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Water births should be treated as a medical intervention

Conditions and Diseases

April 9, 2014

The joint statement on laboring in water and delivering in water (the latter also known as immersion births) from the American Academy Pediatrics (AAP) and the American Congress of Obstetricians and Gynecologists (ACOG) is making the rounds. I’ve linked to the full statement above, but in essence it says that some women find laboring in water helpful for pain relief (in the first stage of labor it reduces the need for …

Do patients care about how much money their doctors make?

Trudy Lieberman

Health Policy

April 9, 2014

I am all for transparency when it comes to health care. So when Medicare announced that it would tell the public how much doctors are paid to treat Medicare patients, my first thought was “hooray.” Another victory for consumer information.

Then I began to think about this in more depth. The Centers for Medicare and Medicaid Services (CMS), in response to a ruling in a federal case …

Do rural provider bonus payments do more good than harm?

Peter Ubel, MD

Health Policy

April 9, 2014

If you live in the rural U.S., you probably face relatively limited access to the wonders of American health care. There won’t be as many physicians per capita offering you their services. This paucity of health care professionals will be especially stark for subspecialty care. There are not many ENT specialists opening up shops in rural Texas when they can find jobs in Houston or San Antonio.

This undersupply of physicians …

What health care can learn from Katz’s Delicatessen

Margalit Gur-Arie

Health Technology

April 9, 2014

Katz's_Delicatessen

Sometime during the last year of the second millennium, I wrote my last letter in response to the last letter I have ever received. It’s been email ever since. I don’t recall making a conscious decision to stop writing letters. It just happened. I cannot pinpoint the exact date when my work memos, agendas, proposals and various notes, disappeared from my desk …

The Heartbleed bug compromises EHRs: Physicians and patients beware

Rigel Hope

Health Technology

April 9, 2014

Technology finds its way into our lives not so much in big flashy ways as little ones. Oh, I can do this a little bit faster now, isn’t that cool? Wow, isn’t this convenient? Oh, isn’t this a huge risk to my privacy?

Oftentimes, when I start talking about Linux or scripting or the command line or any number of tech subjects that seem increasingly esoteric, I get blank stares from …

The alarming decline of internal medicine recertification pass rates

Kevin Pho, MD

KevinMD

April 9, 2014

Let’s talk internal medicine maintenance of certification (MOC).

I recertified back in 2011, and it was an onerous process capped off with a challenging exam. Thankfully I passed, and I’m good until 2022.

Since then, the American Board of Internal Medicine has made maintenance of certification a more “continuous” process, and is sparking some outcry among physicians. Wes Fisher has multiple posts …

Why the future of health care can be found in the Cayman Islands

Robert Pearl, MD

Health Policy

April 9, 2014

The Cayman Islands are nestled in the Caribbean Sea some 430 miles south of Miami. The three-island cluster is known for its inviting coral-sand beaches, laid-back island culture and tax-free status.

While it lures many tourists and big banks, it’s not the first place you’d expect to find the future of American health care. That may change soon.

Last month, I flew to the Caymans to moderate an afternoon-long panel on delivering …

A cancer story that defied the odds

James C. Salwitz, MD

Conditions and Diseases

April 8, 2014

Sometimes it seems that life is unfair and the odds are stacked incredibly against us. More than 1 in 3 persons will get cancer. The chance of survival if you get lung, pancreatic or brain tumors is pathetically small. The most common cancer in 20 to 30-year-olds is the deadly beast melanoma. We have no easy or effective early detection for most cancers.

However, there are remarkable stories of hope. Here …

Read more…

A cancer story that defied the odds

Explain the reasoning behind new prescriptions

Val Jones, MD

Medications

April 8, 2014

A Canadian study published in the Annals of Internal Medicine suggests that about one third of new prescriptions (written by primary care physicians) are never filled. Over 15,000 patients were followed from 2006 to 2009. Prescription and patient characteristics were analyzed, though patients were not directly interviewed about their rationale for not filling their prescriptions.

