Medicare slashes pay to doctors, and what that really means

Health Policy
March 1, 2010

What we’re learning from the 21% Medicare pay cut to physicians that occurred today:

* There really must be a cost-control crisis with Medicare and the only politically-acceptable way to implement those cost controls are by cutting working physicians’ payments.

* There’s was widespread political support for blocking the scheduled pay cuts to doctors, but central government control moves very slowly. That’s because doing so is expensive. For now, doctors have been …

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Medicare slashes pay to doctors, and what that really means

Bipolar disorder and how Rebecca Riley could have been saved

Medications
March 1, 2010

Carolyn Riley’s act of giving her daughter Rebecca an overdose of prescribed medication may have been the immediate cause of Rebecca’s death, the conclusion reached by the jury that convicted her of murder.

Even if, as the prosecutor argued, Carolyn and her husband concocted symptoms of mental illness and the psychiatrist, who diagnosed bipolar disorder, was a gullible enabler, the real guilty party in this story is, in my opinion, …

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Bipolar disorder and how Rebecca Riley could have been saved

Medicare cuts will strengthen doctors’ negotiating position

Health Policy
March 1, 2010

Doctors will soon be wagging the reform dog.

Look at it this way. Expansion of insurance coverage to the 31 million more Americans, as envisioned in the current reform bill, will require more doctors to care for them. The starting entry of 78 million baby boomers in the Medicare pool, starting in 2011, will also take more doctors.

As everybody knows, coverage does not equal access. This is most vividly illustrated in …

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Medicare cuts will strengthen doctors’ negotiating position

Your metformin may smell like dead fish

Medications
March 1, 2010

Originally published in MedPage Today

An immediate-release form of the antidiabetic agent metformin has a dead fish odor that may cause patients to stop taking the drug, clinicians warned.

Metformin is known to cause adverse gastrointestinal effects such as diarrhea, nausea, vomiting, flatulence, distention, and abdominal pain. Those side effects “often necessitate discontinuing the drug,” a group of physicians and pharmacists …

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Your metformin may smell like dead fish

A nurse practitioner is valuable in hospice and palliative care

Patient
February 28, 2010

by Patrice Villars

Recently, a physician colleague expressed her concern about signing routine hospice admission orders for her elderly patient with end stage heart failure. The routine ‘as needed’ (PRN) orders included phenobarbital, pentobarbital, haloperidol, lorazepam, and morphine. “The hospice nurses know more about this than I do, don’t they?” she said.

Yesterday, a longtime palliative care nurse told me she didn’t want to put her mother with end stage heart …

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A nurse practitioner is valuable in hospice and palliative care

A beautiful Valentine’s Day patient story

Patient
February 28, 2010

“I’ll be back in a little while, Hon’. Will you be okay without me?” the frail old woman asked of her husband. She was standing at the front door and breathing heavily.

“I’ll be fine,” her husband replied from his wheelchair. His voice sounded as weak as his body looked – emaciated, scaly, and full of cancer. “I’m sorry I can’t come with you.”

The woman opened the front door. A gust …

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A beautiful Valentine’s Day patient story

How patient comments will affect your physician practice

Physician
February 27, 2010

Originally published in HCPLive.com

by Owen Dahl and Altamash Rahman

“Her MA is very rude, uncompassionate. Dr. ABCD doesn’t return phone calls. They’re not helpful and not good with following up with the care plan for patients. We’re new seeing this doctor, but will never go back. I would not recommend this practice at all!!!!!!”

How would you handle a comment like this when …

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How patient comments will affect your physician practice

The Haiti earthquake and its broken health infrastructure

Physician
February 27, 2010

Dr. Barth Green co-founded Project Medishare, which has worked in Haiti for two decades. He led the first team of U.S. physicians to Port-au-Prince after the earthquake and, together with the University of Miami’s Global Institute, spearheaded the development of a 240-bed tent hospital that is now the country’s largest functioning urgent care hospital. His group is working with the U.S. government to establish Haiti’s first rehabilitation hospital. Green …

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The Haiti earthquake and its broken health infrastructure

Why cancer screening is not a black or white decision

Conditions and Diseases
February 26, 2010

Last month I saw a 65 year-old woman with a mass in her kidney in clinic for follow up. She had recently transferred her medical care to our clinic after her insurance changed.

She came with a few medical problems including high blood pressure, tobacco use and arthritis — diseases which are the bread and butter of primary care medicine — but she also came with a history of a mass …

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Why cancer screening is not a black or white decision

How patient satisfaction scores can affect physicians

Physician
February 26, 2010

I am very blessed. The hospital where I practice, while concerned with patient satisfaction, does not worship at its altar.

