Is health care shifting towards convenient retail clinics?

Physician
September 13, 2010

Mark Perry provides an interesting inference from two news stories: a WSJ article that suggests consumers are using less health care and another that reports a big jump in MinuteClinic volumes.

Consumers aren’t necessarily consuming less health care like the WSJ suggests; rather, they are shifting their demand for health care away from expensive, conventional physician offices with limited hours to affordable and convenient retail clinics.  Especially …

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Is health care shifting towards convenient retail clinics?

A primary care physician who knows history and can relate to people

Patient
September 13, 2010

by Marianne Mattera

Recently, a press release from Mount Sinai School of Medicine in New York City landed in my e-mail inbox. “Students with Humanities Background Equally Successful in Medical School as Traditional Students”, the headline read.

The press release summarized the findings of a study published in the August issue of Academic Medicine. David Muller, MD, and Nathan Kase, MD, reviewed data on the Mount Sinai …

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A primary care physician who knows history and can relate to people

All patients will soon become e-patients

Patient
September 13, 2010

by Daphne Swancutt

I’m having a weird, visceral reaction to all of the recent brouhaha surrounding the term “e-patient.”

For some reason, semantically speaking, the term is slipping in to derogatorium. Up there with “cyberchondriac,” which definitely is derogatory. It’s kind of like research—one day, omigod, it’s Mecca; the next day, it’s the scab on a rotting wound.

Whatever.

I have a chronic condition—I’m not dying, it’s not …

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All patients will soon become e-patients

Why you need the pertussis vaccine, especially if you have children

Conditions and Diseases
September 12, 2010

A reader wrote, “A friend sent me a link to information regarding the pertussis vaccine for adults. I have a 6 month old. What are your thoughts?”

I wrote about vaccines for parents of newborns last year, but recent news about several outbreaks of pertussis make this question especially important. It’s time for an update.

Pertussis, also called “whooping cough,” is bad news. For children …

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Why you need the pertussis vaccine, especially if you have children

Doctors and family members often push for futile, aggressive care

Physician
September 12, 2010

Every once in a while, there’s a magazine piece that so encapsulates the key moral issues — and irrationality — of 21st Century medicine that it warrants designation as mandatory reading for anyone who interacts with patients. Atul Gawande has written some of these; so too has Slate medical columnist, Darshak Sangavi.

The latest entry on the required reading list is Katy Butler’s “My Father’s Broken Heart,” which appeared …

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Doctors and family members often push for futile, aggressive care

KevinMD.com in the New York Times and New York Post and other recent media mentions

Potpourri
September 12, 2010

I’d like to thank various media outlets for recently citing KevinMD.com.

In her New York Times diagnosis column, The heat of the night, Lisa Sanders discusses the case where a patient live-blogged his hospital stay, crowd sourcing his diagnosis:

[Physician blogger John] Schumann was worried, too. He lived nearly a thousand miles away — too far to come and see his friend. Besides, the patient was posting all his test …

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KevinMD.com in the New York Times and New York Post and other recent media mentions

Patients don’t believe the evidence, blame our healthcare system

Health Policy
September 11, 2010

Health Affairs reports on a study that finds Evidence That Consumers Are Skeptical About Evidence-Based Health Care.

According to the abstract,

We found many of these consumers’ beliefs, values, and knowledge to be at odds with what policy makers prescribe as evidence-based health care. Few consumers understood terms such as “medical evidence” or “quality guidelines.” Most believed that more care meant higher-quality, better care. The gaps in …

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Patients don’t believe the evidence, blame our healthcare system

10 tips for troubleshooting complex EHR infrastructure problems

Health Technology
September 11, 2010

I recently joined my team while troubleshooting a complex infrastructure problem affecting our community EHR hosting private cloud.

From years of experience doing this, here are my lessons learned.

1. Once the problem is identified, the first step is to ascertain the scope. Call the users to determine what they are experiencing. Test the application or infrastructure yourself. Do not trust the monitoring tools if they indicate all is well but the …

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10 tips for troubleshooting complex EHR infrastructure problems

How physicians can endure the trauma of a malpractice lawsuit

Physician
September 11, 2010

Several clients have endured the trauma of malpractice law suits, Medicare audits and stinging accusations or criticisms from patients or colleagues that leave them reeling.

These clients have shared feelings of:

  • shame
  • despair
  • depression
  • loss of self-worth
  • disillusionment
  • confusion
  • hurt
  • defeat

Oddly enough, one of the least common feelings they’re able to get in touch with is anger.

Maybe it’s because my clients are self-selected, and many tend to be goal-oriented strivers with a perfectionistic streak. They were, as was I, …

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How physicians can endure the trauma of a malpractice lawsuit

Primary care needs more than 15 minutes for patients

Physician
September 10, 2010

Psychotherapy appointments have traditionally lasted 50 minutes with 10 minutes for paperwork. This has lead to the expression, “the 50-minute hour”.