In short, patients were less likely to fill a prescription if the treatment was expensive, but certain …

Good psychotherapy eventually ends

Steven Reidbord, MD

Physician

April 8, 2014

Traditional psychodynamic therapy is often caricatured as endless, with a complacent therapist silently growing cobwebs, listening to a patient who never plans to leave. This isn’t completely unfounded: There are therapeutic advantages to losing track of time, “swimming in the material,” and letting one’s therapeutic focus be broad. The patient’s chief complaint, i.e., the ostensible reason for coming, often gives way to more troubling underlying conflicts and concerns that might never appear in …

Read more…

Good psychotherapy eventually ends

We must place a higher value on discharge paperwork

Suneel Dhand, MD

Physician

April 8, 2014

The discharge process has now been recognized as one of the most crucial points at which the actions of doctors and hospitals can have a huge impact on immediate health outcomes for our patients. At a time when 30-day readmission rates are still touching almost 20% for Medicare patients, there is an increasingly urgent need to focus on this transition of care point. Discharging a patient is, by its very …

What goes through a surgeon’s mind after a complication

Sid Schwab, MD

Physician

April 8, 2014

One of the hardest things about being a surgeon is the inevitability of complications. It’s true for any doctor; but with surgery, it’s as if they are lit in neon and given a soundtrack. At least to me. Aiming for perfection (as do we all) and beating myself up (more than healthier people) when I miss the mark, I found bad outcomes of nearly any magnitude deeply disturbing. The big …

Sleight of hand: The SGR bill’s important policy changes

Betsy Nicoletti, MS

Health Policy

April 8, 2014

What would you think if I told you that Medicare will require laboratories to disclose to CMS payment rates from private insurers? Or that they will identify physicians who order a high volume of CT tests and require them to pre-authorize those tests in 2020? How about that CMS will begin its own analysis of the time and cost of providing services in order to determine RVUs, a job currently …

When pediatricians write prescriptions for off-label use

Roy Benaroch, MD

Medications

April 7, 2014

You know those little packets of paper, folded over eight times, written in type that can’t possibly be seen? You’ve seen them glommed onto the side of stock bottles of medications, or shoved into the paper box alongside a tube of prescription ointment. That unreadable thing is the official “product information,” often called the “label,” required for every FDA-approved medication. It contains all sorts of information, including lists of Read more…

When pediatricians write prescriptions for off-label use

Why you should care about translational research

Harry Shamoon, MD

Medical Education

April 7, 2014

Translational research is a catchphrase in biomedical circles these days. But if you’re confused about what the term really means, you’re not alone.

It was 35 years ago when I first heard the term “translation” in a scientific context. It was about enabling basic research undertaken by the National Institutes of Health (NIH) to find its way into treatments for patients. Though that sounds pretty straightforward, I still have to explain …

Can narrative medicine inform quality of care?

Don S. Dizon, MD

Physician

April 7, 2014

As characterized by Dr. Rita Charon in her JAMA article almost 15 years ago, narrative medicine is “the ability to acknowledge, absorb, interpret, and act on the stories and plights of others.” It is the recognition that scientific knowledge alone is not enough — not enough for our patients, for ourselves, and for society. It stresses the importance of not only hearing what our …

An erosion of privacy in health care settings

Abigail Schildcrout, MD

Physician

April 7, 2014

Our privacy is eroding. Some of this erosion is our own fault — we post to Facebook, Twitter, and other social media with reckless abandon. Some is the nature of modern communication — electronic trails are just as easy to find as paper trails (if not easier). Some of the privacy erosion really doesn’t bother me so much — if Target knows that I buy a lot of Cheerios, I’m …

Physician report cards make no difference in referral patterns

David B. Nash, MD, MBA

Health Policy

April 6, 2014

Back in 1986, the Health Care Financing Administration launched the brave new era of quality reporting in this country by releasing “report cards” that detailed hospital-specific, risk-adjusted mortality rates for coronary artery bypass graft (CABG) surgery.

Since that time, the number and type of publicly reported quality outcomes has grown exponentially with the goal of helping patients make informed decisions when selecting doctors, thereby driving quality improvement by doctors and hospitals.

Has …

For all those executed, the cause of death is homicide

Joel Zivot, MD

Physician

April 6, 2014

On March 10, I found myself at the front gate of the Florida State Prison, stethoscope and blood pressure cuff in hand, to examine Robert Henry at the request of his public defender.

Henry is scheduled to be executed Thursday evening by lethal injection. His crime was the murder of two people during a robbery more than 30 years ago.

He’s a 55-year-old African-American man with hypertension, elevated cholesterol, and a history …