Having worked with radiologists a lot, I have great respect for their specialty. The job is indeed a very difficult one. Without seeing the patient (the most difficult part of what they do), they have to thoroughly comb through every image put in front of their eyes and give us their assessment of what’s abnormal and what’s not. Their interpretation will be one that other doctors will hang their hats …
Hats off to the airport radiologists
Medical scribes are a burgeoning field with many institutions and practices exploring their use while the many commercial enterprises who lease out scribes are pushing for their widespread acceptance. There is no accepted definition of what scribes do or what their background or training should be. There is no mechanism for licensure of them in any state. They are poorly defined medical assistants. The field is in its infancy and …
Do medical scribes threaten patient privacy?
Perhaps one of our greatest assets and strongest detriments in medicine is our ability to look at a patient and make a quick, thorough assessment of his or her condition and state of distress. Certainly, a good clinician is able to triage and provide greater quality of care in the emergency room if he or she can use the intangibles of a patient’s presentation to provide them better quality of …
Like any other industry, in health care, the books and schooling don’t always match the “real world.” Patients everywhere have the same complaints about physicians and their bedside manner. “I feel like she’s talking at me, not to me.” “He said I had cancer like it was just another sentence.” “He walked in, looked at my meds, and walked right out of the room without saying a word.”
Those training tomorrow’s …
My school is trying to make me an empathic physician
I loved my father. His doctor was fond of him, too. Three times we nearly lost him, and each time he pulled through, weaker, but enjoying life. When the magical recovery didn’t materialize, it was hard to believe that this was really going to be the end — hard for my family, and maybe harder for his doctor.
No one wanted time with my dad more than I did. I wanted …
Speaking up about hospice is not a betrayal of our family members
Through three years of medical school, I’ve seen disgruntled physicians repeatedly slam the recent movement toward patient satisfaction. In our family medicine clinic, a copy of Dr. William Sonnenberg’s essay “Patient Satisfaction is Overrated” hangs on the door to remind attendings, residents, and students of the unfair pressure to keep patients happy despite their demand for antibiotics, imaging studies, or narcotics.
The only way to keep the patients satisfied, the argument …
Patient satisfaction is underrated
During my 2+ decade tenure as a physician I have always believed that a physician’s promise of confidentiality was a pre-requisite to obtaining accurate information from a patient. With the enactment of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) the rules which stipulate when a physician must disclose confidential medical information (protected health information, PHI) without the prior consent of the patient were codified into law.
In today’s …
Certified electronic medical records threaten patient privacy
The day I graduated from medical school and walked across that stage with my diploma in hand, I was sure that I had achieved the highest honor in the land. I could not help envisioning myself in a long, crisp white coat, walking down the long hallways of the hospital, with my name badge perfectly displayed that read: “doctor.”
I was certain in my mind that I had finally made it. …
Dr. Mom: No instructions included
CMS has paid out over $21 billion dollars in incentive payments to providers and hospitals who have successfully attested under the EHR Incentive Program (i.e. meaningful use). With that much money out the door, you can bet that Congress is watching closely to ensure that those dollars are only going to people who really have met the requirements. One way that CMS is monitoring meaningful use is by conducting audits …
How to prepare for a meaningful use audit
Becoming a doctor takes time, but those outside of medicine do not always realize how convoluted the process can be. Central to the perversion is the National Resident Matching Program (or “the Match”).
After college and the two years of classroom-based training in medical school, students are ushered into clinical training through third year core rotations in predetermined specialties. In the spring of their third year, students must decide on their …
It’s time to make the Match disappear
As an income-less medical student, I would be one of the now 7.1 million people who have signed up for Obamacare for this year. Except I live in Texas, one of nearly half of all states that elected to not expand Medicaid. At the same time, I don’t have enough of an income to qualify for federal subsidies, making insurance from the Marketplace unaffordable.
As such, the individual mandate — the …
Considering the latest threat to the Affordable Care Act
As a recently minted MD with a keen interest in health IT that began with working on Google Health six years ago, I’m decidedly on the forward-looking end of the spectrum in the physician community. I think decision-support algorithms have the potential …
How technology can save the craft of medicine
It’s coming up on that time of year again. Spring break is here, next comes school assemblies leading up to the end of the school year.
It’s that inevitable time of year where I see news story after news story where children are rewarded Oprah-style for their awesome record of perfect attendance:
“You get a bike and you get a bike and you get a bike.”
Yeah! It’s pretty heart-warming and exciting, right?
There …
Is perfect attendance what we really want in school?
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A recent study, one that received relatively scant media attention (compared with a concurrent New York Times piece about a new psychiatric diagnosis termed “sluggish cognitive tempo” that may be the “new ADHD”) showed that antipsychotics are being prescribed to nearly one third of kids (age 2-17) in foster care who are diagnosed with attention deficit hyperactivity disorder (ADHD).
This disturbing statistic brought to mind a common complaint I hear from parents …
Kids in foster care end up on antipsychotic medication for ADHD
Recently, we had a wonderful reception at the American College of Physician’s Internal Medicine 2014. Sitting with leadership colleagues we had a wonderful conversation about how medicine changes. One colleague gave the example of ulcer disease. Those who trained in the 1960s and 1970s know most of this history, but it actually goes back to the early part of the 20th century.
Consider the Sippy diet, the Bilroth II, highly selective …
We have performance measures based on rather weak evidence
Stephanie wrote in about a very common problem:
My daughter is 4 years old. She isn’t the tallest cat in town (she is about the 15th-25th percentile for height), and her BMI always ends up being in the high range (like over 85%). I worry about it. I am very health conscious for myself and my family. We live by all of the “rules.” And yet.
The family doctor doesn’t worry — …
Should BMI be used to measure obesity in children?
Hepatitis C virus (HCV) continues to be the number one cause of cirrhosis and liver cancer and the primary indicator for liver transplantation in the United States, yet it remains vastly underdiagnosed.
More than three million people in the U.S. are infected. Guidelines support widespread screening for HCV, and excellent treatments are now available.
So the question remains: Why is HCV underreported?
When “good” news disguises bad
A recently published Read more…
Why is hepatitis C underreported?
It’s here. For the first time in 35 years (or 33, depending on which click bait headline you clicked on), the much anticipated release of data on Medicare payments to physicians, has been released to the public, on the historic date of April 9th, 2014.
“Data trove shows U.S. doctors reap millions from Medicare,” according to the distinguished Reuters news service. The Washington Post will tell you “everything you need …
Transparency is here, and it’s hunting season on doctors
With American health care in the midst of rapid transformation, both doctors and patients will be forced to adapt to changes stemming from the Affordable Care Act, also known as “Obamacare.”
Of course, everyone responds to change differently. But is it possible to predict how doctors will adapt to health care reform based on the year they were born? The answer may surprise some patients and even force them to think differently …
How generations of doctors will handle health care change
As I walk into the hospital each day, I notice patients and families sitting outside on benches that are surrounded by large signs prohibiting smoking on hospital grounds. For over five years, a collaborative and concerted effort by Memphis hospitals has successfully made all the hospital campuses smoke-free.
Now, in other states, hospital systems like Cleveland Clinic and Baylor Health Care have taken another bold step forward. They have stopped hiring …
Should hospitals discriminate against smokers?
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