A doctor in our area was recently indicted for allegedly running a “pill mill”. According to local news reports, patients were recruited to come in and ask for narcotics and the doctor received massive cash payments to write the prescriptions. After the guy was nabbed, his patients (the real ones and the others) spread out in the community looking for new doctors to take care of them (or to write …
Doctors don’t get investigated for being quacks
Suffering from chronic pain or illness—or, as is often the case, both—can feel like a full-time job. One reason for this is that we must constantly assess and evaluate if we’re managing our health and our relationships as skillfully as possible. This ongoing decision making makes up a major part of the workload in this full-time job—a position we certainly never applied …
Being chronically ill or in pain can feel like a full-time job
A response to The creative destruction of the American family physician.
Dr. Brooks’ column shines a bright light on the misconception that some subspecialists have about the core of primary medical care and family medicine. As a former nurse practitioner and current family physician, I’d like to point out the flaws of his argument.
At a time when the health care community is working to end the fragmentation, duplication and gross …
Destroying the family physician: An AAFP member responds
My cardiologist recommended I get a stress echocardiogram so he could rule out the cause of some new symptoms. After I had scheduled the test, I realized that some of my other doctors should have a record of this test. But whose scope of concern would include these troubling symptoms? Probably at least three of them: my primary care physician, my survivorship …
Compensating for the lack of progress in EHRs
My book, co-authored with Susan Gay, is now available: Establishing, Managing, and Protecting Your Online Reputation: A Social Media Guide for Physicians and Medical Practices.
It is available at Greenbranch Publishing, in print or e-book, as well as Amazon.
I sincerely appreciate the following media stories and interviews discussing the book.
Managing your online reputation: Media coverage of the new book
I was changing my daughter’s diaper the other night when I noticed some spots. There was a cluster of six or so around her belly button and a line of them tracing her bottom rib on the right. They were reddish-brownish-purple pinpoints and when I pressed on them, they did not blanch. She did not seem bothered by them at all. I, on the other hand, began to quietly freak …
The reality of illness at work and the reality of wellness at home
As I have mentioned before, all surgeons think they are the best. Of course when we ourselves need surgery, there is a bit of a dilemma deciding who is the best qualified to carry out the procedure. So when I realized there was a strange looking skin lesion in my right inner thigh, I decided only the best would do to operate me.
In my rooms I informed the sister I …
Operating on myself: What could possibly go wrong?
There is an epidemic of gun violence. This is a serious health problem. Watching your diet, exercising, and taking pills is all for naught if a bullet kills you.
In Newtown, Conn., one of the worst mass shooting occurred last week when a gunman shot his mother at home, apparently with her own gun, then walked into an elementary school and shot six other adults and 20 children, before shooting himself. …
Minimize the tragedy of gun violence
Use of generic drugs has the potential to reduce annual consumer spending on prescriptions by billions. A study published in the New England Journal of Medicine and discussed in the New York Times’ Economix blog in 2012 looked at Medicare Part D expenditures and correlated them with drug prescribing patterns. The regions of the United States with the highest Medicare expenditures were those where …
Are generic drugs as safe and effective as name brand drugs?
For just a moment, let’s take a scientific viewpoint about gun control here and try to leave emotions (and the Constitutional argument) out.
The best type of study to determine whether gun control and/or regulation would be a randomized trial: randomizing a state or country to regulation or not.
Since that’s not going to happen, the next best type of evidence we have to go by is observational, either case-control or cohort …
We need an evidence-based, randomized trial on gun control
I knew he was sick when he told me he’d thrown out his cigarettes on account of how badly he felt.
Mr. P had gotten used to the breathlessness when he climbed stairs and the hacking, dry cough that followed him everywhere. What else could he expect after smoking three packs a day since he was six years old? But he had shown …
Smoking has become hidden in the shadow of obesity
From 1974 to 1982, a group of researchers conducted the RAND Health Insurance Experiment. In lay terms, what they did was assign people to different levels of insurance coverage, with a particular focus on the amount of co-payments, co-insurance, and deductibles that people had to pay, and then they observed their use of the health care system. As you might expect, those who had to pay more out of their …
Expanding Medicaid and cost sharing: A recipe for disaster?
It has always been my assumption that my new practice will be as “digital” as possible. No, I am not going into urology, I am talking about computers.
[Waiting for the chuckles to subside]
For at least ten years, I’ve used a digital EKG and spirometer that integrated with our medical record system, taking the data and storing it as meaningful numbers, not just pictures of squiggly lines (which is how EKG’s …
Imagine a doctor actually trying to save money for his patients
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One of the toughest situations in oncology is the discussion about next steps, particularly when it comes to treatment of recurrent or metastatic disease. I believe very much that it is realistic to offer a patient the hope of cancer as a “chronic disease,” that treatment can result in disease stability, even though I cannot predict how chronic “chronic” is.
I was …
Physicians: Improve the experience of communication
Right now, the technology exists to completely transform healthcare.
A doctor should be able to walk into the room where a patient is waiting for them and get everything they need to make an informed decision about that patient’s care.
Location-based technology should sense the doctor approaching and already know which patient is waiting for them. A computer or a tablet in the room should have access to thousands of data points …
Technology is being held back from transforming healthcare
No one knew just how long Freddy had been homeless nor what circumstances had brought him to the doorstep of the Baltimore Rescue Mission shelter. As far as Dr. Dalton – our physician supervisor – and his students knew, Freddy had been there forever. Residents of the shelter were required to help out, sweeping floors or cooking for the other residents. Freddy always volunteered for clinic duty and was charged …
What draws me to primary care: Building relationships
There are an estimated 15,000 medical apps presently on the market and is expected to grow 25% per year according to one study. There are issues which are common in the development of these apps and other categories of apps. However, some technical and non-technical issues are unique to the sector. As someone who does not design apps, …
5 reasons why mobile health apps fail
I recently read an article on the RAND Corporation’s analysis of electronic health records (EHRs). As a practicing pediatrician currently using EHRs, and given the reality that EHRs are still a relatively new addition to the U.S. medical profession and have created a fundamental shift to the care delivery process, I am compelled to respond to assertions made in this article.
The first RAND study, sponsored by a …
Refuting RAND: Why I am optimistic about EHRs
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 67-year-old woman is evaluated for a 2-day history of severe muscle weakness. The patient experienced significant weight gain and developed hypertension and type 2 diabetes mellitus 2 years ago. She also reports developing muscle weakness of the lower extremities 6 months ago. Her diabetes is only partially controlled by metformin; her blood glucose …
MKSAP: 67-year-old woman with severe muscle weakness
Office-based medical practice is changing fast. The government is providing incentives to those practices that use electronic prescribing and electronic records systems and will soon penalize those that don’t. Health reform will shortly deliver many newly insured patients to your office. A host of new patient care models aimed at making healthcare more team-based are emerging. Reimbursement tied to outcomes will demand a greater level of patient management and engagement …
Your EHR needs a population health management system
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