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The consolidation of health care: 5 questions to ask

Rhea Boyd, MD

Health Policy

March 8, 2014

Comcast recently announced it is merging with Time Warner, the 2nd largest cable company in the US. Together, this deal nets Comcast an estimated 57% of the cable subscriber marketplace and heralds a new oligarchy in US media and entertainment. It’s big news for Comcast, but aren’t as excited.

Why?

Because both Comcast and Time Warner have been consistently rated the worst providers of customer service in the cable industry. Now as they …

MKSAP: 43-year-old man with severe abdominal pain

mksap

Conditions and Diseases

March 8, 2014

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

A 43-year-old man is evaluated in the hospital for severe abdominal pain of 2 days’ duration. He is otherwise healthy except for the recent finding of pancytopenia. Family history is noncontributory. His only medication is a daily multivitamin. Following a physical exam and lab results, what test is most likely to establish …

Are doctors contributing to the polarization surrounding vaccines?

Davis Liu, MD

Physician

March 7, 2014

Why is it that illnesses that could be prevented by vaccination are on the rise despite scientific evidence they save lives? Recent articles noted measles exposure to people riding the Bay Area Rapid Transit (BART) public transportation system as well as more cases of whooping cough due to refusal to vaccinate and in some cases getting “non-medical” personal exemptions. The suggestion that vaccines could cause autism has been debunked. So why is …

The request to leave AMA is a signal for an honest conversation

Ishani Ganguli, MD

Physician

March 7, 2014

His nurse paged me at 9pm: Mr. L wants to leave against medical advice (AMA). As the covering doctor, I dreaded the impending standoff even more than usual.

I emerged from the elevator minutes later to find that the gaunt octogenarian had advanced from his isolation room, passed the nurse’s station and the unit doors, and arrived at the elevator bay to greet me. Security guards hovered at a cautious distance …

Has the tide really turned against childhood obesity?

David L. Katz, MD

Conditions and Diseases

March 7, 2014

The media headlines attached to the major medical news story of the past week might have been: “Shocking but true: Nearly 1 in 10 US children under the age of 5 is obese!” Had that been the headline, it would indeed have been every bit as true as it is shocking. And the really shocking part is: that’s the good news! Hold that thought, please.

Some years ago, at the prompting …

The failure of vaccine messages

Roy Benaroch, MD

Conditions and Diseases

March 7, 2014

Vaccine coverage rates, overall, remain very strong in the USA. Well over 90% of kids are well-vaccinated, and the rates of vaccine-preventable diseases remains very low. Newer vaccines have proven especially safe and effective, including immunizations against severe diarrheal illness and cancers of the cervix and throat. In many ways, we are staying ahead in our battle against vaccine-preventable disease.

Yet: there are still pockets of intense resistance …

Read more…

The failure of vaccine messages

Why ICD-10 concerns me deeply

Brian Anderson, MD

Health Technology

March 7, 2014

If you’re a practicing provider, chances are you still feel some anxiety about several issues related to the ICD-10 transition that are critical for maintaining the health of your practice. These probably include reimbursement, documentation workflows, potential audits, and claims denial.

As a family medicine provider, what I hope to see develop is the opportunity for providers to encourage payers to be more transparent about topics like the level of coding …

Read more…

Why ICD-10 concerns me deeply

What is the best way to choose residents?

Skeptical Scalpel, MD

Medical Education

March 7, 2014

On Twitter a while ago, a medical student asked me how surgical program directors select new residents. Then a discussion arose among some academic surgeons on the same topic. Someone suggested that medical school grades were the best way to tell whether an applicant would be a successful resident.

The fact is that we aren’t really sure what the best way to choose residents is.

First, here’s what we really do.

A 2011 Read more…

What is the best way to choose residents?

The risks of treating high blood pressure in the elderly

Leslie Kernisan, MD, MPH

Conditions and Diseases

March 6, 2014

When it comes to high blood pressure treatment in the elderly, the plot continues to thicken.

Last December, a minor controversy erupted when the JNC hypertension guidelines proposed a higher blood pressure (BP) treatment target (150/90) for adults aged 60+.

And now this month, a study in JAMA Internal Medicine reports that over 3 years, among a cohort of 4961 community-dwelling Medicare patients aged 70+ and diagnosed with hypertension, those on blood pressure medication …

The societal problem of opioid addiction

Albert Fuchs, MD

Medications

March 6, 2014

Opioids are a family of pain medications chemically related to opium and heroin. They include morphine, fentanyl, codeine, hydromorphone and others. Opioids have unique properties that make them both indispensable for pain management and extremely dangerous.

