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After retirement, a visit to a dermatology office

Physician

July 31, 2014

I’ve always been good at pattern recognition and my visual-spatial orientation is excellent. Photography is my hobby, so it was only natural that as a medical student and internal medicine resident, I loved my dermatology electives. Each day yielded up a new parade of interesting skin lesions and rashes, and by the end of my rotations I was confident in my diagnoses and recommendations. Contact dermatitis? Steroids! Eczema? Steroids! Psoriasis? …

Correcting the physician shortage isn’t an easy solution

Kevin R. Campbell, MD

Health Policy

July 31, 2014

There is no doubt that Affordable Care Act has changed the landscape of medicine in the U.S. Now, private practice is becoming a thing of the past. Financial pressures, increasing regulatory requirements, electronic medical records and outrageously complex coding systems are forcing long time private physicians to enter into agreements with academic centers and large hospital systems in order to survive.

As a result, medicine today is more about increasing patient …

Getting personal with patients really matters

Imamu Tomlinson, MD, MBA

Physician

July 31, 2014

Ask almost any physician why they chose medicine, and they’ll answer, “I wanted to make a difference in the lives of patients.”

But in today’s high-pressure healthcare environment, it’s easy to get caught up in performance metrics and obsessed with efficiency. We tell ourselves, “It’s OK, as long as we’re delivering great clinical care, we’re delivering great care. After all, the massive heart attack was averted. The wound was stitched. What …

It’s time we stood up for the orphan of organs: the brain

Marilyn B. Benoit, MD

Conditions and Diseases

July 31, 2014

It was with much distress that I read a New York Times front page article by Benedict Carey about the heart wrenching plight of the Serpico family in their journey to get proper psychiatric treatment for their two sons. As a child and adolescent psychiatrist who has served children and families for more than 30 years, trained many child psychiatrists, and served as president of the American Academy of …

Health care efficiency can mean different things

Rahul K. Parikh, MD

Health Policy

July 31, 2014

Whether you’ve praised or vilified Obamacare, see it as an amazing achievement or an existential threat, it is the law of the land. The price transparency created by online exchanges, a vital part of the law, stands to make cost the biggest driver of choice. This, along with cuts in government health spending, will disrupt the economics of health care in dramatic new ways.

Our first response to this brave new …

It’s time to bring back morbidity and mortality conferences

Denitza Blagev, MD

Physician

July 30, 2014

When things go wrong in medicine, as they invariably do, we try to figure out what went wrong, and why. We try to learn if there’s anything we could have done better and what we should do next time.

It used to be, in the days of the giants, that the physician responsible for the patient with the bad outcome presented the case during a morbidity and mortality (M&M) conference. It was …

Why the diversity of medical students is important

Moises Gallegos

Medical Education

July 30, 2014

As a medical student, it’s difficult to face a situation where everything possible is done for a patient, yet due to circumstances (seemingly) beyond our control, the risk of future harm remains uncomfortably certain. The majority of our medical school learning focuses on how to cure illness; unfortunately we’re not always taught how to deal with the real world issues that face our patients and that threaten the medicine we …

After serious self-reflection, is there redemption for Dr. Oz?

Harry Oken, MD

Physician

July 30, 2014

Recently, Dr. Oz has come under scrutiny for his information on a number supplements that he alleges help with weight loss. Over the past 2 years, he has presented information about 3 diet supplements: green coffee extract, raspberry ketones and garcinia cambogia. After reviewing the available information, I can not agree that there is compelling scientific information to …

3 questions to ask prospective family medicine residencies

Jennifer Middleton, MD

Medical Education

July 30, 2014

This time of year I get a lot of questions from fourth-year medical students about applying to residency. So, here’s my answer to the question, “What should I look for in a good family medicine (FM) residency program?”

It’s FM, so everyone (for the most part) is going to be nice, friendly, and welcoming when you go to visit. They will show you a curriculum that’s in line with the Accreditation …

Medicare’s 49th birthday: What is to be done?

Danny Ash

Health Policy

July 30, 2014

At a crowded townhall meeting in 1959, an elderly woman stepped up to the microphone and spoke to a panel of senators. “I am not worried for my son’s time,” she began. “He is 35, and I am sure he will face a better future when his time comes to retire. But what is to be done for those of us who need help right now?”

This was one of a …

Welcome to the world of metamedicine

Hans Duvefelt, MD

Physician

July 30, 2014

Knowing what to do when faced with a sick patient is relatively straightforward. We learned a lot of it in medical school, picked more up by experience, and usually have the opportunity to look things up quickly on the Internet. Even when faced with a brand new situation, we can usually fall back on our general knowledge of science and medicine.

