Why public support for health care reform is falling

Health Policy
November 4, 2010

The latest Kaiser Family Foundation poll, conducted in August, shows public support for health care reform falling. After two monthly polls in which reform was viewed increasingly favorably, the new poll shows a sharp decline in public backing for the new law.

Kaiser polls in the first couple of months after enactment of Patient Protection and Affordable Care Act (PPACA) showed more confusion than clear support or opposition, but by June favorable …

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Why public support for health care reform is falling

Conflicting stories on alcohol and heart disease

Physician
November 4, 2010

Have you ever had a cold beer after a mountain bike ride?

Oh my!

But does such indulgence put one at risk for an arrhythmia? Does alcohol exacerbate an existing arrhythmia? How much, if any, alcohol is acceptable?

These are questions I am asked frequently.  And for those asking, they are very important questions.

I wish the answer was straightforward.  But it is not.

Undoubtedly, excessive alcohol can precipitate an abnormal rhythm.  Look no farther …

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Conflicting stories on alcohol and heart disease

Screening for lung cancer with a CT scan: What the NLST results mean

KevinMD
November 4, 2010

Lung cancer screening has been an area of considerable controversy.  Before today, there had been no evidence that screening patients for lung cancer, either with a CT scan or chest x-ray, saved lives.

For years, doctors have been waiting for the results of the large, randomized National Lung Screening Trial (NLST), conducted by the National Cancer Institute.

This morning, it was announced that the trial was stopped early, with a …

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Screening for lung cancer with a CT scan: What the NLST results mean

Involving a psychiatrist in a patient’s care for the first time

Physician
November 4, 2010

The psychiatrist knocks on the door of the patient’s hospital room.

Patient: “Come in.”

Psychiatrist: “Good afternoon, Mrs. Jones. I’m Dr. Moodbetter, one of the psychiatrists here. Your doctor asked me to see you. Did he say anything about this?”

Patient: “No, he didn’t! You know, I’m not nuts. I didn’t think he believed me. Great. Now he just thinks it’s all in my head.”

Psychiatrist: “Well, I don’t think he meant to imply …

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Involving a psychiatrist in a patient’s care for the first time

Deeply connect and engage your patients with empathy

Patient
November 4, 2010

Doctors and nurses are leaders in health care.  Being a great leader means having a clear vision, mission or goal.  It means being committed, and knowing how to listen and communicate, but it involves much more.  It’s about having heart, empathy, and an uplifting spirit.

I value and respect a well written post by Thomas Goetz, author of The Decision Tree: Taking Control of Your Health in the New Era of …

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Deeply connect and engage your patients with empathy

Tinnitus highlights poor doctor patient communication

Conditions and Diseases
November 4, 2010

I’m both interested in and disturbed by what some doctors have said to patients at the first consultation for tinnitus,  an annoying perception of sound that comes from somewhere within their heads.  Not many of these patients are referred to me – most come of their own accord for a second opinion.  What they tell me their doctor said is a lesson in how not to communicate with patients, and …

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Tinnitus highlights poor doctor patient communication

Use technology and outsourced services to improve practice efficiency

Physician
November 3, 2010

What does it cost to improve operational efficiency using technologies and outsourced services?

For some physicians, the first reaction to every new service or technology is that it’s going to “cost too much.”

And you get pitches for plenty of new services:

* Your clearinghouse vendor or your billing manager wants you to push all your claims, even the claims you can file directly at no cost, through the clearinghouse for efficiencies.
* Your …

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Use technology and outsourced services to improve practice efficiency

Doctors are quietly opting out of medicine

Physician
November 3, 2010

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Dr. Ryan Flesher was working his usual shift in the emergency department that night in July of 2006.  The hospital was short-staffed, per usual, and patients continued streaming through the revolving doors.  Neither the people at the front desk nor the nurses saw Dr. Flesher slip quietly down the hall that night.

The following is a true story that occurred well before healthcare …

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Doctors are quietly opting out of medicine

If health care reform is killed, what happens?

Health Policy
November 2, 2010

If conservatives manage to kill health care reform legislation, what will happen next?

I really don’t want to go there.

First, I’m convinced that conservatives won’t be able to repeal the Affordable Care Act (ACA).  Democrats will hold onto the Senate, and President Obama still has a veto. If necessary, he will use it to protect the bill. Meanwhile, the majority of the public either favors the legislation or want to “wait …

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If health care reform is killed, what happens?

Induction of labor should be restricted to medical indications

Conditions and Diseases
November 2, 2010

It seems rather obvious that medical procedures should be reserved for medical indications. Why? Because almost every medical procedure, even some of the simplest, have small but real risks of complications. And risking complications can only be justified if the medical benefit outweighs the risk.

