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Who’s making the decisions about your health care?

Patient

June 11, 2014

Are insurance companies making more decisions about the health care you receive? While a decade or two ago utilization nurses working for insurance companies had some power to approve or reject certain treatments, the reach of insurers into the patient-physician relationship is lengthening.

In March, I reported that insurers were sending questionnaires to policyholders newly insured under Obamacare asking about their health conditions and medical needs. And some people were filling them …

Should doctors be paid for outcomes?

Hans Duvefelt, MD

Health Policy

June 11, 2014

This is often proposed, but I have trouble understanding it. Real outcomes are not blood pressure or blood sugar numbers; they are deaths, strokes, heart attacks, amputations, hospital-acquired infections and the like. In today’s medicine-as-manufacturing paradigm, such events are seen as preventable and punishable.

Ironically, the U.S. insurance industry has no trouble recognizing “Acts of God” or “force majeure” as events beyond human control in spheres other than health care.

There is …

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Should doctors be paid for outcomes?

The outrage over how much hospital administrators make

Janice Boughton, MD

Health Policy

June 11, 2014

I recently read the New York Times article on the ridiculous amount that insurance company executives and hospital administrators make. So the reason that American health care is so expensive is not because doctors earn too much, or drug companies charge too much or device manufacturers are making ever more expensive devices with ever expanded indications. Except that it is all of that and more.

Hospital administrators and insurance company executives …

Secrets of the VA that aren’t being reported

Chris Porter, MD

Physician

June 11, 2014

I’ve worked at a few VA medical centers, including four years at the Phoenix VA. I’d like to report something missed in the media storm. Before spilling secrets, though, I’ll dispense with the non-secrets. Everyone who has entered a VA hospital knows:

1. The system is overwhelmed. While we might have planned for the increasing needs of aging Vietnam-era vets, I doubt anyone predicted two long wars or the number of …

When did retiring from medicine become an ethical issue?

Shirie Leng, MD

Physician

June 10, 2014

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Apparently all doctors must practice medicine until the day the die. Or so says Gordon Marino in a New York Times piece called “A Life Beyond Do What You Love.” This article caught my eye, since I am currently trying to do “what I love,” having already lived a couple of lives doing “what I think I should love.” I didn’t …

CPR without informed consent in the elderly

Jim deMaine, MD

Physician

June 10, 2014

Agnes was out shopping at her local corner store. At age 82 her body was beginning to show typical signs of aging. She had survived breast cancer surgery, a hip replacement, and cataract surgery. Her doctors told her she had osteoporosis and low vitamin D. She took medications for her hypertension, cholesterol, and osteoporosis. Her spine had begun to curve and her gait was a few steps slower.

Yet, with her …

Primary care and the art of healing

Stephen C. Schimpff, MD

Physician

June 10, 2014

Next in a series.

The art of healing is very important in medicine. There is a difference between being a modern day physician and being a healer. All societies have healers — wise men and women, shamans, medicine men and people of other names. The “old time practitioner” was almost always a healer but many physicians today are not. It is an issue of interest, training, time and prioritization. Most …

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Primary care and the art of healing

5 ways to improve the healing environment of hospitals

Suneel Dhand, MD

Physician

June 10, 2014

The very basic definition of a hospital is a place of healing and recovery. Health care is in a tumultuous state of flux at the moment, with the universal drive for quality improvement and the need to reign in costs. These issues, along with the desire to enhance our patients’ satisfaction and overall health care experience, were barely even talked about a decade ago. Now, they are all the buzz …

Giving challenging patients the best care

James C. Salwitz, MD

Physician

June 10, 2014

It was 1:35 p.m. when we realized that Tom was not just late for his chemotherapy treatment; he probably would not show up at all. A call from one of our staff confirmed, he had “troubles getting a ride” and wanted to move the vital therapy to another day. This was the third time in a month he had missed an appointment, thus wasting a treatment slot, nursing time and …

Dr. Bob Sears deserves blame for declining vaccination rates

Jennifer Gunter, MD

Medications

June 9, 2014

Baby-vaccination

Measles is on its way to an all time high.

In 2000, measles was eliminated (meaning some travelers from areas with low vaccine penetration might arrive in the U.S. with the disease, but no case came from U.S.), but has been slowly creeping back. Since 2008, this has been more than a trickle.

