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A bipartisan solution for Medicaid work requirements

Health Policy

June 20, 2018

When I hear pundits going on about the Medicaid work requirements, I think of my father.

He has worked in the United States for twenty-four years, taking on the role of a handyman, migrant farmer, truck driver, construction roofer, dialysis patient transporter, and elder transporter. His limited English and third-grade education land him in low-paying jobs with limited hours and an oversupply of workers — resulting in frequent periods of unemployment.

For …

How did EHR designers get control of health care?

Fred N. Pelzman, MD

Health Technology

June 20, 2018

Wouldn’t it be cool if … ?

Wouldn’t it be better if … ?

Wouldn’t it be much easier when we see patients if … ?

How come we can’t … ?

It seems like every day, someone in our practice comes up with an idea for a way to do something better:

From our front desk staff who check patients in, and have to deal with a multitude of electronic systems for registration, …
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How did EHR designers get control of health care?

The National Guideline Clearinghouse will go offline. Patients will be worse off.

Kenneth Lin, MD

Health Policy

June 19, 2018

Absent a last-minute, lifesaving intervention, after 20 years of reviewing and summarizing clinical practice guidelines in a continuously updated database, the Agency for Healthcare Research and Quality’s National Guideline Clearinghouse (NGC) will go offline on July 16th. Prior to its untimely death due to budget cuts, the NGC not only served as a one-of-a-kind online resource for clinicians, researchers, and educators, but raised the bar on guideline …

Fixing primary care’s broken business model

Hans Duvefelt, MD

Health Policy

June 19, 2018

Primary care visits are never quick; we don’t give much advice over the phone or online; and we prioritize the government’s and insurance companies’ public health agenda over our own patients’ concerns.

Imagine health care as a retail customer experience for a few minutes:

Imagine you’re going to Walmart to buy a bag of dog food, a new coffee maker or to equip a small kitchen in your newly built mother-in-law apartment.

1. …

A surprising way to connect with the most difficult individuals

Edwin Leap, MD

Physician

June 19, 2018

I have met, in the emergency department, some fierce individuals. Sometimes they can be terrifying. Their clothes, their manner, their demeanor, the way they pace, all suggest potential danger. They seem clearly capable of violence. They look at me with distrust, expecting to be disrespected, dismissed, treated harshly.

Sometimes, they are covered in piercings; a thing alien to me. Other times, the symbology on their clothes speaks volumes. My colleagues in …

An innovative approach to fix the generic drug shortage

Christopher Johnson, MD

Medications

June 19, 2018

Most physicians are increasingly forced to grapple with the problem of shortages in generic drugs. These are drugs for which the patent has expired and any company can make them. Certainly for those of us in the PICU it is a chronic problem because the majority of drugs we use are injectable medications that have been generic for many years. Hardly a week goes by I don’t receive a notification …

Becoming a doctor is the epitome of delayed gratification

Natasha Abadilla

Medical Education

June 19, 2018

Recently, I had the honor of standing by one of my childhood best friends as she promised the love of her life that she’d stand by him forever. The wedding was beautiful, and at the reception, I played with another close friend’s 3-year-old daughter and talked with other friends about their work promotions and apartment searches. All I have to contribute to these conversations are anecdotes about medical school and …

Why do physicians publish in predatory journals?

Skeptical Scalpel, MD

Physician

June 19, 2018

A new study found several senior academic surgeons had published papers in what used to be termed “predatory journals.” The newer, gentler term is “solicited publishing,” but it defines the same pay-to-play, low-quality publications.

Surgeons from the University of California, San Diego examined 110 emails sent to the senior author from 29 publishers during a six-week period and early 2017. Nearly all were requesting manuscript submissions. The 29 publishers represented 113 …

5 ways assembly line medicine harms patients

Linda Girgis, MD

Physician

June 18, 2018

When we go to the deli, we expect to take a number and wait in line. Accomplishing any task at the department of motor vehicles can be an ordeal of waiting and then being herded out the door. This is part of life in American society. However, it should not be part of your health care.

