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Doctors can reduce malpractice by being better people

Physician

January 5, 2011

My father, although retired, is a general and thoracic surgeon, triple boarded in critical care, who ran a trauma unit. My brother is a pretty successful lawyer. Whenever I visit them, inevitably at least one night ends with the three of us around a table, and the two of them going at it about who is to blame for the malpractice system.

My father, of course, blames the lawyers; my brother …

Measuring health outcomes is important but needs caution

Vipan Nikore, MD

Physician

January 5, 2011

I sat at home with a sense of relief. I had just finished my first month of residency – a grueling inpatient hospital month where I was pushed to new limits.

I now finally had my first “golden weekend” (meaning I had both Saturday and Sunday off). More importantly, I had survived my first month without any patient deaths on my service. Given how sick people are when they come to …

An ACO primer and get started on forming an Accountable Care Organization

Donald Tex Bryant

Health Policy

January 5, 2011

In early 2011 Department of Health and Human Services will be issuing guidelines for the formation of Accountable Care Organizations (ACO’s) for CMS (Medicaid and Medicare).

I know of several organizations looking into this type of organization as they anticipate the new guidelines. There seems to be great anticipation of the guidelines in various health care publications that I have recently read. On December 18, 2010 on the Health Affairs website …

How you can reduce preventable mistakes in your medical care

Neil Baum, MD

Patient

January 5, 2011

There are nearly 1.5 million Americans who suffer each year from preventable mistakes. A report by the Institute of Medicine estimates that as many as 98,000 people die in U.S. hospitals each year as the result of medical errors.

Most of these errors are related to drug mistakes. That’s the bad news. The good news is that your doctors and hospitals are trying to reduce these errors by using by using …

Government and health insurance intrusion penalizes efficient doctors

Jordan Grumet, MD

Health Policy

January 4, 2011

I wish I knew how to express myself. I wish I knew how to put this into words. How the direction of things has just become depressing. How each day makes me wonder how we got to where we are today. And I think back. Back to the beginning.

I think back to my childhood. And how I looked up to my father … the physician. How he died when I …

Start thinking about health literacy in a broader framework

Hilary Seligman, MD

Patient

January 4, 2011

I have a patient who I will call Antonia.

Antonia is in her early 70’s. She came to the United States from Guatemala many years ago, but never learned to speak much English. This doesn’t cause her much of a problem; her community is small and tightly-knit, so she doesn’t have much need to speak English in her home or her neighborhood. And she has a large family—children and grandchildren and …

Patients will choose their medicine, based on their doctor’s advice

Dave deBronkart

Patient

January 4, 2011

TEDMED is a truly extraordinary conference in San Diego, a fall sibling of TED talks focused on medicine. TED talks are just 18 minutes long, chosen and designed to blow your mind. They don’t all hit that level, but many do.

True to form, the opening session was a mind-blower. 26 year old Charity Tillemann-Dick stepped out on stage and belted out a soprano aria. I thought that was it – an opening …

Pain contracts threaten the doctor-patient relationship

Kevin Pho, MD

KevinMD

January 4, 2011

Doctors today are wary about treating chronic pain.

One of the main worries is precipitating fatal opioid overdoses. Indeed, according to the CDC, and reported by American Medical News, “fatal opioid overdoses tripled to nearly 14,000 from 1999 to 2006 … [and] emergency department visits involving opioids more than doubled to nearly 306,000 between 2004 and 2008.”

Requiring chronic pain patients to sign pain contracts is a way to mitigate this risk.

But …

Childhood obesity and chronic illnesses that result from being overweight

David B. Nash, MD, MBA

Patient

January 4, 2011

Our national health status is in imminent danger from the effects of a condition that most population health experts acknowledge is out of control.

I am speaking of obesity — and, in particular, its increasing prevalence in American adolescents and children.

Almost every study that has been done concerning obesity shows a correlation with soda consumption. As a result, some states and municipalities have tried to implement initiatives that make it more …

Protecting health care professionals who act based on their conscience

Kevin

Patient

January 4, 2011

by Child of the Ocean

I recently came across an interesting article titled “Conscientious Objection Gone Awry — Restoring Selfless Professionalism in Medicine” by Julie D. Cantor, M.D., J.D., in the New England Journal of Medicine.

