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How will doctors handle the flood of newly insured patients?

Health Policy

September 5, 2012

If you think health care is expensive now, wait until you see what it costs when it’s free.
-P.J. O’Rourke

I distinctly remember that in first grade I had an idea of breathtaking wisdom and profundity. Candy should be free. You may have had a similar thought at the same age. This idea was supported by an incontrovertible rationale, namely that I really liked candy. Tragically, it only took a moment for …

After the ER visit, the financial nightmare begins

Christopher Chang, MD

Physician

September 5, 2012

Imagine this scenario. A young child is playing in the yard when her pet dog bites her face. Bleeding, the child is rushed to the ER and the doctor offers to suture up the child’s face.

A parent will probably ask for a plastic surgeon to suture the face instead of the emergency room doctor.

As such, the plastic surgeon is called in and sutures up the face beautifully.

The child and family …

Family physicians are patient specialists

Aaron George, DO

Physician

September 4, 2012

Many recent conversations in the advancing world of health care delivery have integrated the term “disruption.” At first glance, this is perhaps quite jarring and counter-intuitive to the mind of the forward or progressive thinker. It is ever the more uncomfortable to the medical mind that is trained to carry on in the face of adversity, through exhaustion, and despite resistance. Paradigmatically, the medical world has recently been presented with …

View medical apps with caution, just like any new medical device

Kenneth Lin, MD

Health Technology

September 4, 2012

Doctors of my generation have experienced dramatic changes in the way we access the information we need to care for patients. As a medical student 15 years ago, my “peripheral brain” consisted of fat textbooks sitting on office bookshelves or smaller, spiral-bound references stuffed into the bulging pockets of my lab coat. As a doctor-in-training, I replaced those bulky references with programs loaded onto PDAs. Today, smartphone apps allow health …

Why weight loss advice may be unethical

Arya M. Sharma, MD

Physician

September 4, 2012

And issue of Newsweek quotes me as saying, “A lot of our weight-loss recommendations are unethical because we shouldn’t be saying lose weight when there is no chance people will keep it off.“

This quote appears in the context of a lengthy article by Daniel Heimpel that examines whether or not the obesity epidemic is being oversold.

While I personally do not think that the obesity epidemic is being oversold, I do …

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Why weight loss advice may be unethical

Why this nurse left the intensive care unit to go into hospice

Gina, RN

Patient

September 4, 2012

Earlier this year, I made an announcement that may have made a few people think I was half a bubble off level. I’m leaving CCU.

I’ve worked in CCU (and CVICU) for 14 years. 5 years ago I had a baby, and reduced my hours to one day per week.

It took me just about all of those 5 years to fully comprehend that one just can’t keep up with all there …

Being home with an infant: Take care of your mental health

Claudia M. Gold, MD

Physician

September 3, 2012

I am a devoted fan of Zumba, specifically as it is taught by my wonderful teacher, who has a dedicated following. She has been out for the past month, home with a newborn and two year old. Last week, she came with her baby to try to take the class, now being taught by a substitute, also a regular member of her class.

“I need this for my mental heath, ” …

Diminishing primary care leads to excessive health spending

Brian Klepper, PhD and Paul Fischer, MD

Health Policy

September 3, 2012

Excessive health care spending is overwhelming America’s economy, but the subtler truth is that this excess has been largely facilitated by subjugating primary care. A wealth of evidence shows that empowered primary care results in better outcomes at lower cost. Other developed nations have heeded this truth. But US payment policy has undervalued primary care while favoring specialists. The result has been spotty health quality, with costs that are double …

How we die should never be taken lightly

angienadia, MD

Physician

September 3, 2012

It was another day in the intensive care unit. The night was clean and calm, ventilators beeping their expected melody, and the laborers of medicine went about their night shifts uneventfully, including me sitting with the obnoxious admission pager attached to my hip. The smoothness of it all shattered when the beeper started screaming – I picked up the phone and soon the emergency room physician was on the line.

“We …

The journey from family practice to urgent care

Doug Farrago, MD

Physician

September 3, 2012

As you may know, I left Maine to come to Virginia to work in an urgent care center. It was not how I pictured myself when I trained to be a family doctor 18 years ago but the world has changed.

