All is quiet on the Obamacare front. That’s about to end.

Health Policy
September 14, 2014

It’s been pretty quiet lately on the Obamcare front.

So quiet, that there has been a flurry of articles recently over how Obamacare has dropped to a second or even third tier issue and will hardly matter come election-time.

Wishful thinking.

Obamacare has largely been out of the news cycle for a couple of months but that is about to change.

A few thoughts.

The 2015 rate increases have been largely modest. Does that prove Obamacare …

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All is quiet on the Obamacare front. That’s about to end.

In the age of EHRs, don’t turn your backs to patients

Physician
September 13, 2014

One of the most important tricks of the trade that I learned in medical school was what some might have considered a little throwaway bit of advice.

During my psychiatry clinical rotation the preceptor advised that, when applying the stethoscope to the patient’s back, one should rest the other hand gently on his or her shoulder. Human touch was important. It would relax the patient and convey subconsciously a sense of …

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In the age of EHRs, don’t turn your backs to patients

If a doctor doesn’t do excess testing, he isn’t going to be able to live

Physician
September 13, 2014

An excerpt from Doctored: The Disillusionment of an American Physician.

After the blowup with Rajiv, I committed myself to changing my standoffish ways. Rajiv had been urging me for some time to meet socially with his physician friends in a relaxed atmosphere away from the hospital, and so there I was a few weeks later at a doctors’ party in Manhasset, a tony suburb on the North Shore …

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If a doctor doesn’t do excess testing, he isn’t going to be able to live

Teach back: Reduce the costs of poor patient education

Patient
September 13, 2014

There is a saying in the world of education, “You have to care to teach.” Why is it then in health care, a profession of and about caring, we do such a poor job of teaching our patients?  Is it because we are too busy or too rushed when we are sending our patient’s out the door of our hospitals, clinics or offices? After all, we have treated the patient …

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Teach back: Reduce the costs of poor patient education

High health care costs lead to unhappy workers

Health Policy
September 13, 2014

A recent report from Rutgers University entitled “Unhappy, Worried, and Pessimistic: Americans in the aftermath of the Great Recession” found that 70% of respondents described the typical American worker as not secure in their jobs and 68% of workers are highly stressed. A quote from the study is, “The typical American worker lives in a precarious and doleful existence — unhappy, poorly paid and fearful of losing his or her …

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High health care costs lead to unhappy workers

Take 5 minutes: Tip the scales of work-life balance in your favor

Physician
September 13, 2014

When you feel yourself sinking deeper into a bad case of physician burnout, finding a way out can feel daunting, if not impossible.

But it doesn’t have to.

I believe recovering from burnout begins when you start taking small, purposeful steps in a new direction. I recommend you start by getting a handle on your work-life balance.

Do you balance the time and energy you spend at work with the time and energy …

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Take 5 minutes: Tip the scales of work-life balance in your favor

Taking lawsuits personally: A surgeon’s first malpractice case

Physician
September 13, 2014

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Part 1 of a series.

In all my years of practice, my dad called me at the office only twice. The second was to inform me of a horrible family tragedy. The first — well, I guess in a small way you could say it was the same.

“I hear you joined the club,” he said.

“What?”

I had no idea what he was talking about. I’d …

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Taking lawsuits personally: A surgeon’s first malpractice case

The medical home checkup: Impressing the regulators in 40 minutes

Physician
September 12, 2014

The state stopped by to see us the other day.

Wow, that sounds ominous.

No, really, I mean it felt like the entire Empire State: multiple people from multiple offices of New York state government, department of health, office of compliance this, oversight that, all with a vested interest in how things have been going (i.e., how we have been spending their money) in our patient-centered medical home resident pilot program.

A few …

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The medical home checkup: Impressing the regulators in 40 minutes

Hard truths: Dispelling 10 health care myths

Health Policy
September 12, 2014

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1. Most physicians are intellectually gifted and therefore rarely make mistakes. Perhaps Hollywood is to blame for this misconception, or maybe we simply find comfort in believing that exceptionally brilliant diagnosticians abound. Either way, I wish it weren’t a myth. But the truth is that the vast majority of physicians are average in virtually every way. Despite all claims to the contrary, …

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Hard truths: Dispelling 10 health care myths

Today’s medical students are better prepared to practice medicine

Medical Education
September 12, 2014

As patients, we think of working with medical students as a good deed, a necessary evil to improve the future doctors of America. You spare the extra time, discuss your mother’s sister’s medical history, a detailed account of your drinking (not quite) habit, and succumb to a physical encounter rivaling the awkwardness of a junior high date.

