I can’t remember which lecture it was, or even just when in my first two years of medical school the lecture was given, but I do remember how the concept struck me as really important.
The gist of the message was that the timing of onset of a patient’s symptoms is a key part of understanding the nature of the patient’s diagnosis. Symptoms from a neoplasm come on gradually, tend to …
How time can be used as a diagnostic tool
by Dennis Grace
The last time I visited my physician for an epidural injection, as the doctor’s assistant was situating me under the fluoroscope, the doctor was feverishly dictating notes on his previous patient’s procedure. No doubt your physician has a similar work schedule: when not dashing off notes from one patient or burrowing through medical research to diagnose another, he’s performing delicate medical procedures …
Trust your doctor but review your medical bills
A revealing article in Bloomberg recently described the latest way in which elderly patients are getting screwed by the system.
Medicare reviews all admissions and if the patients don’t meet indications for admission, the hospital doesn’t get paid by Medicare. Medicare has also recently implemented a mercenary system called Recovery Audit Contractors (or RAC for short) in which third parties audit hospital charts to see whether Medicare “overpaid” for a patient’s …
How observation admissions affect Medicare patients
Like it or not, “garbage in, garbage out” is the rule rather than the exception for the vast majority of bureaucratically dictated “quality control” programs that we’re ever likely to launch. There are three primary reasons for this.
First and foremost, there’s Goodhart’s Law:
“Originally, an economic theory stating that if a particular definition of the money supply were to be used as the basis for monetary policy, the stability …
Quality programs have social and medical consequences
The Wall Street Journal’s Health Blog carries an interesting piece about a program at Indiana University–Northwest that allows volunteers from the general public to participate in preparing cadavers for first year medical students.
This is a brilliant idea for several reasons:
Should the public participate in preparing cadavers for students?
NPR has a great blog on their website called Shots about current events in health care. Recently, Scott Hensley, the main blogger there, posted a recent article on treatment of prostate cancer from the Archives of Internal Medicine.
If you look at the article, you may notice a very small subheading above the article’s title. It reads “Less is More.”
Very telling.
The thrust of the article and the …
Watchful waiting is underutilized for most men with prostate cancer
I was recently scanning an online forum about pediatric health concerns. (What can I say? I sometimes need inspiration.) One thread within the forum was significantly longer than any other. Parent after parent posted about how they had noticed a knot on their infant or toddler. This concern parallels what I see in practice. An unexplained knot on the head is a common reason parents bring their child to be …
When parents should be concerned about a lump on their child
[Editor’s note: Please visit part 1 of Dr. Harpham’s take on OpenNotes.]
“Our” Chart
Does the opportunity for patients to read their medical charts help or hurt patients’ ability to become Healthy Survivors?
Open notes can facilitate Healthy Survivorship for some patients.
Unfortunately, other patients may learn something about their condition that makes it more difficult to get good care or live as fully as possible. Or they may experience feelings that threaten the physician-patient bond. …
How open medical charts help Healthy Survivorship
Over the past year, states across the country have begun to develop Regional Extension Centers (RECs) to help support the broad electronic health record (EHR) initiative passed as part of the economic stimulus package in 2009.
Why should physicians care? With benefit of a little background information, the answer is pretty clear.
The evidence suggests — and it is generally believed — that adoption of EHRs by physicians and other healthcare providers …
Why doctors should care about Regional Extension Centers (RECs)
“What does it take to be good at something in which failure is so easy, so effortless?” asks Atul Gawande in his book, Better. For medical students who will soon have responsibility over people’s lives, it’s a daunting question. It draws out our fears of messing up and making mistakes. Of getting a lower grade than our peers on a Structure Function exam. Of answering a question incorrectly and embarrassing …
How to foster a cycle of excellence in medicine
Dr. Kirsch at MD Whistleblower has written about his recent unpleasant experience with malpractice litigation. Despite having full access to the patient’s chart and medical records, the plaintiffs attorney chose to include Dr. Kirsch in the suit … apparently … just because … he had seen the patient.
In Ohio – where this case was filed – a plaintiff in a medical malpractice case is required to obtain …
Medical malpractice and how legal waste increases overall costs
If you’re a health care professional, chances are you know a bit about social media, possibly feel compelled to use it sometimes and you might actually be participating in the Facebook/Twitter/LinkedIn/blog revolution.
But there can be real problems in using social media in the health care context. Whether you are in private practice or work for a group of large hospital network, social media mistakes can be costly in terms of …
7 social media mistakes made in health care
One of my docs was telling us about a patient’s experience at another practice. Apparently, the parent was at her wits end with her crying baby. She called the on call doctor to ask for advice and the doctor told the patient, “your baby has colic’s; turn on the vacuum and stop calling.”
It turned out the baby had some gastric condition (not colic) and needed treatment. The patient ended up …
Why doctors have poor customer service
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by Stephen R. Blumberg, PhD
As a panic disorder specialist, I take an active responsibility in helping my patients feel confident that their physical complaints have no organic etiology.
My day is filled with my patient’s reporting symptoms of heart palpitations, shortness of breath, chest pressure, rubbery legs, lightheaded feelings, inner trembling, numbness and tingling in the extremities, lump in the throat, knot in the stomach and head pressure, to name …
Early diagnosis of panic disorder can improve quality of care
There’s been considerable buzz on the web recently – on the New York Times website, on Facebook, and on a physicians’ forum called Sermo, at least – over a New York Times article recently entitled, “Getting Into Med School Without Hard Sciences.”
The article describes the Humanities and Medicine Program at Mount Sinai Medical School, a program which each year admits into the medical school 35 undergraduates who major …
Should humanities be the focus of prospective medical students?
One of the simultaneously most enjoyable and exasperating aspects of being an infectious disease specialist is the large volume of “curbside” consultations we get from colleagues.
For example, here’s this week’s tally — and it’s only Tuesday — done from memory and without systematically keeping track of emails, pages, phone calls, etc.:
Why specialists don’t do more curbside consults
The following list is from a cancer survivor, Judy Engibous, posted on Hester Hill Schnipper’s blog Living with Breast Cancer.
We first published it back in March of 2009 but are “reloading” it in recognition of Showtimes’ The Big C starring Laura Linney. We were wondering if the story could be considered an example of “Participatory Medicine” with Linney’s character being an “e-patient.”
10. Being able to shamelessly make fun …
10 good things that can happen from cancer
To screen or not to screen? That is not the question.
The question is not whether to screen, it is why, what, where, when, how, and how much, how often, and at what cost for what benefit.
Patients and physicians must and do screen. The issue is cautious appropriateness. Self-screening by patients is easy, free, and fundamentally harmless. Look at your skin for potential melanomas, be alert to warning symptoms of a …
Patients and physicians should screen for cancer, but cautiously
Why is Catherine Zeta-Jones so mad?
It’s a facetious question. Her husband, Michael Douglas, was recently diagnosed with throat cancer he described at “stage 4.”
She was quoted by People magazine as saying, “It makes me furious they didn’t detect it earlier.” They have young children, and anyone who hasn’t personally been faced with this threat can only imagine her fear and anxiety. I suspect no number of large houses, expensive cars, …
Catherine Zeta-Jones blames doctors for Michael Douglas’ throat cancer
Interesting article recently from Health Affairs about the clinical equivalence between the care provided by anesthesiologists and CRNAs. The article concludes by advocating that CRNAs be given permission to practice anesthesiology without physician supervision. It’s more cost effective. And there is no compromise to the quality of care delivered to patients.
We recommend CMS return to its original intention of allowing nurse anesthetists to work independently of surgeon or …
Should CRNAs practice anesthesiology without physician supervision?
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