Let’s put the important goal of measles elimination in perspective. Before …

A parting gift from my grandfather

Natalia Birgisson

Medical Education

June 9, 2014

Recently, I began to think of death as a friend. My grandfather was hospitalized on Mother’s Day, and by the time my parents called me on Monday morning they couldn’t tell me anything more than, “He’s in the ICU with multiple seizures. They’re taking him off ventilation tomorrow.” Reaching for the knowledge I’ve spent all year chipping away at textbooks to acquire, I asked about neurologic exams, autonomic drugs and …

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A parting gift from my grandfather

Criticizing The Fault in Our Stars does childhood cancer a disservice

Suzanne Leigh

Patient

June 9, 2014

A pediatric oncologist seems to suggest we shouldn’t be getting too upset about childhood cancer because kids and teens dying or going blind “are things that we don’t typically encounter.”

“I think the important thing to realize is that cancer in children is highly treatable and ultimately curable,” Dr. Charles Hemenway of Loyola University said in HemOnc Today, in response to the movie …

Health and well-being are holistic concepts

James Marroquin, MD

Physician

June 9, 2014

In his book The Art of Loving, Eric Fromm wrote that “the deepest need of man is to overcome his separateness, to leave the prison of his aloneness.” In the Bible, after forming Adam from the dust of the ground and breathing into his nostrils the breath of life, God declares that something is missing: “It is not good for the man to be alone.”

A number of scientific studies verify that a …

Applying the anti-vaccine mentality to car seats

Lucy Hornstein, MD

Medications

June 9, 2014

What if a big TV station came out with a blockbuster story claiming that infant car seats were implicated in cerebral palsy (CP)? After all, something like 99.7% of babies diagnosed with cerebral palsy had been brought home from the hospital in a car seat. In fact, every single time they went anywhere in a car, they were strapped into them. That’s …

Google Glass has a long way to go in the OR

Skeptical Scalpel, MD

Health Technology

June 9, 2014

The Royal London Hospital and the Barts and The London School of Medicine and Dentistry presented the first live-streamed surgical procedure in the UK. The operation was an extended right hemicolectomy with resection of a metastatic liver lesion.

Here is what I thought about the event.

The case started about 30 minutes late, which is similar to what would have happened in any …

I won’t come back to the ER for glasses again

Sriranjani Padmanabhan, MD

Conditions and Diseases

June 9, 2014

He was a 24-year-old African American man with no history of medical or eye problems. On an ordinary Thursday evening at 8 p.m., he arrived into the emergency department complaining of a sudden loss of vision in both eyes.

“He couldn’t see a thing on our chart. Vitals are fine, pupils are equal and reactive, and the rest of the neuro exam is unremarkable,” the emergency room attending briefly explained. “Can …

What would an EMR on Twitter look like?

David Do, MD

Health Technology

June 8, 2014

It won’t be long before every patient has a Twitter feed, and doctors subscribe to them for real-time updates.

This is a time when the demands of being a physician are changing, and we need to leverage technology to maintain awareness of a huge number of patients. There is also increasing need for handoffs and communication between providers.

Here’s the bottom line: How can we improve technology when doctors seem so resistant? …

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What would an EMR on Twitter look like?

Reflecting on the journey to the clinical years

Gregory Sawisky

Medical Education

June 8, 2014

I remember opening that email. The overwhelming weight of nervous emotion that collapsed into a wave of ecstasy as I read, then re-read, then read again those words: “Congratulations. You have been accepted.”

That moment marked the end of so much. The destination had been reached. The long nights of studying made worthwhile, the pre-requisites taken and survived. Trying to compile an accurate reflection of one’s life wading through resumes, CVs, …

How to reduce the risk of stroke in women

Afshine Ash Emrani, MD

Conditions and Diseases

June 8, 2014

Cardiovascular disease still remains the number one cause of death in women. Heart attacks account for 24% and strokes 7% of all deaths. Among minority women, these numbers are even higher. The challenge remains that doctors traditionally have not identified women at high risk of stroke. Internists and cardiologists do not routinely think of stroke prevention in women, and neurologists have been busy treating stroke victims and have had no …

5 things physicians need to know about a business plan

John W. Mitchell

Potpourri

June 8, 2014

Dr. Arlen Myers, president of the Society of Physician Entrepreneurs, can give you ten good reasons why doctors make great entrepreneurs. However, in my many years of working with physicians, I have learned when it comes to a business idea, doctors, like most new entrepreneurs, often need help getting the nuances wrestled to the ground.

For example, I remember the conversation with an ED medical director about the importance of using “ER” …