This article argues against a rule, the Provider Refusal Rule, from the United States Department of Health and Human Services (DHHS) that legally protects health care professionals who act based on …

Medical care and airlines – should there be a difference?

angienadia, MD

Patient

January 3, 2011

A recent article by Pauline Chen features a group of primary care physicians at Tufts Medical Center in Boston, who have created a concierge practice that funnels income into the traditional general medical practice that sees less-advantaged patients.

Surveys (performed by the medical center itself) found that patients rated the quality of interactions with their doctors similarly regardless of their affiliation. The only significant differences in responses had to …

An automated call center for your medical practice

Peter J. Polack, MD

Physician

January 3, 2011

Having an answering service is essential for the typical medical practice. But what about your regular call center? Do your front desk personnel answer the phone? Do you have a dedicated receptionist? Or a formal call center?

Outsourcing services seem to be on the rise and medical practices are beginning to realize some cost savings just like other businesses.

The trade-off of course can be the perception of less personalized service. Some …

ACP: Clinical decision support – is it time?

American College of Physicians

Health Technology

January 3, 2011

A guest column by the American College of Physicians, exclusive to KevinMD.com.

by John Tooker, MD, MBA, MACP

The recently enacted American Recovery and Reinvestment Act (ARRA, 2009) and Patient Protection and Affordable Care Act (PPACA, 2010) contain provisions that, if implemented, will fundamentally change the way that medicine will be practiced in the future.

As I indicated in a …

Is the media responsible for childhood eating disorders?

Claire McCarthy, MD

Patient

January 3, 2011

I really don’t want my children to be overweight. I know this because I see the consequences every day in my practice, consequences like high blood pressure, impending diabetes, or poor self-esteem.

At the same time, I really, really don’t want my children to have an eating disorder. I know this because I had one.

In college, I suffered from anorexia nervosa. I’m a little more than 5 feet 9 inches tall, …

Permanent makeup risks and dangers

Orly Avitzur, MD

Conditions and Diseases

January 2, 2011

“She just got permanent eye liner and eyebrow augmentation—looks fab,” emailed one of my closest friends last month, about her coworker. “I am seriously considering permanent liner/eyelash augmentation. Do you have any interest in doing this with me?”

I understood the appeal … I’d never have to reapply makeup after showering at the gym, save time on my morning routine and enhance features like thinning lashes and brows. Although we had …

Read more…

Permanent makeup risks and dangers

What will become of health insurance companies after reform?

Paul Levy

Health Policy

January 1, 2011

The talk around the country among health insurance companies is that their insurance business is dying.

What is happening? First, the consolidations in other industries, resulting in large, multistate corporations, already mean that many companies self insure their employees. Even many local firms have large enough work forces that they can be self-contained risk pools. (One source I found says that in 2008, 89 percent of workers employed in …

Discussing cancer treatment with the terminal patient

Bruce Campbell, MD

Conditions and Diseases

January 1, 2011

For everything, there is a season…
– Ecclesiastes

“Are you giving up on me?” My patient looks at me severely. “There must be other treatment options! Aren’t there some experimental drugs out there? I have beaten this cancer twice before. Are you saying that I can’t beat it again?”

No one can ever know with absolute certainty whether my patient’s newly recurrent cancer might miraculously disappear with one more treatment. His recurrence, however, has …

Lessons learned from asthma therapy

Juliet K. Mavromatis, MD

Conditions and Diseases

December 31, 2010

As a kid I had allergies and asthma.

Because of this, for several years, my mother wrote a note excusing me from the 600 meter run in elementary school. My father took me to weekly allergy shots. At times I had eczema on my forearms and eyes, and according to my allergist, whose notes I later read, I had moderate allergic shiners (also known as dark circles under my eyes). My …

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Lessons learned from asthma therapy

Will medical school as we know it exist in a decade?

Scrub, MD

Medical Education

December 31, 2010

A century ago in the U.S., the American Medical Association (AMA) created the Council of Medical Education (CME) to evaluate the standard of medical education.

In 1908, the committee recruited the Carnegie Foundation to survey the 155 medical schools operating at the time in order to see whether they met the standard of medical education set by the CME. The Carnegie Foundation in turn asked Abraham Flexner, a professional educator, to …

Heart attack symptoms in women, in their own words

Carolyn Thomas

Patient

December 31, 2010

Having a heart attack felt nothing like I thought it would feel. For one thing, unlike sudden cardiac arrest, in which the heart stops beating and you stop breathing, during my heart attack (myocardial infarction), my heart continued beating, and I was conscious throughout despite horrific symptoms – so how could I possibly be having a heart …

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