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Profits are not to blame for health care costs in the United States

Peter Ubel, MD

Health Policy

February 21, 2014

We all know that health care costs in the U.S. are too high. But why is American health care so expensive? Some experts blame the desire for profit. Russell Andrews, a neurosurgeon and author of Too Big To Succeed laments “the morphing of American medicine from a function of a humanitarian society into a revenue stream for health care profits, drug and medical device companies, hospitals, and insurance companies. In …

The art of medicine lies in knowing when a little time is needed

Abigail Schildcrout, MD

Physician

February 21, 2014

Our 13-year-old woke up feeling lousy two days ago. He had a sore throat and sinus pressure, and felt really tired and generally icky. He didn’t look toxic — just a little tired. I gave him a zinc lozenge and told him to get ready for school — a method that generally can tease out exactly how bad one of my kids feels. He just sat at the table.

We generally …

Evidence-based guidelines today, malpractice tomorrow

Karen S. Sibert, MD

Physician

February 21, 2014

We hold these truths to be self-evident:

A hospital administrator with a clipboard is in search of a physician who isn’t following “evidence-based guidelines.”

There are fads in medicine just as there are in fashion — today’s ”evidence-based guidelines” may be tomorrow’s malpractice.

Did your hospital, like so many, abruptly switch from povidone-iodine antiseptic solution to ChloraPrep® for cleaning a patient’s skin before surgery? If so, I’m sure the staff was told that ChloraPrep would …

Do patients value their health information privacy?

Jessie Gruman, PhD

Patient

February 20, 2014

Do I value the privacy of my health information? What do you mean?

That if I email my doctor about an embarrassing symptom, only my doctor will read it?

That only my doctor, my nurse and I have access to the information in my electronic medical record, including notes on our confidential conversations, prescriptions and test results?

That my local drug store doesn’t sell information about me to pharmaceutical companies?

That …

Defeating cancer is not an armed conflict

James C. Salwitz, MD

Physician

February 20, 2014

On December 23, 1971, President Richard M. Nixon signed the National Cancer Act of 1971, and declared the “war on cancer.” The allusion to combat appealed to the soul of the American people not long after their success in World War II and the humiliation of Vietnam; they intuitively understood the sacrifice, teamwork and massive effort, which is implied in the concept of War and they were ready for another victory. Committing dollars, …

Perhaps ADHD is a problem of not listening

Claudia M. Gold, MD

Conditions and Diseases

February 20, 2014

Recently I reviewed my son’s high school essay on To Kill A Mockingbird. I was surprised and pleased to rediscover, or perhaps discover for the first time now that I was viewing it from the perspective of over 50 years of life experience, the profound wisdom of the book.

In one of the novel’s most famous quotes, Atticus tell his daughter Scout, “you never really understand a person until you consider things …

What to do if your doctor isn’t polite

Claire McCarthy, MD

Physician

February 20, 2014

Here’s a question I’m almost afraid to ask: when you go to a doctor (not one you see all the time), does the doctor usually introduce himself (or herself) and explain what they are there to do?

And, do they sit down?

I really hope that you are answering yes … but I know that the answer is often no.

In a study recently published in the Journal of Hospital Medicine, researchers observed 29 …

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What to do if your doctor isn’t polite

Don’t blame Obamacare for these 10 things

Margalit Gur-Arie

Health Policy

February 20, 2014

There is a new report out from the Congressional Budget Office (CBO) titled “The Slow Recovery of the Labor Market,” and as its title implies, it predicts a slow recovery from a labor perspective. Among other things, the CBO report is now making headlines in the political game of Obamacare because it forecasts a 2.5 million job reduction by 2024 due to the effects of the health care …

Is there a downside to open access scheduling?

Lucy Hornstein, MD

Physician

February 20, 2014

The term “open access” in the context of primary care means that patients are able to get an appointment whenever they wish.

