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Talking with patients about their impending death

Kevin

Patient

July 23, 2010

by Brad Stuart, MD

The emergency department phoned my office right before lunch.

I was on call for our general IM group, so when I was done with my morning schedule I walked across the street to the hospital. Greg, my partner’s 38 year old patient, was a woodworker admitted with fever, chills, cough, a sharp pain in his right side, and a WBC of 18,000. On the chest x-ray, I …

Does restricting work hours hurt surgical training?

MedPage Today

Medical Education

July 23, 2010

by Michael Smith

Life is better but the quality of surgical training has gone down in the wake of a Swiss law restricting surgical residents’ hours.

That was the view of both the residents and the surgical consultants who supervise them in a survey conducted by Daniel Oertli, MD, of University Hospital Basel in Basel, Switzerland, and colleagues.

Less than 9% of residents and less than 5% of surgical consultants saw the change …

Can patients demand changes in the healthcare system?

WarmSocks

Health Policy

July 23, 2010

Are healthy people patients? Sometimes I wonder.

If you’re healthy, you rarely see a doctor. If you go for a “routine” checkup every five years, you just aren’t very affected by the system. You might not even know what the system is. Your health insurance premium is deducted from your paycheck, so you never really see that money — not the way you would if you had to write a check in that …

The Massachusetts gift ban benefits health insurance companies

Kevin

Medications

July 23, 2010

by Edison Wong, MD

With the recent proposal to repeal the so-called Massachusetts “gift ban” (more appropriately referred to as the “interaction ban”), I asked myself who stands to gain the most from such bans?

Is it the consumers or patients? Is it the physicians or their practices? Is it the federal or state governments? Nope. Sadly, it is the insurers who gain the most, at the expense of patients.

The …

America has a disease industry, not a health care system

Stephen C. Schimpff, MD

Health Policy

July 22, 2010

The decade ahead is one likely to be full of turbulence. How everything will shake out is anybody’s guess.

But we can be sure that technology advancements will slow for no one. The rate of medical technology advancement now is very fast and the speed will only accelerate. One big problem is that technology advances so fast that there is no time for a purchase – say new CT scanner or …

Dana Jennings interview, the world’s most famous patient blogger

Lisa Gualtieri, PhD

Patient

July 22, 2010

Dana Jennings writes what is arguably the world’s most famous patient blog about his treatment for prostate cancer.

Just to be clear, I don’t have any statistics about how many readers he and other patient bloggers have. I believe his blog is the most widely read and best-know patient blog because of the number of comments he receives and its prominent location in the New York Times Health section, itself …

Smoking, hypertension, obesity, and 7 other stroke risk factors

Kristina Fiore

Conditions and Diseases

July 22, 2010

by Kristina Fiore

There are 10 factors that appear to make up the vast majority of stroke risk, and half of those are modifiable, a large population study found.

Hypertension appears to be the strongest predictor of stroke, along with smoking, abdominal obesity, diet, and physical activity, according to Martin J. O’Donnell, MB, PhD, of McMaster University in Hamilton in Ontario, Canada.

“This is good news in the sense that the causes of …

Why Medicaid would be better off as a federal program, like Medicare

Aaron E. Carroll, MD

Health Policy

July 22, 2010

This is a perfect example of why Medicaid is not the same as Medicare:

Having counted on Washington for money that may not be delivered, at least 30 states will have to close larger-than-anticipated shortfalls in the coming fiscal year unless Congress passes a six-month extension of increased federal spending on Medicaid.

Governors and state lawmakers, already facing some of the toughest budgets since the Great Depression, said the repercussions would …

Read more…

Why Medicaid would be better off as a federal program, like Medicare

Viagra for muscular dystrophy and publicity for accidental insight

Jeoffry B. Gordon, MD, MPH

Conditions and Diseases

July 22, 2010

by Jeoffry B. Gordon, MD, MPH

As a family doc in practice for over 30 years I have been always tried to conceptualize disease states beyond the standard text book parameters.

Thus I was elated by the prospect of discovering a new beneficial treatment for muscular dystrophy when 5 years ago I gave some Viagra to a 57-year old patient of mine with limb girdle muscular dystrophy for the usual purpose. In …

How can doctors minimize unnecessary testing?

