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The EHR should work for us, not us for it

Health Technology

June 14, 2014

I’m feeling meaningfully used today.

Once again, we are faced with another set of administrative hurdles, boxes that need to be clicked, tasks that need to be completed, all in the name of demonstrating that we are meaningfully using the electronic health record in which our practice and the federal government have so heavily invested.

An “eligible professional summary” arrives in my email, with lots of bars with lines, and green checks …

Medicaid cost shifting: The case of Denver Health

P. J. Parmar, MD

Health Policy

June 14, 2014

We all know about the increase in Medicaid patients resulting from Obamacare, and how this is exacerbating the shortage of providers who accept Medicaid. I see Medicaid patients in Denver, where there is a reason for the shortage that is often overlooked: managed care Medicaid.

The managed care concept peaked decades ago, a failed attempt to reduce health care spending by forcing patients to go to only one doctor or …

Building a concierge safety net practice

W. Ryan Neuhofel, DO, MPH

Physician

June 14, 2014

“So like a concierge doctor?”

That was the most common response upon explaining my future direct primary care practice while in residency. That perception and label really perturbed me. My vision was to care for a diverse group of people. I spent the majority of my residency clinic hours in an urban safety net clinic, but certainly didn’t want to swing the pendulum to the opposite 1%.

To avoid that stigma, I …

A medical school graduate’s retrospective

Douglas Phelan, DO

Medical Education

June 14, 2014

“Ultimately, I am convinced that in my future lies not simply a profession performed ably, but a vocation performed lovingly and devotedly.”

Soon, after the coming pomp and circumstance fade into fond memories and well-framed photographs, I will be in the hospital. Soon, I will have my own patients in the clinic. With these occasions, life will be what I hoped it once would be some years ago – being a …

To cut health care costs, pay doctors more

Afshine Ash Emrani, MD

Health Policy

June 14, 2014

Overwhelmingly, doctors’ reimbursement has been the target of government programs and insurance companies. The idea underlying this movement has been, pay doctors less and curtail their incentive to see patients and the cost of medical care will decrease. As a result of this faulty reasoning, we have ushered in the era of unhappy doctors, those retiring early, and those asking for extra payments to justify the hours needed to give …

How doctors are paid today

Brian J. Secemsky, MD

Health Policy

June 14, 2014

As our nation struggles with the mind-boggling algebraic-like task of reigning in on health care expenditures while increasing provider access and high-quality medical care, provider payment structures are in flux between traditional payment methods and relatively new financial structures.

While I am no means an expert of health policy nor medical business and financing, I think it’s important for medical trainees and enthusiasts alike to understand the very general basics of …

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How doctors are paid today

There really is no war on doctors: There’s a war on patients.

Margalit Gur-Arie

Health Policy

June 13, 2014

So you think there is a war on doctors, don’t you? It certainly looks that way from your particular vantage point. The government is deftly intruding into your professional life with a computerized fifth column that is extracting information on your every move, and to add insult to injury, it forces you to actually collect the data which is to be used against you in the court of public opinion. …

I so wish I could say: Daddy, thank you so much for the stories.

Claire McCarthy, MD

Physician

June 13, 2014

When my sister and I were little, we had an almost daily ritual with my father: drawing stories.

He would sit us on his lap and get out his clipboard, a piece of paper and his black click pen. He’d divide the paper into four parts, and draw as he told a story. Sometimes he drew old favorites and we knew what …

How bingo kept a patient going

StorytellERdoc, MD

Physician

June 13, 2014

Her wary eyes, magnified from her thick-lensed spectacles, watched my every move as I pulled room 21’s curtain to the side and entered her room. In her early eighties, it was apparent to me that my entrance into her life was more important than the abdominal pain that brought her to our emergency department. In the corner sat a slight man with wispy gray hair poking out from the border …

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How bingo kept a patient going

Why have scribes become so pervasive in health care?

Kaylan Baban, MD, MPH

Physician

June 13, 2014

You may have already seen them — medical scribes hunched over tablets in hospitals and doctors’ offices, working away like Kim Jong-Un’s omnipresent cadre of note takers (though in this case, they’re actually getting things done). Recently, this piece about the phenomenon was making the rounds in my corner of the Twitterverse. In a conversation with a reach so high that it at one point drew in Dr. Farzad Mostashari (former National …

Have ADHD diagnoses reached a tipping point?

