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We have a physician utilization problem

Physician

April 2, 2014

Do we really have a looming physician shortage? We may, but even more acutely I believe we have a physician utilization problem, most particularly in primary care. After shadowing approximately 50 primary care physicians across the country and engaging physicians in conversation during 150 or so presentations on improving the delivery model of care, my observation is that 70-80% of the PCPs work output is direct waste: computer order entry, prescription processing, composing the billing …

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We have a physician utilization problem

When childbirth becomes a financial stress

Ashley Lane

Patient

April 2, 2014

On December 31, 2011 right before midnight, I took the test of excitement and new beginnings and found out that I was pregnant. While this news was joyous in nature, it was soon marred by uncertainty and harsh reality.

After my test, I followed up with a doctor’s visit a month later, as was expected, and soon learned that the cost for this bundle of joy would be around $12,000 to …

Measuring Obamacare’s success: Are enough people getting coverage?

Robert Laszewski

Health Policy

April 2, 2014

Health insurance reform was long overdue. But did it need to be done the way the architects of the Affordable Care Act did it?

Obamacare was enacted, and the private health insurance market fundamentally changed, so that we could cover millions of people who previously couldn’t get coverage.

Are enough people getting coverage who didn’t have it before to justify the sacrifices the people who were already covered — in the individual, …

Do call centers send too many children to the emergency department?

Christopher Johnson, MD

Physician

April 2, 2014

A large number of pediatric practices these days use after-hours call centers for parents who have questions about a sick child. I’ve been looking around to find some data about how common this is, but my sense is that the majority of pediatricians use them. There is no question these call centers make live easier for the doctor; having somebody screen the calls, answer easy questions, and only call you …

An ICU physician’s work is never done

Harlan R. Weinberg, MD

Physician

April 2, 2014

If you are among the thousands of doctors who make their living as intensive care physicians, there is no normal work day with predefined hours or routine. Interruptions are the norm. Your day starts early in the morning, meeting with the ICU nursing staff and respiratory therapists long before morning rounds. Difficult clinical issues are reviewed as you and your team apply critical thinking on the challenging problems of the …

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An ICU physician’s work is never done

Would you admit this patient into hospice?

James C. Salwitz, MD

Conditions and Diseases

April 2, 2014

Allow me to describe a recent case and ask your opinion. Today, you are the intake nurse at hospice and you are asked to evaluate Stan. This gentleman has incurable cancer, but treatment would probably prolong his survival. However, Stan has refused that treatment and been referred to you. It is your job to decide if he is “hospice appropriate.”

Why has Stan refused therapy? It is not that he denies …

Understand the consequences of preventable infectious diseases

Robert Pearl, MD

Conditions and Diseases

April 1, 2014

There is nothing more disheartening for a physician than watching a patient die from a preventable cause. And, of course, the loss for the family involved is unimaginable.

But it’s important, especially for parents, to understand the potential consequences of preventable, infectious diseases.

Here’s a scenario doctors across the country are witnessing first-hand: A 2-year-old girl develops what seems like a cold. Over the next several days, her breathing rate increases. At …

Developing bedside manner comes from understanding who the patient is

Robert Centor, MD

Physician

April 1, 2014

Over the years I have strived to develop my bedside manner. On rounds many learners comment on this aspect of my doctoring, and these comments have led to much self reflection. This commentary may convince some readers that I have the answers, but I do not. Sometimes I do very well, but sometimes my skills fall short. I do try to connect with patients and families, and give them confidence, …

The rise of ADHD diagnoses in young mothers

Claudia M. Gold, MD

Conditions and Diseases

April 1, 2014

“I know its my ADHD acting up,” a mother of three young children recently said to me as an explanation for her inability to recall a particular piece of information. My observation, in the setting of mybehavioral pediatrics practice, of increasing numbers of mothers of young children being diagnosed with ADHD is in keeping with a recent report from Express Scripts. This report, based on pharmacy claims data, showed a 53% rise in writing of prescriptions for ADHD in …

Negative results from clinical trials need to be reported

Kevin R. Campbell, MD

Medications

April 1, 2014

Research and development is critical to battling disease. Now, more than ever, technology can rapidly impact a patient and their disease process in a very positive way. The process of developing a new drug or device is expensive and can be very time consuming. As government funding for projects continues to decline, more funding is coming from private sponsorship according to a recent New York Times piece.

