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Doctors have to learn to play the game of numbers

Wes Fisher, MD

Physician

October 1, 2014

The dark underbelly of health care is becoming all too visible now.

Fresh faces in neatly pressed white coats are in the halls. Eager. Enthusiastic. Clearly very bright. All hoping for a moment, an experience, an encounter that makes all their hard work worth it. Surely they’ll have one, but not before the thousands of keyboard clicks, the mandatory lectures, rounds and lots of lengthy, lonely call nights.

He was a doctor …

5 ways to break into the business of health care

Robert Pearl, MD

Health Policy

October 1, 2014

Every year, ambitious students from around the world flock to America’s leading business schools, hoping to learn how to create new ventures that can change the world.

On the West Coast, situated in the heart of Silicon Valley, Stanford University’s Graduate School of Business attracts budding entrepreneurs with challenging and practical programs. Courses like “Entrepreneurship: Formation of New Ventures” and “Managing Growing Enterprises” encourage students to develop innovative business models that solve real …

Honoring life: Thoughts on the IOM’s end-of-life care report

James C. Salwitz, MD

Physician

October 1, 2014

The Institute of Medicine of the National Academies has released their long anticipated 500-page report, titled ,”Dying in America – Improving Quality and Honoring Individual Preferences near the End of Life.”

This is a critical addition to the ongoing conversation about health care in the United States and makes observations and conclusions, which we need to consider and understand. They conclude, as has been said before, that we waste precious resource’s …

A new drug to treat RSV bronchiolitis

Christopher Johnson, MD

Medications

October 1, 2014

Respiratory syncytial virus infection, aka RSV, is a common infection in children. A key aspect of RSV is how poor a job our immune systems do in fighting it off. Virtually all children are infected with RSV during the first few years of life. Not only that, all of us are reinfected multiple times during our lives. Attempts at devising a vaccine for RSV have all been unsuccessful. In fact, …

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A new drug to treat RSV bronchiolitis

A serial killer and the origins of maintenance of certification

Dr. Saurabh Jha

Physician

September 30, 2014

Britain’s most prolific serial killer was a general practitioner (GP), Dr. Harold Shipman. He wasn’t England’s most famous murderer. That accolade goes to Jack the Ripper. The Ripper killed five women in the streets of Whitechapel. Shipman might have been responsible for over 200 deaths.

Shipman’s legacy to the medical profession was not just a permanent simmering of mistrust. He triggered the introduction of revalidation, Britain’s version of maintenance of certification …

Flipping the basic transaction of health care

Rob Lamberts, MD

Physician

September 30, 2014

My life changed dramatically when I started my new practice. The biggest change personally was a dramatic drop in my income as I built a new business using a model that is fairly new. That’s a tough thing to do with four kids, three of whom were in college last fall. OK, that’s a stupid thing to do, but my stupidity has already been well-established.

Yet even if the income stayed …

Curb the soaring costs of vaccines

Ruth Macklin, PhD

Medications

September 30, 2014

Few medical interventions have been as successful as vaccines in improving public health.

Whether they are childhood vaccinations, vaccines to prevent healthy adults from contracting influenza or the more recent HPV vaccine for adolescents, these preventive methods have resulted in dramatic benefits for individuals and the public. We have only to think of the eradication of smallpox and the virtual eradication of poliomyelitis to see the enormous benefits vaccines can bring. …

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Curb the soaring costs of vaccines

The thinnest of margins: An ER physician ponders, “What if?”

Gregory Bledsoe, MD

Physician

September 30, 2014

It had been crazy busy all night in the emergency department and I had been running from room to room patching holes and trying to get patients seen.

I felt behind all night. Finally, I had a moment to collect my thoughts and turned my attention to a patient who had been waiting for quite a while.

This patient had multiple large and deep lacerations to his forearm, self-inflicted wounds caused during …

A surprising cause for acute hepatitis in the rehab unit

Val Jones, MD

Conditions and Diseases

September 30, 2014

I recently treated a patient who was hospitalized with paraplegia. During some routine lab testing I noticed that his liver function tests were elevated, and so I began looking for a cause. I discussed the patient’s drinking habits (he rarely drank alcohol), risks for viral hepatitis (no IV drug use or exposure to those with known hepatitis), and general medical history (nothing relevant to liver disease). I reviewed his current …

Will 2015 be the year mHealth takes off?

