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The tension between mobile apps and health care

Health Technology

October 9, 2014

I saw another exciting news story on a mobile health intervention the other day. I honestly don’t remember the company or product, but what stuck with me was the declaration of success based on 10 patients using the product for three months. Success was touted in terms of cost reduction and resource utilization reduction in a before/after analysis. This inspired me to collect some thoughts on some of the challenges …

The last visit: Turning off the defibrillator

Wes Fisher, MD

Physician

October 9, 2014

He had called the other day to update me up on his condition. He did not sound upset, but resolute. “They offered me peritoneal dialysis,” he said, “but I decided against it and figured I’d just let nature take its course. The hospice people are so wonderful — I’ve got things all set here at home, but I have two questions. What should I do about my warfarin? You know, …

When treating seriously ill patients, learn to suppress The Look

James C. Salwitz, MD

Physician

October 8, 2014

A friend of mine plays a mean game of poker. She comes out ahead in Atlantic City, finishing near the top in hold ’em tournaments. She is a poker savant. Not long ago I asked her secret to playing the game so well.

“I learned to play cards when I was being trained to treat cancer.”

“Oh,” I said, “the discipline, memorization, patience and statistics?”

“No, that is when I learned not to …

Treating obesity in the physically-challenged child

Keith-Thomas Ayoob, EdD, RD

Conditions and Diseases

October 8, 2014

I direct a nutrition clinic in a large center for children with special needs. My kids can have everything from mild learning disabilities to genetic disorders that affect growth and development to profound intellectual and physical impairments that cause them to be unable to walk, speak or even scratch their heads. My most seriously involved kids are completely dependent for all their care.

Children who are somewhere in between — for example, children who …

The problem with primary care residency programs

Susan Putnins

Medical Education

October 8, 2014

“I’ve been with my doctor for years and years,” an elderly man, voice hoarse but lilting with fondness for his caregiver, told a nurse in the primary care clinic where I was waiting to see a doctor. “He’s fantastic.”

I was coming to the clinic for a follow-up appointment about an injury for which I’d been seen a few months prior, but neither the initial appointment nor this follow-up were with …

How pay for performance leads to overdiagnosis and overtreatment

Peter Ubel, MD

Conditions and Diseases

October 8, 2014

Not long ago, the Joint Commission established that patients with pneumonia should receive antibiotics within four hours of diagnosis. Timely diagnosis and treatment can be the difference between life and death in patients with this illness. In fact, some people believe this kind of quality measure should play a large role in how we pay for medical care. After all, doctors should not be paid solely on the basis of …

Narrow networks on the health care exchanges: Can they survive?

Robert Pearl, MD

Health Policy

October 7, 2014

Baseball fans like me take great joy in studying the way general managers assemble their rosters.

The variations are fascinating. Some teams focus on pitching strength. Others go for speed or power-hitting. Each approach carries distinct advantages and disadvantages on the field.

That same level of variation and strategic decision-making applies to health plans, as well.

With the health care marketplaces reopening for enrollment on Nov. 15, anyone evaluating their coverage options should take …

I will build a practice, but I will also build a life

Adrianne Westmoreland, DO

Physician

October 7, 2014

She grasps her chest dramatically and falls to the floor. Her eyes flutter as she tries to hold them closed. Her one arm across her chest the other flailed in theatrical fashion to her side. She’s dead. Her heart is broken. The other jumps from the bed, and after landing, reports her leg is broken. She hops about the room, unable to use the leg and there are no crutches …

The public perception of oncologists: Is it really true?

Don S. Dizon, MD

Physician

October 7, 2014

I had taken care of her for years. We had faced a new diagnosis, the toxicities of adjuvant treatment, the promises of having no evidence of disease (NED as my friend, Molly, refers to it), only to have it shattered with the first recurrence. Over the next three years, she had undergone treatment — chemotherapy, a trial of endocrine therapy, …

Do we really need soda companies to cut calories for us?

David L. Katz, MD

Conditions and Diseases

October 7, 2014

To the inevitable backdrop of John Philip Souza marches and presidential photo-ops, big soda has announced that it will do some vague kind of something about the excesses they contribute to our intake of calories and sugars over something like ten years. (Unless, of course, they don’t.) Cue the 21-gun salute! Release the confetti!

Folks, that this is heralded as “huge” news — and by our former head of state, no …

Who is blocking EMR interoperability? You are.

