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The New York Times takes a cheap shot at specialists

Wes Fisher, MD

Health Policy

January 22, 2014

Most of us would agree that health care costs are too high in America. They must be controlled or else we won’t have a sustainable health care system here. And we should acknowledge that, on average, all doctors in America are paid higher than their overseas counterparts. But we should also agree that expenses for doctors to earn a degree, maintain that degree and licensure, and pay their malpractice premiums …

How to proceed if patients push back

Starla Fitch, MD

Physician

January 22, 2014

Before any patient can go to the operating room, they need medical clearance from their primary physician. I look at this as a good thing.

Occasionally, a routine chest x-ray reveals lung cancer. Or, blood work shows abnormal values that point toward leukemia.

The bottom line for me is that I never argue when a primary care physician or specialist, such as a cardiologist, says the patient is too sick to have …

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How to proceed if patients push back

It’s never too early to talk about cost-conscious care

Allan Joseph

Medical Education

January 22, 2014

Pretty much every conversation I’ve ever had about working to change physician culture boils down to two words: “medical education.” That was especially true at the 2013 Lown Institute Conference, which focused on the issue of right care: eliminating harmful overuse and harmful underuse. This comes down to reforming the way today’s physicians practice — eliminating the ordering of expensive tests and treatments that provide little to no benefit to …

Who is keeping Marlise Munoz on life support against her wishes?

Jennifer Gunter, MD

Physician

January 21, 2014

Brain death is death. This is one of the definitions of death. Even in Texas.

Because brain death is death, a do not resuscitate (DNR) order or invalidating a DNR are both meaningless, because you don’t do procedures on dead bodies. This is why taking someone off a ventilator who is brain dead is not homicide, assisted suicide, or even following a DNR, it is simply the cessation of forcing air into a …

What if the uninsured don’t buy Obamacare?

Robert Laszewski

Health Policy

January 21, 2014

Now that consumers can generally make an efficient health insurance purchase at Healthcare.gov and most of the state-run exchanges, we can finally get to the real question.

Are the healthy uninsured going to buy it?

The big health insurance changes Obamacare made to the individual and small group market were arguably done in order to get everyone, sick and healthy, covered in a more equitable system.

To be clear, no one I know …

5 ways to change patient behavior

David Lee Scher, MD

Patient

January 21, 2014

It is no secret that one of the best ways towards better health management is a good physician-patient relationship. There needs to be buy in from both participants to shared decision-making. One might object to the title of this post, stating that it puts the biggest burden on the patient, however when examining how this is achieved, you will, I hope, feel differently.

1. Establish a relationship. This might sound trite, but the first few …

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5 ways to change patient behavior

Learning from patients on a speaking tour

Leana Wen, MD

Physician

January 21, 2014

One year ago, my book, When Doctors Don’t Listen: How to Avoid Misdiagnoses and Unnecessary Tests, was published. My goal in this last year has been to travel around the country and talk about the book and its message of advocating to improve your health. I planned a 48-city itinerary where I’d crisscross the U.S. from Massachusetts to California and back. I’d speak at bookstores, libraries, nursing homes, universities, and community …

3 ways parents can partner with their pediatricians’ sex talks

Natasha Burgert, MD

Conditions and Diseases

January 21, 2014

A recent study in JAMA Pediatrics discovered that conversations about sexual health between a health provider and a teen patient are shockingly short (less than 40 seconds), full of bland yes/no answers, and more likely to occur if the patient is older. The research has put a glaring light on the need for better sex education opportunities during routine teen health visits.

I believe all teenagers deserve …

Illness can redefine you

Stewart Decker

Conditions and Diseases

January 20, 2014

I’ve made a huge mistake, I thought.

The fever had come back. The fever had come back, and I was stuck on a bus. The first of five buses, actually…

I am a fourth-year medical student, but right now I’m a long way from home. I am spending a year in South America, studying international public-health issues by working in emergency rooms, non-governmental organizations (NGOs), social projects and surgical suites.

When this story …

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Illness can redefine you

Keep the faith, but get the data

David L. Katz, MD

Physician

January 20, 2014

As a scientist with a brain naturally inclined to skepticism and analysis, I suppose my spiritualism may be best captured by: Keep the faith, but get the data. While some of my fellow skeptalytics, if I may coin such a term to catalog us, may be inclined to renounce that first clause altogether, thinking there is no need for faith, I am obliged to disagree.

