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Can transparency in health care happen in the United States?

Health Policy

March 18, 2014

Most people, regardless of their political leaning, can agree that the market for health care in the United States isn’t really working well. Take one step further, though, and disagreement rapidly ensues.

On the left, the common understanding is that a market failure has occurred, and that the proper thing to do is have government intervene to correct that failure — usually by expanding public insurance programs, subsidizing private insurance, and …

Should doctors grab a .health domain?

Elbert Chu

Health Technology

March 17, 2014

So, you’re setting up a website for your practice. You thought you’d just grab a .com, .net, or maybe .info. But now there’s .health. Will one of those set you apart from the .com crowd?

So what do you need to know about these new domains?

1. Will patients come looking for me on .health? The bottom line is that it’s highly unlikely patients …

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Should doctors grab a .health domain?

Why doctors shouldn’t bill for time

Suneel Dhand, MD

Physician

March 17, 2014

As health care rightly moves towards a model of rewarding quality over quantity, the issue of how best to reimburse physicians is also taking a front seat. If not fee-for-service, then how best to judge and reward quality?

In this new value-based system of the future, some members of the medical community have been increasingly advocating for billing purely for time. In fact, over the years I’ve heard many doctors (usually …

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Why doctors shouldn’t bill for time

Malcolm Gladwell on our health care system

Robert Pearl, MD

Health Policy

March 17, 2014

Malcolm Gladwell hasn’t written much about American health care. But that doesn’t mean he hasn’t been thinking about it. And it sure hasn’t stopped many of his powerful ideas like “tipping point,” “outlier” and “blink” from gaining entry into the national health care debate.

In his most recent book, “David and Goliath,” Gladwell reshaped our perspectives on the underdog and highlighted our tendency to over-value certain strengths. In the health care …

Patients who come with a family member doctor

Natalie Azar, MD

Physician

March 17, 2014

“Never sign anything without me reading it first.”

Cautionary words from my husband, an attorney, whose ability to read and interpret the fine print has saved my life, so to speak, on more than one occasion. That all-in-the-family attitude toward a profession is something almost every doctor also knows well. Through me, my husband, relatives, friends, and sometimes acquaintances can get what I call a “healthcare quickie,” a free, two-minute sideline. They can …

People die without love: Why I prescribe the love drug

Pamela Wible, MD

Physician

March 17, 2014

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As a doctor, it’s my job to figure out what patients really need. Some need antibiotics. Some need pain pills. But everyone needs love.

During medical school I cared for burned children. One of my patients was a 3-year-old with severe burns over most of his body. His roommate, an older boy, had just burned one arm. Yet the older child withered in the …

The doctor will see you now, or will she?

Rebecca E. MacDonell-Yilmaz, MD, MPH

Physician

March 16, 2014

My friend breathed a sigh of relief as she finished her last clinic visit for the day and headed down the hall to the physician workroom. It was only 5pm. She still had notes to write and labs to check, and as a senior resident she needed to make it back to the hospital wards to check on her team’s interns, to get updates on the afternoon’s events and help …

What spending time with critically ill patients taught me

Larry Istrail, MD

Medical Education

March 16, 2014

A hospital is not the homiest of establishments. The bright neon lights, strange smells and piercing high-pitched beeps that radiate from the rooms of dormant patients fill the halls in a symphony of annoying sensory stimulation. But to someone recovering from a relationship that just ended, hospitals are heavenly. When the lonely silence of your one bedroom apartment is overwhelmingly loud, beeping IV lines and incoherent mumbles are surprisingly therapeutic.

As …

Universal coverage remains a big deal

Philip Verhoef, MD, PhD and Stephen Kemble, MD

Health Policy

March 16, 2014

Recently JAMA published a special theme issue on critical issues in U.S. health care. Among the contributors was Dr. Ezekiel Emanuel, the oncologist, bioethicist and former White House adviser on health policy.

