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Should physicians work for hospitals?

Health Policy

June 17, 2014

A physician I have known for many years recently told me about his decision to enter the world of concierge medicine. His reasoning was telling, saying that it came down to a very simple decision on staying independent or becoming a hospital employee. He liked being an independent solo practitioner, and that was his primary motivation: to maintain independence in a time of consolidation.

Richard Gunderman, writing for the Atlantic, tackled …

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Should physicians work for hospitals?

Patient sensors: 5 differences between the consumer and health care market

David Lee Scher, MD

Health Technology

June 17, 2014

The technology industry has been buzzing of late because of the big players entering the wearable sensor market. We are very familiar with Misfit and Nike’s Fitbit for some time. Others investing into the sector include Intel, Microsoft, Apple and Samsung.

There is no doubt that the inertia for fitness trackers is undergoing modulation. This is a result of both a dampening of the initial “wow” factor by consumers and a maturation of the market. Recalls of …

Health care is too nuanced for lengthy scripts

Peter Pronovost, MD, PhD

Physician

June 17, 2014

Recently in one of the Johns Hopkins Hospital’s intensive care units, a patient was dying from cancer and sepsis, and there was nothing that I, nurse Mandy Schwartz or anyone else could do to stop it. Yet as the patient’s family — two daughters and a husband — suffered at her bedside, Mandy saw their need for comfort, and she responded. Although she was busy with nursing tasks, she delved …

Can conflicting guidelines be good for patients?

Kenneth Lin, MD

Physician

June 17, 2014

After I left my position as a staffer for the U.S. Preventive Services Task Force in November 2010, it was three years before I was tapped for another guideline post, this time at the American Academy of Family Physicians. Recently I joined the AAFP’s Commission on Health of the Public and Science, which formulates guidance for family physicians on a variety of topics, including clinical preventive services. My appointment coincided …

Be personable and make a huge difference in a patient’s recovery

Ira Nash, MD

Physician

June 17, 2014

I have long been a fan of the Case Records of the Massachusetts General Hospital, which is published weekly in the New England Journal of Medicine. For many years, I made a point of recommending them to medical students and internal medicine residents as a model of concise yet comprehensive case presentations.

No wasted words, no missing information, and none of the filler that trainees often added when they presented cases, such …

Reasons why your wait time at the doctor’s office is so long

Justin Smith, MD

Physician

June 16, 2014

Painful wait times at the doctor’s office. It’s an old story with few exceptions.

As a dad, I have to deal with many of the same issues of parenting that you deal with: sleepless nights , fevers and holding my kids down for shots (my wife did it once, I think, then she promptly retired from this job). However, waiting at the pediatrician is not something I have to do. So, I can’t truly empathize …

Nonjudgmental listening is the first step in healing

Stephen C. Schimpff, MD

Physician

June 16, 2014

Next in a series.

Years ago while in oncology training, I was on night duty when a patient of one of my colleagues was having severe penile pain. He had received a new investigational chemotherapy and it turned out to have an unexpected property of damaging the lining of the bladder and urethra. It gave him a strong uncontrollable urge to urinate yet each time the burning was excruciating. Oral …

Embrace the age of digital medicine

Kevin R. Campbell, MD

Health Technology

June 16, 2014

As a child, I often watched science fiction movies and television shows wondering how much would become reality in my lifetime. From space travel in Buck Rogers and Star Trek to time travel in Back to the Future, I often imagined growing up in a world where the impossible became probable. Bionics and the repair of human tissues was captivating and the Six Million Dollar Man became a hit series.

Now, much of what was thought to be …

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Embrace the age of digital medicine

Palliative surgery: A surgeon reflects

Sid Schwab, MD

Physician

June 16, 2014

Palliative surgery is tough stuff. Nobody wins much, and it often challenges one’s ability to think clearly, let alone to tell the truth. Sometimes, I think, it borders on the deceptive; it makes me wonder who’s the object of comfort. And yet, when there’s nothing else to do, it’s often just the right thing. I hate it.

To be clear: We’re talking about surgery to relieve some sort of specific problem, …

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Palliative surgery: A surgeon reflects

A passion for family-centered care

Hamsika Chandrasekar

Medical Education

June 16, 2014

This quarter of medical school has by far been my favorite, because almost everything we do has an explicit clinical correlation. Each week we work in small groups of 10 or so students to go over patient cases, practice respiratory and cardiovascular (our two organ blocks this quarter) physical exam skills, and interface with real patients in the hospital. These experiences have been both exciting and humbling, and two in …

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A passion for family-centered care

Stop trying to copy health care systems from other countries

Luis Collar, MD

Health Policy

June 16, 2014

“It is immoral that the wealthiest nation on the planet does not provide affordable, high-quality health care to all of its citizens. Despite being the only global ‘superpower’ still standing, we trail much of the industrialized world in life expectancy, infant mortality, and countless other indicators of health. Until we fix our broken, prohibitively expensive delivery system, things will only get worse.”

