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Father and son, doctor and grieving family member

Physician

September 28, 2011

The edges of Cameron’s lips rise undeniably toward the clear blue sky. His legs move methodically. One motionless on the scooter and the other periodically kicking to propel himself forward. He weaves in and out dodging my shadow as I jog beside him.

I struggle to keep pace. My breathing unsteady and labored. My joints aching. And my brain foggy from lack of sleep and replaying the events of the day.

***

The …

It is not easy being a patient-consumer, but it can be done

Jeffrey Rice, MD, JD

Patient

September 28, 2011

I would like to share a story about my son’s recent surgery that, while only one simple case, reveals the foundational problem with the U.S. health care system.

I write this story as a father of a 12 year old boy who has cerebral palsy. Jack is fortunate to be healthy and active with minor medical needs. As he has grown he experienced some issues with contractures in his right lower …

If you need to say you’re all about the patient, you aren’t

Sanford C. Sharp, MD

Physician

September 27, 2011

Sir William of Ockham has achieved a degree of mortality via the wide promulgation of an aphorism, now generally known at Occam’s Razor (I’ll use the more economical spelling). There are many iterations of the razor, but my favorite is this: “simpler explanations are, other things being equal, generally better than more complex ones.” That trips off the tongue more easily than, say, “plurality should not be posited without necessity.”

In …

Learning the hard way that there is an art to medicine

Tracy Krulik

Patient

September 27, 2011

In med school budding doctors are told: “When you hear hoof beats, think horse.” The problem is that sometimes when you hear hoof beats, it’s a zebra, and when that “zebra” is a disease, your patient leaves your office misdiagnosed. I’m that patient.

In 1998 I had my first abdominal attack. I vomited for days and walked hunched over like a frail octogenarian. (For reference, I was extremely fit and twenty-seven …

The threats to profit in academic medical centers

Robert Wachter, MD

Health Policy

September 27, 2011

My hospital, UCSF Medical Center, is thriving. Our profits this year will be nearly $200 million. We’re building a sparkling clinical complex – a combined women’s, children’s, and cancer hospital – adjacent to our new downtown biomedical research campus.

We are installing a state-of-the-art computer system. US News & World Report calls us the 7th best hospital in the country. Our students, residents, and fellows have never been better.

Yet angst is in the air, borne …

A hundred shifts in, I have fine tuned my instincts as a physician

Anne K. Merritt, MD

Physician

September 27, 2011

I gather my belongings: stained white coat, stethoscope, pen light, black ballpoint. I stuff the last two granola bars into my canvas bag. I glance at the clock on the microwave, which is three minutes fast.

Twenty-two minutes until my shift begins. One minute before I will lock the door to my apartment.

Precision is critical: ER shifts change fast and blend together, from late nights to early mornings to mid-afternoons. Suns …

How to predict which patients will be hospitalized

Eric Schultz and Andrew Wickerham

Health Policy

September 27, 2011

What’s the most effective way to predict which patients will be hospitalized in the coming year? The Heritage Provider Network, a managed care group in California, hopes to answer this question through its sponsorship of the Heritage Health Prize, a $3 million X Prize-like competition for health care. The contest invites participants to develop a prediction algorithm to identify patients who will spend time in the hospital in …

Doctors can help patients make informed decisions and prevent overtreatment

Davis Liu, MD

Patient

September 26, 2011

There are many tips to saving money on medical costs like asking your doctor only for generic medications, choosing an insurance plan with a high deductible and lower monthly premiums, going to an urgent care or retail clinic rather than the emergency room, and getting prescriptions mailed rather than go to a pharmacy.

How about getting your old medical records and having them reviewed by a primary care doctor? It …

Patient transparency cannot be mandated by a federal agency

Manoj Jain, MD, MPH

Physician

September 26, 2011

Not long ago, when my father was about to undergo a heart procedure, I hinted to the cardiologist, a colleague, that I wanted to be there, too, not just to offer comfort but also to be present for the play-by-play that would lead to a critical decision: whether to open his blocked arteries with a stent or to perform bypass surgery. Draped in an X-ray-shielding body suit over his blue …

See more patients with same day appointments

Neil Baum, MD

Physician

September 26, 2011

No one knows for certain what the future holds for American medicine. With cutbacks again on the horizon, we do know that reimbursements are going to decrease in the near future resulting in a decrease in income. An effective way to maintain our incomes is to increase the volume of patients seen but also to increase the income per patient that is seen in our offices. One of the best …

Why medicine is not health

Anonymous

Medications

September 26, 2011

Being a physician certainly biases how I view the world around me. I can’t help but think in terms of problem-solving and healing. But have you noticed how medicalized our society has become? The other night watching television, we watched at least four drug commercials and one health insurance commercial — during a half-hour show! I believe we are in the middle of the medicalization of America, and I don’t …

Read more…

Why medicine is not health

Few doctors will meet meaningful use in 2011, and that’s ok

Brian Klepper, PhD and David C. Kibbe, MD, MBA

Health Technology

September 26, 2011

2011 will be a disappointing year for the Centers for Medicare and Medicaid Services and the Office of the National Coordinator’s electronic health record incentive programs. We predict that few doctors and hospitals will meet the objectives set for the “meaningful use” of certified EHR technology. Meaningful use is, of course, the term that describes the objectives and measures providers and hospitals must meet in order to receive financial bonuses …

Why deferral of emergency care is risky and unethical

Myles Riner, MD

Health Policy

September 26, 2011

Boondoggle – a scheme that wastes time and money. Perhaps this is not the best way to describe the many efforts that are being made to try to keep patients with non-urgent problems from using the emergency department, but from where I sit, deferral of ED care is a cost-saving tactic that not only fails to deliver much in the way of cost savings, it also is a strategy that …

Why do doctors cling to continuous fetal heart monitoring?

Alexander Friedman, MD

Physician

September 25, 2011

My patient needed to be delivered. She had just developed eclampsia, a potentially fatal disease that afflicts women in the second half of pregnancy. She had suffered a seizure and dangerously high blood pressure, and was at risk for far worse, including a stroke. No one knows why this condition arises, but delivery sure clears it up in a hurry.

So we gave medication to start labor, and the nurses placed …

My good intentions had helped start a reaction

Jordan Grumet, MD

Patient

September 25, 2011

If death was the end zone, George had been on the one yard line twice in the last five years. And I, as part of his team of doctors, watched as he stubbornly maintained his goal line stand. Miracles rarely happen in medicine. They certainly don’t happen to the same person more then once.

Yesterday as George glided into my office you would have never known that eternity’s grip had been …

Why I left a top children’s hospital for a private office

Anonymous

Physician

September 25, 2011

All medical students and residents, those with any sense of introspection anyway, wonder if we (they) should be on the front lines. We wonder if we should be meeting, examining, trying to diagnose and treat families and children when we know that an experienced clinician just around the corner or in the next room could see the patient, perform the procedure faster and with more panache than our feeble …

Divorce after the diagnosis of Alzheimer’s disease

Dominic A. Carone, PhD

Conditions and Diseases

September 25, 2011

I was tempted to avoid venturing into this topic, only because I strive to keep my website and blog away from politics and religion. In that light, I am going to stay away from the politics and religion of this topic and just stick with the main theme of the story and respond based on my own experiences, which includes assessing patients who are known to have or are suspected …

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