Margalit Gur-Arie

Health Technology

October 7, 2014

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The Senate Appropriations Committee has defined a new transgression perpetrated in the committee’s expert opinion by vendors of certified EHRs, as well as “eligible hospitals or providers.” Since the committee has no data or evidence of any kind that this transgression is actually occurring, it requires the Office of the National Coordinator for Health Information Technology (ONC) to embark on a fishing expedition …

Patient outcomes: It’s time to account for socioeconomic factors

Ashish Jha, MD, MPH

Health Policy

October 7, 2014

We recently had a readmission — a straightforward case, really. Mr. Jones, a 64-year-old homeless veteran, intermittently took his diabetes medications and would often run out. He had recently been discharged from our hospital (a VA hospital) after admission for hyperglycemia. The discharging team had been meticulous in their care. At the time of discharge, they had simplified his medication regimen, called him at his shelter to check in a few …

How to talk to a patient with terminal cancer? Not like this.

Allen Frances, MD

Physician

October 6, 2014

A friend of mine has been living well with lung cancer for five years — working, running several miles a day, traveling, doing good stuff with his family, and generally enjoying the pleasures of everyday life. He knows the cancer will eventually kill him, but has been making the most of every remaining minute.

Then, a month ago, things suddenly turned dramatically south. Severe shortness of breath, constant coughing, sleeplessness, fatigue, …

Team-based care needs to be more than a buzzword

Hans Duvefelt, MD

Physician

October 6, 2014

Team-based care is one of today’s buzzwords without real substance, because unless the payment systems change, only the physician members of the team can bill for their work.

Few people seem to be concerned with the simple but essential question of how physicians spend their time and how medical offices are paid. As a primary care physician who doesn’t do any major procedures, and who in 2014 is essentially paid fee …

From PA to MD: An appreciation for physician education

Christin M. Giordano, PA

Medical Education

October 6, 2014

My journey in medicine began as a young child: I was the typical kid who knew I wanted to a be a doctor since I was a child and was thrilled when I was accepted into an 8-year college program which culminated in a medical degree. However, by the end of my undergraduate program, medicine was changing: doctors were spending less …

Money is a poor way to motivate doctors

Alexandra S. Brown, MD

Physician

October 6, 2014

As a physician, I enjoy listening to non-physicians tell me how to motivate doctors. I don’t mean this in a totally snarky way (well, maybe just a little). These conversations often highlight the chasm that exists between physicians and administration.

What’s the most common motivator people throw out there? Money. Certainly everyone wants to make more money, I don’t refute that. What I take issue with is the notion that the …

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Money is a poor way to motivate doctors

Prevent the overdose of OTC pain medications

Byron Cryer, MD

Medications

October 6, 2014

Recently in the emergency room, I saw a 35-year-old patient — we’ll call her Jane — who was vomiting blood. The source of the vomiting turned out to be a bleeding ulcer caused by unintentionally overdosing on ibuprofen. Jane was in pain — she was taking prescription ibuprofen for her chronic knee pain — but she was also taking over-the-counter (OTC) …

Karl Marx foreshadowed the plight of today’s physicians

Richard Gunderman, MD, PhD

Health Policy

October 6, 2014

On September 28, 1864, the first meeting of the International Workingmen’s Association (IWA) was convened at St. Martin’s Hall, London. Among the attendees was a relatively obscure German journalist by the name of Karl Marx. Though Marx did not speak during the meeting, he soon began playing a crucial role in the life of the organization, in part because he was assigned the task of drafting its founding documents.

The work …

5 ways pharma can incorporate digital technologies

David Lee Scher, MD

Health Technology

October 5, 2014

Few would argue that today digital technology represents a critical part of marketing in any business sector. Though all health care stakeholders are usually late to the technology table, market and customer pressure are rapidly accelerating this adoption. It needs to be emphasized that technologies are not solutions. They must be incorporated into human workflow processes.

To do so in health care, culture must change, specifically with regards to patient participation, …

Ebola in Texas: Why you shouldn’t freak out

Albert Fuchs, MD

Conditions and Diseases

October 5, 2014

The first Ebola patient has been diagnosed in the U.S. This news is likely making many of my regular readers wonder, “Should I freak out?” This is a reasonable question, and I will attempt to answer it. But first, let’s go over how this nasty microbe spreads.

Ebola is caused by a virus that is transmitted through contact with the bodily fluids of someone who is sick. It is not airborne; …