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Let’s reframe the question of physician frustration

Health Policy

May 5, 2014

Next in a series.

There has been a lot of interest in the Daily Beast article written by Dr. Daniela Drake, about very frustrated primary care physicians (PCPs). She quoted both Dr. Kevin Pho and myself from posts here at KevinMD.com. Dr. Drake noted that nine of 10 doctors would not recommend medicine to their children as a career and that 300 physicians commit suicide each year: “Simply put, being a …

Empowering patients to become proactive with their medical bills

Michelle Del Monico

Patient

May 5, 2014

As health care providers are tasked with more administrative duties such as documentation, coding, and billing, the goal to minimize health care costs will continue to be extremely challenging.

In my role, I work with physicians on these challenges daily to ensure not only do the physicians get paid accurately but patients understand their benefits when they see our physicians. Currently, I am the revenue cycle manager for the department of …

Can I listen to your history or must I take it?

Eric J. Keller, MD

Medical Education

May 4, 2014

“You will have 15 minutes to take a full medical history,” the moderator says in a plain, mechanical voice. We stand at our assigned exam room doors ready to embark on a mission that will be recorded, reviewed, and graded as part of an OSCE (objective structured clinical examination).

“You may begin!”

I knock, enter, and make a b-line to the soap dispenser — check. I take the history in record time …

It’s time to reverse the standardized patient experience

Adam Bitterman, DO

Medical Education

May 4, 2014

Congratulations, student doctor, you studied hard and scored well on your exams — not only on your MCAT but in your organic chemistry classes as well. You mastered anatomy as well as pharmacology, neurology and more “ologies” than you care to remember. Now it is time to get hands-on learning experience, without being able to hide in the library while preparing for your clerkship shelf exams or showcasing your talents …

To medical students: We’re all in the same boat

Serena Zhou-Talbert, MD, MPH

Medical Education

May 4, 2014

I am an imposter in a white coat. I’m not sure if anyone knows yet, I hope I am good at hiding it. It’s a well-kept secret amongst all medical students. In the hospital, I am at the bottom. I know the least and have the least power. Most patients don’t realize this and look up to me like I’m an all-knowing, wise muse or something of that nature. Sometimes, …

Turn basic science breakthroughs into captivating headlines

Ann C. Bonham, PhD

Health Policy

May 4, 2014

The New York Times recently published a front page story by William J. Broad, “Billionaires with Big Ideas Are Privatizing American Science.” The piece drew nearly 500 comments on the Times’ website in 24 hours, debating the pros and cons of philanthropic support for research.

Philanthropic investment in research is most welcome, but I was struck that this story made the front page, over a much less flashy yet far more important story: that the …

Medical students can rebuild our broken system from within

Jonathan O’Donnell

Medical Education

May 4, 2014

As a medical student seeking to learn the principles of entrepreneurship, I have found Steve Blank’s insight to be a great guide and resource. His Harvard Business Review article, entitled “Why the Lean Start-Up Changes Everything,” was my first exposure to the idea of customer discovery.

The idea of customer discovery is a simple practice — listening intimately to multiple customers’ needs and pain points and using it to inform …

Why I’m not ready to prescribe mobile health apps

Kevin Pho, MD

KevinMD

May 4, 2014

A version of column was published in USA Today on April 2, 2014.

Patients in my clinic increasingly use health apps on their mobile devices. Many of these apps track various health metrics, such as weight or calories eaten, while others go a step further and help patients make sense of their symptoms or even suggest diagnoses. It’s estimated that 500 million people worldwide will use a health app by 2015, with the …

Uncovering the answer to a case of chronic hip pain

Martine Ehrenclou, MA

Patient

May 3, 2014

My husband suffered with hip and low back pain for about four months. It started right about the same time he was prescribed a new blood pressure medication. He didn’t think much of the pain at first because he was recovering from a groin injury, the result of a close encounter with a hockey puck while playing the game.

But the pain grew in intensity over the following weeks. He’s a …

The complex interplay between masculinity and health care

Olutoyin Okanlawon, MD, MPH

Physician

May 3, 2014

About 25km outside of Sao Paulo, Brasil, in a small city called Barueri, lies the grave of my mother’s cousin. Henrique was the Brasilian version of Mr. T — a larger than life character, he spent his days on the pitch as the starting goalie of a local football club. “Senhor Henrique” was well known. He had three major trademarks:

His favorite words to opposing players were “tenho pena de tolo” …
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The complex interplay between masculinity and health care

Sitting with a patient: The least practiced communication skill

Howard Luks, MD

Physician

May 3, 2014

In a voice confident and ringing with anticipation, Mr. A explained with meticulous detail how he determined which approach shot to hit to the second green on the Black Course at Bethpage State Park.

