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How ideology is shaping health care reform

Health Policy

January 21, 2010

I’m an ideological pragmatist. I believe in what works and what suits the temperament of American people, rather than what is politically correct or what passes some moral litmus test.

Whatever reform measure passes, it will be a public-private mix and will superimpose more government regulations on our private system. It will have uneven effects. It will cost more than the status quo. And it will expose the reality, that when …

How to prevent diabetes with diet and exercise

Erin Marcus, MD

Conditions and Diseases

January 20, 2010

By all accounts, Frances Vasquez ought to be a diabetic. Raised on a diet of fried steak, fried pork chops and lots of rice, her father, mother, and two sisters suffered from the disease. At age 47, Frances was overweight and already experiencing high blood sugar.

But over the past 11 years, Frances has been able to avoid diabetes, and her sugars are now normal. By participating in a ground-breaking, government-funded …

Why scaring patients to quit smoking may not be effective

Kevin

Physician

January 20, 2010

Originally published in MedPage Today

by Crystal Phend, MedPage Today Senior Staff Writer

Telling people about the benefits of quitting is more likely to help smokers break the habit than scaring them with the dangers of continuing, researchers found.

Callers to a tobacco quitline were nearly twice as likely to stop in the short term when they got positive messages rather than …

Did Martha Coakley kill health reform, and what Senator Scott Brown means for healthcare

Kevin

Health Policy

January 20, 2010

In case you haven’t heard, in a stunning result in yesterday’s special election in Massachusetts, Republican Scott Brown won the Senate seat previously occupied by the late Edward Kennedy.

Needless to say, pundits are going crazy analyzing the results, and its implications on health reform. I’ll leave the political commentary to them, but I’ll comment on what this means for health reform’s future.

In essence, what turned into a 95% likelihood …

A doctor writes about his first day in Haiti

Kevin

Physician

January 19, 2010

by Jonathan Crocker, MD

From Cange, Central Plateau
Haiti
01-18-10

We arrived at Cange, in the Central Plateau, the heart of operations for Partners In Health/Zamni Lasante, yesterday. As we expected, things are incredibly busy. People are still arriving from Port au Prince. Those who have been fortunate enough to survive their injuries this long are now running into complications of wound infections, some of which have turned septic, and venous blood clots (from …

ACP: 10 major challenges that confront medical education over the next decade

American College of Physicians

Medical Education

January 19, 2010

The following is part of a series of original guest columns by the American College of Physicians.

by Steven Weinberger, MD, FACP

At times of calendar transitions, e.g., at the onset of a new year or a new decade, the popular press often takes a broad view in looking retrospectively at the outstanding or defining events and people of the past …

Tips for doctors who negotiate reimbursement rates with insurance companies

Kevin

Physician

January 19, 2010

Originally published in HCPLive.com

by Ed Rabinowitz

When it comes to negotiating fees with health plans, practices and physicians have more leverage than they realize. The problem, says John Schmitt, a managed care expert with EthosPartners Healthcare Management Group, is that practices often don’t even try. “Groups negotiate an agreement with a payor and then, for whatever reason, just file it away. Most medical groups do not have a good, proactive methodology …

How root cause analysis can improve patient safety

Robert Wachter, MD

Physician

January 19, 2010

Hospitals face so many urgent tasks in safety – computerize, promote teamwork, implement evidence-based safety practices, discover unsafe conditions – that it’s hard to know where to start. If you’re struggling, I recommend that you put your Root Cause Analysis enterprise on steroids. This is what we did at UCSF Medical Center, and it was the most important change we’ve made in our safety journey. Here’s the story, …

Scenes from Haiti before the earthquake, and what the future holds

Kevin

Physician

January 18, 2010

Originally published in MedPage Today

by Michael Smith

I remember walking through the squalid downtown of Port-au-Prince and coming across a woman sitting by the roadside selling carefully washed tin cans. That was how she made her meager living.

