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The slippery slope of shorter hospital stays

Conditions and Diseases

June 25, 2014

This story has become all too familiar. The patient enters the ER with crushing chest pain and their EKG shows an acute MI, (known today in the colloquial as STEMI, for ST-elevation myocardial infarction). The interventional cardiologist is summoned quickly and in less than 90 minutes from the patient’s arrival across the ER door threshold, he or she is on a cardiac cath lab table, where a coronary stent is …

IBD versus IBS: The difference is everything

Sophie M. Balzora, MD

Conditions and Diseases

June 24, 2014

The New York Times recently published two articles in a series about inflammatory bowel disease, or IBD, in hopes to destigmatize the disease, and to broadcast medical and surgical advancements that have worked to change how we conceptualize IBD. I applauded the Times for highlighting what can be a debilitating disease for the 1.4 million Americans who are afflicted with it, and thought: Finally! IBD is getting the attention it deserves.

Albeit …

Taking a page from firefighting to fix health care

Rob Burnside

Health Policy

June 24, 2014

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In firefighting, pump physics is one of the most critical things an engine company officer must understand. How do we “get the wet stuff on the red stuff” in sufficient quantity without sacrificing penetrating power? The inverse ratio between volume and pressure (as the water pressure increases, volume decreases) has befuddled many a rookie lieutenant.

The same, I think, is now true …

Empowering patients: Emergency department palliative care

Rob Hamilton, MD

Physician

June 24, 2014

A few months ago, I walked into work on a late-night shift. One of the nurse practitioners came up to me and said, “There’s someone you need to see right away.”

The patient was a woman of about 60, and it was clear that she was critically ill. According to her husband, she’d been diagnosed with cancer six months ago. It had metastasized throughout her body. Her oncology team made several …

A country doctor’s proposal for health insurance reform

Hans Duvefelt, MD

Health Policy

June 24, 2014

In the forty years since I started medical school, I have worked in socialized medicine, student health, a cash-only practice and a traditional fee for service small group practice. The bulk of my experience has been in a government-sponsored rural health clinic, working for an underserved, underinsured rural population.

Today, I will make a couple of concrete suggestions, borrowing from all the places I have worked and from the latest trends …

How does evidence-based medicine affect the art of medicine?

Danielle Jones, MD

Physician

June 24, 2014

There’s no arguing the fact that evidence-based medicine (EBM) is moving us in the right direction as far as treating and preventing illness in medicine as a whole, but what does EBM, in its current interpretation, mean for medicine as an individualized art?

Everything new or controversial in medicine seems to have a swinging pendulum. From vaccines to hormonal treatment to alternative therapies, the pendulums of medicine seem to be in …

Momentum for telehealth is accelerating

Joseph Kvedar, MD

Health Technology

June 24, 2014

The nation’s ongoing battle to strike a delicate balance between increasing access to quality health care for all Americans and reducing overall health care spending just scored one of its most substantial victories. In late April, after several months of thoughtful and robust collaboration, the Federation of State Medical Boards (FSMB) ratified a new model national policy: the Appropriate Use of Telemedicine in the Practice of Medicine. This marks the first …

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Momentum for telehealth is accelerating

Why patient satisfaction surveys are riddled with problems

Christopher Johnson, MD

Physician

June 23, 2014

Nearly all physicians are now subject to patient satisfaction ratings. In my case, and many thousands of my colleagues across the country, it is via the survey tool sold to health care facilities by the Press Ganey Company. There are also many, many online sources that rate physicians.

The idea is a good one: Physicians should be subject to feedback from patients about patient perceptions of how good a job the doctors …

How entitlement undermines patient engagement

Jessie Gruman, PhD

Patient

June 23, 2014

I know the ropes at the VA … I’ll pick up the phone in a heartbeat and call my senator and get what I need right away. A lot of guys aren’t like that.
–Max Gruzen, PTSD patient, Vietnam veteran from the New York Times

So this is what it means to be an “engaged” patient in the VA system today. You have to know a senator who will intervene …

The payment bigotry against primary care doctors

Richard Young, MD

Health Policy

June 23, 2014

I’ve listened over the years to well-meaning people say that the general public doesn’t care about physician payments, because they think all doctors are rich and any physician who complains is just whining. This is a huge mistake on the part of people who want to have a long-term relationship with comprehensive family physicians as their primary care givers, and those who want better health care at a lower cost.

Let’s …

What are some of the characteristics of healers?

Stephen C. Schimpff, MD

Patient

June 23, 2014

Next in a series.

