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Primary care suffers from guideline overload

Paul Bergl, MD

Medical Education

November 21, 2013

In my 3 years of residency, the nearly universal resident response to outpatient continuity clinic was a disturbing, guttural groan. I recognize that many aspects of primary care drag down even the most enduring physicians. But I have also found primary care — particularly with a panel of high-risk and complex patients — to be a welcome challenge. I recently spoke with one of my institution’s main advocates for academic primary …

Getting the medicine right, but failing in the art

James C. Salwitz, MD

Conditions and Diseases

November 21, 2013

When a patient leaves you for another physician, they simply cancel their appointments. You might get a message that says they are moving on and, two months later, you get a follow up letter from the new doctor.

However, Sam was unusual. He came in to tell me that because of my mistakes, his wife was transferring her care. What made our confrontation remarkable was that Sam was wrong.

I had recommended that …

The ethics of paying living kidney donors

Ruth Macklin, PhD

Conditions and Diseases

November 20, 2013

The very idea of living individuals selling body parts prompts revulsion in some people, while others may ask whether the price is right.

A recent nbcnews.com article reported on an organ-transplant study conducted by Canadian researchers. It began with this finding: “Paying living kidney donors $10,000 to give up their organs would save money over the current system based solely on altruism—even if it only boosts donations by a conservative 5 percent.”

Actually, the …

Do safety scalpels reduce the risk of injury?

Skeptical Scalpel, MD

Conditions and Diseases

November 20, 2013

pro_safety_scalpel

A Twitter follower wrote me this: “Hospital making me use ‘safety scalpel’ w/retractable sheath. I’ve almost cut myself x 2. Do you know of any data about it?”

That got me interested because I like to question things. Was this going to be yet another rule without evidence?

I thought I would have to do an exhaustive search to see if anyone had ever …

What is the best metric to measure a hospital?

Michael Cetta, MD

Health Policy

November 20, 2013

If you had to pick a single metric to a measure a hospital, which would you choose?

Of course, you can’t boil everything about a hospital down to one, single data point. Defining quality, throughput, and other factors used to evaluate a hospital is difficult business. The Centers of Medicare & Medicaid Services (CMS) tracks dozens of core metrics related to both quality and process, both inpatients and outpatients. As a practicing …

Generic drugs play a central role in reining in health care spending

Naomi Freundlich

Medications

November 20, 2013

It was a huge relief to Carol Thompson in 2011 when her breast cancer drug Femara (letrozole) went off patent and became available in a generic version. With a high deductible in her private insurance plan, Thompson was forking over $450 for a month’s supply of the life-saving drug. After the generic hit the market she was thrilled to find letrozole available for just $11 a month at Costco. But …

How will repealing the SGR affect your practice?

Margalit Gur-Arie

Health Policy

November 20, 2013

The sustainable growth rate (SGR) formula was enacted into law in 1997 to tie Medicare payment for services to physicians to the overall status of the economy. Basically, if the U.S. gross domestic product (GDP) does well, doctors get more money, and if it does poorly, doctors get less money for the same service. A decade of tinkering with legislation for circumventing the application of the SGR formula, preferably a few days …

Stopping the threat of drug resistant bacteria

Roy Benaroch, MD

Medications

November 20, 2013

Well, this isn’t good news.

The CDC has compiled an extensive report of the top US health risks from infections. Called “Threat Report 2013,” their evaluation shows that the three most worrisome risks have all been created by our own indiscriminate overuse of antibiotics. The biggest baddies:

Carbapenem-resistant Enterobacteriaceae. The carbenapenem antibiotics were first developed in the 1970s and grew into wide use in the late 1980s. They had been the biggest, baddest …

It’s time for anesthesiologists to be real doctors

Shirie Leng, MD

Physician

November 19, 2013

I have written a good amount about automation, the good, the bad and the ugly. I have written about doctors and ancillary providers and physician extenders, also good, bad and ugly. A recent comment on Karen Sibert’s excellent blog A Penned Point caught my eye as an amalgamation of these subjects.

This person wrote, and I hope he doesn’t mind my quoting him:

American anesthesiologists should focus much more on becoming true …

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It’s time for anesthesiologists to be real doctors

The focus on patient satisfaction is enough to make you sick

BirdStrike, MD

Physician

November 19, 2013

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All patients should be treated with professionalism and respect. We all want our patients leaving our care happy, healthy and satisfied, if at all possible. However, sometimes patients don’t leave an emergency department very happy or satisfied. Sometimes the doctor could have prevented it, but many if not most times, such dissatisfaction has little if anything to do with what the …

Introducing the palliative care ICU

Jordan Grumet, MD

Physician

November 19, 2013

I think we are overly limited by our descriptive terms. We throw around concepts like hospice and palliative care, but in reality the medicine I practice is much more a hybrid. Many of my patients are elderly, demented, and plagued by metastatic disease. Often when one of them becomes ill, it is unclear if they are merely treading water, or about to drown. The problem with our modern definitions is that they leave little …

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Introducing the palliative care ICU

Will PSA screening be an ethical tragedy in the future?

