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We should value quality when we shop for health care

Physician

June 21, 2014

Over the years, my husband’s parents, Helen and Dave, have both suffered unnecessarily from bad medical care. They are not alone.

A botched cataract surgery left Helen with a torn iris. One of her eyes can’t adjust to light, and for the last several years she’s worn sunglasses indoors. Her urologist kept treating her with the same antibiotic for urinary tract infections without testing to see what bacteria she had. When …

We need more clinical time outs

David Schlueter, MD

Physician

June 21, 2014

A few months ago, the father of a primary care physician came into the emergency department with syncope. He was 102 years old. His age was more than double his heart rate. That may or may not be bad but it certainly is often a reason for more testing. The senior resident seeing the patient ordered an EKG, a battery of labs, a head scan, and anticipated admitting the patient …

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We need more clinical time outs

A new buzz around primary care

Anoop Raman, MD, MBA

Health Policy

June 21, 2014

I recently described the loathsome “relative value unit” (RVU) and its role in the decline in prestige and pay in primary care. The RVU is maintained and updated by a small panel of 31 physicians called the Specialty Society Relative Value Scale Update Committee (RUC). Twenty-seven of the 31 physicians are specialists, which is not at all representative of the physician workforce, given that primary care doctors comprise over one third …

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A new buzz around primary care

A prayer by a physician

Afshine Ash Emrani, MD

Physician

June 21, 2014

When I first met Ralph, he was 82-years-old. He suffered from shortness of breath which started when his wife of 56 years was diagnosed with a rare bone cancer. Upon further investigation, I diagnosed him with a weak heart and a very tight aortic valve which required immediate surgery. Ralph made it; his wife died. Today, twelve years later, he brings me treasures from his metal detecting hobby on the …

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A prayer by a physician

We need fewer doctor MBAs and more doctor healers

Suneel Dhand, MD

Physician

June 20, 2014

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I read an article in the Boston Globe about how doctors are flocking to get Master of Business Administration (MBA) degrees in record numbers. The prestigious program at the Massachusetts Institute of Technology, MIT, apparently now has more students from the health care sector than any other field — accounting for almost 20 percent of the class.

A large number of these …

A doctor is skeptical about Apple’s HealthKit. Here’s why.

Mike Sevilla, MD

Health Technology

June 20, 2014

Apple recently previewed a new framework called HealthKit that will be included in their next mobile operating system called iOS 8.

Features mentioned in the video above:

One central app to integrate data from wearable technology like NikeFuel, the Withings blood pressure monitor, and Fitbit.

Working with the Mayo Clinic (for an app to launch in September) to integrate incoming and outgoing health information into HealthKit so that if there is a really high blood pressure, the Mayo Clinic …

The problem with vendor management systems to solve staffing shortages

Val Jones, MD

Physician

June 20, 2014

In an effort to save on human resources costs, some hospitals have decided to make locum tenens* doctors and nurses line items in a supply list. Next to IV tubing, liquid nutritional supplements and anti-bacterial wipes you’ll find slots for nurses, surgeons, and hospitalist positions.

This depressing commoditization of professional staffing is a new trend in health care promoted by software companies promising to solve staffing shortages with vendor management systems (VMS). In …

Innovation in health care: 3 lessons from Kaiser Permanente

Robert Pearl, MD

Health Policy

June 20, 2014

At the end of my interview with Chip Heath, co-author of the New York Times bestsellers “Made to Stick” and “Decisive,” I asked him what topic he’d like me to cover in the future.

“I’m impressed by the culture you’ve created at Kaiser Permanente in Northern California,” he said. “You’ve generated quarter-to-quarter change that I think would have taken three years elsewhere. I don’t think most organizations know how to do that. …

Technology should enhance connections and improve relationships

Rob Lamberts, MD

Health Technology

June 20, 2014

My 87-year-old father broke his hip this past weekend. He was in Michigan for a party for his 101-year-old sister, and fell as he tried to put away her wheelchair. The good news is that he’s otherwise pretty healthy, so he should do fine.

Still, getting old sucks.

During the whole situation around his injury, surgery, and upcoming recovery, one thing became very clear: Technology can really make things much easier:

I …
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Technology should enhance connections and improve relationships

Pay-for-performance is all about cost control

Michael Kirsch, MD

Health Policy

June 19, 2014

If you read my articles, then you likely know about the scam known as pay-for-performance (P4P). This program not only fails to deliver on its stated mission to improve medical quality, but it actually diminishes it.