That is, so far our administrators seem to understand that people will occasionally be angry or unsatisfied, and that such dissatisfaction is within the realm of real life. We still have people storm out of the emergency department, prattling on about lawyers and lawsuits, promising to go to another hospital in …

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How patient satisfaction scores can affect physicians

Condoms don’t work all the time, and here’s why

Patient
February 26, 2010

Originally published in MedPage Today

by Chris Emery, MedPage Today Contributing Writer

Condoms that don’t fit properly are more likely to break, slip off, and decrease the pleasure of both partners during sex, which may discourage their use and undermine their public health benefits, a survey found.

Ill-fitting condoms were reported by 44.7% of the men polled. They were more likely than …

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Condoms don’t work all the time, and here’s why

Can doctors learn medicine from physician lounges?

Physician
February 25, 2010

I just finished rotating at a community hospital where one of the most interesting things I’ve enjoyed is stopping by the Doctor’s Lounge. I can always count on a getting coffee there and hearing some good conversation – doctors asking for input on interesting cases, laughing, sharing stories, both personal and professional, and catching up on each other’s busy lives. In fact, I ran into an old friend of mine …

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Can doctors learn medicine from physician lounges?

Value doctors as listeners to prevent primary care burn out

Physician
February 25, 2010

A recent editorial in the Boston Globe addressed the dearth of primary care physicians. The piece concluded: “Federal funding for new residency slots should follow reforms that address the underlying reasons – principally money – that lead doctors to choose to specialize.”

Money is certainly important. But there is another obstacle to attracting primary care doctors that is more subtle, though perhaps equally important. Consider the following story.

Recently I had …

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Value doctors as listeners to prevent primary care burn out

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Never events in hospitals depend on patient risk

Health Policy
February 25, 2010

Originally published in MedPage Today

by John Gever, MedPage Today Senior Editor

Occurrence of some so-called “never events” in hospitals may depend partly on unmodifiable risk factors such as patient characteristics, undermining the rationale for denying Medicare payment for their treatment, researchers said.

Analysis of some 890,000 surgeries performed in 1,368 hospitals showed that patient age and pre-existing conditions such as weight …

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Never events in hospitals depend on patient risk

How doctors can improve patient interactions

Patient
February 24, 2010

by Lockup Doc

Physicians learn a lot about many different topics, both in medical training and in practice. However, there are some life lessons that we never learn as well as when we become patients ourselves.

When I was 13 or 14 years old, I regularly interacted with 2 different physicians with disparate interpersonal styles. Little did I know then that these seemingly meaningless encounters would indelibly shape my own beliefs about …

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How doctors can improve patient interactions

Atul Gawande’s The Checklist Manifesto reviewed

Physician
February 24, 2010

Every now and then, I read and enjoy a book, but only later fully appreciate it as its lessons and insights slowly become apparent. Judging by the number of times I’ve said, “That reminds me of Gawande’s observations about ___” over the past month, The Checklist Manifesto is one such book.

In this short, deceptively simple volume, Atul (who I count as both friend and inspiration) discusses the …

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Atul Gawande’s The Checklist Manifesto reviewed

Why being President of the United States is a health hazard

Patient
February 24, 2010

Originally published in MedPage Today

by Liz O’Brien

Exactly whom are we honoring on Presidents (or is it President’s) Day?

A. George Washington
B. George Washington and Abraham Lincoln
C. All presidents

The answer is more complicated than you’d ever expect. Probably A is most correct, but if it were up to me, I’d pick C.

Certainly every one of these 43 men has earned the …

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Why being President of the United States is a health hazard

Is Google Android or the iPhone the future of mobile smartphones?

Health Technology
February 23, 2010

by Felasfa Wodajo, MD

Over the last few months, a great deal of time has been expended on the “hot competition” between Apple and Google in relation to smart phones.

Much of this interest probably had to do with a partially imagined story of a once close friendship between Apple and Google, founded on their mutual enmity of Microsoft, now fractured on the rocks of competition and greed. While the truth probably …

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Is Google Android or the iPhone the future of mobile smartphones?

Some hospitals tube feed patients with advanced dementia

Physician
February 23, 2010

Originally published in MedPage Today

by John Gever, MedPage Today Senior Editor

Tube-feeding patients with advanced dementia — a practice whose effectiveness has been questioned by two widely cited literature reviews — is most common in larger hospitals and those run for profit, researchers said.

The odds of a feeding-tube insertion in a hospitalized patient with advanced dementia were about 50% greater …

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Some hospitals tube feed patients with advanced dementia

How the ER is now used to triage every patient

Physician
February 22, 2010

The ER is the portal of entry to our hospitals now, for better and for worse.

On the plus side, this means that most patients being admitted to general medical and surgical services have a workup at least started and are triaged appropriately to their destination.

A good ER evaluation should answer the following questions:

1. What’s the nature of the illness?

Are we dealing with the heart, the brain, or an abdominal organ? …

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How the ER is now used to triage every patient

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