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Change of culture in a rapidly evolving health care environment

Health Policy

February 19, 2011

When a health system asked me to facilitate a Board discussion on physician alignment and integration on November 12, 2010, I was already committed to giving a keynote on the future of health care for the American Institute of CPAs in Las Vegas on November 11. Although I usually fly Delta or USAir where I have priority frequent flyer status, the only way I could get to the Board meeting …

Social medicine and its role in medical school curriculum

Eric Lu

Medical Education

February 19, 2011

This semester is coming to an end and we are almost halfway done with first year. I say semester, but technically we use the block system. What’s the block system? Here, it refers to dividing the academic school year into single subject blocks. Instead of taking concurrent, year-long courses, we spend several weeks on one course. For instance, we started off with 5 weeks of only biochemistry, then 8 weeks …

Tragedy of cancer in a small child

gcs15, MD

Conditions and Diseases

February 18, 2011

The OR was hushed on Friday.

Normally, it is a loud, busy place. The staff and surgeons are almost like a big family; we chat with each other and banter cheerfully with patients to help get their minds off the imminent ordeal of surgery. Chaplains pray with patients and families. Sometimes there are disagreements, as in any workplace. But everyone cares about everyone else.

Because of that caring, it was hushed. Instead …

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Tragedy of cancer in a small child

US medical education is in moral crisis

Roy Poses, MD

Medical Education

February 18, 2011

We recently discussed the plight of young medical faculty. It appears that their plight is even worse than we imagined.

Recently, an abstract was presented at the Annual Conference on Research in Medical Education at the Annual Meeting of the Association of American Medical Colleges, in a session entitled, “Your Career is More than Your Specialty.”

The authors described a large survey, of over 5000 faculty at 26 US nationally representative …

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US medical education is in moral crisis

Every American deserves the right to have a death with dignity

George Lundberg, MD

Patient

February 18, 2011

My old Canadian friend toxicologist Cliff Walberg was right when he famously said, “there is absolutely no limit to how revolting things can be.”

Remember that. It comes in handy, in addition to strong swear words, when stuff happens.

Case in point: I believe that every American deserves the right to choose to have a death with dignity and as pain-free as medical science and practice can provide.

To achieve that, patients and …

ER and internal medicine docs, arguing over a patient admission

Maria Yang, MD

Patient

February 18, 2011

Dr. Erdoc happened to look up when the internist walked into the emergency department.

“Oh no,” he murmured under his breath. The consulting psychiatrist was sitting next to him, typing a note. She looked at him and raised an eyebrow.

“I hoped it wouldn’t be him. Unlike his colleagues, Dr. Internist seems to have a deep loathing for us emergency docs,” Dr. Erdoc explained as he stood up. Dr. Internist was frowning …

The care was futile, and the patient’s wishes

Jim deMaine, MD

Physician

February 18, 2011

“We have a patient on a ventilator here who is stable enough to transfer to your ICU, if that’s OK with you.”

This call, coming from the transfer coordinator, is emblematic of an insurance generated “medical care” coverage issue. I am salaried under the patient’s insurance carrier so the insurer wants this patient back under its wing as soon as possible.

The community hospital has been keeping Stella Norris (not her real …

Why Watson makes board certification exams obsolete in medicine

Kevin Pho, MD

KevinMD

February 17, 2011

Like most everyone else, I took a break from my evening chores the past few nights, and watched Jeopardy!

IBM’s super-computer, Watson, was taking on Jeopardy! phenoms Ken Jennings and Brad Rutter. [SPOILER] The computer won handily.

After watching, I began to study for my upcoming board re-certification exam.

But, then, I wondered. Why?

In the New York Times, applications for Watson are …

How medical students should present patients to their attendings

Vineet Arora, MD

Medical Education

February 17, 2011

I just finished another inpatient service stretch at our community hospital with some great cases and lots of good medicine. While attending rounds may have changed a lot in the last 40 years as highlighted in a recent Annals of Internal Medicine article, some things have not changed – the focus on medical student presentations during attending rounds.

Students spend hours through their call nights preparing for …

Let Me Down Easy and facing illness and death

Danielle Ofri, MD, PhD

Physician

February 17, 2011

Every illness is unique, and every person faces illness in his or her own way.

