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Real health reform cannot happen without a primary care foundation

Health Policy

August 16, 2012

Annie Lowrey’s July 28 article “Doctor shortage likely to worsen with health law” in the New York Times noted the growing shortage of primary care doctors particularly in economically disadvantaged communities, both in rural and inner-city America. This problem will likely get worse before it gets better as more Americans gain coverage and seek a regular source of care. As the article suggests, training more doctors and incentivizing them …

Mandating care in the ER but not payment: Why that’s a problem

Thomas Pane, MD, MBA

Physician

August 16, 2012

A recent case from Dayton, OH highlights the tangled mess of emergency department specialty coverage, federal law, and out-of-network insurance benefits. When these interact, patients, doctors, insurers and hospitals can be left frustrated and perplexed.

Here’s a brief summary.

A 6-year old boy suffered a fingertip injury and the emergency staff called the covering plastic surgeon, who repaired the injury. The surgeon, who does not participate with insurance, submitted a bill for …

Why must medical care be provided for free?

Edwin Leap, MD

Health Policy

August 16, 2012

Our septic tank backed up recently. When I say backed up, I mean, into the basement. And when I say into the basement, I mean, out of the bathroom and onto the carpet. And under the walls. The stars were aligned, and I had to go to work. My wife borrowed a Shop-Vac and rented a steam cleaner. I was assigned to call the septic-tank guy. The kids helped clean …

Hospital discharge planning: Involve the patients

Jessie Gruman, PhD

Patient

August 15, 2012

“Here is a prescription for pain medication. Don’t drive if you take it. Call your surgeon if you have a temperature or are worried about anything. Go see your doctor in two weeks. Do you want a flu shot? I can give you one before you leave. If you need a wheel chair to take you to the door, I’ll call for one. If not, you can go home. Take care of yourself. You are going to …

Doctors who prescribe too many antibiotics: It’s not that simple

Anonymous

Medications

August 15, 2012

Physicians who liberally prescribe empiric antibiotics are often maligned as irresponsible or unthinking by condescending colleagues and policy wonks. But are these doctors actually courageous and prudent, saving countless thousands of lives every year by refusing to bend to misguided pressure from antibiotic-conserving paper-pushers?

As antibiotic resistance has emerged, many hospitals have begun requiring physicians to provide a rationale for every antibiotic dose prescribed. The Centers for Medicare and Medicaid (CMS) …

Why the drug shortage is leading to desperate measures in hospitals

Al Patterson, PharmD

Medications

August 15, 2012

More than 80 percent of the United States supply of heparin, a commonly used blood thinner, originates from pigs reared in farm co-ops in China. Farmers scrape mucus from the intestines and send it to central processing facilities, where heparin is extracted and purified before being sold to U.S. pharmaceutical companies.

But in 2007, blue-ear pig disease, causing a respiratory syndrome, became endemic in Asia—leading to a shortage of pigs …

AMA works to reduce administrative burden for physicians

Jeremy Lazarus, MD

Physician

August 15, 2012

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

Since the American Medical Association launched our National Health Insurer Report Card in 2008, there has been noticeable progress by health insurers in response to the AMA’s call to improve the accuracy, efficiency and transparency of their claims processing.

The AMA has been working constructively with insurers, and as a result the …

We have kept Daddy out of heaven with what we have already done

Monica Williams-Murphy, MD

Physician

August 14, 2012

Mr. Omer had once held a position of social prominence, a moral influence on the lives of individuals and communities. Until one year ago. A construction accident changed everything. He suffered injuries that left him in control of only one side of his body and his mind functioning as a 5-year old child.

Most recently, he had resided in an extended rehabilitation nursing facility, until yesterday.

When the nurse tried to arouse …

Why always saying yes could be dangerous for you and your patient

Jock Hoffman

Physician

August 14, 2012

Encouraging patients to be more engaged, may also encourage more people to go beyond assertive to demanding care unsupported by good clinical judgment. Of course, physicians worry that saying “no” to a patient increases their risk of being disliked, dismissed, or even sued for medical malpractice.

