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Even when using rankings, differences among hospitals may be subtle

Patient

October 4, 2012

As a longtime consumer reporter, I’ve always thought the best way to see how the marketplace works is to put yourself in the shoes of someone buying the product or service you’re investigating. After learning recently that I may need cataract surgery, it was time for me to check out the hospitals where that procedure might take place.

To begin my quest for the best, I searched for ratings for four …

Should medical students learn how to use an EHR in medical school?

Ishani Ganguli, MD

Health Technology

October 4, 2012

Outside a patient’s room in the cardiac intensive care unit (CICU), a senior doctor, a nurse, and several residents in various stages of wakefulness cluster for morning rounds. Each resident mans a computer-on-wheels (once called a C.O.W., the acronym was formally abandoned at MGH, legend has it, after a patient thought it was directed at her and took offense).

One of the residents reads off laboratory test results from the patient’s …

Are Medicare vouchers a good idea for patients and their physicians?

Bob Doherty

Health Policy

October 4, 2012

Trying to figure out whether Medicare vouchers are a good idea for patients and their physicians? Then consider these two basic questions:

1. How much will the federal government contribute?
2. Who is at risk for health care cost increases?

How much will the government contribute? The traditional Medicare program has no set limit on how much the federal government will contribute to a beneficiary’s health care, although there are limits on how …

Talk about hepatitis C screening at your next scheduled visit

Steven Reznick, MD

Conditions and Diseases

October 4, 2012

The Center for Disease Control and Prevention (CDC) has requested that all individuals born between 1945 and 1965 be tested for the presence of the hepatitis C virus. This is a clear cut change in their policy which had previously asked that only high risk patients be tested.

Hepatitis C is a viral infection usually transmitted by blood to blood transmission. High risk patients include intravenous drug users who share needles, …

When patient histories start to blur

Greg Smith, MD

Physician

October 3, 2012

I am guilty of neglect.

I’ll admit it. I’ll own it. I’ll embrace it.

When I am doing a consult now for one of many hospital emergency rooms, I am sent a pretty standard package of history, nurses notes, doctor’s assessment, physical exam report, lab results and other information that I review prior to actually seeing the patient on the screen and doing my own assessment. Now, on a day like today, …

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When patient histories start to blur

Can the airline industry teach customer service lessons to medicine?

Michael Kirsch, MD

Physician

October 3, 2012

“Your call is important to us. Please listen carefully because our options have changed.”

During your current or any prior lifetime, has any phone menu option ever changed?

I have more than once experienced an option not offered on the robotic phone menu option choices – a dead phone line after a 30 minute wait.

Have you tried this customer plea as I have? Could you pretty-please jot down my cell phone number in …

To fix health care, we need to be screwed

Peter Ubel, MD

Health Policy

October 3, 2012

“We need to be screwed!”

Not altogether surprising words to spill out of a college student’s mouth. But this particular student was not talking about sex. She was discussing the U.S. healthcare system—more specifically what she thought it would take for our two political parties to come together to find a reasonable way to control our nation’s healthcare costs.

It was the last day of the semester, the last class discussion in …

What is your doctor worth per hour in the open market?

Wes Fisher, MD

Physician

October 3, 2012

Recently I was asked to serve as a consultant on a medical matter. Interestingly, they requested my hourly price for my services. I thought about this and wondered, “What am I worth per hour in the open market?”

It is an interesting question to ponder.

I have decided to ask the blog-o-sphere. Call it a bit of “free market economics.” For the record, 100% of my hourly wage for my services will …

How well does your doctor play with others?

James C. Salwitz, MD

Physician

October 3, 2012

How do you choose a doctor? Perhaps you start with a recommendation from a friend or a trusted physician, then you look at factors such as training, experience, board certification, access, online reviews and of course that vital issue, how well you like the doctor when you meet him or her. Tough thing, picking a person you barely know to whom you trust health and life. To this list, I …

How the surplus of patients will impact primary care

Dike Drummond, MD

Health Policy

October 2, 2012

I believe the projected shortage of physicians caused by the Affordable Care Act will drive primary care into two opposite tracks. Each is a distinct and logical response to the patient overload and each points out gaping holes in our medical education that must be addressed.