The ultimate in open access is 24/7 availability. No, I don’t offer this, although I come pretty close. I’m available by cell phone virtually 24/7 and I’m also almost always willing to come in and see someone if they really need to be seen. This seldom happens. Most of …

Is Big Pharma evil? Doctors should share the blame

Luis Collar, MD

Medications

February 19, 2014

Despite representing only 4% of the world’s population, the United States accounted for almost 35% ($326 billion) of the global market for pharmaceutical drugs in 2012. Not surprisingly, the pharmaceutical industry’s business practices, considerable marketing budgets, and substantial profits are hotly debated as part of virtually every health policy discussion. But before addressing the possibility of transcendent evil in that industry, we should pose a more mundane yet critical question: …

When is the right time to die?

K.D. Hayes

Patient

February 19, 2014

Uncle Walt died this morning. Finally.

I say “finally” because I believed this day would come four months ago, when he had emergency bypass surgery.

At the time, I didn’t believe Walt would live; he was an ailing, seventy-seven-year-old man with severe pulmonary disease. When his heart started to hurt one Friday, his doctors told him, “With bypass surgery, you might live. Without it, you’ll be dead before the weekend is over.”

Walt’s …

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When is the right time to die?

The true service your doctor is providing is thinking

J. Russell Strader, MD

Physician

February 19, 2014

Ms. Smith (name changed) is 82-years-old, but currently looks about a hundred. I met her, intubated, in the ICU two weeks ago. She lived alone, hadn’t told family she wasn’t feeling well, but had called 911.

In the emergency department, she was struggling to breath, and was intubated, having gone into respiratory failure. She was found to have a severe pneumonia affecting the majority of both her lungs. She also went …

5 straightforward ways to improve patient satisfaction in hospitals

Suneel Dhand, MD

Physician

February 19, 2014

Patient satisfaction and improving the hospital experience is being discussed in hospital boardrooms across the country. Now that financial reimbursements are directly tied to HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) survey scores, there is a significant incentive to do so. A multitude of ideas are being put forward into how this can be achieved, and hospitals are investing heavily to get tangible results. Many involve complicated and …

Obamacare supporters shouldn’t cast a blind eye to its faults

Bob Doherty

Health Policy

February 19, 2014

Even the best of families have skeletons: the uncle who had some shady business dealings, the cousin in drug rehab, brother with the messy divorce and custody fight, or the adult kids who are maxed out on their credit and behind in their mortgage payments but have to “keep up appearances” with their expensive suburban lifestyle. When these things happen, there is a tendency to “keep it all in the …

Why hospitals should be scared of cyberattacks

Joe Flower

Health Technology

February 18, 2014

If you are a CEO or COO of a health care organization, and your IT people have been trying to get your attention, it’s time to have a serious sit-down with them.

If they haven’t been trying to get your attention, it’s time to have an more serious sit-down with them, complete with charts and graphs and arrows on fip charts.

Here’s why.

Remember in November it was revealed that the Target retail …

Will resident autonomy disappear completely in the future?

Paul Bergl, MD

Medical Education

February 18, 2014

Recently, our residency program had the excellent fortune of hosting Dr. Bob Wachter as a visiting speaker. Dr. Wachter is considered a pioneer in the hospitalist movement and has built his career around inpatient quality and safety. During lunch with Dr. Wachter, some of our residents, and hospitalist faculty, we discussed the topic of resident autonomy in the hospital.

In the glory days of residency, I imagine that house officers …

The high cost of “free,” unnecessary medical equipment

Yul Ejnes, MD

Physician

February 18, 2014

A guest column by the American College of Physicians, exclusive to KevinMD.com.

A couple of weeks ago, a television commercial caught my attention. It was an official-sounding announcement, a “national healthcare alert” that if you have Medicare, you might qualify for a knee brace “at little or no cost to you.” I found it interesting because a week earlier, a durable …

Analyzing the Katie Couric effect on the vaccine conversation

Natasha Burgert, MD

Social Media in Medicine

February 18, 2014

On December 4th, 2013, Katie Couric gave the HPV vaccine center stage during a segment on her talk show, Katie. The segment, entitled “The HPV Controversy,” was 20 minutes long, but ignited a digital firestorm between pro- and anti-vaccine voices that raged for days after the stage lights went dark.

In partnership with Global Prairie, the entire online conversation surrounding this Katie segment was digitally captured using …