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Scripting with patients is a silly game

Edwin Leap, MD

Physician

March 15, 2013

Our nurses will soon have “scripting” guidelines for their interactions with patients. This is apparently widespread in many industries. The idea being, patients will be more satisfied with their care if certain key phrases are repeated to them; phrases which might, possibly, just maybe find their way onto satisfaction surveys. Wink, wink!

Whether I will have to engage in this tawdry bit of theater remains to be seen. But bless the …

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Scripting with patients is a silly game

The fine balance between hope and cope in cancer patients

James C. Salwitz, MD

Physician

March 15, 2013

At tumor board recently, we discussed what we tell our patients about prognosis. Some oncologists give detailed information, including specific survival times. Others never discuss the future, and let the events of the illness teach patient and family. All try to adjust what they say by what the patient needs, because each physician expressed one core goal; “Whatever I say I don’t want the patient to lose hope.” I thought …

How to avoid becoming a gunner in medical school

Wayfaring MD

Medical Education

March 15, 2013

gunner: a pre-med or medical student who is ambitious to a fault. They often throw other students under the bus, put their accomplishments and grades on display, and generally make life miserable for any student who they perceive to be a threat to their own success. In short, they are what Hermione would be if she was a Slytherin.

On my blog, I am fairly vocal about my disdain for gunners. They …

Health reformers fail to hold patients accountable for health costs

Kevin Pho, MD

KevinMD

March 15, 2013

To cut costs in our health system, reformers target the massive of waste. One way to reduce waste is to change the way doctors are paid. The fee for service payment system, they say, encourages doctors to prescribe more expensive care, which lines their pockets and drive up the cost of care.

To combat this trend, reformers often have providers in their crosshairs, …

The act of incising human flesh is never routine

Sid Schwab, MD

Physician

March 15, 2013

Next in a continuing series.

The preliminaries are over. Sponges, needles, and instruments have been counted and checked, their number recorded on a whiteboard on the wall, as well as a clipboard. The checkoff is a comforting hum of words; the tuned machinery of the workplace. As the bottle of local is opened and poured into a sterile bowl on …

The key for patient satisfaction is physician satisfaction

Dike Drummond, MD

Physician

March 14, 2013

In these early days of pay for performance (P4P) reimbursement, as the size of your paycheck begins to reflect your patient satisfaction scores, let’s have a frank discussion about three important topics all healthcare providers and organizations must understand going forward.

How your performance will be measured
How to get the highest patient satisfaction scores and be a happier doctor at the same time
The first step to improving performance …
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The key for patient satisfaction is physician satisfaction

When doctors don’t know the cost of medical care

Benjamin Robbins

Physician

March 14, 2013

The Saturday after Sandy hit, I was the medical student in a Cambridge, Massachusetts emergency room. Around the time my shift started, Andrew, a man about my age, couldn’t bear the pain in his nose any longer. The ED nurse still talks about the “huge booger” bulging from his nose. A few days before coming to the ED, he’d left behind his flooded, powerless Brooklyn apartment seeking refuge in his …

My workflow for going through old paper charts

Leslie Kernisan, MD, MPH

Physician

March 14, 2013

A few months ago I wrote a post about the 159 page digital fax that I received, containing records for a patient’s recent lengthy hospitalization.

I’ve now discovered something even more time-consuming and annoying: a 202 page paper record mailed to me by a major medical system. (I won’t name names right now; suffice to say this system uses Read more…

My workflow for going through old paper charts

The importance of saying goodbye at the end of life

Don S. Dizon, MD

Physician

March 14, 2013

An email was waiting for me one morning from my wonderful nurse, Laura. “Very sad day,” it said in the subject line. I opened the email quickly upon receiving it and read that one of my patients had died. This age-old dilemma again made me wonder what I should do: Should I call the family? Send an email or a card …

Why the primary care physician shortage is overblown

Peter Ubel, MD

Physician

March 14, 2013

Are there really too few primary care physicians? And if so, what can we do to solve the PCP shortage? The standard answer to the first question is “yes, we have too few PCPs.” And the standard solution is to train more such docs, or allow more foreign-trained primary care docs into the country or, better yet, simply pay PCPs more money, so that graduating medical students will be more …

10 ways to make EMRs more doctor-friendly

Shirie Leng, MD

Health Technology

March 13, 2013

Today I’m doing anesthesia for colonoscopies and upper GI scopes. Nowadays we have three board-certified anesthesiologists doing anesthesia for GI procedures every single day at my institution. I’ll probably do 8 cases today. I will sign into a computer or electronically sign something 32 times. I have to type my user name and password into 3 different systems 24 times.

