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The largest barrier to achieving humanistic nirvana in medical care

Physician

April 14, 2013

The dictionary defines humanism as “a system of thought that centers on humans and their values, capacities, and worth.” No sector of the economy comprehends this definition better than a small business. In a sea of competition, the small business whose primary focus strays from its customer’s best interests will surely sink. Those with business experience will undoubtedly attest that, whether in a hair salon or restaurant, a happy customer …

With health reform, flexibility is important

Rob Burnside

Patient

April 13, 2013

Flexibility is important these days, perhaps more than ever before. I’m reminded of this almost every time I order lunch at a fast food joint: “I’d like a double cheeseburger, please, with ketchup only.” “You mean ‘only ketchup,’ don’t you?” “Okay, a double cheeseburger with only ketchup.” “Right, got it, coming up!”

So many changes on the medical care horizon and everyone speaking a slightly different language — it’s bound to …

America’s health system is dangerously out of balance

Brian Klepper, PhD

Health Policy

April 13, 2013

For a large and growing number of us with meager or no coverage, health care is the ultimate “gotcha.” Events conspire, we receive care and then are on the hook for a car- or house-sized bill. There are few alternatives except going without or going broke.

Steven Brill’s recent cover story clearly detailed the predatory health care pricing that has been ruinous for many rank-and-file Americans. In Brill’s report, a key mechanism, …

If you build a patient portal, why won’t they come?

Steve Wilkins, MPH

Health Technology

April 13, 2013

I hate saying I told you so. But “patient engagement is a physician-patient communications challenge and not an HIT (health information technology) challenge.”

Just take a look at the Mayo Clinic’s patient portal experience which was discussed at a HIMSS 2013.

The headline: “Mayo Clinic struggles to meet stage 2 meaningful use thresholds for engaging patients.”

Always innovating, the Mayo Clinic some three years ago introduced a web-based portal to share information with …

Health reform faces tension with integrated health systems

Kevin Pho, MD

KevinMD

April 13, 2013

kaiser permanente

The following column was published on March 26th, 2013 in the New York Times’ Room for Debate blog.

In the coming years, health care reform will drive consolidation in the industry. Reformers, including the president himself, point to integrated health systems like Kaiser Permanente as the future of health care delivery. While this movement may improve patient care, whether it will shield …

MKSAP: 19-year-old woman with bilateral leg weakness

mksap

Conditions and Diseases

April 13, 2013

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

A 19-year-old woman is admitted to the hospital because of a 2-week history of bilateral leg weakness and numbness accompanied by urinary incontinence that began after a viral gastrointestinal illness of 3 days’ duration. She has no personal or family medical history of note and takes no medication.

On physical examination, temperature is 36.7 °C …

The power of words in guiding patients toward recovery

Joyce Hyam, RN

Patient

April 12, 2013

Just three words, a short phrase, heard from an ICU nurse that changed my friend’s well-being as she lay in an ICU bed. In fact, it is the only phrase my friend remembers from her entire hospital stay after having brain surgery to remove a tumor.

She was experiencing nausea, a sick feeling, and needing and wanting care, direction, and guidance from hospital staff. And three powerful words spoken from a …

The Physician Payment Sunshine Act is here: Are you ready?

Jeremy Lazarus, MD

Health Policy

April 12, 2013

A guest column by the American Medical Association, exclusive to KevinMD.com.

Information is a source of learning. But unless it is organized, processed and available to the right people in a format for decision making, it is a burden, not a benefit.

-Former ServiceMaster CEO C. William Pollard

The new Physician Payment Sunshine Act (Sunshine Act) was created by Congress to ensure transparency in physicians’ …

Change the warfare metaphors when it comes to illness

Rob A. Ruff

Patient

April 12, 2013

The metaphor we use, almost universally, to describe the experience of illness is that of warfare. Someone diagnosed with cancer is said to be “battling” cancer (as if the diagnosis itself implies a fight). Family members often say that their hospitalized loved one is a “fighter” who “will never give up” or surrender. Doctors refer to the most potent antibiotics as “big guns” that are prescribed to “kill the bugs” …

The patient experience can be dehumanizing

Joyce Ho, MD

Physician

April 12, 2013

Being a clinical student is not a walk in the park. When we get together for “Reflections on Clerkship” days every two months in our small groups, students let the floodgates open about the hardships they have been facing on rotations. I am no exception. Transitioning to a strict schedule in the hierarchical world of academic medicine has been no small feat. In fact I was planning earlier this morning …

The male gynecologist: Tips to connect with female patients

Suzanne Hall, MD

Physician

April 12, 2013

With all due respect to the many caring, compassionate, and skilled male OB/GYN physicians out there, we’d be amiss in ignoring the research showing a near majority of younger women preferring a female gynecologist. Some call this reverse discrimination in gynecology. I’d more simply call it patient preference. The bigger question is, “Where does this leave the male gynecologist?”, especially in a current marketing climate promoting the “female only” OB/GYN …

Walgreens moves into primary care, and it’s our own damn fault

Kevin Pho, MD

KevinMD

April 12, 2013

Will your next primary care appointment be at a drugstore?

