Professionalism matters in correctional health care

Physician
March 19, 2010

As correctional health care professionals, there may be times when we are tempted to conduct ourselves in a less than professional manner simply because we can.

We may be able to get away with speaking to our patients rudely, using profanity profusely, or wearing inappropriate clothing. After all, we work in jails and prisons. This culture is far from prim and proper. And, our patients are inmates. Many may tolerate misbehavior …

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Professionalism matters in correctional health care

Medicare rates and capping payments to hospitals

Health Policy
March 19, 2010

If there is anything about economics that has been proven over and over, it is that price controls do not work. The unintended consequences are usually worse than the problem that led to the solution in the first place.

Massachusetts legislators, feeling the frustration of higher insurance premiums, are now considering a bill to limit doctor and hospital reimbursement payments to 110% of Medicare rates, or perhaps some other percentage …

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Medicare rates and capping payments to hospitals

Coronary angiography is being overused

Conditions and Diseases
March 19, 2010

Originally published in MedPage Today

by Kristina Fiore, MedPage Today Staff Writer

For patients without known heart disease, the diagnostic yield of coronary angiography appears to be low, researchers found.

Only about 38% of those referred to the cath lab for the elective procedure had obstructive coronary artery disease, Manesh R. Patel, MD, of Duke University, and colleagues reported online in the New England …

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Coronary angiography is being overused

Business model woes traps doctors and impedes health care

Health Policy
March 18, 2010

If you are a physician, therapist or any other helping professional whose business model relies on third party manged care reimbursement you are engaged in the world’s worst business model.

Let me start with a story to set the stage.

Imagine you are a bright, idealistic college student. You’re good at academics, want to make a difference in the world and have hundreds of career options in front of you.

After lots of …

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Business model woes traps doctors and impedes health care

Dance healed this physician and helped with burnout

Physician
March 18, 2010

Ten years ago, I was an Emergency Medicine Resident and wanted to die. Today, I’m a general practitioner in part-time practice and am in love with life. What made the difference? I signed up for a dance class.

Reports on physician burnout list the personality traits that set us up for trouble: we’re excessively conscientious, feel overly responsible, want to please everyone, and function on an extremely high level – even …

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Dance healed this physician and helped with burnout

Medicare and how a grandmother worries about its costs

Health Policy
March 18, 2010

Originally published in MedPage Today

by Liz O’Brien

My grandmother and her hospital roommate — aged, tiny, frail, and sporting matching bright pink hairnets.

They looked like twins — two thin shrubs in winter that had each sprouted an improbable, big pink rose.

Although sick and scared, my grandmother had admired the pink hairnet on the lady in the next bed, so my mother …

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Medicare and how a grandmother worries about its costs

Match Day and how each medical school celebrates

Medical Education
March 18, 2010

by Brian Eule

While the debate continues to rage over the health care reform bill in Washington D.C., today at Noon Eastern time, the newest class of 15,000-plus graduating medical students will get their marching orders, beginning their lives working in medicine.

It’s called Match Day and each year, on the third Thursday of March, the nation’s graduating medical school students gather with their classmates and wait for an envelope with their …

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Match Day and how each medical school celebrates

Medicare doc fix questions and answers

Health Policy
March 17, 2010

A 21% cut for Medicare physician fees is set to go into place soon. This year, fixing physician payment has been overshadowed by all the talk about health insurance reform.

In fact, I remember being invited to talk about healthcare reform on a panel for medical students this past fall. As part of my remarks, I mentioned the 21% pending cut in physician payment and recall the questions and …

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Medicare doc fix questions and answers

Taxing junk food may improve your health

Patient
March 17, 2010

Originally published in MedPage Today

by Kristina Fiore, MedPage Today Staff Writer

Taxing junk food may help reduce obesity and improve health, researchers have found.

Patients got significantly less of their energy (calories) from soda or pizza when there was a 10% increase in the price of either (P<0.001), Penny Gordon-Larsen, PhD, of the University of North Carolina at Chapel Hill, and colleagues …

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Taxing junk food may improve your health

Homebirth does not protect against serious maternal infections

Conditions and Diseases
March 16, 2010

Homebirth advocates like to tout the many “advantages” of giving birth at home. High on the list is limiting exposure to hospital acquired infections, and since only your “own germs” are in your home, you are protected.

Yes, you are protected from hospital acquired infections, but the most dangerous infectious agents are actually those that live inside the mother, not the ones in the hospital. Consider that for newborns both Group …

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Homebirth does not protect against serious maternal infections

Patient costs when making medical decisions

Patient
March 16, 2010

At my office we provide care for a fair number of patients without medical insurance. Sometimes we are faced situations with no good options.