But in today’s practice of medicine, that’s not enough. Physicians, …

Read more…

Welcome to the world of metamedicine

Raw Medicare data singles out radiation oncology. That’s misleading.

Sea Chen, MD, PhD

Physician

July 30, 2014

This past April, just after the Centers for Medicare & Medicaid Services (CMS) released the highly-anticipated 2012 Medicare provider charge data, the New York Times published an article,”Sliver of Medicare Doctors Get Big Share of Payout.”

Almost everyone agrees that transparency in the Medicare payment system will likely lead to more efficient health care delivery with less waste and less fraud. However, thoughtful analysis must be performed so that undue stigmatization …

Achieving the holy grail of wait-free medical care

Celine Gounder, MD

Health Technology

July 30, 2014

We’ve all come to expect our doctors to run late for appointments. I’m a doctor, and when I go to see my doctor, I expect the same. I bring my laptop or something to read to bide the time. Waiting makes us feel like we or our time isn’t valued, and doctors know this. So why is it so hard for doctors, including myself, to stay on time?

Most doctors have …

Digital health may no longer be a slow sell

Jesse Slade Shantz, MD, MBA

Health Technology

July 30, 2014

Though there have been notable exceptions, digital health has often proved a slow sell to the medical establishment. The failures of Google Health and HealthVault to gain traction, for example, underscore the challenges of breaking into the workflow of doctors.

Yet over the past month, three technology giants have, in the form of a series of launches, given an endorsement that digital health will be one of the next important technological …

Seniors pay the price for Medicare’s two-midnight rule

Tanya Feke, MD

Physician

July 29, 2014

The old adage “time is money” holds true, especially in health care. Apparently the medicine time crunch spans two midnights.

In October 2013, Medicare enacted a provision that changed coverage for hospitalized patients. The “two-midnight rule” states that a patient will not be covered as an inpatient unless their hospital stay is expected to cross two midnights. The end result is that many seniors are placed under observation, even if they stay …

5 ways health care IT must improve

Suneel Dhand, MD

Health Technology

July 29, 2014

Health care information technology has of course grown exponentially over the last decade, as electronic medical records (EMRs) and computerized physician order entry (CPOE) systems have become ubiquitous. It’s funny to think that not so long ago, physicians and nurses had to trawl through piles and piles of paper charts to search for the information we needed — whether it was lab results or patients’ notes.

However, the road to this …

Read more…

5 ways health care IT must improve

We should all be anonymous Samaritans

Farokh Jamalyaria, MD

Physician

July 29, 2014

I almost died today. I was driving from one clinic to another, on a busy highway in the rain, when my car hit a standing body of water and hydroplaned. I lost control of the car, spun counterclockwise across three or more lanes, and slammed into the dividing median. I remember screaming “NO!” internally right before impact. I couldn’t believe what was happening as it happened.Read more…

We should all be anonymous Samaritans

Can doctors really learn from having an illness themselves?

James C. Salwitz, MD

Physician

July 29, 2014

Once upon a time, I was a lifeguard. This was the natural result of swimming fairly well, Red Cross training, and team competition. I saw myself as a handsome, tanned guardian at the ready. OK, I was prone to self-delusion. When I became a doctor I carried over that image of high-perched protector on stilt chair, whistle in hand, rescue float close, ready to dive to the assistance of a …

Hypoliquidemia has now come to health care

Margalit Gur-Arie

Health Policy

July 29, 2014

The venerable University of Texas MD Anderson Cancer Center in Houston will accept patients with traditional Texas Medicaid health insurance, and some patients in Medicaid managed care plans. Memorial Hermann, another large health system in Houston, will accept traditional Medicaid patients and also those in Medicaid managed care plans. Neither institution will accept the Blue Cross Blue Shield HMO silver plan sold on the Affordable Care marketplace, according to Read more…

Hypoliquidemia has now come to health care

The unintended consequences of well-meaning FDA regulations

Brian C. Joondeph, MD

Medications

July 29, 2014

We rely on the FDA to protect public health “by assuring the safety, efficacy, and security” of medical drugs and devices. The FDA takes its marching orders from Congress via the legislative process. One such law is the Compounding Quality Act of 2013, passed in response to a series of fatal infections due to improper compounding pharmacy processes. While such oversight is important and well meaning, the unintended consequences may be …

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