Joseph Kvedar, MD

Health Technology

September 29, 2014

I’ve been toiling in the field of connected health for 20 years now, watching for signs of adoption that will move us into the steep part of the curve. I have to wonder, with announcements from several huge consumer companies recently, if that time is coming.

By now you’ve heard about Apple’s HealthKit announcement, which involved not only Apple, but Mayo Clinic and Epic.

Samsung is not sitting still, having released increasingly …

Small practices aren’t dead yet. Some are even thriving.

Kenneth Lin, MD

Health Policy

September 29, 2014

When I was in high school, a national hardware retailer opened a new franchise down the street from the mom-and-pop hardware store that had served my neighborhood for many years. Since the new store had the advantage of larger volumes and lower costs, it seemed to be only a matter of time before it drove its smaller competitor out of business, the way that big bookstore chains and fast-food restaurants …

The outrageous $117,000 bill from an assistant surgeon

Skeptical Scalpel, MD

Physician

September 29, 2014

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Recently, I wondered why Medicare could not control its costs using the investigative power of the federal government instead of releasing physician payment data and relying on journalists to do the work.

Two stories that appeared within days of each other raise a similar question about the private insurance industry’s methods.

An article in Modern Healthcare described the impending closure of …

What is going on with generic drug prices?

Hans Duvefelt, MD

Medications

September 29, 2014

Fran Barker called today. She was in a panic because the cost of her monthly prescription of 150 mg amitriptyline tablets had gone up to $130 from $13 the month before.

Amitriptyline has been available in this country since 1961, and the 100 mg strength was on Walmart’s list of $4/month drugs the last time I looked at it a few months …

Joan Rivers’ death: What went wrong?

Karen S. Sibert, MD

Physician

September 29, 2014

The ear, nose and throat specialist who treated comedian Joan Rivers on August 28 has been identified as Dr. Gwen Korovin, a prominent New York physician who is known as a voice doctor to many entertainers and Broadway stars including Hugh Jackman and Julie Andrews.

With a physician who is an expert in airway anatomy at her side, and all the technologic …

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Joan Rivers’ death: What went wrong?

Why must medical malpractice cases be devoid of decency?

Sid Schwab, MD

Physician

September 29, 2014

Part 2 of a series. Read part 1.

I realized I was entering into a process the rules of which were entirely separate from normal human interaction when it hit me that news of the lawsuit was in the newspaper before anyone had had the decency to contact me. What kind of people act like that? Civilized behavior, respectfulness — in short, all the ways in which you’d think nice …

Caring for patients after coming back from vacation

Fred N. Pelzman, MD

Physician

September 28, 2014

One hundred forty-nine messages.

This is what I return to on my first day back from vacation.

Many of them were marked with a little red arrow, indicating a high-priority phone message.

Recharging with a little time off is a darn good thing, something we all need, and something which has been shown to help all of us be better at what we do. All of us, no matter what our jobs are. …

The problem with physically disciplining children

Justin Morgan, MD

Conditions and Diseases

September 28, 2014

The recent arrest of Minnesota Vikings star running back Adrian Peterson on child abuse charges has sparked a national conversation on the manner in which parents should discipline their children. Allegedly, Adrian Peterson injured his 4-year-old son by spanking him with a thin tree branch (“a switch”) and leaving cuts and bruises all over his body.

After learning of Adrian Peterson’s indictment, Peterson’s mother, Bonita Jackson, was interviewed by the …

Where is compassionate end-of-life care for the elderly patient?

Martine Ehrenclou, MA

Patient

September 28, 2014

When my 82-year-old uncle had a heart attack in the kitchen of his home, I was on the next plane to the East Coast. No one knew how long his brain had been deprived of oxygen before he’d been resuscitated. As I stood next to his bed in the hospital’s ICU, I feared that my uncle would not make it. I …

Will integrated physician groups appeal to millennials?

Marc-David Munk, MD

Health Policy

September 28, 2014

Around the country, doctors are leaving independent practice and joining large groups owned by health care systems. It’s a trend: the recruiting firm Merritt Hawkins predicts that if current growth continues, over 75% of newly hired physicians will be hospital employees within two years.

There seem to be a number of reasons for this consolidation of physicians and hospitals into islands of care. One is the desire for larger groups to …

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