| KevinMD.com

The logistics behind Google Glass in the ER

Health Technology

March 19, 2014

Over the past few months, Beth Israel Deaconess Medical Center (BIDMC) has been exploring the use of wearable computing.

In the emergency department we’ve been evaluating an early unit of Google Glass, a high tech pair of glasses that includes a video camera, video screen, speaker, microphone, touch pad, and motion sensor.

We have been able to access our internal web-based ED dashboard on Glass, in a secure manner that ensures all …

The act of doing surgery will always be honorable

Sid Schwab, MD

Physician

March 19, 2014

In my core, I always loved doing surgery, and being surgeon to my patients. As I hope I’ve made clear in my blog, I was always amazed that I was allowed to do it, and awed at the mysterious beauty of it all. As much of a responsibility as it is, it’s also an inexplicably wondrous honor and privilege. Those words aren’t lightly written. But in a diabolical …

The impediments to being a good primary care doctor

Stephen C. Schimpff, MD

Physician

March 19, 2014

Next in a series.

The primary care physician (PCP) is the most broadly yet deeply focused care giver and as such is the backbone of the healthcare system. But to do this work effectively requires time — time which all too often is not adequately available.

What constitutes primary care and who are the primary care physicians? They are the first responders, the first line of care, and very frequently …

Vivek Murthy: A surgeon general nominee hijacked by special interests

Ali Khan, MD, Sanjay Kishore, and Christopher Lillis, MD

Physician

March 18, 2014

His is the story of which American dreams are made: a first-generation immigrant who grew up in South Florida, where he worked on weekends to support his father’s small business. After winning a spot at Harvard at 16, he set his sights on medicine and leadership. He founded an international non-profit focused on HIV/AIDS youth education while at Yale for medical school — and threw on an MBA for good …

Don’t take the damn EMR into the exam room

Doug Farrago, MD

Health Technology

March 18, 2014

Do you believe that I have to mention this? I can’t believe it either but since the advent of the EMR, this seems to be an issue; a really big issue. Amazingly enough, you are there, as a doctor, to treat the patient and not the computer. You would think it was the other way around with all the bogus quality indicators, meaningful use baloney and pay-for-performance nonsense being stuffed …

Don’t hesitate to talk to your doctor about work

Suzanne Koven, MD

Physician

March 18, 2014

This month, the literature and medicine group at my hospital met to discuss Arthur Miller’s Death of a Salesman. The play, which first opened in 1949 with Lee J. Cobb in the leading role (clip here) and is now playing in Boston at the Lyric Stage Company, concerns Willy Loman, a man in his sixties who hauls a sample case up and down New England with “a shoeshine and a smile.” …

How do we avoid initiative fatigue?

Peter Pronovost, MD, PhD

Health Policy

March 18, 2014

Frontline caregivers across the United States — and in many other countries, no doubt — are bombarded by multiple quality improvement (QI) projects. A clinical unit might simultaneously be engaged in efforts to reduce readmissions, eliminate hospital-acquired infections and other complications, increase hand-hygiene compliance, improve performance on core measures, and enhance the patient experience. The demands brought by participating in all of these efforts risk overwhelming health care professionals, who …

Read more…

How do we avoid initiative fatigue?

A simple thank you makes all the frustration worth it

BirdStrike, MD

Physician

March 18, 2014

I was a work today and I was given this message, “ —–’s husband called and wants you to call back right away! He sounded very upset. His wife died.”

Uh oh, I thought to myself, this is never good. It was a patient I remembered well, that I had seen repeatedly for a chronic problem, and who always came with her husband. We seemed to get along well. I didn’t …

Can transparency in health care happen in the United States?

Brad Wright, PhD

Health Policy

March 18, 2014

Most people, regardless of their political leaning, can agree that the market for health care in the United States isn’t really working well. Take one step further, though, and disagreement rapidly ensues.

On the left, the common understanding is that a market failure has occurred, and that the proper thing to do is have government intervene to correct that failure — usually by expanding public insurance programs, subsidizing private insurance, and …

Should doctors grab a .health domain?

Elbert Chu

Health Technology

March 17, 2014

So, you’re setting up a website for your practice. You thought you’d just grab a .com, .net, or maybe .info. But now there’s .health. Will one of those set you apart from the .com crowd?

So what do you need to know about these new domains?

