“How to Haggle With Your Doctor” was the title of a recent Business section column in the New York Times. This is one of many similar directives to the public in magazines, TV and Websites urging us to lower the high price of our health care by going mano a mano with our physicians about the price of tests they recommend and the drugs they prescribe. Such articles provide simple, …
Haggling with your doctor about the costs of care
I recently pointed to a BMJ study concluding that pay for performance doesn’t seem to motivate doctors. It has been picking up steam in major media with TIME, for instance, saying, “Money isn’t everything, even to doctors.”
So much is riding on the concept of pay for performance, that it’s hard to fathom what other options there are should it fail. And there’s mounting evidence that it will.
Aaron Carroll, a …
What’s next for doctors if pay for performance fails?
In a hospital setting, administrators love to work with physicians; they make sure whenever a new system is being formulated and implemented, this is discussed with a team of physicians, as they are also an integral part of success. All physicians work with each other in harmony and synchronicity.
Cardiologists never step on each other’s toes, radiologists call admitting doctors for any bizarre findings and hospitalists notify the primary about their …
The void between physicians and administrators in hospitals
I recently headed off to a reception for students from the new Pacific Northwest University of Health Sciences in Yakima, WA who are spending their third year of osteopathic medical school in Puyallup, WA doing rotations with the physicians in our community. I’ve had a student with me recently, and it brings back memories of my third year in med school, and how things have changed. It also leads me …
Seeing a family physician at work is valuable for medical students
Electronic medical records and pay for performance are among the ways health reformers are going to improve patient care.
It’s a fundamental shift in how doctors practice, with more practices adopting expensive EMRs. And with the advent of Accountable Care Organizations, doctors will soon be compensated in part by quality measures.
But will they work? Well, the jury’s still out.
Two articles caught my eye recently.
The first, from the WSJ’s Health Blog, reports …
Electronic medical records and pay for performance don’t improve care
by Dennis Grace
I recently received a message from the Center for Connected Health. I must admit the opening of the letter really put me off. It asked:
How do you solve the puzzle of patient compliance?
I responded to the gentleman who sent the invitation with:
Well, you might start by calling it something less offensive. Patient compliance? The phrase assumes “patient” as direct object rather than subject of participatory medicine. We …
Solving the puzzle of patient compliance
The approval of dabigatran (Pradaxa) has been long awaited in the cardiology community. Although just about everyone agrees that a good alternative to warfarin is highly desirable, there are many remaining questions about the drug as it prepares to enter the marketplace.
Here are a few questions raised by electrophysiologist John Mandrola on his blog:
Dabigatran (Pradaxa) questions in atrial fibrillation
by Danielle Leach, MPA
“A true friend walks in when everyone else walks out.”
I read that on a magnet on my friend’s refrigerator recently and the simple power of that saying brought me to tears. I have learned that lesson of true friends since my son’s diagnosis of cancer in 2007.
Anyone who has faced a serious illness as a patient or a caregiver knows that you quickly learn who your …
A lesson about true friends for those facing serious illnesses
Adoption of electronic health records (EHR) systems remains a challenge, both for hospitals as well as for physicians in ambulatory practice. The process of adoption, implementation, and meaningful use of EHRs (let us keep in mind) is actually quite different between those two setting.
Much has been written concerning EHR adoption within hospitals. Much of the experience in computerized physician order entry (CPOE) comes from hospital EHR adoption, and many of …
EHR implementation in the ambulatory or hospital setting
As I walked into the ED for my shift, the nursing supervisor was fumbling with a syringe attempting to get medication out of a small vial.
“Ummmm. Looks like you need to adjust your bifocals,” I quipped. We have a running joke about who is older and bust on each other about our ages every chance we get.
When she turned around, the look she gave me signaled that it was no …
Your worth as a physician can be judged by how people invoke God
The other day, I happened to be talking to Mark, a sales representative from one of the pharmaceutical companies. He’s the type of rep that many doctors don’t mind seeing – someone who is careful of your time, is happy to hunt down the answers to questions that come up on the medications his company makes, and brings by useful information about new drugs that seem to be practice-appropriate. He …
FDA regulation and non-approved use of drugs
The following is a brief list of some of the things I think have been useful and worth their money in my first two years of med school:
1. Large, widescreen computer monitor. The volume of information required to internalize during the preclinical years of medical school can’t be compiled and organized on paper. You would end up with bookshelves filled with those gigantic 4″ binders. Therefore, almost everything happens on …
Useful things to buy during medical school
The Institute of Medicine has been an advocate for clinical guidelines for many years.
Although the value of guidelines has never really been established, both clinicians and medical malpractice attorneys often want to ascribe greater credibility to them than they deserve. The issue was raised again in the past few months and I review it briefly here.
A few years ago Dr. Robert Ewart discussed the ethics of using guidelines to screen patients …
Malpractice attorneys shouldn’t rely on clinical guidelines
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US District Judge George Steeh of Michigan ruled last year that the constitution permits the federal government to require individuals to obtain health insurance coverage.
This lawsuit was filed by a Christian legal organization called the Thomas More Law Center, as well as others. Other lawsuits are in the works in numerous other states. These suits are filed primarily by Libertarian-types who don’t want to be forced to buy health insurance …
Government is already involved with the majority of health care
Every once in awhile amidst the weekly deluge of medical articles comes a show-stopper that has the potential to change the way we practice.
Rarer yet is the article that not only changes how we practice, but calls into question why we do what we do.
This recent article from the New England Journal of Medicine is just such an article. Before you bolt, let me simplify it for you.
Palliative care can lead to higher quality of live and longer survival
You are a new parent. Your infant is gassy, fussy, spitty, and does not sleep much. In other words your infant is a normal baby. You are stressed, and like any good parent, you want to fix what “ails” your infant. As you stroll down the baby aisle at the grocery store, you see labels that tout words like gentle, comfort, and restful. Formula manufacturers are brilliant. They know their …
Formula and the placebo effect on your baby
A common complaint about modern medicine is the depersonalization of the patient and the loss of compassion.
So let’s take a look at compassion.
Compassion is derived from the Latin “cum” (together with) and “patior” (suffer). From the perspective of clinicians, compassion is defined by two concurrent emotions: (1) a feeling of deep sympathy and sorrow for another who is stricken by medical misfortune accompanied by (2) a strong desire to relieve that …
Depersonalization of the patient and the loss of compassion
by Rishi Manchanda, MD
As a primary care doctor for working families, I am interested in anything that can tangibly address my patients’ health problems. But how do I prescribe repeal?
The House effort to repeal and replace last year’s health care law is not just an untested placebo with major potential side effects, like increasing the number of Americans without health coverage. For those of us on …
How repeal and replace will affect patients
Antibodies are complex proteins created by immune cells that are targeted to very specific parts of other large and complex molecules called antigens.
Much smaller molecules like nicotine, called haptens, do not normally induce any significant immunologic response so researchers chemically bound several nicotine molecules to a large protein to form an adduct. This combined molecule does induce an immune response, i.e, causes immune cells to produce antibodies targeted to the …
Nicotine vaccine to treat tobacco abuse and nicotine addiction
This past summer I got a chance to visit Washington DC. While I was there, I saw a Norman Rockwell exhibition at the Smithsonian American Art Museum. As it turned out, the exhibition was the private collection of George Lucas and Steven Spielberg. The exhibition highlighted Rockwell’s masterful storytelling.
I didn’t know much about Norman Rockwell before that day. I knew he was a famous American painter and I had seen …
What your medical office can learn from Norman Rockwell
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