Anna Deveare Smith, in her one-woman Broadway show “Let Me Down Easy,” slips into the persona of twenty individuals who have faced an aspect of illness or death. In ninety minutes, Deveare Smith takes the audience on an existential scavenger hunt, allowing us to observe, and occasionally pluck, insights from this gathering of individuals.

These individuals do …

Treatment guidelines pros and cons

David Williams

Conditions and Diseases

February 17, 2011

I was puzzled by a Health Affairs article showing the public finds arguments against treatment guidelines a lot more compelling than arguments in favor. But after reading the technical appendix, which contains the full text of the survey, I think the problem is that the researchers framed the question poorly. In particular, the researchers portrayed guidelines as unrealistically rigid.

In A National Survey Reveals Public Skepticism About Research-Based Treatment …

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Treatment guidelines pros and cons

Requiring an ultrasound and counselling before an abortion

Robert Luedecke, MD

Health Policy

February 17, 2011

A bill given emergency status by Texas Governor Rick Perry is the largest invasion of the patient-physician relationship that I am aware of. Proposed by Senator Dan Patrick (R-Houston) and supported by Lt. Gov. David Dewhurst, the bill as originally written would require physicians to perform a ultrasound and explain the physical characteristics of the fetus to anyone contemplating an abortion.

Physicians would be required to inform women about alternatives to …

Clinical guidelines in healthcare reform

Richard N. Fogoros, MD

Health Policy

February 17, 2011

While DrRich is a conservative American, and has made plain the difficulties he has with the Progressive program in general and with Progressive healthcare reform in particular, at times he is forced to admit that, on occasion, the Progressive way of looking at the world has certain merits. And as DrRich contemplates a question that has been bothering him lately, a question that no doubt plagues many American physicians who …

Time with your patients in the hospital and time with your children

Felicity Billings, MD

Physician

February 16, 2011

As part of the routine scut of the overnight call team, I was sent up to the floor to preop an add-on for the next day’s OR schedule.

The Preoperative Anesthesia Assessment form has tidy little boxes for cardiac, pulmonary, renal, hematologic and an assortment of other complaints, and spaces for height, weight, allergies and personal or family history of untoward reactions to anesthesia. I put a single slash through the …

What makes a good, competent psychiatrist?

Dheeraj Raina, MD

Physician

February 16, 2011

A reader recently asked, how does someone find a good psychiatrist?

Stated another way, the questions are:

What qualities make a good, competent psychiatrist?
How do I find a good, competent psychiatrist?
How do I get my concerns heard about the direction of my treatment?

I typed the question “How do I find a good psychiatrist?” in Google and got almost half a million results from around the world. I find it hard to believe …

Hospitals need healthcare flight crews

Kevin

Physician

February 16, 2011

by John LaBine

What are the root causes of communication inefficiencies in hospitals? Hovering around any given patient/case are many players, each with a huge variety of demands for his/her time, attention and presence. And they know there are costs of certain outcomes (medical errors, stress, wasted nurse/physician time, etc.). Each caregiver has his own long list of things to do, places to be, people …

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Hospitals need healthcare flight crews

Difference between proactive and reactive medicine

Dr. Martin Young

Physician

February 16, 2011

Looking back, some of my biggest medical mistakes have been times when I was reactive rather than proactive when faced with a clinical problem. A doctor may have to be one or the other depending on the circumstances, but knowing when and which approach to take is one of the harder skills of medicine, taking time and experience to master.

What do I mean? Here are some examples from my field.

Treating …

Teamwork helps doctors with patient safety

Robert Wachter, MD

Physician

February 15, 2011

One of the central tenets of the patient safety movement is that modern medicine is a team sport. Unfortunately, its players – particularly physicians – were trained and socialized to be free-spirited individualists. We need the Celtics of the 80s; what we have is a collection of young John McEnroes.

While this theory has been generally accepted, there is less agreement regarding how to change things. When I speak about Read more…

Teamwork helps doctors with patient safety

Top 5 NICU tips from a preemie parent

Deb Discenza

Patient

February 15, 2011

Heads up folks in the Neonatal Intensive Care Unit (NICU), parents of premature babies want you to succeed more than you may realize. It is just hard for them to communicate this through the fog of stress and exhaustion that has consumed them for countless hours, days and even months.

So here is a little insight into the parent mind and what they want you to know about what it is …

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Top 5 NICU tips from a preemie parent