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Why medical scribes are the ultimate answer to our health IT woes

Physician

November 14, 2015

Statistics suggest that physicians are now spending a minimal amount of time in direct patient care, shockingly as little as 10 percent of their day. This proportion of time that physicians (and nurses) actually spend interacting with patients has been shrinking year by year.

There’s the need to communicate with other members of the expanding health care team, increased bureaucratic requirements, and over the last several years — the need to …

Why doctors won’t use the new end-of-life Medicare counseling codes

Lucy Hornstein, MD

Physician

November 14, 2015

Poor bored government. So much time on their hands; so little real work that needs to get done, all they can do is micromanage poor physicians like me to death. Well, they can try.

For its first forty-five years, Medicare was (in)famous for the very narrow limits on things it covered. It would pay for medical care when you were sick or injured, and that was basically it. No preventive care. …

Test your medicine knowledge: 62-year-old man is evaluated during a routine visit

mksap

Conditions and Diseases

November 14, 2015

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 62-year-old man is evaluated during a routine visit. He is asymptomatic and walks 1 mile most days of the week. Medical history is significant for aortic stenosis, type 2 diabetes mellitus, hypertension, and hyperlipidemia. Medications are aspirin, metformin, lisinopril, metoprolol, and rosuvastatin.

On physical examination, the patient is afebrile, blood pressure is 130/66 mm Hg, …

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Emergency departments of the rich and famous

Edwin Leap, MD

Physician

November 13, 2015

The following excerpts will give you an idea of what life can be like while practicing emergency medicine in very beautiful, very coveted areas of the United States. I will not name towns or hospitals, as the situations are highly reproducible from place to place and season to season. We’ll just call it St. Resort hospital. If you doubt me, call up your friends who work in such locales, with …

This is what it’s like to practice 14 hours of medicine without computers

Heather E. Gantzer, MD

Health Technology

November 13, 2015

“It’s going to be ugly today” was my colleague’s assessment at 6:30 a.m. Wednesday morning, when the electronic medical record failed to launch, the Internet could not be accessed, pagers and phones could not connect, and a recording on the helpdesk line noted, “Systems are down, and there is currently no estimated time of resolution.” So we waded into fourteen hours of practicing medicine without computers.

This was not good. Patients’ …

Embracing the sick role and not so sick: Ann Romney and multiple sclerosis

Sarah Poggi, MD

Conditions and Diseases

November 13, 2015

In her new book In This Together: My Story, the former First Lady of Massachusetts, Ann Romney, describes receiving in her mid-40s a diagnosis of multiple sclerosis (MS). She offers vignettes of a “life upended”: her abandonment of therapeutic swimming because it made her hair “look bad” and the need to revise plans for her Park City home to include an elevator.

In her case, MS is invisible, characterized by fatigue, …

The chasm between British doctors and Jeremy Hunt

Dr. Saurabh Jha

Health Policy

November 13, 2015

Britain’s health secretary wants to uncharm his way to a revolution.

To galvanize support for a seven-day National Health Service (NHS), which the NHS was before Jeremy Hunt’s radical plans, and still is, he asserted that thousands die because there is a shortage of senior doctors during weekends. This is an expedient interpretation of a study which showed that mortality was higher in patients admitted on weekends. Hunt ignored the Read more…

The chasm between British doctors and Jeremy Hunt

Maybe medical school applications should come with a warning label

Anonymous

Medical Education

November 12, 2015

I did some pretty crazy things to get into medical school (don’t worry, Mom, nothing illegal). For several years before applying, I became a medicine groupie. I read books about being a doctor, watched documentaries about medicine, and shadowed physicians for hours on end so I could imagine what it might be like. I watched many a friend go off to med school and graduate … and I waited, I …

Believe it or not, most young physicians love their electronic health records

Manan Shah, MD

Health Technology

November 12, 2015

As more hospitals move to electronic health records (EHRs), many physicians have started writing about their growing discontent with the new systems. Authors have declared that EHRs are poorly designed, inefficient, lead to over-billing, and are downright dangerous. When my supervising physicians gripe about this, I mainly nod along to avoid conflict. But I have a confession to make: Most physicians currently in training love electronic …

Who’s to blame for this psychiatric failure?

Raymond Abbott

Conditions and Diseases

November 12, 2015

Jerry once killed a man, his best friend. He told me about it, unemotionally, but as if it had just happened.

He wandered the street like a refugee in a war-torn country, except he was in mid-America: Louisville, Kentucky, as it were. He was homeless. I’ve known him for five years, anyway. He’s approaching fifty, a rough-looking man, large, with thick gray hair, which is quite long now. He has lost …

Primary care for the sickest of the sick: A model to consider

Stephen C. Schimpff, MD

Health Policy

November 12, 2015

Part of a series.