There were scenes that were more appalling — a man on a street corner with his head split open by a machete, a corpse …

Good doctors sometimes may make patients unhappy

Edwin Leap, MD

Physician

January 18, 2010

Most of us went into medicine because, in addition to being good students, we wanted to help people. How many oceans of ink and forests of paper have been used explaining that point to admissions committees we’ll never know. Suffice it to say, it felt very good when our professors wrote us glowing letters of recommendation. Of course, we were also saying, “I want to feel good about helping people. …

How a doctor’s office can affect patient trust

Kevin

Patient

January 17, 2010

Originally published in MedPage Today

by Marianne Mattera

Trust is an essential element in the doctor-patient relationship.

You’re well aware of how important it is that you can trust the history the patient gives you. You know the problems that can arise in planning and managing care if you’re working with only part of the story. And you probably even feel a twinge …

How doctors can look for the right non-clinical medical job

Joseph Kim, MD, MPH

Physician

January 17, 2010

How many physicians do you know who have chosen to leave their clinical practice?

There’s no doubt that physicians are getting burned out. Many are tired of fighting insurance companies and even more physicians are getting discouraged about reductions in reimbursement. This has caused some physicians to drop Medicare and Medicaid. Others have switched to cash-only or concierge/boutique practice models. Then you have your group of physicians who have simply decided …

How psychiatrists may be giving their patients too many drugs

Kevin

Medications

January 16, 2010

Originally published in MedPage Today

by John Gever, MedPage Today Senior Editor

Psychiatrists who prescribe drugs for their patients today usually give more than one at a time, often with little scientific basis, researchers said.

About 60% of patients with psychiatrist office visits leading to a drug prescription received at least two medications in 2005-2006, according to government survey data analyzed by Ramin …

How bad patient outcomes affect physicians

Shantanu Nundy, MD

Physician

January 16, 2010

Ms. FR didn’t look so great even when I first met her. She had been admitted to the hospital three times in past 6 weeks for nausea/vomiting and generalized malaise. While the cause of her acute illness was not entirely clear, we suspected that her widely metastatic breast cancer had something to do with it.

By the time I met her she had already been in the hospital for 1 week. …

What diseases can arise from the lack of clean water in Haiti?

Kevin

Conditions and Diseases

January 15, 2010

Originally published in MedPage Today

by Michael Smith, MedPage Today North American Correspondent

The lack of clean water in the stricken Haitian capital fosters conditions that may spawn an epidemic of enteric disease.

“Having large numbers of people in close proximity and not using appropriate sanitation can potentially spark those epidemics, particularly if people are forced to drink surface water,” said Rebecca Dillingham, …

We are becoming a nation of people with multiple chronic diseases

Kevin

Patient

January 15, 2010

by Monte Ladner, MD

Many Americans are resolving that this will be the year they finally lose weight. Sadly, most of them will reach the end of 2010 heavier than when they started. We continue losing the weight loss game because our efforts are misplaced. The issue is lifestyle.

Dr. Dana King of the Medical University of South Carolina recently published two papers on the erosion of American lifestyle …

Do neuroenhancement pills really improve attention, memory, or cognition?

Kevin

Medications

January 15, 2010

Originally published in HCPLive.com

by Victor G. Dostrow, MD

The Internet is filled with reports of remarkable cognitive enhancement with various nostrums.

Many are not regulated, and the pages are typically associated with glowing testimonials and a link to sign up for uninterrupted (and uninterruptible) delivery of the miracle substance. More to the point of this post, other blogs, reports, and forum comments opine as to notable benefits of taking prescription medications marketed …

Don’t use kitchen spoons to measure drug dosages

Kevin

Medications

January 15, 2010

Originally published in MedPage Today

by Todd Neale, MedPage Today Staff Writer

Individuals using standard spoons from their home kitchen to dispense liquid medications may be pouring too little or too much of the drugs, researchers found.

Among volunteers trying to pour a teaspoonful of cold and cough medicine, using a slightly larger spoon resulted in underdosing and using a much larger …

Tips for Haiti earthquake relief: How to find the right charity for donations

Erin Marcus, MD

Physician

January 15, 2010

It’s impossible to watch coverage of the immense suffering in Haiti and not want to help. But many charitable groups seem to have sprung up since the disaster, and it’s tough to know which ones will be most effective at getting your donation to those most in need.

To try to sort out the difference between the major aid groups, I asked Haitian-American community organizers, as well as physicians I know …