In short, P4P pays physicians (or hospitals) more if certain benchmarks are met. More accurately, those who do not achieve these benchmarks are penalized financially. I do not object to this concept. Folks who perform …

8 essential tips for physician entrepreneurs

Elizabeth Chabner Thompson, MD, MPH

Health Technology

June 19, 2014

While there are many creative people who go into medicine, the challenge of turning experience into innovation can be stifling. My classmates at Johns Hopkins, fellow residents at Harvard, and peers came from a wide variety of backgrounds. But medical school, internship, and residency don’t afford students much time to tinker around.

“Free time” in academic medicine means working in a lab with the “publish or perish” dictum hanging over one’s …

Our veterans deserve so much better than the VA

Shirie Leng, MD

Physician

June 19, 2014

After I graduated from medical school, my very first real ward rotation as an internal medicine intern was at the VA. Therefore, I can say with absolute certainty that all the stuff being said about the VA health system is true. The place is a mess.

Let’s start with the computer system. The VA medical record system has been held up as an example of an effective EMR system, in which …

It was time to proclaim myself as a wounded healer

Josephine Ensign, DrPH

Patient

June 19, 2014

Recently I had dinner with a friend of mine who, decades ago, had sat on my doctoral dissertation committee. At one point we touched on my dissertation, which covered the health issues of Baltimore’s homeless teens.

“You always had an uncanny connection with homeless kids,” my friend said. “You really understood them.”

I gazed out the window, seeing the homeless people with their shopping carts in the park across the street.

Then I …

Has abolishing medical paternalism gone too far?

James C. Salwitz, MD

Physician

June 19, 2014

Carrie is a 72-year-old retired real estate agent with a high school education. She raised three kids, but they do not talk to her anymore. Since her husband died, Carrie has lived alone. A melanoma was removed from her right shoulder 2 years ago. In my office, we stare at the CT scan display of a mass in her right lung.

“What does that mean?”

“Well, we wouldn’t know for sure until …

Exploring the mind of a mass murderer

Allen Frances, MD

Conditions and Diseases

June 18, 2014

Mass murders are becoming a depressingly familiar routine in the United States — we can now expect to experience a media grabbing shooting about once a month. And the frequency can only increase as future cohorts of copycat killers are spawned by the seductive opportunity to temporarily gain the spotlight.

Amidst the anguish and heartbreak felt by the victims’ families, there are always two haunting questions. What motivates someone to kill …

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Exploring the mind of a mass murderer

Cancer screening in those with metastatic disease

Don S. Dizon, MD

Conditions and Diseases

June 18, 2014

“Your cancer has come back.”

These are words no one treated for cancer wants to hear, yet they are words I have said far too often in my own career. In this case, I had said this to a patient I had cared for ever since her initial diagnosis. At that time, she had stage III breast cancer. After her surgery, …

Why this doctor loves her EHR

Jennifer Gunter, MD

Health Technology

June 18, 2014

There is a recent and interesting piece in the Wall Street Journal by an orthopedic surgeon, Dr. Craviotto, about the maddening aspect of forced mandates and bureaucratic requirements in medicine that seem to have very little to do with actual medical care and more about hoops through which we must jump that seemingly lead to nowhere.

While I do find the bureaucracy of medicine in the United States insane versus the Canadian system, I …

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Why this doctor loves her EHR

The importance of professional evolution in medicine

The Red Humor, MD

Medical Education

June 18, 2014

I’ve been a practicing oncologist for all of seven months, and so was surprised when my chief asked that I take part in our quality review panel. The quality review panel is an internal group that is tasked with the responsibility of looking into allegations that a patient’s care was not in keeping with best practice or what is generally considered the standard of care. Cases (often in the form …

Hospital bills should not outlive our loved ones

Nadi Nina Kaonga

Conditions and Diseases

June 18, 2014

In 2010, I lost my mother to cancer. She was a fighter and had survived well past her prognosis, but her hospital costs outlived her.

Let me go back to late 2004. That was the year the doctors suspected she had cancer. My mother, who was not a smoker, was officially diagnosed with non-small cell lung cancer early on in 2005. When the biopsy confirmed that the small lesion in the …

A prostate cancer breakthrough: The good and not-so-good news

J. Leonard Lichtenfeld, MD

Medications

June 18, 2014

The annual meeting of the American Society of Clinical Oncology is a place where many commercial interests jostle for attention to make their latest promising therapy the star of the show. But a standard widely available generic drug stole the show by producing incredible results in improving survival for men with advanced prostate cancer. And that has some of us …

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