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Lessons learned from LGBT Communities and the ACA

Health Policy

October 27, 2014

The Affordable Care Act (ACA) has created an unprecedented opportunity to improve the well-being and economic security of millions of Americans, including lesbian, gay, bisexual, and transgender (LGBT) people and their families. Notably, health care reform has the potential to reduce and eliminate LGBT health disparities by improving access to quality, affordable health insurance coverage that connects LGBT individuals and communities with the care they need. However, this opportunity …

Ebola causes a crisis of commitment in physicians

Pamela Davis, MD

Physician

October 27, 2014

What happens when your faith, commitment and professional integrity collide with great personal risk? This is what I imagine is happening across the country to physicians, nurses and other health care workers as we all face the Ebola tragedy.

Sure, people dying in far away Africa bring an ache to our hearts. Admiration for those working with aide groups brings the passing thought so easily conjured from the safety of our …

Ebola forces us to rethink how we document in the EMR

John Halamka, MD

Health Technology

October 26, 2014

Over the past several years I’ve written about the inadequate state of clinical documentation, which is largely unchanged since the days of Osler, (except for a bit more structure introduced by Larry Weed in the 1970s) and was created for billing/legal purposes not for care coordination.

One of the most frequent complaints in my email box these days is a sense that the current record is filled with data, but little knowledge and …

Ebola presents a new paradigm from the ER

Joshua Elder, MD, MPH

Physician

October 26, 2014

Ebola is frightening but not for the reason you may imagine.

A little over a year ago Asiana Flight 214 crashed while landing at San Francisco International Airport resulting in 181 injuries and 3 deaths. As an emergency medicine resident, this fast-forwarded my training as I took care of many of the patients arriving in our emergency department. I left that day inspired that I had the education and training to …

Patient perceptions of the hospital experience

James Merlino, MD

Physician

October 26, 2014

An excerpt from Service Fanatics: How to Build Superior Patient Experience the Cleveland Clinic Way.

Patients’ definition of their own experience is quite divergent. We ask patients for feedback, and the results are fascinating. We’ve found that patients often use the word experience in their comments: “I can’t believe how the experience in this hospital was.” “This place is amazing— everyone is so friendly and caring.” A …

Want to know why residents don’t chose primary care? Read this.

Fred N. Pelzman, MD

Physician

October 26, 2014

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I just got a taste of improved access, and I gotta tell you, it sapped my energy.

It reminds me of the old standup comic one-liner, “I just flew in from Vegas, and boy, are my arms tired.”

Today was the department of medicine housestaff picnic (pretty much a guarantee to cause the weather to change from clear skies to rain), and so …

What Apple can teach health care: Hire unorthodox applicants

Marc-David Munk, MD

Physician

October 26, 2014

Recently, Apple introduced its newest product, the Apple Watch. According to Businessweek, Apple spent years researching watches before deciding to build one. The company flew watch historians to California and they worked to understand how wristwatches have traditionally been used, and how a new “wrist computer” might work. They have hired leaders from diverse backgrounds — none of them techies — to lead these efforts.

It struck me that health care could learn a lot …

Suicide puts the medical profession in a difficult position

Elaine Khoong, MD

Physician

October 26, 2014

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Recently, I wrote about the importance (and difficulty) of maintaining a healthy lifestyle as a resident. Now, I’d like focus more specifically on the toll that residency — and in general, a career in medicine — takes on a health care provider’s mind and soul.

As you may have heard, in August two young physicians decided to end their lives. No one …

Ebola: Local hospitals cannot be prepared

Manoj Jain, MD, MPH

Physician

October 25, 2014

Recently at our community hospital, after we concluded a nearly two-hour standing room only Ebola preparedness meeting, I practiced donning and doffing the personal protective equipment (PPE) for Ebola cases.

PPE is the protective wardrobe health workers wear when examining a patient with a contagious infectious disease. Each disease has a different level of transmission and requires an appropriate level of protection. I wear gloves 25 times a day to examine …

An interdisciplinary approach to hospital malnutrition

Kelly A. Tappenden, PhD, RD

Conditions and Diseases

October 25, 2014

Hendersonville, North Carolina may not have a Mayo Clinic that is known for medical innovation, but it is making waves in solving a stubborn problem in health care: malnutrition.

Pardee UNC Health Care is implementing a new nursing protocol that puts nutrition at the center of the care team and the locus for reducing readmissions, pressure ulcers and lengths of stay.

Pardee’s efforts come as more and more studies document the seriousness …

5 reasons why physician champions are needed

David Lee Scher, MD

Health Technology

October 25, 2014

It has been 5 years since the passage of the HITECH Act portion of the Affordable Care Act. The purpose of HITECH was “to promote the adoption and meaningful use of health information technology.” While the result of this legislation has been the significant increase in the adoption of EHRs, most of the potential benefits of digital technology have yet to be demonstrated. there are multiple reasons for this lack of proof.

The portions of …

The success of health programs depends on execution

Akhilesh Pathipati, MD

Medical Education

October 25, 2014

A few years ago, I was doing a summer internship in which I looked at health outcomes for hospitalized patients. I sat in an office and read about patients with issues like high blood pressure and cholesterol. At a certain point, I realized that the reports on their outcomes were interesting, but the real solution to the problems I was studying was happening outside my window. My window overlooked a …

Helicopter emergency services: A disparity between aviation and medical proficiency

Michael K. Abernethy, MD

Physician

October 25, 2014

As the helicopter emergency services (HEMS) industry enters its fifth decade, there is an 800-pound gorilla in the room and nobody is talking. The average EMT, fireman and emergency physician too often make the flawed assumption that when it comes to HEMS, the industry is a uniform, high quality, strictly regulated entity. They assume that all HEMS programs use state of …

MKSAP: 42-year-old man with severe burning and stabbing pain

mksap

Conditions and Diseases

October 25, 2014

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

A 42-year-old man is evaluated for a 6-day history of severe burning and stabbing pain in both feet that is worse in the toes. The pain is more severe at night, is aggravated when the bed sheets touch his skin, and is partially relieved when he walks or massages his feet. The …

Dissociate EMRs from billing. Here’s how to do it.

David Mann, MD

Health Technology

October 24, 2014

The idea of starting over with computerized electronic health record (EHR) systems and doing them right as mentioned in a previous post has struck a resonant chord. Unfortunately designing an EHR that works may be a fantasy, due to one huge hurdle that would have to be overcome first. But it is fun to imagine an alternative universe where EHR systems were patient-centric instead of …

Assimilating independent physician practices: Is resistance futile?

Bob Doherty

Health Policy

October 24, 2014

Fans of Star Trek: The Next Generation will recall that the most disturbing aliens encountered by the Federation were the Borg, a part-cyber, part human collective race that functioned as an integrated and cyber-connected whole that existed only for the good of the collective, rather than as distinct individuals with their own thoughts and personalities — much like honey bees work together as …

Quit smoking: It takes a community to spread the word

J. Leonard Lichtenfeld, MD

Physician

October 24, 2014

You never know when something special is going to happen, as in one of those times when you just wish you had a camera rolling to capture a moment, a comment, a statement about the way the world is — and the way the world could be.

This past weekend my wife and I were attending a meeting in …

The lack of joy at the doctor’s office, and a reason why

Jordan Grumet, MD

Physician

October 24, 2014

Ruth was problematic. Well into her seventies, her body may have dulled but her tongue was sharper than ever. And she used it to lash me with complaint after complaint. If it wasn’t her knees, it was her ankles. If it wasn’t her ankles, it was her hips. I battled the impossible month after month, year after year. Our interactions left a bitter taste in my mouth. Nothing makes a …

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