Only ten minutes earlier, when we first met, Mr. A had been weary, his face drawn, and his speech so quiet that the sound of the aortic balloon pump keeping him alive made it nearly impossible to …

The lies in the doctor-patient relationship

Julie Craig, MD

Physician

May 3, 2014

People lie. Patients lie. Patients tell blank untruths, patients misunderstand truth, patients confabulate with the damage of a thousand fifths of vodka of yesteryear.

A core conceit of medicine posits that health care providers expect pure honesty from patients from first handshake on. Violating every social norm around encounters with strangers, we expect that patients with no grounds for trust reveal all.

Providing primary care to patients on the furthest margins of …

Should medical schools start teaching to USMLE Step 1?

Abraar Karan, MD

Medical Education

May 3, 2014

In the 2012 National Residency Match Program survey, which is sent out to residency program directors around the country by the NRMP, the factor that was ranked highest with regards to criteria considered for receiving an interview — higher than honors in clinical clerkships, higher than extracurricular experiences or AOA election, and even higher than evidence of professionalism, interpersonal skills, and humanistic qualities — was the USMLE Step 1 score.

When …

How the Medicare data release subtly rations health care

Brian C. Joondeph, MD

Health Policy

May 3, 2014

Medicare released the most comprehensive ever look at how Medicare dollars are paid out to physicians across the United States. In the name of transparency, this data drop will “provide consumers with an ability to compare doctors and treatments in a way they have never had until now.”

Will it really? Let’s look a bit closer at the data release.

According to the Centers for Medicare and Medicaid Services, the payment data release aims to “make our …

Is authenticity a luxury in medicine?

Jennifer Adaeze Anyaegbunam

Medical Education

May 2, 2014

As physicians-in-training, medical students suppress feelings and mask them under the veil of professionalism. Sometimes however, medical training requires us to manufacture emotions. During the third year of medical school, the majority of student grades are derived from the subjective evaluations of the residents and attendings that work with us. To achieve the highest marks, students must appear to be “engaged” and “excited” at all times. While most of us …

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Is authenticity a luxury in medicine?

A dose of reality on the dietary fat issue

Keith-Thomas Ayoob, EdD, RD

Conditions and Diseases

May 2, 2014

With the Mediterranean diet all the rage, not only because consumers like its tasty composition but because of research touting its health benefits, experts have had to become more specific about recommendations for fats.

There’s a steady drumbeat these days — from everyone from chefs to food writers to health gurus — criticizing nutritionists and the “diet police,” who, they claim, …

Table manners for physicians: 30 tips for better dining etiquette

Karen Hickman

Physician

May 2, 2014

knife-and-fork

A few years ago I was engaged by the director of a residency program in my community to teach the program residents table manners. Now, you may wonder why medical residents need to know how to navigate a dining table gracefully. But good table manners are a must for professionals in any arena.

The director of the program stated that she felt some …

There was a time when doctors were doctors

James Ong, MD

Physician

May 2, 2014

There was a time when doctors were doctors. There was a time when young men and women sacrificed the best years of their youth, learning to treat patients and conquer diseases, not to become typists, paper pushers, data-entry clerks, or to have hospitals, insurance companies, and the federal government dictate to us how to practice medicine.

There was a time when doctors were …

We will never really understand the motivations of mass murderers

Allen Frances, MD

Physician

May 2, 2014

After every mass murder, the question everyone asks is why it happened. How could anyone possibly be so violent, or so evil, or so out of control, or so crazy as to engage in the wholesale and indiscriminate killing of a bunch of people who are usually complete strangers?

In some cases, there are longstanding preexisting warning signs: a history of mental illness, substance use, isolation and/or estrangement; the repeated experience …

The problems with making oral board recertification universal

Skeptical Scalpel, MD

Medical Education

May 1, 2014

A loyal reader, who agrees with me that we may be teaching and testing medical students and residents the wrong way, asks why aren’t all board recertification examinations given orally. She correctly asserts that oral examinations are better because they assess how people think rather than how much they have memorized.

Here’s why it would be difficult to do.

The initial surgery board exam is given in two parts. First a written …