At a patient visit, often times the diagnosis is not clear without doing some diagnostic tests other than the history and physical exam. Many of these tests are ordered from sources outside the office, where I have little or no control over the cost of the test …

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Patient costs when making medical decisions

EMR conversion doesn’t always help physician communication

Health Technology
March 16, 2010

by Stuart Sutton, MD

Our very large and very integrated health care system is plowing ahead with EMR implementation. All the offices are gradually converting from paper charts and all the hospitals have completed the process.

As a member of one of the last offices to be converted to the EMR, I’ve had the pleasure of patients being assured that the notes were sent to me (albeit via the EMR we are …

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EMR conversion doesn’t always help physician communication

Physical exam evidence and whether it’s still useful

Conditions and Diseases
March 15, 2010

A number of respected physicians have called for a renewed emphasis on the physical exam. Perhaps most prominently, Abraham Verghese has joined with colleagues at Stanford University to publicize the Stanford 25, a list of physical-exam maneuvers that they hold should be required of internal medicine residents.

These calls reflect in part the fear that checklist medicine will lead to doctors’ obsession with what Jerome Groopman calls the “iPatient” (the …

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Physical exam evidence and whether it’s still useful

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Use iPhone apps for emergency room wait times with caution

Health Technology
March 15, 2010

Emergency rooms are notorious for their long waiting times – that’s pretty common knowledge. But now the Hospitals of Central Connecticut are looking to a new medical app for the iPhone to help improve their emergency room wait times.

Having spent a fair amount of time recently working in an emergency room, I (and probably everyone with similar experiences) can assure you that no one – physicians, nurses, administrators – want …

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Use iPhone apps for emergency room wait times with caution

PSA for prostate cancer screening is likely to continue

Conditions and Diseases
March 15, 2010

Originally published in MedPage Today

by Crystal Phend

The ASCO Genitourinary Cancers Symposium met recently, just after the American Cancer Society updated its prostate cancer screening guidelines to emphasize shared decision making and Congress heard testimony over use of prostate specific antigen (PSA) in prostate cancer screening.

Now urology is no stranger to debate. Controversy continues on overdiagnosis, overtreatment, and other issues raised …

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PSA for prostate cancer screening is likely to continue

PSA screening for prostate cancer debated in Congress

Conditions and Diseases
March 14, 2010

Originally posted in MedPage Today

by Emily P. Walker, MedPage Today Washington Correspondent

A day after the American Cancer Society (ACS) released updated prostate cancer screening guidelines, the group’s chief medical officer was before Congress urging the government to fund research into alternative screening methods for prostate cancer.

Otis Brawley, MD, an oncologist and chief medical officer for the ACS, told the House Oversight …

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PSA screening for prostate cancer debated in Congress

Why doctors should blog with their real name

Social Media in Medicine
March 14, 2010

Blogging is a great way to get things into an open forum for discussion.  But I still have nagging doubts about doctors who post blogs or replies about healthcare issues without giving their names.

As a new blogger, I often look at those replies to my postings that are anonymous and think, “Who are you? Why do you think the way you do? Why will you not put a name and …

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Why doctors should blog with their real name

Poetry that your patient can appreciate

Patient
March 13, 2010

When I make rounds with my students and interns, I always try to sneak in a poem at the end. I think poetry is important because it helps convey the parts of the medical experience that don’t make it into textbooks. It’s important because it teaches creative thinking—something of immense value to doctors.

It’s important because interpreting metaphors is a critical clinical skill in diagnosis; patients’ symptoms often present in metaphorical …

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Poetry that your patient can appreciate

7 ways inmates can receive quality medical care from doctors

Patient
March 12, 2010

Many non-correctional health care providers will also treat inmates from time to time. This may occur in the office or hospital. How can one best approach the challenges of working with the incarcerated in order to deliver the best possible care while simultaneously managing risk?

1. Treat the patient with respect. Not submissive respect, but mutual respect — the way we all want to be treated. I believe that this principle …

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7 ways inmates can receive quality medical care from doctors

Children with special healthcare needs are underinsured

Health Policy
March 12, 2010

Originally published in MedPage Today

by Chris Emery, MedPage Today Contributing Writer

Nearly a third of children with special healthcare needs are underinsured, and where a child lives strongly influences whether he or she will have adequate healthcare coverage, a new study found.

The unadjusted proportion of underinsured special-needs children varied strongly by state, ranging from 24% in Hawaii (standard error=1.75) to 38% …

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Children with special healthcare needs are underinsured

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