Yes, if Walgreens can help it.

It was recently announced that the drug chain will have its nurse practitioners and physician assistants begin to diagnose and manage chronic conditions, such as hypertension and diabetes.

“We’re not trying to take over primary care, but we think we can help support physicians and transform …

Increasing the role of nurse practitioners in the inpatient setting

Gene Uzawa Dorio, MD

Physician

April 12, 2013

We are fortunate in our country to have the best medical technology in the world. Unfortunately, delivery of this technology, reflected in a worldwide healthcare ranking of 37th, is a disservice to the American people and must be rectified especially when Cuba is ranked 39th.

As provisions of the Affordable Care Act are put in place, a daunting factor is the shortage of doctors who will be needed to provide this …

Beauty in surgery: Traction and counter-traction

Sid Schwab, MD

Physician

April 11, 2013

Next in a continuing series.

Traction and counter-traction: along with maintaining excellent exposure, that is one of the fundamental principles of operating. It’s Newtonian: equal and opposite. In nearly all forms of surgical dissection, there’s a need for some pull in the opposing direction: tissues that are a little stretched-out, that are under some tension, fall open more easily when dissected. Plus, it’s a form of stabilization, another obligatory …

Tiger Woods and the pre-med gunner mentality

Ryan Gray, MD

Medical Education

April 11, 2013

What can Tiger Woods teach us about pre-med competition and the medical school gunner mentality? A lot.

I was recently watching Tiger’s latest win, his 76th win on the PGA. Tiger was dominating the competition, not unlike your classmate in your organic chemistry or biochemistry class that just crushes every test and sets the curve for everybody else.

What was different about this …

Sharing my loss helped a patient’s loss

Paul Rousseau, MD

Physician

April 11, 2013

“I want everything done. Please, Dr. Rousseau, do everything. We have two children–they can’t be without their father. Do you understand? Do what it takes to keep him alive!”

Angie, a petite woman with long blonde hair, fixes me with piercing blue eyes. Her husband, Joe, fifty-two, has scleroderma, an autoimmune disease. In its most devastating form, it hardens the skin and destroys the kidneys, heart and lungs.

Joe is dying of …

Read more…

Sharing my loss helped a patient’s loss

Patients who are in denial may be doing themselves harm

Miranda Fielding, MD

Physician

April 11, 2013

If you desire healing,
let yourself fall ill
let yourself fall ill.
–Rumi

Yesterday I saw a patient—an 80 year old woman with metastatic cancer involving her bones. She had near complete replacement of her twelfth thoracic vertebra by tumor, and also significant destruction of her fourth and fifth lumbar vertebrae, demonstrated by PET-CT scan and bone scan.

She had so much pain in her legs that it was difficult to walk. In …

Why this doctor is compelled to write

Davis Liu, MD

Physician

April 11, 2013

As a doctor, I am compelled to write because of what I know is occurring with alarming frequency in our country. Americans are skipping needed and recommended care that could save their lives and allow them to live to their fullest. Patients are more distracted, as life is more complicated and busier than ever. Households have both parents working, sometimes two jobs, just to make ends meet. They easily would …

Read more…

Why this doctor is compelled to write

Roger Ebert did not lose his battle with cancer

Michael A. Wosnick, PhD

Conditions and Diseases

April 11, 2013

I was very saddened to learn of the death of Roger Ebert. I, like so many around the world, was impressed and inspired at how he handled himself in the aftermath of his cancer surgery years ago that left him disabled and disfigured and unable to eat, drink or speak. And yet, despite his struggles he remained a dominant force in film …

The New York Times gets it wrong on health IT

Robert Wachter, MD

Health Technology

April 11, 2013

I’m well aware that a good fraction of the people in this country spend their lives furious at the New York Times. I am not one of them. I love the Grey Lady; it would be high on my list of things to bring to a desert island. But every now and then, the paper screws up, and it did so in a big way in its …

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