1. Will patients come looking for me on .health? The bottom line is that it’s highly unlikely patients …

Read more…

Should doctors grab a .health domain?

Why doctors shouldn’t bill for time

Suneel Dhand, MD

Physician

March 17, 2014

As health care rightly moves towards a model of rewarding quality over quantity, the issue of how best to reimburse physicians is also taking a front seat. If not fee-for-service, then how best to judge and reward quality?

In this new value-based system of the future, some members of the medical community have been increasingly advocating for billing purely for time. In fact, over the years I’ve heard many doctors (usually …

Read more…

Why doctors shouldn’t bill for time

Malcolm Gladwell on our health care system

Robert Pearl, MD

Health Policy

March 17, 2014

Malcolm Gladwell hasn’t written much about American health care. But that doesn’t mean he hasn’t been thinking about it. And it sure hasn’t stopped many of his powerful ideas like “tipping point,” “outlier” and “blink” from gaining entry into the national health care debate.

In his most recent book, “David and Goliath,” Gladwell reshaped our perspectives on the underdog and highlighted our tendency to over-value certain strengths. In the health care …

Patients who come with a family member doctor

Natalie Azar, MD

Physician

March 17, 2014

“Never sign anything without me reading it first.”

Cautionary words from my husband, an attorney, whose ability to read and interpret the fine print has saved my life, so to speak, on more than one occasion. That all-in-the-family attitude toward a profession is something almost every doctor also knows well. Through me, my husband, relatives, friends, and sometimes acquaintances can get what I call a “healthcare quickie,” a free, two-minute sideline. They can …

People die without love: Why I prescribe the love drug

Pamela Wible, MD

Physician

March 17, 2014

As a doctor, it’s my job to figure out what patients really need. Some need antibiotics. Some need pain pills. But everyone needs love.

During medical school I cared for burned children. One of my patients was a 3-year-old with severe burns over most of his body. His roommate, an older boy, had just burned one arm. Yet the older child withered in the …

The doctor will see you now, or will she?

Rebecca E. MacDonell-Yilmaz, MD, MPH

Physician

March 16, 2014

My friend breathed a sigh of relief as she finished her last clinic visit for the day and headed down the hall to the physician workroom. It was only 5pm. She still had notes to write and labs to check, and as a senior resident she needed to make it back to the hospital wards to check on her team’s interns, to get updates on the afternoon’s events and help …

What spending time with critically ill patients taught me

Larry Istrail, MD

Medical Education

March 16, 2014

A hospital is not the homiest of establishments. The bright neon lights, strange smells and piercing high-pitched beeps that radiate from the rooms of dormant patients fill the halls in a symphony of annoying sensory stimulation. But to someone recovering from a relationship that just ended, hospitals are heavenly. When the lonely silence of your one bedroom apartment is overwhelmingly loud, beeping IV lines and incoherent mumbles are surprisingly therapeutic.

As …

Universal coverage remains a big deal

Philip Verhoef, MD, PhD and Stephen Kemble, MD

Health Policy

March 16, 2014

Recently JAMA published a special theme issue on critical issues in U.S. health care. Among the contributors was Dr. Ezekiel Emanuel, the oncologist, bioethicist and former White House adviser on health policy.

In his article, “Going to the Moon in Health Care: Medicine’s Big Hairy Audacious Goal (BHAG),” Emanuel argues that contemporary medicine is in need of vision, an overarching, aspirational goal “like going to the moon that can make …

Read more…

Universal coverage remains a big deal

The surge of physician membership in Congress

Brian Powers and Sachin H. Jain, MD, MBA

Health Policy

March 16, 2014

Physicians in Congress are on the rise. From 1960 to 2004, only 25 of the 2196 members of Congress were physicians. During an era that brought such fundamental changes to health policy as the creation of Medicare and Medicaid, physicians were disproportionately less likely to hold congressional office than their counterparts in law (979) and in business (298). In recent years, the ranks of physician-representatives have swelled — twenty physicians …

Imagine a physician-designed EMR

Israel Green-Hopkins, MD

Health Technology

March 16, 2014

The title itself should make us all cringe! If there’s one thing I know to be true, it is that putting clinicians at the helm of electronic medical record (EMR) design is doomed to create a product with limited scope and lack of forward-thinking trajectory. Yet, the concept of integrating and considering the physician point of view and workflow is critical to successful EMR functionality.

The question is how can clinician …

Read more…

Imagine a physician-designed EMR