“Dr. Vashist, I’m sorry to bother but you really need to look at this medication being taken by our patient.”
My hospital pharmacist gently prodded me as he handed over the patient’s medication list along with cost information and side-effects of the offending medication. The issue with the list was a subcutaneous injectable form of calcitonin, Miacalcin, costing approximately $11,300 per day of treatment.
The patient had been admitted about 11 days back …
He attends a public elementary school in town, and very soon, he will start preparing for an exam known as the STAAR test.
The STAAR test is an “assessment of academic readiness.” In my state, it gets administered to publicly-funded school children. Students must pass the exam to continue progressing in school, and ultimately, students must master the exit level test to graduate high school.
I was incredibly impressed by the announcement that three top U.S. health systems — Dartmouth-Hitchcock Medical Center, Johns Hopkins Medicine, and the University of Michigan Health System — will be enforcing standards that prevent low-volume hospitals from performing certain surgeries.
This comes on the heels of a major US News story which showed that patients who had surgeries at low-volume hospitals faced significantly higher risks of complications and death.
Dr. Atul Gawande is an American surgeon and public health extraordinaire. He is one of the most successful physician authors of this century, and he writes routinely for the New Yorker. His most recent article discussing unnecessary health care is, as expected, a good read.
I applaud Dr. Gawande’s passion towards advancing medicine. And, yes, there is universal agreement that we need to be better in America at providing high-quality low-cost health …
Earlier this year, I spoke to an audience of physician anesthesiologists about setting up a basic quality assurance (QA) program within their departments. At the end of the presentation, one physician anesthesiologist stated that his group “will not let anyone out of the operating room …
The war on medical error was officially launched in 1999, when the Institute of Medicine (IOM) published its landmark report To Err is Human, alleging that up to 98,000 yearly deaths in US hospitals were due to human missteps.
I’m usually a huge fan of Dr. Ezekiel J. Emanuel’s writing — whether it’s his controversial piece on health care resources at the end of life or his book describing the tumultuous health care policy that led up to the Affordable Care Act, I generally enjoy reading his editorials and vehemently agree with many of his opinions. This being said, when I saw that …
Some months back I read an interesting interview with Jonathan Skinner, a researcher who works with the group at the renowned Dartmouth Atlas of Health Care. More than anyone else I can think of, the people at the Dartmouth Atlas have studied and tried both to understand and to explain the amazing variations we see in how …
Imagine a surgeon removing a gallbladder miles away from where he or she actually is. Imagine when you are ill, a physician has the ability to diagnose you from your living room. Telemedicine.
Telemedicine itself is not a concept that is all that new. In the 1930’s, Italy used telemedicine to communicate with ships at sea, while in the United States, NASA …
Recently, I was back in the United Kingdom for a short trip home. It happened to be the week of the general election, and after a long campaign the country finally went to the polls on Thursday.
For those of you unfamiliar with U.K. politics, for the last five years there’s been a coalition government between David Cameron’s Conservatives and the Liberal Democrats (the first coalition government for 70 years). The …
After four years working as a child and adolescent psychiatrist in Brooklyn treating the underserved, I decided it was time to dedicate myself fully to my growing private practice.
Functioning solely as an out of network provider in private practice, as expected, my clientele grossly changed. Unlike my hospital patients, a majority of my patients are upper class to wealthy. Finances are not concerns or stressors.
One of the goals of the Affordable Care Act (a.k.a. Obamacare) was to increase access to primary care physicians. The notion is that if people have insurance it would be easier for them to get appointments with primary care physicians. This is because many physicians are unwilling to accept new patients who are uninsured.
Further, a key component of the ACA was to increase physician reimbursement for Medicaid because this program …
The buzzwords many use in medicine today are “personalized,” “individualized,” or “targeted.” Rather than doctors prescribing tests or treatments that work in most people but might not work for you, proponents argue, we should tailor medical interventions to unique patient characteristics, such as genomic data. (The White House’s Precision Medicine Initiative is an example of this kind of thinking.) Although I am skeptical that big …
It’s very hard to find a product or service that is both lousy and unaffordable. Such expensive duds are usually quickly replaced by cheaper and better competitors. Prior to the Affordable Care Act, health care was becoming more expensive every year while simultaneously becoming less convenient, less personal, and less satisfying. In 2009, I wrote a series of four posts explaining how the health care marketplace reached such …
In October, 2013, at the launch of the Affordable Care Act, I predicted that the health insurance exchanges about to go into effect would grow in popularity and improve the health insurance marketplace, then so imperfect.
Twenty months later, the exchanges are proving effective in reducing the number of uninsured and are beginning to provide the information people need to make an informed selection about which plan is best …
Now that we no longer have to worry about the SGR, we have a new worry. The law consolidates several measurement tools into one big tool. CMS has declared that it wants to pay for value. The law provides a blueprint for paying for value. The underlying assumption of this approach is that we can define and measure value through measuring quality components.
Can we define health care value through measurement? …
Recently, the new surgeon general of the United States, Vivek Murthy, was officially sworn in by Vice President Joe Biden. Congratulations to him, it’s quite an achievement at the relatively young age of 37. Nobody can doubt the hard work, intelligence and passion that must have gone into reaching such a height.
His nomination was first put forward at the end of 2013, and he faced something of an uphill political …
You gotta hand it to our health department. They are laser focused on this one. They want 85 percent of payments made to doctors by the Centers for Medicare & Medicaid Services (CMS) to be linked to clinical quality measures within the next two years.
Moreover, I suspect the health department is still giddy from Congress passing a new health care …
Inscribed on a plaque just below a statue of an eagle in front of my hospital is a famous quote from President Abraham Lincoln that begins, “To care for him who shall have borne the battle …” It is the reason why the Veterans Affairs (VA) system exists. It is the reason why we VA physicians come to work each day.
I am honored to care for our special patient population, …
It has been known for a long time that “health care” — all the stuff that we do, prescribe and provide — is a minor determinant of how “healthy” any of us is. Overall health, or more technically, the variability in health outcomes, is much more dependent on the combination of genetics, personal behavior (think smoking and seat belts), environmental factors and socioeconomic status than it is on health care.
