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Reporting physician quality: The dangerous game the government plays

Health Policy

November 25, 2014

We have heard ad nauseum that the data collection mandated by Medicare and Medicaid is to improve quality of care. Significant taxpayer dollars have been expended as bonuses in the name of PQRS (Physician Quality Reporting System). With all this investment and mandating, one would assume that the PQRS must be highly indicative of better quality of patient care, right? Not so fast.

Two recent reports demonstrate how ineffective this program is and how much physicians hate …

What a messy house has to do with medicine today

Abigail Schildcrout, MD

Physician

November 25, 2014

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I spent this past week worrying that my in-laws were going to divorce me. For sure. No getting out of it this time.

I do not keep a neat house. There are piles everywhere. Piles of books. Piles of papers. Piles of clean-but-unfolded laundry. Piles of mail. Piles of music. Piles (believe it or not) of instruments. Piles of shoes. Piles of …

Ezekiel Emanuel’s wrong ethical view of aging

Jim deMaine, MD

Physician

November 24, 2014

Ezekiel Emanuel wrote an article for the Atlantic on “Why I Hope to Die at 75: An argument that society and families — and you — will be better off if nature takes its course swiftly and promptly.” As an oncologist and ethicist, he says he speaks for himself but implies not so subtlety that avoiding our declining years may be in our best interest — and that …

When physicians need backup during a routine procedure

Michael Kirsch, MD

Physician

November 24, 2014

A few days before I wrote this, a patient had a complication in my office. I have discussed previously the distinction between a complication, which is a blameless event, and a negligent act. In my experience, most lawsuits are initiated against complications or adverse medical outcomes, neither of which are the result of medical negligence. This is the basis for my strong belief that the current medical malpractice system …

The rational ignorance of Jonathan Gruber

Dr. Saurabh Jha

Health Policy

November 24, 2014

I think it’s fair to say Jonathan Gruber will not be offered the role of Pinocchio. Although intelligence agencies, in search of the truth serum, might have an interest in the ingredients of what he drinks.

Please put away the pitchforks. Gruber deserves credit for honesty and bipartisanship. Plus a complete rejection of Disneyland economics. If you’re looking for transparency, the other face of honesty, Gruber is ground zero.

Stupidity, though, was …

What is the secret sauce to digital health?

John Nosta

Health Technology

November 24, 2014

I understand that for some, digital health still might be a bitter pill, but the promise of techno-medical mumbo jumbo is bold and transformative. That being said, in my opinion, the “secret sauce” to digital health might be a bit outside the conventional “drug development” methodology — both in logistics and psychology.

Therefore, I thought it would be fun to take a page out of IBM’s Watson playbook. IBM recently used “cognitive …

The costs of fertility preservation in cancer treatment

Anne Katz, RN, PhD

Conditions and Diseases

November 24, 2014

I have fertility on my mind — and it’s definitely not personal. And it’s really fertility preservation that has me thinking. I recently completed the manuscript of my 10th book — a text for oncology care providers about the provision of psychosocial care to young adults with cancer

Writing the book was at times frustrating due to the paucity of research and …

How to survive a night float rotation

Kerri Vincenti, MD

Medical Education

November 24, 2014

I recently began a rotation at the hospital as one of the night float interns. As part of this responsibility, I manage the care for approximately fifty patients each night. Day after day, I perform the same routine in preparation for the night ahead: Grab my stethoscope and pager, claim one of the code pagers, pick up a time sheet to fill in the nightly team to-do’s and mentally prepare …

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How to survive a night float rotation

A diagnosis of HIV: God had nothing to do with it

Lawrence Rifkin, MD

Physician

November 23, 2014

It didn’t seem like my college-age patient Quincy had any idea what was in store when I entered the exam room.

“Hi Dr. Rifkin,” he said with a warm smile as I sat next to him. Quincy (not his real name) had been my pediatric patient for years.

I didn’t delay. “Hi Quincy. I’m afraid I have some terrible news. Your lab work came back — you’re HIV-positive.”