Robert Centor, MD

Physician

July 21, 2010

A recent comment raised a minor controversy about the strategy of minimizing tests. I actually do not think that the disagreement is that great, but I feel like exploring the issue.

This is the sentence that triggered the comment, courtesy of primary care physician Rob Lamberts:

Order as few tests as possible. No test should be ordered for informational purposes only; the question, “What will I do with these results?” should always …

Read more…

How can doctors minimize unnecessary testing?

Understanding balance billing, a primer for patients

Lucy Hornstein, MD

Health Policy

July 21, 2010

The topic of balance billing has arisen once again, this time in this post by Movin’ Meat about the new health care insurance bill and emergency medicine.

Without further explanation, “balance billing” is generally thought of as a bad thing; a way for rich doctors to squeeze even more ill-gotten gains from their poor beleaguered patients. And that’s without even realizing what it is. …

Can Shrek and Dora combat the junk food epidemic?

MedPage Today

Potpourri

July 21, 2010

by Michael Smith

Can Dora the Explorer help kids find a taste for carrots?

It may be possible that licensed characters such as Dora, Shrek, and Scooby-Doo can tilt the balance away from junk food and toward healthy snacks, according to Christina Roberto, MS, and colleagues at Yale University.

In a study of 40 preschoolers, the presence of a licensed character on a package influenced the children’s perception of taste and their preference …

Data and transparency is needed to reduce medical mistakes

Kevin

Physician

July 21, 2010

An excerpt from On the Mend: Revolutionizing Healthcare to Save Lives and Transform the Industry.

by John Toussaint, MD, and Roger Gerard, PhD

Admitting Error

In a lean environment, doctors and nurses must allow mistakes to be visible in order to perform root-cause analysis and fix the process. But showing mistakes hits most medical providers in a vulnerable place—right in the collective fear of lawsuits and a highly conditioned need to be …

Participatory medicine and evidence from medical journals

Dave deBronkart

Patient

July 20, 2010

I’ve only been studying healthcare for two years and I hesitate to be overly assertive.

But I have, finally, reached the point where I feel confident in citing cases where people are simply being unscientific: ignoring evidence. That’s always hazardous, and it becomes insidious when it’s caused by a blind, unquestioning belief in our institutions.

Case in point:

Julie Thoren is an active practitioner of Participatory Medicine who’s seen first-hand the tremendous value …

Health care needs public acceptance of evidence based medicine

Brad Wright, PhD

Health Policy

July 20, 2010

Although a majority of Americans probably couldn’t give you an accurate description of the differences between fascism, socialism, and communism, they have no trouble applying–and often interchanging–those labels to any effort by government to reform health care.

And, based on their efforts, one might conclude that the defining characteristic of any government involvement in health care is rationing. As if we don’t already ration, but will as soon as the government …

5 principles of self-care for health professionals

Lisa Chu, MD

Physician

July 20, 2010

As trained caring professionals, often we think of self-care as “selfish” or something that we do after we’ve taken care of our other “duties”, “responsibilities” and “obligations”.

Just for a moment, I invite you to think of self-care in a different way. I invite you to consider that your knowledge and practice of self-care is essential to creating a healing relationship with your patients and creating a healing environment in your …

The value of comparative effectiveness reviews is locally based

Kevin

Health Policy

July 20, 2010

by Craig A. Umscheid, MD, MSCE

In its 2010 comparison, the Commonwealth Fund has rendered the verdict yet again: the United States leaves other nations in the dust when it comes to healthcare costs — and yet provides its residents with the worst outcomes overall. In the study, the U.S. underperformed on virtually every front in comparison to Australia, Canada, Germany, Netherlands, New Zealand, and the United Kingdom.

The …

How Massachusetts can set hospital payment rates

Paul Levy

Health Policy

July 19, 2010

My suggestion last year that Massachusetts move away from the “free market” approach it uses to set hospital reimbursement rates was not well received by the hospital world.

But, this year, as people notice that their rates are being set by insurance companies in an unaccountable and unreviewable fashion, more and more are saying, “Well, maybe. What would it look like?”

There is a range of options. Let me lay out …

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