What are some of the characteristics of healers? They listen and do so nonjudgmentally. They respond on the patient’s terms. They are humble. They are truthful. The healer communicates on the patient’s (and family’s) own terms. The healer always explains his or her reasoning. The healer tries to diminish the information gap.

Despite all of medicine’s sophisticated technology and providers’ skills, the patient still needs the doctor …

The civic responsibility of physicians in our community

Dharam Persaud-Sharma, MD, PhD

Physician

June 22, 2014

It was just a regular hot and humid Saturday morning in Miami, and I was on my way out of a local Walmart after buying a few items. As I walked to my car at the end of the parking lot, I heard a voice asking me “Son, any change?” In a neighborhood that is known to have a disproportionately large amount of vagrants, I did what I usually do …

Women’s right to vote and the e-patient movement

Dave deBronkart

Patient

June 22, 2014

Feminism is the radical notion that women are people.
– Marie Shear

Recent speaking clients know that I often note the parallels between the patient movement and other cultural revolutions: the women’s movements, civil rights, gay rights, disability rights. (I mention disability issues less often, but it was disability advocate Ed Roberts who said in the 1990s, after years of struggle: “When someone else speaks for you, you lose.”)

As anyone who’s heard me …

Ethical physicians, now and then

Barron H. Lerner, MD

Physician

June 22, 2014

“Robert Loeb was the best damned ethicist I ever met.”

When I first heard a senior colleague of mine utter these words in the mid-1990s, I was surprised. Time had not been particularly kind to Loeb, who had been the chairman of medicine at Columbia-Presbyterian Medical Center from 1947 to 1960. Among other things, critics had chastised Loeb for being imperious and unwilling to listen; former students had even accused him …

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Ethical physicians, now and then

Estimating a patient’s age-clinical implications

Neil Baum, MD

Physician

June 22, 2014

As a medical student I was in awe when a professor looked at a patient’s hands or nail beds and described their medical condition without taking a history. I was also enthralled by a TED talk by the best selling author, Abraham Verghese, where he described a lesson that Arthur Conan Doyle, author of Sherlock Holmes, learned as a medical student at the medical school in Edinburgh, Scotland from the famous …

Patient profiling is part of the medical school curriculum

Aesculapius, Jr.

Medical Education

June 22, 2014

I recently read an article entitled, “Are you a victim of patient profiling?” and it got me thinking about my medical school career thus far, particularly my recent preparations for USMLE step 1.

Patient profiling is part of medical school curriculum. Many of the practice questions that I’ve done for Step 1 have relied on patient profiling (a euphemism for prejudice I believe) to get the correct answer. If the question starts …

How physical therapy gave an elderly patient hope

Arsheeya Mashaw, MD

Physician

June 22, 2014

Mr. Katz sat on the edge of his chair in my clinic room, teetering as if he might fall at any moment. He was 86-years-old, and his thin body had become weak and tired. But his angry eyes, like a petulant child, stared at me.

“Doc, you should have just let me die,” he said to break the ice.

I had just discharged Mr. Katz earlier in the week from the hospital. …

Don’t mistake patient satisfaction for patient-centeredness

Stanley Frencher, Jr., MD, MPH

Physician

June 22, 2014

As a new physician, I find myself besieged by data about how happy patients are with the care we deliver. Press Ganey, HCAPS, Consumer Reports, US News and World Report were merely the beginning.

Now, physician reimbursement is tied to how happy patients are after facing and overcoming, at times, life-threatening illnesses in our hospitals. Given the financial incentive, hospitals across the country are seeking the aid of companies like Disney: well-known …

The hidden costs of Obamacare

Brian C. Joondeph, MD

Health Policy

June 21, 2014

Labor unions have been reliable supporters of President Obama and his policies. Their support for Obamacare was critical to its passage in 2010. Yet they are continuing to learn that their members will be paying more for their health care, not less.

One of the selling points of Obamacare was the lowering of health insurance costs. Nancy Pelosi promised, “Everybody will have lower rates.” President Obama was more specific, telling us that his signature …

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The hidden costs of Obamacare

Living with my son’s schizophrenia: From fear to hope

Randye Kaye

Patient

June 21, 2014

When my son Ben was 20-years-old, he was finally diagnosed with schizophrenia after five years of chaos and frustration — what I later came to know had been symptoms of the gradual onset of his illness. At the time, I’d thought he was just having a tough adolescence. I’d thought perhaps he needed more father figures (Ben’s father had deserted the family when Ben and his sister were little, and …

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