One of my patients thanked me for saving his life. Apparently, many years ago I had told him that most men’s first complete physical is in the emergency room in the midst of their heart attack or stroke. I have been in practice long enough to have forgotten many of the things I have told patients. I try to capture the pearls I have learned over the last 30 …
Using the emergency room for routine physicals
Last July, I found myself needing to visit a doctor for an urgent medical issue. My period had started in April and never stopped. It was light, so it wasn’t too much of an annoyance, but after three months I figured I needed professional help.
I had started graduate school in Michigan the year before and was back home in California for the summer. I wasn’t sure if the new insurance …
Unexpected medical bills on a graduate student’s budget
One of the main considerations in physician pay under CMS’ relative value system is the training required to complete a task. This is generally thought to be well understood but is, in fact. a quagmire of controversy.
Take for example the specialty of family medicine compared with dermatology, anesthesiology, or ophthalmology. Family physicians make between 1/2 and 1/3 of what these other specialties make, so one would think that there …
Does longer physician training merit more pay?
Social connectivity to engage patients has real the potential to impact health through improvements in lifestyle, the main driver of wellness. This is in increasingly shorter supply as we collectively increase pounds, cholesterol, and blood pressure readings.
Many have written compellingly on why social matters for health. The best I’ve seen are a post by Jay Parkinson (of Hello Health and Fast Company fame) that borrows from Atul …
Social gaming to engage patients and improve wellness
You’ve had the sex talk, the smoking talk, and the drugs and drinking talk. But have you talked to your kids about tanning beds?
You should. Tanning bed use can cause skin cancer, including the deadliest form, melanoma. And, using tanning beds before age 30 increases a person’s risk of melanoma by 75%.
Equally worrisome: tanning beds can become addictive. A recent study showed that 80% of college-age tanning beds users couldn’t kick the habit.
This …
How to talk to teens about tanning beds
For the past 24 hours I’ve squirmed about whether to or how to criticize NBC’s Andrea Mitchell about her on-air announcement of her breast cancer diagnosis and treatment. How can you criticize someone who is dealing with what she – and so many other women – are dealing with? But it’s now clear that some breast cancer survivors and others who know the science are critical of the message …
Andrea Mitchell breast cancer thoughts
Up until last May, my experience of medical costs was limited to the $100 per month premium I contributed towards my employer-sponsored insurance and the nominal co-pays associated with well-child checkups and generic prescriptions. There was never any hesitation in seeing a doctor or filling a prescription. That all changed when went I back to school.
I blindly signed up for the school-recommended family insurance and naïvely assumed myself, my …
Care costs a lot and it’s not straightforward what the cost is
A recent study from Health Affairs took aim at physician salaries.
Well, not exactly their salaries, but fees. It’s a subtle difference, but that nuance is lost in the mainstream media narrative.
According to the study, “American primary care and orthopedic physicians are paid more for each service than are their counterparts in Australia, Canada, France, Germany and the United Kingdom.”
Thankfully …
Targeting physician salaries is a poor strategy for health care costs
con·nect (from dictionary.com)
verb (used with object)
1. to join, link, or fasten together; unite or bind: to connect the two cities by a bridge; Communication satellites connect the local stations into a network.
2. to establish communication between; put in communication: Operator, will you please connect me with Mr. Jones?
To connect with your patients is truly the key solution.
Connect takes on two meanings:
To connect with patients is key
All of us are role models, whether we see ourselves that way or not. Of course I love to imagine myself as a positive role model, but my eleven-year-old daughter has already informed me that things will be way different at her house when she’s a mama. However, we’re not going to focus on how uncool I am, instead, I’m going to share the stories of a couple of people …
All of us are role models, whether we see ourselves that way or not
An interview by Curaspan Health Group with Stephen Jencks, MD, MPH.
Stephen Jencks is lead author of the 2009 landmark study of the multibillion-dollar cost of readmissions, says there’s “been a great deal of movement” on readmissions since his work was published in The New England Journal of Medicine, but there’s more that hospitals and communities can do.
Dr. Jencks, an independent consultant in health-care safety and quality, and …
How hospitals can avoid readmissions
A guest column by the American College of Physicians, exclusive to KevinMD.com.
In April 2011 I finished seven years on the Board of Regents of the American College of Physicians (ACP) including two years as Chair of the ACP Health and Public Policy Committee and serving during the last year as President. During that time I had the opportunity to …
ACP: Current and future payment and practice trends in medicine
The Annals of Internal Medicine occasionally reviews the articles and studies of note in a particular field of internal medicine for those of us who don’t read all of the specialty journals. Recently, there was an update in pulmonary and critical care medicine, the internal medicine specialty that is most intimately involved with caring for the very ill and those people who are at the ends of their lives. …
The problem of inadequate discussions of end of life wishes
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Today was a rough day at work. My schedule of 10 patients for the afternoon rapidly ballooned into 17. People were sick and miserable. Those who were healthy were frustrated by the long wait. I heard myself apologizing over and over to each family.
The day was mostly a chaotic blur. Babies crying, phones ringing, parents reprimanding children on the brink of a meltdown. I don’t remember much of it, except …
Children who curse, and the power of words
We’re five years old. We’ve been doing the same thing the same way for five years and have analyzed over 1,488 stories using our ten standardized criteria on HealthNewsReview.org.
We’ve recently returned from the annual Association of Health Care Journalists (AHCJ) conference in Philadelphia, where we led a two-hour workshop, and where we received a tremendous amount of gratifying feedback on our work and many terrific suggestions about …
Essential tips for medical journalists
When I saw my first patient die, I was in shock. You will never forget your first one, that always stays with you.
My first patient died during medical school, a young guy around 40. He died of complications from endocarditis. He was fine in the afternoon, talking about his family and what he does, but when I came back in the morning he was gone. I was shocked beyond …
Physicians need to be more proactive asking about code status
In the September 2011 issue of Harvard Business Review, Harvard Business School professors Robert Kaplan and Michael Porter argue that a better understanding of the actual cost of care patient-by-patient can have a dramatic impact in the effort to control health care costs. They maintain that actual costs are poorly understood, that there is a mistaken belief that many costs are too complex to allocate accurately, and that …
Can cost accounting save health care?
An excerpt from Living with Depression: Why Biology and Biography Matter along the Path to Hope and Healing (Rowman & Littlefield Publishing Group).
To be human is to experience an array of different emotions. We can feel upbeat and hopeful, cool and unconcerned or frustrated and fearful in a given day—even in a given moment. The heart of human experience beats with moments of joy and flashes of sorrow, and with …
Biology and biography: The Two-B Factor of depression
We have all seen people exhibit flagrantly unhealthy behavior. Some of us–though we’d never admit it–derive a certain, smug satisfaction by observing them. At least I don’t do that!
Somewhere in the course of our daily lives though, most of us do exhibit behavior that suggests at least some disregard for our health. We don’t change our diet, though we know we should. We don’t floss, take medications as prescribed, or …
Explaining human motivation towards unhealthy behavior
Most OTC products, excepting some medical equipment like crutches and diabetic supplies, now cannot be purchased with flexible spending account dollars without a physician prescription.
One of my partners asked last week how I am dealing with this issue. He has had several patients ask for a long list of prescriptions for OTC products so that they can use their FSP to pay for these things with pre-tax dollars. This puts …
Requiring a prescription for OTC products is a waste of physician time
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