“It is all about vigilance and caring. Our aim is to put the caring back into health care and we are serious about that. Our standards are not how many patients did you see today but how much quality did you dispense today,” Dr. Greg Foti told me about the clinic where he works in downtown Baltimore, MD.

Individuals that have multiple chronic illnesses compounded by …

So who are we, patients or consumers?

Robert Pearl, MD

Physician

November 11, 2015

What should we call the people who get medical care? Are they “patients,” the traditional term for anyone receiving medical attention from physicians, nurses, pharmacists, therapists, dentists and other providers? Or are they “consumers,” people who purchase goods and services for personal use?

The debate about nomenclature is growing, and it’s more than a matter of hair-splitting semantics. Among passionate advocates on both sides of the argument, emotions run high.

Sometimes we …

Read more…

So who are we, patients or consumers?

Health IT: Damaging patient satisfaction one click at a time

Suneel Dhand, MD

Health Technology

November 11, 2015

The use of information technology in health care holds so much promise, and potential yet to be realized. Ask any front line physician and they will list electronic medical records (EMRs) as one of their biggest daily frustrations. A brilliant video by Zubin Damania, also known as ZDoggMD, recently parodied the current situation and the pain felt by doctors on a daily basis.

But it really isn’t all about …

Transgender discrimination: Physicians must not lag behind

Tehreem Rehman

Medical Education

November 11, 2015

As a native New Yorker, I was thrilled when Governor Cuomo announced plans for an executive order that prohibits discrimination against transgender people in areas such as employment and housing. Specifically, this executive order would expand existing anti-discrimination protections to include gender identity, transgender status, and gender dysphoria. There have also been advancements regarding the protection of transgender people from discrimination in health care.

Recently, the Department of Health and Human …

What a pediatrician learned from having ranch dressing on his stethoscope

Ahmad Bailony, MD

Physician

November 11, 2015

Every weekday during lunch time, I scurry out of my clinic and head towards the doctor’s lounge because the food is free. (Even though most of the time I am not sure what it is!) But more appealing than the costless lunch are the conversations that I have in that lounge with other physicians from the hospital. Being a pediatrician, I am more inclined to pay closer attention to stories …

Should tackling be removed from youth football?

Claire McCarthy, MD

Conditions and Diseases

November 10, 2015

Tackling: in so many ways, it’s what football is all about.

Now, of course running, passing and scoring (and strategy) are important parts of football too. But it’s tackling that stops the opponent. Without tackling, you can’t play football.

Or can you?

A policy statement just released by the American Academy of Pediatrics (AAP) suggests that we need to do some thinking about tackling and its impact — literally — on …

It’s time to stop comparing health care to manufacturing

Hans Duvefelt, MD

Physician

November 10, 2015

From ancient times, doctors have appreciated that, for all their similarities, no two patients are exactly alike. This understanding is what made physicians act like, and earn society’s respect as, professionals.

The commercialization of health care has brought in managers from other industries and other branches of academia, and their rise to power has been predicated on their ability to treat patients and doctors not as individuals, but as small cogs …

4 questions about Theranos that are actually worth discussing

Dave Steiner, MD, PhD

Conditions and Diseases

November 10, 2015

Combine a hot start-up valued at 9 billion dollars, an articulate Stanford drop-out CEO with celebrity-like press coverage, and a recent Wall Street Journal report that calls into question the reliability of the company’s “revolutionary” testing, and you have the perfect storm to set the internet abuzz about Theranos.

Amidst the melee of accusations, “change-the-world” start-up jargon, and anecdotes of incongruent lab results, something has been missing: an organized, …

Is it time to update antiquated medical buzzwords?

John Biemer, MD

Physician

November 10, 2015

“What is the term we use to describe the cells that help us diagnose papillary thyroid cancer?” the attending pathologist asked a room full of residents at a noon didactic.

“Orphan Annie Eyes,” they nearly all responded at once.

“And does anyone here know who Orphan Annie was?” he asked next.

It is something memorized by every medical student — the papillary thyroid carcinoma cells with cleared out nuclei are called “Orphan Annie …

You have no idea what it’s like working in the ER as a pregnant physician

Archana Reddy Shrestha, MD

Physician

November 9, 2015

When I was pregnant with my first child, I worked full time as a physician in the emergency department. I worked mostly 9-hour shifts, but some 12-hour shifts as well. Days, evenings, nights, holidays and weekends were divided up amongst the entire group of physicians. I worked my share of those shifts as well.

I have worked in the ER while pregnant twice now, and while I am proud to be …