But medical students are changing.  Today’s students are starting medical school with more experience …

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Today’s medical students are better prepared to practice medicine

Sex or death: The difficult decisions of prostate cancer treatment

Conditions and Diseases
September 12, 2014

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As part of my role as a clinical nurse specialist in a busy prostate clinic, I see men (with their partner) as part of their decision-making process for active treatment for prostate cancer. The purpose of the appointment is for me to explain the results of their prostate biopsy, dispel any …

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Sex or death: The difficult decisions of prostate cancer treatment

What is a gomer? And why should you know about it?

Video
September 12, 2014
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Ever wonder what a “gomer” is? While certainly passé and unprofessional, does it shed light into the frustrations both doctors and patients have with end-of-life care? Emergency physician and author Brian Goldman explains the origins and use of such medical slang in his book, The Secret Language of Doctors.

What is a gomer? And why should you know about it?

Between paternalism and servility: A balance physicians must straddle

Physician
September 12, 2014

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Even today there are patients who leave diagnosis and treatment entirely to their doctors.  They make no effort to inform themselves about their illness or chart their course; they do whatever their doctors advise.  Once the norm, this passive, willfully naive attitude has withered in the face of a multigenerational attitude shift, coupled with the wealth of medical information at hand today.

Direct-to-consumer drug ads on television, online peer support, medical websites and …

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Between paternalism and servility: A balance physicians must straddle

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Value-based care: Bad for doctors, bad for patients?

Health Policy
September 11, 2014

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Value-based health care is antithetic to patient-centered care. Value-based health care is also diametrically opposed to excellence, transparency and competitive markets. And value-based health care is a shrewdly selected and disingenuously applied misnomer. Value-based pricing is not a health-care innovation. Value-based pricing is why a plastic cup filled with tepid beer costs $8 at the ballpark, why a pack of gum …

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Value-based care: Bad for doctors, bad for patients?

Don’t become your kids’ drug dealers

Medications
September 11, 2014

Doing drugs no longer requires a dealer on the street corner.

Between the late 1990′s and 2010 sales of narcotic pain medicines quadrupled in the United States. Hydrocodone use increased by 280%, methadone by 1300%, and oxycodone by 900%. As the consumption of these medicines increased, so did ER visits and deaths from overdose — up by about 500%.

A whole lot of these medicines are not going to medical use. And …

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Don’t become your kids’ drug dealers

Implantables and embeddables: Is health care ready?

Health Technology
September 11, 2014

Are you still wearing your wearable? We must confess that, by and large, we aren’t. This, despite the fact that between the two of us, we own countless such devices. Each was bought with the best of intentions: Walk more, run more, sit up straighter, quit slouching, eat less, lose weight. You know the list, right? You might even have one yourself.

Don’t get us wrong. We love digital health and we love …

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Implantables and embeddables: Is health care ready?

Docs versus Glocks: Why doesn’t the public trust physicians?

Health Policy
September 11, 2014

Doctors talk with their patients about many things that might make some people uncomfortable — sexual issues, abuse (physical or emotional), anxiety, depression, sleep habits, bowel habits, and fears about health-related topics — things that many people might not talk about in casual conversation at the coffee shop or at work. Doctors talk with their patients about smoking, weight, eating habits, exercise, seat belt use, helmet use, and a myriad …

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Docs versus Glocks: Why doesn’t the public trust physicians?

CVS removes tobacco products: Did they go far enough?

Health Policy
September 11, 2014

As of September 2, CVS — the ubiquitous pharmacy/convenience store — has stopped selling tobacco products, including both cigarettes and smokeless tobacco. This is a bold move from the retailer, which is also planning to rebrand itself as “CVS Health” to emphasize its place in the health care delivery chain. I personally applaud the decision, because there are simply no benefits to tobacco use in any form.

And it’s also …

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CVS removes tobacco products: Did they go far enough?

Bottom up: How grassroots input shapes ACP policies

Health Policy
September 11, 2014

acp new logoA guest column by the American College of Physicians, exclusive to KevinMD.com.

This month, the American College of Physicians’ Board of Governors (BOG) will meet in Chicago. One of the items on the agenda is the discussion of resolutions that will help to shape ACP policy. The resolutions process, which looks at proposed policy changes and directives to …

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Bottom up: How grassroots input shapes ACP policies

The ice bucket challenge: A poor way to allocate your donations

Physician
September 10, 2014

Amyotrophic lateral sclerosis (ALS, sometimes called Lou Gehrig’s disease) is a truly horrible illness. It is a progressive fatal neurodegenerative disorder that leads to worsening muscle weakness.

Weakness in the limbs initially makes handwriting sloppy and makes it hard to button clothes and eventually causes paralysis. Patients also develop weakness in the muscles that control swallowing and speech, eventually requiring them to use feeding tubes and computer text-to-speech software. Eventually the …

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The ice bucket challenge: A poor way to allocate your donations

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