Allen Frances, MD

Conditions and Diseases

June 13, 2014

I have been blogging and tweeting about ADHD a lot lately because I believe that change is in the air.

This is the worst of times for ADHD diagnosis because statistics show it is wildly overdiagnosed and overtreated. This is possibly the best of times for ADHD diagnosis because I think we have reached the tipping point and feel hopeful that the ADHD fad will soon begin to fade.

We humans are …

The advance directive impact of PET scans in vegetative states

Ruth Macklin, PhD

Physician

June 13, 2014

One typically thinks of advances in medical science and technology as having unalloyed benefits. The ability to cure illness, the mitigation of pain and the possibility of making diagnoses that are more accurate are some of the uncontroversial results of medical progress. Yet as a new study of vegetative states demonstrates, such advances can raise ethical quandaries for physicians and the families of patients diagnosed as vegetative.

Physician well-being is essential to optimal patient care

Diane W. Shannon, MD, MPH

Physician

June 13, 2014

I chose to leave clinical medicine in 1996 after just three years as a general internist. At the time, I was certain that it was the right decision and necessary for my overall health, but could not have articulated all the reasons why I needed to leave. I loved both the intellectual challenge and the art of medicine. I thoroughly enjoyed my connections with patients. I regarded my professional life …

Hold off on patient satisfaction scores until they are done right

Roy Benaroch, MD

Physician

June 12, 2014

We’re living in a world or ratings. Books get rated on Amazon, dry cleaners get rated on Yelp. Doctors are getting rated, too — not only on web sites, but also in ways that end up dictating how much money we can make, or whether we can keep our ability to work in a hospital. Is this a good way to improve medical care or medical outcomes? Is it …

When will technology actually transform health care?

Joe Flower

Health Technology

June 12, 2014

After decades of bravely keeping them at bay, health care is beginning to be overwhelmed by “fast, cheap, and out of control” new technologies, from BYOD (“bring your own device”) tablets in the operating room, to apps and dongles that turn your smart phone into a Star Trek tricorder, to 3-D printed skulls. (No, not a souvenir of the Grateful Dead, a Harley decoration or a pastry for the Mexican Dia de …

New skill sets are raising the prestige of primary care

Anoop Raman, MD, MBA

Physician

June 12, 2014

Prestige in medicine often follows research. Physician-scientists who do basic science research have often been considered among the giants of medicine. As the field of medicine advanced, the gap between what we knew from basic science and how we practiced grew. This created a need for more translational researchers: physicians who could bring what they knew from the laboratory bench to the bedside through large clinical trials.

Now, the next great gap …

It is wrong to subsidize rich, European nations

Peter Ubel, MD

Health Policy

June 12, 2014

People have criticized the Affordable Care Act for amounting to a large transfer of wealth, from wealthy Americans to those not as well-off. But the real transfer of wealth has been from United States to other developed nations, whose health care costs we have subsidized for many years by paying so generously for many of our health care services. No better example of this comes to mind than the price …

Optimize nurse partnerships to improve patient care

Val Jones, MD

Physician

June 12, 2014

As I travel the country providing coverage for inpatient rehab units, I have been struck by the generally high quality of nursing care. Excellent nurses are the glue that holds a hospital unit together. They sound the first alarm when a patient’s health is at risk, they double-check orders and keep an eye out for medical errors. Nurses spend more time with patients than any other hospital staff, and they are therefore …

You can never make sense of cancer

Kenneth D. Bishop, MD, PhD

Physician

June 12, 2014

When you tell people that your dad died of lung cancer, often the follow up question is, “Did he smoke?”

In my case, the answer is, sort of.

I have fuzzy memories of my dad in our basement, smoking his pipe in his black leather chair and watching the original Doctor Who (I’m still processing the cultural implications of that last detail). Rumor has it he smoked cigars in the ’60s, but …

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You can never make sense of cancer

Collateral damage after cancer surgery

Anonymous

Patient

June 11, 2014

Dr. Robert’s office felt right to me, with a musical birdsong soundtrack, soft lighting and fresh green tea, and I had my best friend in tow: piece of cake. In this serene atmosphere, I was sure that I’d find out what to do next to finish treating my endometrial cancer.

“It’s probably gone now, since my hysterectomy two weeks back,” I thought. “But let’s play it safe; he’s the gynecological-cancer guru.”

Like …

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Collateral damage after cancer surgery