More recently there has been talk of incorporating psychotherapy techniques in brief visits in primary care. The provoking title “The Fifteen Minute Hour” is from a book about addressing the emotional aspects of disease in primary care during brief appointments. The title and the concept seem relevant to much of …

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Primary care needs more than 15 minutes for patients

How doctors can cope with stress

Physician
September 10, 2010

by Walter van den Broek, MD, PhD

Often I ask my residents that if you can’t take care of yourself, how do you expect to take care of your patients?

Or in another way: the only difference between God and a doctor is that God knows he’s not a doctor. These sound like cliches but there is some truth in them. In short, doctors are just ordinary people …

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How doctors can cope with stress

Contraceptive pill prices have a huge price range

Conditions and Diseases
September 10, 2010

Do you know that the price of a contraceptive pill in Chicago pharmacies varies from $9 (Trinessa, aka generic Tricyclen, at Target pharmacy) to $84 (Loestrin 24 at Kmart pharmacy) a month? That means, over the course of the year, depending on what pill you take and where you shop, you could drop as little as $84 or — let me get my calculator here — $1008! These prices are if you pay out …

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Contraceptive pill prices have a huge price range

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Beyond the final Medicare and Medicaid EHR incentive rules

Health Technology
September 10, 2010

by David C. Kibbe, MD, MBA and Brian Klepper, PhD

Finally, we have a Final Rule on the Medicare and Medicaid EHR incentive programs.

The rules and criteria are simpler and more flexible, and the measures easier to compute. But they are still an “all or nothing” proposition for physicians, who will have to meet all of the objectives and measures to receive any incentive payment. Doctors …

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Beyond the final Medicare and Medicaid EHR incentive rules

What is an adequate trial of an antidepressant?

Conditions and Diseases
September 10, 2010

Since there are many antidepressants with varying dosage ranges, and many more degrees of variations between individual responses to particular antidepressants, psychiatrists have been unable to agree upon an operational definition of an “adequate trial” of an antidepressant.

However, it’s worth looking at some guidelines.

A 2003 study from the Journal of American Medical Association found that only 21.7% of Americans diagnosed with depression received “minimally adequate treatment” in the past 12 …

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What is an adequate trial of an antidepressant?

Chronic disease and using social media for health

Social Media in Medicine
September 9, 2010

Speaking to the senior staff of the National Library of Medicine recently was like going before the best kind of murder board.

Picture it: 30 of the nation’s smartest health information mavens around a polished conference room table, asking me sharp questions, suggesting new lines of inquiry, and offering their own insights. In other words, heaven.

Our jumping-off point was the Pew Internet Project’s latest research on internet penetration, mobile use, and …

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Chronic disease and using social media for health

Bringing a friend or family member on doctor’s appointments

Patient
September 9, 2010

by Diana E. Lee

Most of the resources I’ve read about how to prepare for a doctor’s appointment recommend bringing a loved one with you so that person can help you remember what the doctor said and make sure you get your questions and concerns addressed.

But when I read Paula Kamen’s book All in My Head: An Epic Quest to Cure an Unrelenting, Totally Unreasonable and …

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Bringing a friend or family member on doctor’s appointments

Working with industry requires building a culture of trust

Health Policy
September 9, 2010

Howard Brody, a family physician, recently wrote an article in the Annals of Family Medicine discussing, “Professional Medical Organizations and Commercial Conflicts of Interest: Ethical Issues.”

The article focused on how AAFP has “recently been criticized for accepting a large corporate donation from Coca-Cola to fund patient education and materials on obesity prevention,” and how this money has been called a “conflict of interest.” To that effect, Dr. Brody defines such …

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Working with industry requires building a culture of trust

Physician resistance to EMR and why CPT should be replaced

Health Technology
September 9, 2010

After 5 successful years with electronic medical records (EMR), I am convinced that the promise of EMR to improve physician practices and to improve the health care system is real.

If that is true, why is adoption of EMR currently limited to only 5-10% of medical practices?  Why is there so much resistance?  As folks who work in heath care IT so often ask, why don’t doctors “get it?”  I don’t …

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Physician resistance to EMR and why CPT should be replaced

Why are most physicians writing their prescriptions by hand?

Health Policy
September 8, 2010

Is the pen mightier than the PC?

When it comes to prescribing, it appears so. A new report from the Center for Studying Health System Change finds that most physicians write their RX scripts by hand, despite financial incentives for physicians to adopt electronic prescribing. Even those who have e-RX systems do not always use them, and when they do, they may not to use the features that were …

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Why are most physicians writing their prescriptions by hand?

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