His head went back slightly. …

The mystery of diagnosing Lyme disease

Andrew Pugliese, MD

Conditions and Diseases

November 23, 2014

Four months ago, a 44-year-old woman was referred to me by her audiologist and ENT for acute deafness of the right ear. She is a healthy woman without any past medical history and was not on any medication. Her otolaryngologist (ENT) could not find any physical reason for the patient’s acute unilateral deafness, including a negative CT scan. She was being referred to me to determine if there was an …

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The mystery of diagnosing Lyme disease

2014: The death of meaningful use?

Robert Wachter, MD

Health Technology

November 23, 2014

The policy known as meaningful use was designed to ensure that clinicians and hospitals actually used the computers they bought with the help of government subsidies. In the last few months, though, it has become clear that the policy is failing. Moreover, the federal office that administers it is losing leaders faster than American Idol is losing viewers.

Because I believe that meaningful use is now doing more harm than good, I see these …

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2014: The death of meaningful use?

I will honor my patients by hearing them out

Samyukta Mullangi

Medical Education

November 23, 2014

Since the first day of medical school, I was in breathless anticipation of my third year. I came to Harvard with a background in creative writing and the big draw of medicine for me lay in its compendium of human stories.

In college, I volunteered at local hospitals where my primary responsibility was to go knock on patients’ doors and keep them company for a little while. This was awesome. Few …

(Dis)comfort measures

Jay Baruch, MD

Physician

November 23, 2014

Close to midnight and Tonya is somnolent, lying on an emergency department (ED) stretcher and not in her own bed at home. The change in location alters the fairy tale quality of the word somnolent from sleepy or drowsy to one that’s more sinister and worrisome. Especially when Tonya is dying of brain cancer, a single mother of thirty-four, a hospice patient now …

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(Dis)comfort measures

What will future of medicine look like? Start here.

Bertalan Mesko, MD, PhD

Health Technology

November 23, 2014

Excerpts from The Guide to the Future of Medicine.

Enormous technological changes are heading our way. If they hit us unprepared, which we are now, they will wash away the medical system we know and leave it a purely technology–based service without personal interaction. Such a complicated system should not be washed away. Rather, it should be consciously and purposefully redesigned piece by piece. If we are …

Reflections after the first cadaver lab

Avi Friedman

Medical Education

November 22, 2014

“To help other people overcome their injuries.”

This mantra was accompanied by flushed faces, hidden trembling hands, and nervous chuckles as the majority of my peers told the class why they decided to pursue physical therapy as a career. Soon thereafter, this adage was lost as we dived into our studies, learning every bone, muscle, and organ. Focusing on the human body is a must for all healthcare professionals, and PTs …

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Reflections after the first cadaver lab

Medicaid is Obamacare’s sleeping giant

Richard Reece, MD

Health Policy

November 22, 2014

To me, Medicaid is Obamacare’s sleeping giant — the enabler of federal power and control over the health system. It is a far more powerful enabler than health exchanges, which have gotten most of the publicity. It surpasses the number of uninsured and underinsured that the exchanges have enrolled.

In the next year, four million more Americans will joing Medicaid’s rolls. It already covers one third of America’s uninsured. Under Obamacare, …

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Medicaid is Obamacare’s sleeping giant

Transforming primary care to spend extra time with patients

Eunice Yu, MD

Physician

November 22, 2014

When I started my internal medicine residency, I was pretty sure I was going to rock this primary care thing. I knew the drugs for hypertension, the guidelines for diabetes management, and depression management seemed like nothing more than an algorithm. I felt buoyed by familiarity as I looked at the problem list for my first primary care patient: basically diabetes, hypertension, and depression.

As I opened the exam room door that early July day, I …

MKSAP: 40-year-old woman is evaluated for a rash

mksap

Conditions and Diseases

November 22, 2014

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 40-year-old woman is evaluated for a rash on her hands that has been present for 6 weeks. This rash comes and goes throughout the year and has been present for many years, but never as severe as it is now. She also experiences itchy skin on her body. She had eczema …

A letter to Dr. Oz for his inbox

Jennifer Gunter, MD

Physician

November 21, 2014

dr oz

Dear Dr. Oz,

I know the #OzsInBox question on Twitter didn’t exactly go the way you or your social media team expected. You told Sen. McCaskill when she asked you about the so-called miracles and medically baseless products that you promote on your show that you view yourself as a cheerleader, but consider #OzsInBox a wake-up call that …

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A letter to Dr. Oz for his inbox

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