| KevinMD.com

Marcus Welby and the relentless growth of specialization

Physician

January 31, 2011

In the very first episode of the TV series Marcus Welby, MD, our hero delivers an after dinner speech to a group of young interns. As he’s introduced, he hastily scribbles the title of his talk and hands it to the hospital director: “The future of the general practice of medicine, if any.” The year was 1969.

In his introduction, the director somewhat tactlessly remarks that many “eminent specialists” have addressed …

Focus advance care planning on outcomes

Kevin

Conditions and Diseases

January 31, 2011

by Drew Rosielle, MD

The Annals of Internal Medicine recently had a timely discussion of advance care planning, trying to focus the discussion away from helping patients specify what they’d want, and more towards laying the groundwork for appropriate decision making by loved ones whenever that time comes. Good one for the teaching file.

That is, instead of thinking of ACP as patients pre-specifying “if X …

Read more…

Focus advance care planning on outcomes

Patient safety lapses in the hospital

David B. Nash, MD, MBA

Physician

January 31, 2011

Earlier this month, at the third annual American Medical Student Association Patient Safety and Quality Leadership Institute, I listened with sympathy — and, frankly, a certain amount of discomfort — to a fourth-year medical student’s account of his grandmother’s recent hospitalization at a well regarded inpatient facility in New York City.

Admitted with an initial diagnosis of pneumonia, Cole Zanetti’s grandmother languished in the hospital for almost four weeks.

As the medically …

Read more…

Patient safety lapses in the hospital

Help your doctor formulate an accurate differential diagnosis

Stewart Segal, MD

Conditions and Diseases

January 31, 2011

Last night, I turned on “House,” a TV show about a physician who is in charge of a team of highly specialized diagnosticians. Every week the team solves a difficult to diagnose medical case by working through an exhaustive differential (DD) diagnosis list. While the show is absurd to the extreme (as the team of physicians almost kills the patient each week), eventually the correct …

Patient advocacy is essential in health insurance appeals

Steven Reznick, MD

Patient

January 30, 2011

An active 61 year female, who has been in my practice for 30 years, developed strange aches and pains and abdominal symptoms. My evaluation turned up nothing.

I then asked for help at the University of Miami rheumatology and gastroenterology divisions. With the help of a brilliant local gastroenterologist and rheumatologist, and after a trip to Johns Hopkins Medical Center and the Mayo Clinic, collagenous …

Having insurance does not mean you get health care

Joseph Paduda

Health Policy

January 30, 2011

There’s no question the Accountable Care Act needs work – everyone agrees on that.

So let’s talk about the specifics – what needs fixing, why, and how can we get those fixes passed.

First, let’s understand how bad our current system is. Some who want to repeal and/or replace the ACA continue to publicly state we have “the best health care in the world.”

While that may – or may not – have …

Healthcare costs can be reduced with emerging business models

Joe Flower

Health Policy

January 29, 2011

Here’s a simple key to parsing the future economics of healthcare. We have been trying for over 30 years to control healthcare costs. And there is little evidence that any of these efforts have had much effect. For decades the rise in healthcare costs has been consistently several times higher than the general inflation level.

There have been dozens of schemes used in various parts of the industry — inpatient, ambulatory, …

Where an extremely premature baby immediately receives care matters

Jennifer Gunter, MD

Conditions and Diseases

January 28, 2011

When you think about giving a premature baby the best possible start in life, it is important to consider the hospital where they are born. The care an extremely premature baby receives immediately after birth makes a big difference in outcomes.

A premature baby who is less than 32 weeks gestation or weighs less than 1500 g at birth should be cared for in a level III NICU. These babies also …

Integrity, discipline, respect: Using kung fu to control your eating

Melanie Lane, MD

Conditions and Diseases

January 28, 2011

About seven months ago, I began training kung fu with my family. Our classes are intense and require the students to really pull out our personal best. Periodically our instructor will remind us by shouting out, “Train like a black belt!” when she catches us being sloppy or less than enthusiastic. Her exclamation inspires me to squat a little lower in my horse stance, amps up my intensity, and focuses …

Haggling with your doctor about the costs of care

Jessie Gruman, PhD

Patient

January 28, 2011

“How to Haggle With Your Doctor” was the title of a recent Business section column in the New York Times. This is one of many similar directives to the public in magazines, TV and Websites urging us to lower the high price of our health care by going mano a mano with our physicians about the price of tests they recommend and the drugs they prescribe. Such articles provide simple, …

What’s next for doctors if pay for performance fails?