I like my present job fine and there isn’t a bunch of suits looking over my shoulder all day. That being said, I want to share my thoughts about the …

Why doctors complain: A history of physician income

Richard Patterson, MD

Physician

September 2, 2012

We’re not going for sympathy here. Doctors as a whole enjoy less sympathy than many other professional groups (members of Congress enjoy the least, I would think), and that’s probably appropriate. They have high incomes and many prerogatives and rank highly in esteem polls as individuals, if not as a group. It’s not where they are that is causing the grieving, it is where they are coming from.

Let’s deal with …

Patient care is not meal preparation

Art Fougner, MD and Kira Geraci-Ciardullo, MD

Physician

September 2, 2012

Dr. Atul Gawande has written a much-ballyhooed essay in the New Yorker, entitled “Big Med.” His piece proposes The Cheesecake Factory as a model for healthcare. For me, a physician, Dr. Gawande’s message left a bad taste in my mouth.

The Cheesecake Factory succeeds because of standardization and efficiencies, with complete control over purchasing and production. What recipes work become menu items throughout the chain. What recipes don’t work are …

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Patient care is not meal preparation

How to create YouTube videos for patient education

Neil Baum, MD

Health Technology

September 2, 2012

Many doctors are now getting into movie production and making videos that are loaded onto YouTube. These videos are effective in attracting new patients and educating your existing patients. There are a few guidelines that you can use to create an effective script for each of your videos. These scripts can be loaded onto your computer in a PowerPoint format and will serve as poor man’s teleprompter to assist in …

MKSAP: 29-year-old woman with systemic lupus erythematosus (SLE)

mksap

Conditions and Diseases

September 2, 2012

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

A 29-year-old woman with systemic lupus erythematosus (SLE) is evaluated in the office after obtaining positive results on a home pregnancy test. She has a 1-month history of nausea but is otherwise asymptomatic. Her last menstrual period was 2 months ago. This is her first pregnancy. Her SLE is well controlled with hydroxychloroquine, and …

My doctor isn’t listening to me! How you can help

Dike Drummond, MD

Physician

September 1, 2012

The most common complaint about physicians on the Internet is, “They didn’t listen to me.”

You were sitting in the office and the doctor was physically present in the room, but they weren’t all there. Even worse is when the doctor doesn’t try to understand what you are going through. Sometimes it can seem like they didn’t even care.

Most of us take for granted that we are the center of the …

If you’re not an AMA member, you have no right to complain

George Lundberg, MD

Physician

September 1, 2012

All American physicians should be members of the American Medical Association (AMA). And, while they are at it, they should also be members of their county, state, and principal specialty societies.

Why? Because they are the only games in town, and both security and safety are top Maslow imperatives.

The only real political power any physician has is the individual power of persuasion and participation (or not) and the power of a …

How to plan for a long hospital stay

Andrew Griffith

Patient

September 1, 2012

Planning a lengthy hospital stay is like planning any extended vacation or business trip, with the difference that transitioning to hospital life means transitioning to no longer being in control, where choice is limited, and where one is dependent on others.

Given my lengthy hospital stays as part of my stem cell transplants – some planned, some as a result of complications – the following may be helpful should you find …

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How to plan for a long hospital stay

MKSAP: 27-year-old man with a 6-month history of cough

mksap

Conditions and Diseases

September 1, 2012

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

A 27-year-old man is evaluated for a 6-month history of cough, which is worse at night and after exposure to cold air. Often his cough is brought on by taking a deep breath or by laughter. He does not have postnasal drip, wheezing, or heartburn. He has a strong family history of allergies.

Physical examination, …

What makes a psychiatrist?

Greg Smith, MD

Physician

August 31, 2012

Years.

Years of learning that the smallest details of a patient’s life can be the most compelling and important part of their story.

Years of listening to tales of love, anger, and loss until the patterns become less daunting and more obvious.

Years of hearing things that are so bizarre, so far-fetched, so on the fringe of humanity that nothing surprises anymore, but everything still fascinates unceasingly.

Years of trying every new thing under …

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What makes a psychiatrist?

Leading the ABIM: What does the future hold for internists?

Robert Wachter, MD

Physician

August 31, 2012

On September 10, 1986, soon after I completed my residency in internal medicine, I “took the Boards” – the certifying examination administered by the American Board of Internal Medicine (ABIM). A few months later, I learned that I passed the exam, and that success, combined with an attestation by my residency program director, rendered me “board certified.” I was granted lifetime certification – my framed certificate …

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