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A growing culture of hostile dependency toward doctors

Wes Fisher, MD

Physician

June 22, 2013

An interesting phenomenon is occurring in media circles these days. No doubt others have seen it, too.

Lately, doctors are being schooled by the media.

From how to learn empathy, to improving communication with patients, the breadth and depth of what we should do for our patients is endless. Why, some even have our own colleague experts tell us how we should really do things.

These efforts, while probably well-intentioned, are patronizing. …

Gun control: Whether the means justify the ends

David L. Katz, MD

Physician

June 22, 2013

Doctors, psychologists, ethicists and others, along with our society at large, debate whether “the ends justify the means.” But nobody debates whether “the means justify the ends.” There is no point even looking for an answer to a question that is patently silly. For now, just hold that thought, please.

Medical ethics can be very challenging. There are the difficulties of interpreting “do everything” in desperate situations where heroic …

The Affordable Care Act is more of our broken health care model

Matt McCord, MD

Health Policy

June 22, 2013

Every week we read another article on the fuzzy math and ridiculous mark-up for our routine healthcare. Do your own research; see Elizabeth Rosenthal’s article in a recent Sunday New York Times, the $2.7 Trillion Medical Bill or Steven Brill’s lengthy tome in Time, Bitter Pill.

We spend, and will continue to spend, more on healthcare than any other nation in the world and yet we are 38th in …

Will health care price transparency help reduce costs?

Peter Ubel, MD

Health Policy

June 22, 2013

Getting your appendix out can cost between $2,000 and $180,000. Hip replacements run from $10,000 to more than $100,000. Hospitals, we have also learned, frequently mark up the price of cotton swabs and routine X-rays by 300 or 400 percent, with most patients oblivious to the reason their health care bills are so large.

As a response to the hidden variability in health care prices, an increasing number of states have …

MKSAP: A 56-year-old woman with a severe generalized headache

mksap

Conditions and Diseases

June 22, 2013

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 56-year-old woman is evaluated in the emergency department for sudden onset of a severe generalized headache that began 36 hours ago and has not responded to over-the-counter medications. The patient has a history of hypertension treated with lifestyle modifications. She has a 30-pack-year smoking history.

On physical examination, blood pressure is 148/68 mm Hg, …

No anesthesia resident left behind

Shirie Leng, MD

Medical Education

June 21, 2013

At a recent faculty meeting, we learned that the first year residents in anesthesia will now have to take and pass a written exam at the end of their first year. They will have a certain number of tries and if a resident can’t pass it by the third try they’re either out of the program or held back in some way.

Now, it used to be when I was a baby …

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No anesthesia resident left behind

The ER is a cost effective place to receive acute care

Angelo Falcone, MD

Health Policy

June 21, 2013

There is a persistent narrative about emergency rooms. This narrative says that emergency rooms are overly expensive places to receive healthcare, that they are a cost drain on the hospitals they are attached to, and that they are a key driver of rising healthcare costs.

A RAND study released recently challenges most of that narrative, and lends support to a view that most of us emergency physicians have long held: that …

A cautionary tale of employing doctors

David Mokotoff, MD

Health Policy

June 21, 2013

For all of those out there anticipating the 2014 official roll out of Obamacare, officially known as Affordable Care Act (ACA), here is a cautionary tale.

Many years ago, as I was growing my cardiology practice, it became evident that diagnostic services for my specialty, like stress tests and echocardiograms, were done less efficiently and cost more at the local hospital, than in the office. This stimulated many groups in the …

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A cautionary tale of employing doctors

A far more interesting lesson from the Oregon experiment

Ashish Jha, MD, MPH

Health Policy

June 21, 2013

It has been a couple of weeks since the landmark Oregon experiment paper came out, and the buzz around it has subsided. So what now? First, with passage of time, I think it is worth reflecting on what worked in Oregon. Second, we should take a step back, and recognize that what Oregon really exposed is that health insurance is a small part of a much bigger story about …

There’s not much to do but wait

Linda E. Clarke

Patient

June 21, 2013

From your perch in the coffee shop you watch a woman exit the big grey church across the street from the hospital. She’s young, probably not even 40, but she’s dressed like an elderly woman. She’s wearing a shapeless blue raincoat, heavy stockings and wide, steady shoes. Her rosary is looped around her fingers. Across from the church door there is a statue of the Virgin Mary against the fence. …

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There’s not much to do but wait

Most companies don’t consider the older medically complex patient

Leslie Kernisan, MD, MPH

Health Technology

June 21, 2013

What user personas do healthcare technology designers and entrepreneurs have in mind as they create their products? And how often is it the family caregiver of an elderly person?