Kevin Pho, MD

KevinMD

January 28, 2011

I recently pointed to a BMJ study concluding that pay for performance doesn’t seem to motivate doctors. It has been picking up steam in major media with TIME, for instance, saying, “Money isn’t everything, even to doctors.”

So much is riding on the concept of pay for performance, that it’s hard to fathom what other options there are should it fail. And there’s mounting evidence that it will.

Aaron Carroll, a …

The void between physicians and administrators in hospitals

S. Irfan Ali, MD

Physician

January 28, 2011

In a hospital setting, administrators love to work with physicians; they make sure whenever a new system is being formulated and implemented, this is discussed with a team of physicians, as they are also an integral part of success. All physicians work with each other in harmony and synchronicity.

Cardiologists never step on each other’s toes, radiologists call admitting doctors for any bizarre findings and hospitalists notify the primary about their …

Seeing a family physician at work is valuable for medical students

Edward Pullen, MD

Physician

January 27, 2011

I recently headed off to a reception for students from the new Pacific Northwest University of Health Sciences in Yakima, WA who are spending their third year of osteopathic medical school in Puyallup, WA doing rotations with the physicians in our community. I’ve had a student with me recently, and it brings back memories of my third year in med school, and how things have changed. It also leads me …

Electronic medical records and pay for performance don’t improve care

Kevin Pho, MD

KevinMD

January 27, 2011

Electronic medical records and pay for performance are among the ways health reformers are going to improve patient care.

It’s a fundamental shift in how doctors practice, with more practices adopting expensive EMRs. And with the advent of Accountable Care Organizations, doctors will soon be compensated in part by quality measures.

But will they work? Well, the jury’s still out.

Two articles caught my eye recently.

The first, from the WSJ’s Health Blog, reports …

Solving the puzzle of patient compliance

Dennis Grace

Patient

January 27, 2011

by Dennis Grace

I recently received a message from the Center for Connected Health. I must admit the opening of the letter really put me off. It asked:

How do you solve the puzzle of patient compliance?

I responded to the gentleman who sent the invitation with:

Well, you might start by calling it something less offensive. Patient compliance? The phrase assumes “patient” as direct object rather than subject of participatory medicine. We …

Read more…

Solving the puzzle of patient compliance

Dabigatran (Pradaxa) questions in atrial fibrillation

Larry Husten, PhD

Patient

January 27, 2011

The approval of dabigatran (Pradaxa) has been long awaited in the cardiology community. Although just about everyone agrees that a good alternative to warfarin is highly desirable, there are many remaining questions about the drug as it prepares to enter the marketplace.

Here are a few questions raised by electrophysiologist John Mandrola on his blog:

In the RE-LY trial, dabigatran was used twice daily. When not symptomatic, patients often …
Read more…

Dabigatran (Pradaxa) questions in atrial fibrillation

A lesson about true friends for those facing serious illnesses

Kevin

Patient

January 27, 2011

by Danielle Leach, MPA

“A true friend walks in when everyone else walks out.”

I read that on a magnet on my friend’s refrigerator recently and the simple power of that saying brought me to tears. I have learned that lesson of true friends since my son’s diagnosis of cancer in 2007.

Anyone who has faced a serious illness as a patient or a caregiver knows that you quickly learn who your …

EHR implementation in the ambulatory or hospital setting

Robert Rowley, MD

Health Technology

January 27, 2011

Adoption of electronic health records (EHR) systems remains a challenge, both for hospitals as well as for physicians in ambulatory practice. The process of adoption, implementation, and meaningful use of EHRs (let us keep in mind) is actually quite different between those two setting.

Much has been written concerning EHR adoption within hospitals. Much of the experience in computerized physician order entry (CPOE) comes from hospital EHR adoption, and many of …

Most Popular

Past Week

Past 6 Months

Recent Posts

Subscribe to KevinMD and never miss a story!

Most Popular

Past Week

Past 6 Months

Recent Posts