Everybody has a theory of what’s wrong with American health care and why costs are high.
I have my own theory – talk is cheap. By this, I mean Americans and third party payers are unwilling to pay more for what mere talk is worth.
They do not want to pay more for a visit to the family doctor, …
Why cognitive doctors need to be paid more
Ok, I confess. I have contributed to the $2.3 trillion that our country spends on health care every year. As a patient I want the best possible care for my family and me. As a physician I am the gatekeeper to expensive procedures, medications, and diagnostic tests. However, by several indices including life expectancy, infant mortality rate, and satisfaction with the health care system, we are not getting our money’s …
How primary care physicians can improve health and lower costs
Part two of the three-part series, Let’s Pay Popular People More!
Take a moment to ask yourself whether any of these categories describe you or someone you love:
If any of these terms describes you or a loved one, then you are statistically more likely to give a doctor a lower Read more…
How paying doctors for patient satisfaction is racist
When I was called to see the patient after a motorcycle accident I expected the worst. The patient sustained a thoracic spine injury with cord transection at T5 level as well as significant chest wall injury on the right side.
Multiple ribs were broken; some with a significant displacement. Managing patients with a significant chest wall trauma could be a nightmare. Pain control is only one of the challenges.
Read more…
Pain control in a patient with rib fractures and a spinal cord transection
by Jeffrey L. Cohen and Albert R. Meyer
Chiropractors and medical doctors (or D.O.s) have had a long and somewhat complex relationship.
Though they approach healthcare issues differently, there are many instances where they share care or even work together. Such “M.D./D.C.” relationships are legally complex, but often prove to be rewarding in many respects. Properly constructing the arrangements is critical, especially since government regulators and payers tend …
The legal issues of doctors and chiropractors working together
Dr. Kevin Kikta was one of two emergency physicians on duty at St. John’s Regional Medical Center in Joplin, MO on Sunday, May 22, 2011, when an EF-5 tornado struck the hospital.
You never know that it will be the most important day of your life until the day is over. The day started like any other day for me: …
What happened inside the hospital during the Joplin, MO tornado
In recent weeks, headline news has been reporting on the battle to curb the federal debt. What does this have to do with medical professionalism?
The federal government must borrow forty cents of every dollar it spends. In health care, it needs to borrow from China and other lenders to reimburse doctors, hospitals and other providers who bill federal programs.
The government’s debt totals $14.3 trillion. It is …
What medical professionalism has to do with the federal debt
by Mary McNaughton-Collins, MD, MPH
Aging does not have to be all about appointments, pills, tests, treatments and procedures – instead aging should be about celebrating life and rewarding those older individuals who are “living well” by encouraging pursuits outside of the medical realm.
The current state of our health care system tends to revolve around the idea that “more is better,” however, that is not always true — especially when caring …
Shared decision making in the golden years
In the real world of medicine, “great saves” are rare. Most patients that you expect to die will die, and those who experience a cardiac arrest or code rarely survive. Mr. GR is the closest I’ve seen to an exception to both of these rules, and his story illustrates the best but also the worst of what our health care system achieves.
I first met Mr. GR in the emergency room. As …
In medicine, the greatest save is not having to make a save at all
The psychosocial needs of patients can feel overwhelming for a doctor.
Our rite of passage as medical students, after all, is anatomy, not sociology. Even now, after a family medicine residency specializing in the biopsychosocial approach to medicine, I still brace myself for surprises before asking routine mental health screening questions of the patients in …
Helping with the psychosocial needs of patients
by Setu Mazumdar, MD
Everywhere I go I see unhappy doctors.
All everyone does is complain about rising malpractice premiums, more paperwork, declining pay, and 60 hour workweeks. This includes physicians just graduating from residency and physicians who’ve been practicing medicine for several decades.
All of those complaints are legitimate, but one question I always have in …
Physicians should blame themselves for why they are unhappy in medicine
I was sitting next to a resident in the preceptor room yesterday. He was calling a patient to discuss lab results, and introduced himself on the phone by his first name and last name … but not with “Doctor.” (e.g., “Hi, this is John Smith from the Family Health Center.”)
I occasionally see the residents’ patients for urgent visits. When I ask them who their regular PCP is at the office, …
Should doctors be addressed by their first name?
A recent survey in the American Journal of Bioethics, indicates that 80 percent of patients expect to see a physician when they come to the emergency department.
Parents were more insistent about their child see a physician or resident for even a minor condition such as a sprained ankle.
Patients indicated a preference for seeing a resident alone for non-urgent conditions (60%) and compared to a physician …
How PAs and NPs impact emergency room care
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by Greg Smith, MD
As a psychiatrist, part of my job is to listen as you tell me about symptoms that bother you every day.
If I can help you put these symptoms into a framework such as a syndrome or a disease, then we can work together on trying to figure out how to treat them. Often times in Read more…
Why cookbook medicine detracts from compassionate care
I had a patient once who wanted an exercise stress test even though he had neither symptoms nor risk factors to suggest the presence of coronary artery disease (such as chest pain with exertion). I argued vociferously against it. However, extenuating circumstances (not relevant here) prompted our mutual decision to go ahead with it anyway. To our surprise and dismay, it came …
Why doctors can’t screen patients for every disease
Here are the three most useful words for a doctor: “I don’t know.”
A close second would be “I’m not sure,” another three that have got me out of trouble more times than I can remember. The older I get, and more experience I have, the more useful it becomes.
Pattern recognition is essential in effective medical practice. So often patient complaints are vague and nondescript, and in the absence of physical …
The three most useful words for a doctor
I’m a big game theory guy.
I think you can explain the actions of the participants in any structured activity or enterprise by looking at the rules of the game. When you look backwards in time you discover that the “players” almost always made choices that represented rational self-interest. This is especially true in games played using zero sum rules: someone wins only if someone else loses. How the game is …
Medical malpractice tort reform equals healthcare reform
by Alex Smith, MD
I used to get Sports Illustrated, and my favorite column was titled, “This week’s sign that the apocalypse Is upon us.” Well, JAMA recently published the medical equivalent.
Sima and colleagues at Memorial Sloan Kettering used a population based dataset of patients with cancer to compare rates of cancer screening (mammography, PAP smears, PSA …
Cancer screening on autopilot in patients with advanced cancer
To address the huge problem of errors by health professionals causing injuries and deaths to hospitalized patients, the U.S. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius unveiled the Partnership for Patients initiative.
Secretary Sebelius referred to a recent study showing that adverse events in hospitalized patients, including those caused by human errors (i.e., preventable), occur about 10 times …
Cut hospitalizations to reduce hospital related medical errors
I love running.
I typically run 3-4 miles a day 5 to 6 days per week. It’s only about a half hour of time, and it’s well worth it. I get ‘in the zone’ when I run, and I can tune out the rest of the world and enjoy just being. It feels great physically and mentally each time. It’s helped me immensely to stave off the obesity issues that have …
A psychiatrist on the compulsion behind running and exercise
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