I’m doing essentially …

Is this the year Congress repeals the SGR?

Bob Doherty

Health Policy

March 13, 2013

An elderly doctor passes away, and he find himself standing before the Pearly Gates. The Almighty greets him and says, “In recognition of your stellar life of service to your patients, family and community, I welcome you to paradise. And because I know that doctors have a great sense of curiosity about all things, you can now ask me any question—any—and I will answer it.” The doctor ponders for a …

Doctors: Pronounce the names of your patients correctly

Deep Ramachandran, MD

Physician

March 13, 2013

I have it on good authority that it’s not easy being green. But I’m willing to wager that it’s a whole lot easier when you have a lovable name like “Kermit.” Imagine being green (or brown) with a name like “Ramachandran”? Growing up with a name like mine certainly had its disadvantages. While most neighborhoods have a local bully who kicks ass and takes names, in my case, he would …

Death by voluntary cessation of fluids and nutrition needs discussion

Jim deMaine, MD

Physician

March 13, 2013

Amour 2

If you haven’t seen the movie, “Amour”, but are planning to, you might want to skip this commentary – but by all means do go!

It starts and ends with love, but not in Hollywood’s usual youthful romantic fashion. It also starts and ends with death after much caring, love and suffering. The agonizing toll on the patient and caregiver are equally …

ACP: 5 excuses physicians and patients should question

Yul Ejnes, MD

Physician

March 13, 2013

A guest column by the American College of Physicians, exclusive to KevinMD.com.

Whether we call them “unnecessary,” “not indicated,” “inappropriate,” or “overused,” certain tests and procedures add little or no clinical benefit to patients and in some cases they cause harm. They also contribute to the cost of care without improving care. At a time when payers are challenging payment …

Home genetic testing raises more questions than answers

Lucy Hornstein, MD

Physician

March 12, 2013

A reader recently wrote:

My [spouse] and I are 63 and childless. We are thinking of spending $99 to get genetic screening on the theory that it could help us plan a little better for our old age. Just as a random example, if I knew my chances for getting Alzheimer’s disease were high, I might want to move into assisted living sooner rather than later. We have many questions. Is …

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Home genetic testing raises more questions than answers

Why malpractice reform will happen, whether lawyers like it or not

Wes Fisher, MD

Physician

March 12, 2013

A collision is coming.

Scratch that.

The collision is here.

I’m not quite sure how to describe this, but I’ll try.

Every day, I look at a computer screen for health care delivery with an increasing number of menu options. I tried counting these menu options once and after scrolling through them, I never reached all of them after counting up to 275 items.

Yes, there are …

Working in an urgent care center: An assault on the soul

Richard Young, MD

Physician

March 12, 2013

I recently received this email message from one of my residents who has moonlighted in a local commercial urgent care center. This message is reprinted with his permission just as I received it, except I removed the brand name.

Hey Dr. Young, I’m looking for some basic mentoring advice. I’ve been moonlighting at ZZZ Urgent Care for about a year. Not my favorite work, but oh well. I don’t routinely prescribe antibiotics …

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Working in an urgent care center: An assault on the soul

Is a winning health reform strategy best for patients?

Joe Flower

Health Policy

March 12, 2013

Rapid change is engulfing health care across the United States, but the strategic responses of organizations to these changes are sharply divided. In the shift that has been broadly shorthanded “from volume to value,” many organizations across the country are deeply engaged in moving toward “value” by building new partnerships, affiliations, capacities and economic structures, striving to bring better health and health care to more people for less money.

At the …

Lessons from starting a new practice from scratch

Rob Lamberts, MD

Physician

March 12, 2013

Since I started my new practice, it’s been an über hectic and very draining time, but I am happy to report that the end of the week was significantly better than the beginning.

Here are some things I am learning.

1. Starting a business is really, really hard. I did my best to make my business as simple as possible, mainly because I understand my own deficiencies when it comes to business-related activities. …

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