John Schumann, MD

Conditions and Diseases

November 19, 2013

The New York Times ran a fascinating piece about a dusty old medical experiment that was brought back to life recently after one of its perpetrators — err, researchers, decided to come clean to a medical historian after having read the book The Immortal Life of Henrietta Lacks.

The unnamed confessor was a surgical resident in the 1950s under Dr. Perry Hudson, the man in charge of the experiment. Dr. Hudson …

Embrace failure to succeed

Rob Lamberts, MD

Physician

November 19, 2013

Things are going well with the practice, but I am being wrung a bit dry. That’s the reason for my dip in writing. I am putting a lot of energy and emotion into the practice, and I don’t have a whole lot left at the end of the day. I have always been one to write out of passion and convictions — I write because I believe what I am …

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Embrace failure to succeed

Lessons from the polio outbreak in Syria

Albert Fuchs, MD

Conditions and Diseases

November 19, 2013

If you remember the 1950s you probably remember the terror of polio. Polio, short for poliomyelitis, is a disease caused by a virus which can cause severe inflammation of the spinal cord. Though most infected people have no symptoms, a small fraction of patients are left with permanent paralysis and deformities. The disease is sometimes fatal. In the US, the 1952 polio epidemic killed over 3,000 people and left over …

Why physicians are hesitant to take Medicaid patients

Peter Ubel, MD

Health Policy

November 18, 2013

In an earlier post, I presented some data on which kind of physicians in the United States are most and least likely to see new patients who receive Medicaid, the state/federal program to pay healthcare costs for low income people. Now a recent study lays out some reasons why many physicians are so reluctant to see such patients.

Not surprisingly, it starts with low reimbursement rates. Medicaid pays about 61% …

You can now keep your plan: What does this mean for you?

Brad Wright, PhD

Health Policy

November 18, 2013

The president, by his own admission, did “fumble the ball” on the rollout of the major elements of health reform implementation. Not only is Healthcare.gov not functioning as it should, but people in the individual market are having their health insurance coverage cancelled–despite repeated assurances that if they liked their current coverage, they could keep it.

While that is absolutely a problem, it needs to be put into perspective. For …

Why quality doesn’t affect hospital CEO pay

Ashish Jha, MD, MPH

Health Policy

November 18, 2013

In my previous blog, I made the argument that whatever strategy we use to improve care in hospitals will not be implemented and executed well without proper focus by hospital leadership. So, it is in this context, that we recently published some pretty disappointing findings that are worth reflecting on.

We examined the pay of CEOs across U.S. hospitals and found that some CEOs got paid a lot more than others. This …

What Healthcare.gov can learn from the Challenger shuttle disaster

Wes Fisher, MD

Health Policy

November 18, 2013

By now, the Obamacare insurance exchange debacle is old news. Our attention spans are so short, we’re on to the next disaster. So we sit before our TVs and enjoy the Humana ads with a smiling senior pointing to a whiteboards with their insurance plan name, or watch the news sponsored by UnitedHealthcare or Walmart’s pharmacy department. Everyone’s got a cheaper plan these days with more benefits than the other …

Is Obamacare paternalistic?

Bob Doherty

Health Policy

November 18, 2013

Dr. Bob Centor, author of the always provocative and thoughtful DB’s Medical Rants, suggests that the deep divide over the Affordable Care Act is based on “a major philosophic disagreement” over the respective roles of government and of individuals in choosing what is best for them:

The administration and their supporters believe that government’s job is to protect citizens from their bad choices. They want to decide what the people need and …

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Is Obamacare paternalistic?

California offers clues to the future of the Obamacare exchanges

Robert Laszewski

Health Policy

November 18, 2013

Covered California, the state-run Obamacare health insurance exchange, announced recently that 59,000 people have so far signed up for health insurance.

Given that California amounts to about 10% of the nation’s population, this would suggest a smooth running federal exchange might well have enabled the Obama administration to have met its national first month goal of 500,000 sign-ups.

But the California enrollment also points to the real challenge Obamacare faces.

In the first …