Greater transparency in health care means patients are more aware of options for screening, testing, procedures, and medications—often via direct advertising or public service campaigns. …

Why medical management is critical to health reform

Brian Klepper, PhD

Health Policy

August 14, 2012

Several years ago I had dinner with a woman who had served in the late 1990s as the national Chief Medical Officer of a major health plan. At the time, she said, she had developed a strategic initiative that called for abandoning the plan’s utilization review and medical management efforts, which had produced heartburn and a backlash among both physicians and patients. Instead, the idea was to retrospectively analyze utilization …

Do I need the shingles vaccine? A doctor explains

James C. Salwitz, MD

Conditions and Diseases

August 14, 2012

What if there was an infection that can cause permanent nerve damage and pain? What if the virus could affect the eye and cause blindness or affect the brain and cause meningitis? What if the burning rash attacks almost half of all Americans sometime in their life? If you knew there was a vaccine which could protect you from that malady, would you get the shot? The disease is called …

Used needles on the sidewalks: Why we need needle exchange programs

Erin Marcus, MD

Physician

August 13, 2012

On a recent afternoon, Hansel Tookes stood on a sidewalk in downtown Miami, peering into a thicket of scraggly weeds. “I found a bunch over here,” he said, edging toward an overpass. A small orange plastic cap came into sight, and next to it two slender insulin syringes, with the needles exposed. Scattered about were tiny plastic zipper bags — evidence that the needles had been used to inject heroin …

How will Paul Ryan change Medicare?

David Pittman

News

August 13, 2012

The selection of Wisconsin congressman Paul Ryan as the running mate for presumptive Republican Presidential nominee Mitt Romney could have serious consequences for the Medicare program.

Ryan, Budget Committee chair for the House of Representatives since Republicans gained control of the chamber 2 years ago, is best known for budget proposal, which includes a plan to overhaul Medicare and transform it …

Read more…

How will Paul Ryan change Medicare?

For health care to be better, doctors must lead the change

Davis Liu, MD

Physician

August 13, 2012

Recently New Yorker staff writers and best-selling authors Malcolm Gladwell and Atul Gawande addressed the question of whether the problem in health care is that patients are too reliant on doctors and don’t have the ability to make decisions. In reading between the lines, is that the reason health care is not affordable and care not commoditized or consumer driven like other industries?

At a conference for America’s Health Insurance Plans, …

Work-life balance in medicine: Is it possible?

Karen S. Sibert, MD

Physician

August 13, 2012

Unless you’ve lately returned from a retreat at a remote Cistercian abbey, if you’re interested at all in women’s issues you’ve probably read Anne-Marie Slaughter’s recent article in the Atlantic, “Why Women Still Can’t Have It All.” The author eloquently tells how she left her dream job in the State Department as the first woman director of policy planning in order to return to her husband, her …

Why are so many doctors complete jerks?

Eric Van De Graaff, MD

Physician

August 12, 2012

As odd as this might sound, my mother was upset when I declared my intention to go to medical school.

It wasn’t the mountain of debt I was sure to incur since I’d already figured out how to get Uncle Sam to pick up the bill (a small deal that put me in a military uniform for a decade). It wasn’t the …

Read more…

Why are so many doctors complete jerks?

Should I get a spray tan? A doctor discusses whether it’s safe

Bobby Ghaheri, MD

Conditions and Diseases

August 12, 2012

We all know that the use of baby oils and baking in the sun for hours on end is probably not a good idea. We know that increased sun exposure correlates with increasing skin cancer rates. We know that it can cause accelerated skin damage in the form of pigmentation changes, wrinkles, and increased skin laxity. Don’t believe me? Check out this picture! Truck drivers tend to get increased sun …

Apply folk wisdom to your family practice patients

Peter Elias, MD

Physician

August 12, 2012

“The best defense is a good offense.”

This folk wisdom is variously attributed to Sun Tzu, Carl von Clausewitz, Mae Zedong, and the heavyweight prizefighter Jack Dempsey. Regardless of origin, it deserves its place in the pantheon of behavioral truths.

During a recent conversation with a patient about her irritable bowel syndrome, I asked about possible stressors.

“So, tell me, I know it’s hard to manage both full time school and a part …

An American oncologist looks at health in China

Richard Just, MD

Physician

August 11, 2012

In today’s China, both eastern and western medical philosophies and practices exist relatively harmoniously. Patients with minor, usually self limited problems are treated initially with a seven day course of seven liquid herbal preparations taken each day. If symptoms subside, usually treatment is discontinued. If improved but not resolved, formula may be modified. If worse, regimen can be changed and/or referral to specialists arranged. There are hospitals that practice purely …

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