That rule applies to labor inductions, although many obstetricians have forgotten it. Induction of labor for non-medical reasons, primarily convenience, is attractive, but labor induction is …

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Induction of labor should be restricted to medical indications

Do patients want to be empowered or managed?

Patient
November 2, 2010

by Toni Bigby

Lately there has been a lot of conversation around patient empowerment – an ambiguous term, but one that is fodder for many conversations across the health care industry. Patient empowerment – to put it simply – is about providing the necessary tools and information to a patient so that he or she can take a more active and involved position in his or her health …

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Do patients want to be empowered or managed?

Covering the uninsured and the costs to society

Health Policy
November 2, 2010

by Lucas Restrepo, MD

Recently, the fire department of a small town in Tennessee called South Fulton ignored the call of a man who needed help quelling a fire near his house.

The firefighters declined lending a hand because the caller neglected to pay a $75 bill, the prerequisite for deserving assistance. The caller tried to put down the fire with a garden hose, but …

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Covering the uninsured and the costs to society

Spanking your kids and corporal punishment

Physician
November 1, 2010

Something recently stopped me in my tracks.

A study published in Pediatrics recently found that 65% of parents to 3 year-olds said they had spanked their child within the last month. Sixty five percent? The number surprised me. If you’d asked me to guess, I would have said 20-25%. Talk about way off. Another reminder of how much I have to learn.

The study evaluated risk factors, including domestic violence and intimate …

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Spanking your kids and corporal punishment

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What would you do if you had a year left to live?

Patient
November 1, 2010

Though I’ve spoken about breast cancer for Susan G. Komen for the Cure (emphasizing the importance of early screening and detection), until recently I had never had a mammogram. In my training I’d been taught that mammograms weren’t that accurate or useful in women under 40 (our health system’s protocols reflect that), so I got regularly checked by my physician whenever I had a physical and otherwise was waiting until …

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What would you do if you had a year left to live?

Case reports continue to be an important part of journal publication

Conditions and Diseases
November 1, 2010

I am teaching a new course entitled “Turning your Clinical Cases into Scholarly Work.”

I hope to draw on my own experiences through the years mentoring students and residents in writing up several clinical cases, but also in making diagnoses.  In preparing for this course, I have also learned quite a bit about the controversy surrounding case reports and the challenges that they face in today’s healthcare system.

Unfortunately, case reports have …

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Case reports continue to be an important part of journal publication

Is The Empowered Patient too adversarial?

Patient
November 1, 2010

I understand the frustration and anger in CNN Senior Medical Correspondent Elizabeth Cohen’s new book, The Empowered Patient.  I agree that all of the horrible patient stories should have never occurred.  As a practicing primary care doctor who has witnessed near misses and bad medical outcomes affect family members, I too wrote a book encouraging patients to be informed and engaged about their care.

The problem is that The Empowered …

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Is The Empowered Patient too adversarial?

Coaches can help with lifestyle goals in a way that doctors cannot

Patient
November 1, 2010

More Americans are overweight and out of shape than ever before.  Their sedentary, high-calorie lifestyles are causing an epidemic of obesity, high blood pressure, heart disease, and degenerative arthritis among other preventable conditions.  If those aren’t bad enough, obesity and a sedentary lifestyle also raise the risk of breast cancer, colon cancer, and other common forms of cancer.

Doctors all across the nation are struggling to treat these lifestyle-induced conditions with …

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Coaches can help with lifestyle goals in a way that doctors cannot

Empathy cannot be simply turned on and off

Medical Education
October 31, 2010

In our clinical years, our medical school has instituted a program in which we do learning modules along with our in hospital experience and didactics.

I was happy to see a module on empathy for my second month of surgery. The last question to be answered in this module was: “Although the studies on empathy are very consistent other authors have indicated that medical students are really not losing cognitive empathy, …

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Empathy cannot be simply turned on and off

Doctors should embrace feedback and learn from it

Physician
October 31, 2010

In Quality Measures and the Individual Physician, Danielle Ofri, MD, PhD questions the usefulness of feedback report cards for individual providers. She states, “Only 33% of my patients with diabetes have glycated hemoglobin levels that are at goal. Only 44% have cholesterol levels at goal. A measly 26% have blood pressure at goal. All my grades are well below my institution’s targets.”

It would be better for Dr. Ofri’s patients if …

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Doctors should embrace feedback and learn from it

Providing Medicare to everybody increases continuity of coverage

Health Policy
October 31, 2010

At a recent staff meeting, a colleague mentioned her client was at an “awkward age”.

I thought she was referring to a teenager, but she quickly clarified herself. She was referring to the age before someone is old enough for Medicare at sixty five, an awkward time indeed.  Many people between the ages of fifty to sixty four find that relatively minor health problems make health insurance unaffordable. For those with …

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Providing Medicare to everybody increases continuity of coverage

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