In his article, “Going to the Moon in Health Care: Medicine’s Big Hairy Audacious Goal (BHAG),” Emanuel argues that contemporary medicine is in need of vision, an overarching, aspirational goal “like going to the moon that can make …

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Universal coverage remains a big deal

The surge of physician membership in Congress

Brian Powers and Sachin H. Jain, MD, MBA

Health Policy

March 16, 2014

Physicians in Congress are on the rise. From 1960 to 2004, only 25 of the 2196 members of Congress were physicians. During an era that brought such fundamental changes to health policy as the creation of Medicare and Medicaid, physicians were disproportionately less likely to hold congressional office than their counterparts in law (979) and in business (298). In recent years, the ranks of physician-representatives have swelled — twenty physicians …

Imagine a physician-designed EMR

Israel Green-Hopkins, MD

Health Technology

March 16, 2014

The title itself should make us all cringe! If there’s one thing I know to be true, it is that putting clinicians at the helm of electronic medical record (EMR) design is doomed to create a product with limited scope and lack of forward-thinking trajectory. Yet, the concept of integrating and considering the physician point of view and workflow is critical to successful EMR functionality.

The question is how can clinician …

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Imagine a physician-designed EMR

Preserving antibiotics for future generations

Neil Fishman, MD and Kenneth Sands, MD, MPH

Medications

March 16, 2014

The discovery of antibiotics is one of the most significant medical achievements of the 20th century. In the 1920s Alexander Fleming pioneered the discovery and use of penicillin, winning the Nobel Prize in Physiology and Medicine for his work. Other pioneers built upon his success and scientific research to pave the way for even more antibiotic development. The ability to fight infections has ultimately resulted in longer life spans and …

Screening for poverty should be included in the medical curriculum

Matthew J. To and Colin Van Zoost, MD

Medical Education

March 15, 2014

Poverty is a significant public health concern affecting 10-15% of individuals living in Canada and the United States. Recommendations to eliminate poverty have focused on areas of income, housing, food security, and early childhood development. Calls for government action and provision of resources to healthcare professionals have been issued. Notably, educating medical trainees to address poverty has been absent from the discussion.

Low socioeconomic status (SES) is a risk factor …

3 concerns about the legalization of marijuana

Jonathon Savage, DO

Medications

March 15, 2014

It was like watching the news footage of shoppers trampling each other to get through the doors of a Filene’s Basement sale or witnessing people standing outside all night for the new iPhone even though it isn’t a sale and it will be made in mass production for months or years to come. I am talking about seeing people line up in the dark of pre-dawn to get their fingers …

How safety net ERs can save health care reform

Andrew G. Lim

Health Policy

March 15, 2014

Safety net emergency departments are frequently blamed for being the source of rising health care costs. After all, they care for the millions of underserved and un-insured Americans forced by a variety of circumstances to visit ERs for their primary care and low-acuity concerns.

With the Affordable Care Act (ACA) reforms initiated in January, demand for emergency services will rise significantly. Medicaid already covers over 50 million individuals – most of …

Radiologists aren’t the only ones criticizing the new mammogram study

Geraldine McGinty, MD, MBA

Physician

March 15, 2014

Supporters of the most recent paper from the Canadian National Breast Screening Study (CNBSS) falsely contend that only radiologists are criticizing this study. This simply is not true. The Canadian study flaws have been well documented for decades.

Robert E. Tarone at the National Cancer Institute (who isn’t a radiologist) wrote in 1995 that there was a statistically significant excess of advanced cancers that were allocated to the mammography …

CT in neck trauma: Changing the culture in the ED

Dr. Saurabh Jha

Conditions and Diseases

March 15, 2014

Schuur and colleagues in JAMA Internal Medicine listed five low value services in the emergency department (ED). Although compilation was not solicited by the American College of Emergency Physicians as part of the Choosing Wisely program, it has its ethos.

The list was developed by a technical expert panel after multiple iterations. The list is not only wise but derived from sound methodology. Most importantly, the recommendations are …

MKSAP: 35-year-old man with nonproductive cough and fever

mksap

Conditions and Diseases

March 15, 2014

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 35-year-old man is evaluated for a 2-week history of nonproductive cough and fever. He has a 20-year history of asthma. Three weeks ago, he visited friends in Indiana. He has no dyspnea, hemoptysis, or worsening of his baseline asthma symptoms. His only medication is an albuterol inhaler as needed.

On physical examination, …

Redesign the medical home to thrive in the real world

Michael L. Millenson

Health Policy

March 14, 2014

I was reading a medical home advocacy group’s upbeat approach to a recent JAMA study that had found scant benefit in the concept when, suddenly, we tumbled into Alice in Wonderland territory.

The press release from the leadership of the Patient-Centered Primary Care Collaborative (PCPCC) started out reasonably enough. The three-year study of medical practices had concluded that the patient-centered medical home (PCMH) contributed little to better quality of care, lower cost …

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