The Association of American Medical Colleges estimates that there will be a shortage of 63,000 doctors by 2015 and 130,600 by 2025 in the wake …

Spinning medicine into soundbites hides the facts

Suzanne Koven, MD

Physician

October 2, 2012

Medicine, like politics, sports, and everything else, has gotten sucked into a 24/7 sound bite culture in which the most complex issues are spun into a few provocative words on news sites, TV, and radio shows. Enraged readers and listeners then weigh in. As the old expression goes, much heat, but little light ensues.

But three recent stories involving medicine are worth a closer look, and cooler heads.

First, consider the Read more…

Spinning medicine into soundbites hides the facts

There is no app for patient engagement

Steve Wilkins, MPH

Patient

October 2, 2012

Physicians, hospitals and other providers are being misled by industry pundits claiming that more health information technology (as in EMRs, PHRs, smartphone apps, and web portals) is the key to greater patient engagement. It’s not.

If health information technology were all that was needed to “engage” patients then patient and member adoption rates of provider and payer web portals offering personal health records (PHRs) and electronic health records (EHRs) would not …

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There is no app for patient engagement

Humility and humanity is required of us to best respect our patients

Meghana Gadgil, MD

Physician

October 2, 2012

Several days ago, I had the opportunity to listen to a lecture by a visiting physician who practices narrative medicine, a medical humanist. She is well-known for bringing a voice to the interactions between doctor and patient, the healing relationship, the unparalleled bond formed between these two individuals. In her talk, she spoke of the “turmoil” that ensues when caring for a patient, caused by the interaction of deep concern …

Thank you for setting me on the road to practice medicine

Emily Gibson, MD

Physician

October 1, 2012

All of us come to the study and practice of medicine through different pathways: some because of family members who were doctors or patients, some out of our own illness or woundedness, some out of intense drive to achieve and serve.

I came to medicine because of my grade school classmate Michael.

My grade school represented a grand social experiment of the early 1960’s. It was one of the first schools to …

Doctors are notoriously awful about dealing with death and dying

Miranda Fielding, MD

Physician

October 1, 2012

Some things are just so damned hard to write about. People often ask me, “Why do you have so many animals?” The current count is 4 dogs, two horses and a cat. I used to say, “Because it’s good for my children to learn responsibility. Having a dog, whose life is so much shorter than our own, teaches them about love, and about death. They get to practice parenthood, before …

How many times have you done this procedure, doc?

Max Berry, MD, PhD

Physician

October 1, 2012

Questions such as this from proactive, increasingly knowledgeable patients place a physician on the horns of an ethical dilemma. Although fellows are closely supervised and trained under a gradually increasing responsibility principle (based upon subjective evaluation), a time will come when there is no one available to back you up in the catheterization lab.

Fact: Someone has to be a physician’s first case of any given type. However, no one really …

What happens if Medicaid expansion is undermined

Erin Marcus, MD

Health Policy

October 1, 2012

He was a “frequent flyer” — a patient with multiple health problems who gets admitted to the hospital repeatedly. It was usually because he hadn’t taken his medicine correctly, if at all. When he left the hospital 10 days earlier, he told his physician that he wouldn’t have problems filling his prescriptions, because he had Medicaid. But when he arrived at his local drug store, it wasn’t so easy.

“I was …

Speak the truth, document the truth: To do otherwise is malpractice

Edwin Leap, MD

Physician

October 1, 2012

I remember a short lecture I received in my medical officer’s course when I joined the Air National Guard around 1988. The room was full of young medical students, physicians, nurses, and other health care folks who were beginning their service. The topic was appropriate documentation in the medical record.

Among the notable examples of what not to do was this gem, written by a medical officer about another officer’s wife: …

ADHD medications: Performance enhancing drugs of the mind

Dr. Joe Kosterich

Medications

September 30, 2012

There are interesting double standards that we apply to different fields of human endeavor. In sports the use of performance enhancing drugs is forbidden. Whilst that does not necessarily stop athletes using them at least it is not condoned. Efforts are made to try and catch and sanction those who are found to be using such drugs.

The rationale behind this is that sporting contests are meant to be about who …