Another critical source of …

Powerless to treat a complicated cancer case in Kenya

Bruce Campbell, MD

Conditions and Diseases

April 1, 2014

I was working side-by-side with a Kenyan ENT doctor at his hospital in Eldoret, Kenya. My wife, Kathi, and I were part of a team of head and neck surgeons organized by Indiana University spending two weeks working with Kenyan ENT surgeons to help them build confidence to perform operations independently. In rapid sequence, we were seeing dozens of patients who had signed up to be examined and hoping to …

Why are doctors crazy enough to accept health care’s status quo?

Davis Liu, MD

Health Policy

April 1, 2014

We believe integrated will triumph fragmented every time.
-Steve Jobs

Two articles recently got my attention. The first was an interview by Dr. Robert Pearl, CEO of the Permanente Medical Group with my favorite author and thinker Malcolm Gladwell. On Pearl’s blog, he answered Gladwell’s request to tell people what is was like to be a doctor.

The second was a NPR article, “When Facts Are Scarce, ER Doctor Turns …

One example where the EMR can really make a difference in outcomes

Margaret Polaneczky, MD

Conditions and Diseases

March 31, 2014

Given all the complaining I and my colleagues do about the problems with the EMR, I figured I’d take the opportunity to tell you about something good that came from having my practice online.

A patient came to see me last week for a check up and requested a prescription for birth control pills. She’d used them in the past without problems. I wrote the script and sent her on her …

It’s OK to laugh after a procedure

Susan D. Klugman, MD

Conditions and Diseases

March 31, 2014

She asked me, “Is it OK to laugh?”

My patient Linda, who was only 12 weeks pregnant, had just had a chorionic villus sampling, or CVS. During this procedure, a small piece of placenta (chorionic villi) is removed via a long, thin needle inserted into the woman’s uterus, and then the sample is sent to a laboratory for genetic analysis. My patient fell into the category of advanced maternal age, and …

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It’s OK to laugh after a procedure

The dreadful cost of denying how you really feel

Anoop Kumar, MD

Physician

March 31, 2014

I was recently sent a link to this article entitled “Smile! You’ve Got Cancer” written by Barbara Ehrenreich. I encourage everyone to read it. The article lives up to its striking title and more. And I couldn’t help but respond with my perspective. So that you know where I’m coming from, my most personal encounter with cancer is that my grandmother died from cancer. I also treat people with acute …

Weight loss resistance is real

David L. Katz, MD

Conditions and Diseases

March 31, 2014

Weight is not a behavior, and weight is not a choice. Nobody wakes up and decides what to weigh today. In an age when healthy and unhealthy behaviors are increasingly subject to incentives and disincentives, respectively, this is all too easily forgotten.

Of course, weight is largely the byproduct of behaviors and choices, namely what and how much we eat, and what and how much we do: calories in and calories …

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Weight loss resistance is real

My best teachers are my patients

Greg Smith, MD

Physician

March 31, 2014

One good thing about doing anything for three decades or longer is that you get to see cycles and repeated events, things that fail and things that work. I hope that over the last thirty years of learning about psychiatry and mental health (and yes, I am still learning and hope to acquire that one last little piece of knowledge on my deathbed) that I have paid attention to the …

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My best teachers are my patients

Hospital medicine doctors are key to improving patient satisfaction

Suneel Dhand, MD

Physician

March 31, 2014

Improving patient satisfaction and enhancing the hospital experience is all the buzz today in health care. Every hospital executive across the country is talking about it, and coming to terms with how their organization’s reimbursements will be directly tied to their performance in this area.

A decade ago, none of us had ever heard of HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) scores, the core metric by which health …

Did the NEJM publish a bad study about checklists?

Josh Herigon, MPH

Medical Education

March 30, 2014

Recently, a study in the New England Journal of Medicine called into question the effectiveness of surgical checklists for preventing harm. Atul Gawande, one of the original researchers demonstrating the effectiveness of such checklists and author of a book on the subject, quickly wrote a rebuttal on the Incidental Economist. He writes, “I wish the Ontario study were better,” and I join him in that assessment, but want to take it a step further.

Gawande first criticizes …

Understanding the uproar over Zohydro ER

James Patrick Murphy, MD

Medications

March 30, 2014

In March 2014, Zohydro ER (hydrocodone extended-release) was introduced to the market. Never in my medical lifetime do I recall a medication stirring such angst. Worries of mass overdoses, backdoor FDA conspiracies, and blatant disregard for the public well-being abound. Is there method to this madness?

Zohydro ER is a pain pill that, when taken by mouth, is released slowly over twelve hours. The active ingredient, hydrocodone, is an opioid (i.e. narcotic) that’s been around for decades …

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