vast majority of recorded history, honor was pretty much all it had. The Hippocratean ideals of “first do no harm” and putting the patient first and all held special importance when medicine truly had nothing to offer. Make no mistake: up until the last two centuries, the vast majority of what passed as …

How patient stories can enhance health websites

Lisa Gualtieri, PhD

Health Technology

August 22, 2010

Stories can enhance health websites because they resonate with health information seekers, who find support and encouragement from the experiences of others like them. Two excellent examples are Weight Watchers’ Success Stories and Livestrong.org’s Survivorship Stories. Both sites include extensive libraries of well-written stories about people’s experiences losing weight and surviving cancer, respectively.

Because of the effectiveness of stories in health websites like these, I challenge my Online Consumer Health students …

Why family medicine and internal medicine should not merge

Robert Centor, MD

Physician

August 21, 2010

Recently, I had a discussion with a prominent academic family physician. I had last seen him 37 years ago when he was getting ready to graduate from medical school and I was a new medical student.

We had a wonderful discussion and agreed to disagree about merging primary care. Long time readers know that I dislike the term for the tasks that outpatient internists do. Most of the push for merger …

OpenNotes and whether patients should see their medical notes

Dave deBronkart

Patient

August 21, 2010

The opening anecdote of the e-patient white paper tells of a patient who impersonated a doctor in 1994, to get his hands on an article about an operation he was about to have. He got busted. Two years later episode 139 of Seinfeld had something similar – Kramer impersonates a doctor to try to get Elaine’s medical record.

It aired October 17, 1996. It was a turning point in American healthcare: …

The public option dissonance in health reform

Brad Wright, PhD

Health Policy

August 20, 2010

Health reform will do a lot of things that most Americans don’t realize it will do, and it will not do a lot of things that many Americans mistakenly believe it will do.

One of the most recognizable components of health reform that didn’t actually become law is the public option. The public option was the lighting rod in the health reform debate. After all, it had a concise name, and …

Healthcare reform ethical questions

Jeffrey Hall Dobken, MD, MPH

Health Policy

August 20, 2010

Hard choices and healthcare reform are here. Donald Berwick, M.D., has been installed as the administrator for the Centers for Medicare and Medicaid services as a “recess appointment” by President Obama.

Dr. Berwick is an academician, a pediatrician who has spent the bulk of his professional existence as the CEO of the Institute for Healthcare Improvement of Cambridge, MA. He is an outspoken advocate for the single-payer system, admires Britain’s National …

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Healthcare reform ethical questions

Health care reform needs cooperation and compromise

Paul Levy

Health Policy

August 20, 2010

There are strange things going on in the Massachusetts health care insurance market. For those from out of state, here are some quotes that will give you a sense of the contradictions in the public policy arena.

They are, respectively, from two stories that appeared on the same day in the Boston Globe: “Rate cap for insurer overturned” and “Officials give up cutting health perks.”

1. An insurance …

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Health care reform needs cooperation and compromise

Balancing a surgeon’s beliefs with the needs of the practice

Peter J. Polack, MD

Physician

August 20, 2010

Not long ago, we interviewed a physician for possible partnership in our practice. After showing him around our town, some of us partners had dinner with him to discuss business. He was a quite pleasant fellow, well trained, and seemed to be a good ‘fit’ for our practice. As dessert was being served, he said he needed to get one more thing off his chest: he prays aloud in the …

Americans will need doctors but physicians are leaving primary care

Davis Liu, MD

Health Policy

August 20, 2010

Everyone understands the need for a robust primary care workforce in making healthcare more affordable and accessible while keeping those in our care healthy. With the aging of America and healthcare reform, even more Americans will need primary care doctors at precisely the same time doctors are leaving the specialty in droves and medical students shun the career choice. So as a practicing primary care doctor, I’ve watched with …

Gifts and money influence physician prescribing

Marya Zilberberg, MD, MPH

Medications

August 19, 2010

It is not a secret that large sums of money have passed from the pharmaceutical and device manufacturers into physicians’ hands.

This money has been paid not only for such socially beneficial pursuits as research and consulting, but also for lavish gifts and junkets. And interestingly, despite disingenuous assertions to the contrary by many a stake holder, these gifts generated a return on investment — surprise! It turns out that the …

Before ordering a test, know what to do with the result

Bruce Campbell, MD

Conditions and Diseases

August 19, 2010

Insanity: Doing the same thing over and over and expecting different results.
– Albert Einstein

As medical students rotating through the wards, we spent a significant portion of each day ordering laboratory tests and then chasing down the results. We wanted to investigate our patients’ illnesses and, just as importantly, we wanted to be prepared for any question with which our professors might surprise us during Attending Rounds.

One day, as I was …

PCMH and retainer fee medicine are primary care solutions

Juliet K. Mavromatis, MD

Physician

August 19, 2010

For years now we’ve been hearing about the trials and tribulations that have evolved in the practice of primary care medicine.

However, the discussion has intensified in recent months with passage of national health reform. Recent publications highlight the problems. A paper in the New England Journal of Medicine by Dr. Richard Baron entitled, What Keeps Us So Busy in Primary Care? discusses the time spent by primary care …

Why nurses need better EMR design to care for patients

Jared Sinclair, RN

Health Technology

August 19, 2010

There’s always a lot of stink from physicians over usability problems with EHRs: too many clicks, too many contextual menus, etc. The gist of these complaints is, “Physicians aren’t data entry clerks!” The computer is getting in the way of their interactions with their patients.

Everybody has a finite amount of mental space available at any given moment. Imagine having to transcribe a conversation in real-time. If half of your mental …

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