I recently visited a friend who works at Google and was pleasantly surprised by the Bay-area tech giant’s health-promotion efforts. Its crowded cafeteria offered mostly healthy food, with low-fat, low-carb, and high-fiber delicacies. Any dietitian would have appreciated the plethora of organic dairy products, the salad servers filled …
Why do hospitals feed their staff so poorly?
A sleeping dragon awakes.
At our weekly health policy colloquium recently, the presenter described plans for our organization to form its own accountable care organization, or ACO.
The idea behind an ACO is to find patients who get the majority of their primary care within our system, and then “attribute” their health care and all of its attendant costs to that system, making the providers ultimately responsible for providing both high-quality and …
ACOs: Another layer of oversight for physicians?
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 67-year-old man is evaluated following a recent diagnosis of type 2 diabetes mellitus.
On physical examination, blood pressure is 134/84 mm Hg; other vital signs are normal. BMI is 30. The remainder of the examination is unremarkable.
Laboratory studies show an HbA1c of 7.8%, blood urea nitrogen 15 mg/dL (5.4 mmol/L), and serum …
MKSAP: 67-year-old man with type 2 diabetes mellitus
By decisively taking control of the U.S. Senate and increasing their majority in the House of Representatives, the Republicans now have a chance to force some modest changes in the Affordable Care Act, but they will not be able to repeal or reverse it. But Republican gains in state legislatures and governorships may put the brakes on Medicaid expansion, leaving millions without coverage.
First, let’s start …
After the 2014 elections: Is Obamacare safe?
Nearly every day a press release from a health care provider or health care technology vendor shows up in my inbox urging me to look at what they offer and to write about it. Most of the time I don’t find their news worth passing along, but occasionally a pitch sparks a column idea. That’s the case with the press …
How to choose a good hospital? Hint: Don’t listen to the ads.
“So, is this the sickest list you’ve ever had?” the resident asked me at 2 AM, after I finally finished checking off all my boxes for the night. I nodded. I agreed.
I was also shaking.
I had been covering nine patients that night. Almost none were stable. In the span of one shift, we called three rapid responses. One person went into cardiogenic shock right in front of me was transferred to …
Sick or not sick? Handling the reality of inpatient medicine.
Making primary care better for doctors currently in practice and attractive to medical students and residents is critical given the needs of our health care system. It also has been a major focus of the health care organization where I work. A few colleagues and I noticed that many primary care doctors still stayed later than others despite lowering patient panel responsibilities and the implementation of the nation’s most robust …
Improve the lives of primary care doctors. Here’s how.
We had our first child during the fourth year of my husband’s ophthalmology residency, and our second son joined us during the first year of a surgical retina fellowship. Juggling long hours, multiple medical commitments and the needs of two small children can be exhausting but every day is complete with fulfillment and laughter — and who can ask for anything …
Having children during medical residency: 6 tips to survive
Autism was first reported in the medical literature 70 years ago. In 1943 a child psychologist named Leo Kanner described a child with social difficulties and repetitive, stereotypic movements; the following year Hans Asperger described four such children. Since then we have gradually learned more about what we now call autism spectrum disorders (ASD), although we still do not know what causes it. From early on it was apparent that the …
Autism’s cause: How much genetic? How much environmental?
At a recent conference I was approached by more than a few colleagues and asked about the Kardashian Index (K-index). For those oblivious to the term, K-index is a ratio of a researcher’s Twitter followers (as a measure of “celebrity”) over the number of their research citations (as a measure of “scientific value”).
The article implies, and I quote: “A high K-index is a warning to the community that researcher X may …
Physicians and their social accountability in the digital world
By the time the next decade rolls in there will be no paper charts. There will probably still be paper floating around in various capacities, but there will be no one charting on paper. The term “charting” itself may become obsolete, like yonder or popinjay. The term EHR, which is what replaces the paper chart, won’t last either because it doesn’t …
EMRs remove the soul of the medical record. So, what’s next?
I was listening to the news on my way to work recently, and heard a story about the review conducted after the well-publicized security breach at the White House. Like many people, I was shocked when the story of the fence-jumper first broke. How was it possible that some guy with a knife managed to get over the fence, cross the lawn, enter the White House and get deep into the …
What medicine can learn from the Secret Service failure
It is well known that Medicare expenditures threaten the financial solvency of the U.S. government. And it is pretty well agreed upon that some of our Medicare spending goes towards wasteful medical care.
But which medical care is wasteful and how much is such care costing us? A study in JAMA Internal Medicine provides a sneak peek at answers to these important questions. The research, led by Aaron Schwartz, a graduate student …
We waste a lot of dollars on unnecessary medical care
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It was a Friday morning, in the wee hours. I had come in to the hospital early to get caught up on the ever-present computer work. As I got a quick cup of tea, a young surgeon I’d seen around the operating room came in. He’d clearly been up most of the night.
We exchanged a few pleasantries. And then he cut to …
What is it about doctors that makes them think they don’t need help?
Check.
The administrator’s voice wavered as I picked up the phone. He was calling about the nursing home patient that I admitted the day before. While normally forthright, I could feel the discomfort in his tone as he danced around the issue. The patient’s insurer had called. Apparently they made an “arrangement” with the mega-ACO owned by the latest consolidation of Goliath health systems. They wanted my patient transferred to another …
Health care monopoly: How it affects the nursing home
I walk out of the patient room. My eyes stare at the computer screen. I’m behind, way behind. I roll my head on my neck. My neck feels tense, and I have a headache. It’s been a long week. I need a vacation. Hurry up, click-click-click this computer, I think to myself. Dammit, is this EMR really freezing up again?
I look …
Even if no life was saved, an ER physician makes a difference
In recent months, Silicon Valley has surpassed Hollywood as America’s home for high-profile split ups.
Last month, computer security giant Symantec announced its intentions to split in two. And three days before that, HP announced plans to divide up into parts. In September, eBay announced its intention to spin off PayPal.
With enough twists and turns to fill a screenplay, the tech industry’s recent split-up saga raises a …
Silicon Valley breakups: Are there lessons for health care?
Much has been made about physicians’ tendencies to interrupt patients. Studies have shown that patients are permitted 12 to 18 seconds of talk time before they are redirected (or interrupted) by their doctor. This leads to patients feeling that the physician didn’t listen or didn’t care. I believe that there is a way to solve the problem without wasting time or being rude. …
Physician goes first: A way to not interrupt patients
The numbers about skin cancer incidence and costs in the United States are worse than anyone expected.
That’s the message that comes from a report published recently in the American Journal of Preventive Medicine on research from the Centers For Disease Control and Prevention, the Agency for Healthcare Research and Quality and the National Cancer Institute.
The researchers took a look at the number of skin cancers …
We need to start skin cancer prevention with our children
Andy was new to me. He told me he had seen several doctors over the past few years for various pains in his right arm.
Some months ago, he had right shoulder pain that went away on its own, but for the past few weeks, he had pain in the middle of his upper arm. Last year he had tennis elbow and forearm pain for many months.
A slender, middle aged man, …
When the art of medicine gets lost in the business
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