A stark reality of the past year has been the ever-looming ICD-10 transition, which ultimately got punted on by the federal government to October 2015.
With the deadline to make the transition to ICD-10 now more than a year away instead of six months (and who knows if that will even be the case next summer), I’d still wager that many health systems are working to keep their transitions on track …
How to prepare yourself for the ICD-10 era
As an early Google Glass explorer, I see many ways this and other wearable technologies will soon enhance patient care.
Google Glass is “smart” eyewear that offers features similar to a “smart” phone: It can take photographs, video, make phone calls, display Internet-based information. The data is transposed onto the glass lens in the wearer’s field of vision. The device is activated by voice command or a touch to the tiny …
Google Glass is the tip of the iceberg for wearable technologies
Health behavior change is hard; if it were easy, everyone would be doing it. But running a marathon is also hard, and lately it seems that just about everyone is doing it. The health care industry could learn a lot from the increasing popularity of the marathon about how to design programs that help people make positive health behavior changes.
At its core, running 26.2 miles has much in common with the process of health …
5 things health care can learn from running a marathon
Toilet training can sometimes be a stressful process. This is particularly the case for children who achieve daytime dryness but continue to wet themselves, and the bed, overnight. It may leave you wondering what’s normal and what you can do to help your child.
Nighttime wetting is one of the most common urologic conditions in childhood. The vast majority of cases are not related to a physical cause. Most commonly, nighttime …
What to know about children’s enuresis and nighttime wetting
As the VA scandal unfolds, with continued revelations of secret waitlists and delayed or denied medical care, calls have been building Veterans Affairs Secretary Eric Shinseki to resign. He did just that, resigning because, “He had become a distraction as the department struggles.”
President Obama, eager to show America that he was being proactive about the scandal, regretfully accepted the General’s resignation. But other than allowing the president to show that he is doing something about …
Shinseki’s resignation: Rearranging Titanic deck chairs at the VA
I met Madelyn for the first time last month in clinic. Six months prior, she was an otherwise healthy 14-year-old girl. One afternoon, Madelyn’s phys ed teacher led a gym class aimed at completing fitness and health assessments on all of the children in the grade. One at a time, each child was asked to step up and onto a scale …
When school boards fancy themselves health care providers
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 38-year-old man is evaluated for a 1-year history of cough with mucoid sputum and a 6-month history of mildly progressive dyspnea. He has a 12-pack-year history of smoking. He has no history of asthma, allergies, skin disease, or liver disease.
On physical examination, vital signs are normal. Pulmonary examination discloses decreased breath …
MKSAP: 38-year-old man with a 1-year history of cough
Mental health patients and their families already pay a hefty price with the stigma of mental illness and the emotional roller coaster they often face dealing with symptoms. But insufficient mental health resources across the United States also means that they must pay a financial price as well in the form of lost productivity, out-of-pocket costs for treatment and sometimes periods of unemployment. A recent USA Today special report estimates …
The troubling deficiencies in our mental health system
There are over 16,000,000 American children (21.8%) who live in official poverty and double that number who are just poor. This is not happening in an obscure country, in a continent far away. It is happening right here, across the street from you. For those enjoying a good episode of Duck Dynasty, these are not children of illegal immigrants, and the vast majority is white kids.
Over 44,000,000 American children (more than 1 …
Health care for the poor: A race to the bottom
There is a tremendous amount of handwringing among students, workforce researchers, and medical school deans about the record amount of debt that medical students incur — more than $175,000, according to the Association of American Medical Colleges. This has unintended consequences, including student selection of more lucrative specialties and placing medical education beyond the reach of low-income and minority students. The average …
5 sensible ways to decrease medical school debt
Earlier this year, I started teaching a course to first year pediatric residents at Stanford. In it, I challenge the trainees to identify the structural contexts in which patients and families make choices that may impact their health and well-being. Termed structural competency, the goal is to enable young physicians to understand and confront stigma and inequality as key determinants of health. We …
Inequality in medicine: Be thoughtful about the way we educate our trainees
The Ellen DeGeneres Show has repeatedly put out a call for viewers to send in their funny sunburn pictures and stories. The following was posted on the website:
Summer is here and everyone is hitting the beach or pool. Just don’t forget the sunscreen! If you did, and you have the bad sunburn to prove it, we want to see the funny photos. Be sure to tell us the story behind …
Social media advocacy matters: The case of the Ellen DeGeneres Show
I get paid by Medicaid to see patients. How much?
Exactly $52.28 if it is an easy patient issue, like a cold, and $78.54 for a harder one, like a kidney stone. Who decides when the issue is easy and when it is hard? I do. But I have to follow some complex rules when deciding whether to bill a 99213 …
Conflicting state versus federal incentives confuse doctors
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According to the recent Wall Street Journal article patients are encouraged to engage in care, keep track of their medical data, seek preventive care, and to manage their conditions. Studies show that if patients are actively involved in care and partner with providers, that they experience better health outcomes and lower costs.
But for patients to be active participants in care they must acquire knowledge about their diagnoses and treatment plans, …
Patients need education about their role in care
On a cold, blustery Cleveland day when I was a resident, a forty-year-old man walked into our infectious disease clinic at the Cleveland Clinic. The patient was undergoing routine visits in preparation for a kidney transplant. This poor man had been hospitalized six months earlier at another hospital where he caught a terrible infection and was readmitted in septic shock and multi-organ failure. Luckily he survived, but in the process …
The importance of recognizing immunodeficiency
There’s no good age to die.
Way too many of the patients I’ve seen over the past two years are harrowingly close to my own age. I think it’s less startling to hear that an older person has cancer than when a young person is diagnosed, but I have yet to identify the age when this transition happens.
Maybe it’s an unspoken understanding that older people die and younger people shouldn’t, but …
Chemotherapy: Giving a man one more day of good life
In his commencement address at Sarah Lawrence College, international affairs journalist and author Fareed Zakaria defended the value of a liberal arts education. “At its essence,” explained Zakaria, “a liberal education is an education to free the mind from dogma, from controls, from constraints. It is an exercise in freedom.” His speech, I imagine, was well received and much appreciated by the over 400 graduates earning liberal arts degrees that day …
Why premedical students need the liberal arts
An intriguing article was recently published in the Proceedings of the National Academy of Sciences — one of the most prestigious (more on “prestige” later) journals around — with the provocative title, “Rescuing U.S. Biomedical Research from Its Systemic Flaws.” That this was written by some of our country’s most well-respected scientists provides credibility to this challenging and thought-provoking critique. The …
Applying translational research to real world scenarios
Let me show you four simple steps, requiring just 15 seconds, that will turn a patient thank you into a two-way healing encounter of the highest order.
It is incredibly easy for a thank you from a patient to slip by during a busy day in the office. We can get so caught up in the blizzard of clinical tasks we fail to hear what the patient is trying to communicate. We don’t …
What to do when a patient says thank you
Nobody likes waking up in the middle of the night gasping for air. When you make a mistake in the emergency department, that’s exactly what happens.
They come in all sorts of shapes and colors:
Preventing nightmares: A guide for medical students and residents
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