Patients need personalized attention and they need a health care team that listens to them, …

Why it’s time to humanize addiction

Sandeep Kapoor, MD

Physician

June 18, 2018

One of the most sought-after tickets on Broadway these days is Angels in America, a revival of Tony Kushner’s seminal play about the AIDS crisis and its aftermath. While only a few of us will be fortunate enough to see the show in person, everyone can benefit from the following insight: When the play originally debuted in …

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Why it’s time to humanize addiction

It’s always easier to judge someone’s failures from higher ground

Michael Kirsch, MD

Health Policy

June 18, 2018

We’ve all heard the excuse or explanation that “it’s society’s fault,” to explain someone’s failure. We hear expressions like this often when an individual has committed a crime or simply failed to succeed. Personal accountability is diluted as we are told that this person came from an imperfect home, had no role models or ample education.

These arguments are often wielded by those who have been favored with society’s blessings and …

When asking about suicide, are you ready for the answer?

Maria Yang, MD

Conditions and Diseases

June 18, 2018

I still feel a little anxiety whenever I ask someone about suicide.

I have no fear when asking The Question — “Have you been thinking about killing yourself?” — but sometimes I find that I’m not breathing while I await the answer.

What if this person says “yes”?

This anxiety persists even though it’s literally part of my job to ask this question. Despite having asked this question thousands of times, I still …

How this physician curbs his smartphone addiction

Suneel Dhand, MD

Health Technology

June 18, 2018

I am a frequent traveler and spend a lot of time in a number of different cities. The one I’ve currently been spending the most time in is a place, quite frankly, I’m crazy about: New York City! Anyone who writes a lot is usually also by default, a keen observer of people, and there’s no place better to do this than a busy, crowded city.

There’s an interesting habit that …

Obesity from the pathologist’s perspective

Jena Martin, MD

Conditions and Diseases

June 18, 2018

Editor’s note: Graphic image below.

Envision a large, loafy muffin top. Not just a central bulge or even love handles. I’m speaking of an apron of skin and fat that hangs down over many an American’s lower torso and groin. Surely you’ve seen it — you may even have one. Its medical name is the pannus.

I had never heard of a pannus in medical school and I still never hear it …

Antidepressant use and the climbing rate of the suicide

Martha Rosenberg

Conditions and Diseases

June 17, 2018

It is not clear whether Anthony Bourdain and Kate Spade were getting drug treatment for depression. What is clear is that suicide in the U.S. has never been higher even as the use of SSRI antidepressants has also never been higher. One in every eight American adults recently took an antidepressant says the CDC and the number is only rising. Are the drugs working?

The use of …

It’s time to create the safety net by normalizing psychiatric care

Torie S. Sepah, MD

Conditions and Diseases

June 17, 2018

I’ve thought a great deal about what to say, if anything, about the two suicides recently of two people who were not merely celebrities in the TMZ sense, but people who represented creativity — perhaps in a way that seemed tangible to the rest of us — and seem to have become celebrities almost by happenstance.

Suicide is not an unfamiliar or difficult topic for me. After all, I am someone …

A physician was fired for standing up for his beliefs

Jamie Katuna

Health Policy

June 17, 2018

Dr. Eugene Gu. He is — was — a surgical resident at Vanderbilt University. His resume exemplifies academic perfection: valedictorian in high school, undergraduate degree from Stanford, medical degree from Duke, surgical residency at Vanderbilt. He also founded his own research company. Not once throughout the span of his academic or professional career would one have any reason question his capability or competency. But several weeks ago Vanderbilt fired him, citing “performance” issues.

Why?

Because …

Call suicide by what it is: the cause of death

Darrell E. White, MD

Conditions and Diseases

June 17, 2018

As is often the case when flying I was rewarded for offering a greeting to my row mate on the plane with a bit of insight and knowledge I’d have missed had I not simply reached out a hand and said, “Hi, I’m Darrell.” My momentary companion (we each moved to more spacious seats) had been a schoolmate of the recently deceased Kate Spade. He confirmed her years-long struggle with …

Physician heal thyself: Practice medicine on your own terms

Nana Korsah, MD

Physician

June 16, 2018

Being intentional about everything in your life is one of the major pillars to having a balanced life. It all begins with organizing your priorities; and once you have set your priorities, you can develop a schedule that reflects them. In my case, my top priority is having a career that will allow me to live life on my own terms. Personally, living life on my own terms means having …

The story of a physician who fought back against MOC

Meg Edison, MD

Physician

June 16, 2018

Today one of my favorite families came for a visit. The kids were behind on their check-ups, but this wasn’t too surprising. Their young mom was recently diagnosed with stage 3 cancer and was working her way through surgeries and chemo. The length of time since our last visit made me worry that mom’s health kept the kids from their routine visits, but upon entering the room she looked well. …

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