Unlike virtually any other family of medications, opioids have no maximum effective dose. If any dose, no matter how high, is ineffective at controlling pain, a higher dose can give more pain relief. Most other …

Does texting ER wait times affect patient care?

Jennifer Gunter, MD

Physician

March 6, 2014

On our recent road trip I was amazed by the number of billboards (from several health care systems and hospitals) advertising texting for emergency room (ER) wait times. My first thought was, “if you can text, how emergent is it?” This was quickly followed by the concern that the option/advertising of texting about wait times might make the ER seem, well, less for acute care and more for convenient care.

Should I be concerned?

There …

A perfect day in the cancer clinic

James C. Salwitz, MD

Physician

March 6, 2014

It happens, now and then; not as often as one would wish, but occasionally. In other professions, a perfect day is when you make that super sale, finish a protracted project, win an important race or craft a special, remarkable piece of art. An oncology perfect day can be without bells, whistles, pats on the back, nor cash register’s whirr. Some of the best days lack pizzazz, vibrant emotion or …

Read more…

A perfect day in the cancer clinic

Treating a symptom is not the same as treating a disease

Michael Kirsch, MD

Conditions and Diseases

March 6, 2014

Physicians and patients collaborate to treat symptoms. This is not newsworthy and even sounds appropriate. Isn’t that what doctors are trained to do? It is but I’m not sure this should be a central focus of our healing mission. Treating a symptom is not the same as treating a disease.

For example, if an individual is having abdominal discomfort, pain medicine should not be the first responder, even if this would …

We will be waiting for something until the day we die

Greg Smith, MD

Physician

March 6, 2014

We’re all waiting for something.

As kids, we waited for the time that we could do it ourselves, go it alone, tie our own shoelaces, order our own food off the menu, take our baths by ourselves, and walk up and down the street or around the mall without parental supervision. We were kids. We didn’t yet have enough life experience or enough insight to realize that the time we occupied, …

A hospital stay provides new insights into the patient experience

Kevin R. Campbell, MD

Physician

March 5, 2014

Communication is critical to success in medicine. Our patients depend on us to help them understand their disease and the risks that it may pose. In previous blogs I have commented on how vital effective communication can be in determining outcome — much of my writing has focused on the success associated with outpatient doctor-patient relationships. We now know that when doctors and patients engage, patients become invested in their …

Vaccines: An unprecedented use of state power?

Christopher Johnson, MD

Physician

March 5, 2014

One aspect of the endless vaccine debate is the aspect of coercion some parents feel about requiring children to be vaccinated before they can go to school. The government mandates vaccination. But this isn’t really an absolute requirement. Although all 50 states ostensibly require vaccination, all but 2 (Mississippi and West Virginia) allow parents to opt out for religious reasons, and 19 states allow this for philosophical reasons. (See Read more…

Vaccines: An unprecedented use of state power?

The sixth sense of an experienced clinician

Lucy Hornstein, MD

Conditions and Diseases

March 5, 2014

I just didn’t like the looks of him.

It was the way he was breathing. I counted for a full minute: 24 breaths. (The ER would later document 40.) No accessory muscle use. Not even much coughing. He didn’t look overly anxious or uncomfortable, though he said he couldn’t breathe. No fever. No wheezing or other abnormal lung sounds on exam. No leg swelling or tenderness. Pulse ox 95% on room air (97% in …

5 ways to engage your patients in the office

David Lee Scher, MD

Health Technology

March 5, 2014

There are over 58 million references to “patient engagement” if one conducts a Google search. The term has been diluted and changed in the past couple of years and has become a buzz phrase, used more from a business than clinical benefit perspective.

The Center for Advancing Health defines patient engagement as “actions individuals must take to obtain the greatest benefit from the health care services available to them.” …

The costs of care was far beyond her means

Monica Williams-Murphy, MD

Conditions and Diseases

March 5, 2014

Mrs. Sandra Jackson knew that she was no Warren Buffet. She knew that she was no Bill Gates. Instead, Mrs. Jackson knew that she worked two jobs, 7 days a week to support her family. So, she hid her breast condition for a better time, another day. She would ask herself, which was more important: going to a doctor or buying her children dinner? For a true mother, the answer …

Remember why you got into medicine in the first place

Starla Fitch, MD

Physician

March 5, 2014

Remembering why we got into medicine in the first place can often soften the edges of long, difficult days.

My story unfolded on a circuitous route to medical school. I started with a master’s degree in sociology, and my first job after I graduated was working for the Virginia Center on Aging. I administered hour-long assessment surveys to the elderly population of the state. I would drive my old Volkswagen to …

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