We are all a mass of electrons …

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Keep the faith, but get the data

Let’s learn from No Child Left Behind: Measuring quality in healthcare

Luis Collar, MD

Health Policy

January 20, 2014

As we address the issue of quality in healthcare, there is much to be learned from other industries. I believe our current approach, though, is a dangerous one, one that won’t yield the desired results. Thus far, we’ve approached quality assurance as if healing were an industrial process, a process similar to those that yield cars, air conditioners, or even cheeseburgers.

But in an age where science, technology, and health policy …

The unidentified cause of one man’s hypertension: Racism

Pamela Wible, MD

Conditions and Diseases

January 20, 2014

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Meet Damien, my Facebook friend, photographer, and IT guy.

This morning, he messages me: “I would like to make an appointment.”

I reply: “For?”

“High blood pressure.”

I offer to see him, but he never comes in. Weeks later, he writes, “I got busy Pam. How are you? High blood pressure pills keep making me sick. I am doing the best I can. On bad …

Balancing the physician work force: It takes more than money

Richard Young, MD

Health Policy

January 20, 2014

Here we go again. There is yet another round of evidence of how the physician workforce hole we’ve dug for ourselves keeps getting deeper, but there has been still no substantive payment reform on the government side (Medicare/Medicaid) or the private payer side.

One recent study appeared in Academic Medicine. Clese Erikson and colleagues surveyed a random sample of 4th-year medical students in 2010. Only 13% of the students stated they …

Patient portals for hospitalized patients: Do they make sense?

Suneel Dhand, MD

Health Technology

January 20, 2014

Patient portals are very much the future of health care. Having easy access to ones’ medical history, diagnoses, and test results, seems like such a natural thing that it’s hard to imagine that only a couple of decades ago medical information was regarded as private for the physician’s eyes only.

Of course, the Internet and technology revolution has taken this concept to a whole new level. Health care organizations across the …

The wishes of the patient and family versus fetal rights

Ruth Macklin, PhD

Physician

January 19, 2014

Numerous strategies by antiabortion groups to curb women’s constitutional right to abortion are frequently reported in the news, and come as no surprise. However, a recent development illustrates novel circumstances in which people are using legal maneuvers to conspire to restrict medical decisions by patients and their families even when the right to abortion is not at issue.

On January 8, 2014, a front-page story in the New York Times Read more…

The wishes of the patient and family versus fetal rights

Public awareness of C. difficile must rise

Christian John Lillis

Conditions and Diseases

January 19, 2014

Most bacteria never have a breakout year. But when the nerve center for the nation’s fight against deadly diseases last fall ranked C. diff. first among the three most “urgent” threats to public health, an overdue spotlight shone on an epidemic that much of the press overlooked for decades.

Scientists at the Centers for Disease Control and Prevention (CDC) weren’t the only ones calling attention to the threat from C. diff last …

Beyond Dr. Google: How new technologies will affect patient-provider relationship

Fard Johnmar

Patient

January 19, 2014

Here are a few words some physicians and medical professionals have used to describe patients who have turned to Dr. Google for information and advice on their medical conditions: irritating, suspicious, distrustful and challenging.

Perhaps frustrated with physicians’ continued resistance to Internet-empowered patients, Dr. Kevin Pho urged them to “deal with” the fact that patients “Google their symptoms.”

But, we all know the Internet-informed patient is old news. I’m here with …

Why the Oregon Medicaid study ultimately won’t matter

Angelo Falcone, MD

Health Policy

January 19, 2014

2014 has dawned, and with it more than 2.1 million people have new health insurance under the Affordable Care Act. This, as they say, is where the rubber meets the road. But a new study out of Oregon is challenging a key argument for extending health insurance to millions: that doing so will reduce costly emergency room visits.

The study in question showed that when health insurance was extended to Oregon residents …

We should not succumb to spiritual darkness

Afshine Ash Emrani, MD

Physician

January 19, 2014

It was the first time I had every flunked a test. My fragile ego was shattered. It was my first year at University of California, San Diego School of Medicine, one of the most difficult to enter. I failed my pharmacology test, not because I was stupid, not because it was difficult, but because I was clinically depressed.

A dark cloud covered my head and I could not see. Much of my …