This is the question I found myself mulling over as I wandered around the Health Refactored conference recently, surrounded by developers, designers, and entrepreneurs.

The issue particularly popped into my head when I decided to try Microsoft HealthVault after listening to …

A voice is missing from discussions of the patient experiences

Jessie Gruman, PhD

Patient

June 20, 2013

The demand for patient voices is on the rise as hospitals and dialysis centers, research teams and health care advisory groups face requirements to document our participation in governance and program decisions. And many of us have stepped forward to take on these roles.

Some of us do so as victims of horrific medical errors or uncoordinated care resulting in injury or from disrespectful care that undermines all confidence in health …

Can Republicans and Democrats agree on an SGR fix?

Bob Doherty

Health Policy

June 20, 2013

Getting rid of Medicare’s SGR formula has been organized medicine’s Holy Grail. But medicine has gotten no closer to finding a solution to the SGR than the medieval knights did in their search. This year could be different, though. The House and Senate both are working on bipartisan plans to repeal the SGR and reform Medicare payments, plans that are being developed with the input of physicians.

Yes, you heard that …

Can the fight against healthcare disparities be won?

Adrian Diaz

Medical Education

June 20, 2013

The summer before starting medical school I had the fortune of traveling to both Southeast Asia and Central America on humanitarian medical relief mission trips. I was initially exhilarated by the idea that I soon too will acquire the skills honed by the doctors, nurses, and other health care providers I was working with. The idea of mastering the science of healing had inspired me for so long, yet the …

A hospital transfer may not always be a good thing

Colin Son, MD

Physician

June 20, 2013

Injury to the brain continues to be a unique thing in medicine. These injuries are scary and unfamiliar to many health care providers. There is a finality to them. Their consequences are hidden a little bit; the asystole is easy to figure in the emergency room but the suppression and brain death isn’t something so easily recognized.

They’re what you might imagine, along with polytrauma, as poster child conditions for tertiarization …

The reality of medicine’s inherently unequal power dynamic

Abraar Karan, MD

Medical Education

June 20, 2013

As part of the first-year curriculum, medical students at the David Geffen School of Medicine at UCLA are required to attend chaplain rounds at local hospitals during which they accompany chaplains to offer spiritual care to patients. This is designed to encourage students to empathize with patients who are enduring difficult end-of-life issues and is part of a ubiquitous and important theme that inundates almost every medical student across the …

Being called to assist with an in-flight medical emergency

Ishani Ganguli, MD

Physician

June 20, 2013

Most doctors have a story about being called to assist with an in-flight medical emergency. I have yet to earn one for myself, but my favorite story – passed down from resident to resident – goes something like this: An airline attendant called for a veterinarian’s help. When no one answered, they settled for a doctor and an anesthesiology resident stepped up. He learned that a passenger traveling with her …

Will health reform address the racial disparity of the uninsured?

Brad Wright, PhD

Health Policy

June 19, 2013

For all intents and purposes, the Affordable Care Act (ACA), the president’s signature piece of legislation, will provide more health care coverage to poor and underserved populations. Persistently disadvantaged communities have much further to go than those with insurance, and new means of accessing and paying for care will benefit them disproportionately. Nevertheless, with more than 20 percent of the nation’s black population uninsured, more than 30 percent of Hispanics …

The problem with a negative BRCA test

Jan Gurley, MD

Conditions and Diseases

June 19, 2013

There is nothing so horrifying as when your doctor is too nice to you. During my first mammogram at Kaiser Permanente, I knew I had cancer before they even told me because of the hushed voices, the pats on my shoulder, and the way, suddenly, no one cared how much time was being spent on my visit. When that happens to you before the diagnosis is official, there is nothing …

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The problem with a negative BRCA test

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