I’m not sure if anyone has used those …

Today’s high deductibles are tomorrow’s bad debt

Josh Umbehr, MD

Health Policy

June 15, 2014

I’m not sure if you’ve heard the parable of the tall man and the cat.

Maybe not, since I had to make it up in light of health care’s unending cost increase.

In this allegorical village, there was a group of citizens who were very upset with a man who lived there. This man was very, very tall, and he made all the villagers feel uneasy (they were insecure about the crowns of their heads, …

Watching people die is sometimes the compassionate thing to do

DocBastard, MD

Physician

June 15, 2014

It is unethical not to be compassionate when you are a physician. Treating people or their families poorly isn’t helpful to anyone in a stressful situation. But a big problem exists there – ethics is not taught in medical school. Then again, neither is compassion. So where do you learn them? Can you learn compassion, or is it something you just have?

Or don’t have?

She could have been anyone’s grandmother. White …

How do we turn data into wisdom?

Israel Green-Hopkins, MD

Health Technology

June 15, 2014

The practice of medicine is an art based on science.
– Sir William Osler

This was famously stated over 100 years ago by Dr. Osler, the father of modern medicine and the physician who laid the foundation for professionalism in health care. In this vein, a panel of experts from Boston-area hospitals and elsewhere recently convened to attack the question, “What needs to change to get doctors back to the patients?” While the primary …

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How do we turn data into wisdom?

4 questions to ask your plastic surgeon before surgery

Patrick Hsu, MD

Physician

June 15, 2014

As the number of people undergoing plastic surgery rises, the number of people who get bad results also increases. Numerous cases of botched plastic surgeries persist to linger the news which continue to put plastic surgery in a bad light. As a doctor specializing in cosmetic and reconstructive surgery myself, I am saddened by the fact that such cases carry on.

With more and more people choosing to undergo plastic surgery, …

Choosing words wisely: Can healing get lost in translation?

Allison Goldberg

Medical Education

June 15, 2014

A few months ago, we had an opportunity for one-on-one time with standardized patients (SPs): the trained actors that are well-versed in how us medical school fledglings should and shouldn’t be performing physical exams. It was a laid-back, non-graded session wherein we could ask for advice and even have the SPs walk us through exactly what we should do. So, when it came time for the abdominal exam, I asked my …

Malpractice lawsuits aren’t just about money

Steve Cohen, JD

Health Policy

June 15, 2014

I saw the caller ID and immediately picked up the phone; it was an old friend from college.

“I want to sue a doctor, and I want to sue the hospital,” said Karen.

Sadly, I hear those words all too often. I’m a newly-minted lawyer — after a 35-year career as a publisher — working at one of New York’s top medical malpractice plaintiff’s firms. What made this particular call so unusual …

Remember the fathers of sick children

Courtney Schmidt, PharmD

Patient

June 15, 2014

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When I was a little girl, my dad was my hero. He was strong and brave, and it only took his presence to make me feel safe and secure. I thought he understood everything there was to know in the world. I believed he could solve any problem, slay any dragon, protect me from all harm.

That’s the best thing about dads, …

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Remember the fathers of sick children

The EHR should work for us, not us for it

Fred N. Pelzman, MD

Health Technology

June 14, 2014

I’m feeling meaningfully used today.

Once again, we are faced with another set of administrative hurdles, boxes that need to be clicked, tasks that need to be completed, all in the name of demonstrating that we are meaningfully using the electronic health record in which our practice and the federal government have so heavily invested.

An “eligible professional summary” arrives in my email, with lots of bars with lines, and green checks …

Medicaid cost shifting: The case of Denver Health

P. J. Parmar, MD

Health Policy

June 14, 2014

We all know about the increase in Medicaid patients resulting from Obamacare, and how this is exacerbating the shortage of providers who accept Medicaid. I see Medicaid patients in Denver, where there is a reason for the shortage that is often overlooked: managed care Medicaid.

The managed care concept peaked decades ago, a failed attempt to reduce health care spending by forcing patients to go to only one doctor or …