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4 scenarios that would dramatically improve health care

Health Policy

January 14, 2014

Radical change often happens suddenly, the result of a single decision or event.

The fall of the Berlin Wall and the dissolution of the USSR stand out as two dramatic political examples. In a social context, Supreme Court decisions in Brown v. Board of Education or Roe v. Wade both radically changed our society.

Then there’s the U.S. health care system. We know it can take 17 years for a new, proven treatment to …

A patient trapped in his own body

Edward Thompson, MD

Physician

January 14, 2014

Donald is large. Very large.

At more than 600 pounds, he is a mountain of flesh with a small opening at the top through which he speaks.

“My stomach hurts,” he says, his voice surprisingly high and childlike.

It is 10:00pm in the emergency room, and I am already swamped with patients I’m trying to move through the ER before my shift is over.

Asked if he’s ever felt this kind of pain before, …

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A patient trapped in his own body

When doctors disagree: What should you tell patients?

Zackary Berger, MD, PhD

Physician

January 14, 2014

A recent research article in the Journal of General Internal Medicine, and the gap between its findings and the real world, helps point up the usefulness and limitations of research. The article, by Susan H. McDaniel, PhD, and coauthors, set out to determine how often doctors speak about their colleagues in supportive or critical ways.

Their method is one widely used in the field: simulated patients, actors, were prepared with lifelike …

Why Obamacare isn’t at risk for a death spiral anytime soon

Robert Laszewski

Health Policy

January 14, 2014

If the Obamacare health insurance exchanges are not able to get a good spread of risk — many more healthy people than sick — the long-term viability of the program will be placed in great jeopardy.

Given the early signs — far fewer people signing up than expected, enormous negative publicity about website problems, rate shock, big average deductibles, narrow provider networks, and a general growing dissatisfaction over the new health …

Reflections of a new mother in medicine

Ishani Ganguli, MD

Physician

January 14, 2014

Months before my life was upended, a doctor friend tried to explain my forthcoming role in terms I’d understand. “Imagine being on call 24 hours a day, seven days a week,” he said. “You’re in charge of a single patient, but she is needy as hell.”

Medical training prepared me for motherhood in some ways (the assortment of facts blurrily retained from my pediatrics rotation in medical school; the skill, or delusion, …

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Reflections of a new mother in medicine

Lebron James: The king of junk food

Peter Ubel, MD

Conditions and Diseases

January 13, 2014

lebronfood

Lebron James makes over $19 million per year playing basketball for the Miami Heat. Not surprisingly, this salary is peanuts compared his endorsement earnings, which in 2012 topped $42 million. Although perhaps peanuts is the wrong word to use when discussing James outside earnings, which to my knowledge have not involved foods anywhere near as healthy as peanuts. Instead, according to …

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Lebron James: The king of junk food

It is time to re-evaluate ADHD and return to safe practice habits

Allen Frances, MD

Medications

January 13, 2014

Every once in a while a brilliant investigative journalist can get us back on track when we have been led badly astray. I hope that a recent New York Times front page story, “The Selling of Attention Deficit Disorder,” by Alan Schwarz will have that kind of special societal impact.

Schwartz has previously written a series of accurate and hard-hitting articles exposing the over-diagnosis of ADHD and the consequent careless and …

What are politicians doing about the shameful infant mortality rate?

Jennifer Gunter, MD

Physician

January 13, 2014

The infant mortality statistics are out again. This always depresses me because: 1) The rates are atrociously high, and, 2) There is so much legislation passed to restrict abortion in the name of “life,” but politicians and judges seems awfully silent on infant mortality.

In the United States 6.4 infants out of every 1,000 born will not reach their first birthday. This is more than 24,000 infant deaths a year. The United States is also the leader …

A culture of contempt has led to medicine’s downfall

Luis Collar, MD

Physician

January 13, 2014

“Doctors are crooks.”

“They’re getting worse than lawyers.”

“I don’t go anymore. They’re just out for a buck, and they don’t really do anything for you anyway.”

“I stopped getting checkups when my old one retired. He was good, took his time. I haven’t found anyone like him since.”

“They always think they know everything … a bit too much self-importance there, without ever walking in my shoes.”

“They all say the same thing; it’s …

A nurse masters the art of medical slang

John F. Hunt, MD

Physician

January 12, 2014

An excerpt from ASSUME THE PHYSICIAN: Modern Medicine’s “Catch-22”.

“What did you learn today?” I asked, fearing the answer.

I was suspecting a recitation about the new methods of documenting nursing competencies, or a delineation of the process by which she helped the hospital maintain its “magnet” status to attract …

Bringing health care technology to the developing world

Varun Verma, MD

Physician

January 12, 2014

This post is a question, an invitation and a challenge. How can we bring technologies we take for granted back home to those in the developing world? Many before me have spoken with outrage about the reality of two worlds: one of abundance, and the other where people live like they have in centuries past.

The situation is more complicated since even poor people may have some technologies like cellphones now, but vital lifesaving technologies …

Radiation therapy is a leap of faith

Matthew Katz, MD

Conditions and Diseases

January 12, 2014

Each time I reach the point of recommending radiation treatment for someone with a brain tumor or head and neck cancer, I ask for a higher level of trust from each patient than usual: let us make a mask to keep you safe.

Radiation therapy is already a leap of faith — who wants invisible rays shooting through them? Fear of unknown …

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Radiation therapy is a leap of faith

Increase patient and provider satisfaction by reducing phone messages

Rosemarie Nelson

Physician

January 12, 2014

Incoming telephone calls should be a good thing in a medical practice, right? Requests for appointments from new patients and established patients are the lifeblood of the practice. But for many practices, the phones are an overwhelming burden for everyone, from the receptionist and nurse to the provider with an inbox full of patient messages to sort through.

In general, approximately 25% of incoming calls to a medical practice are repeat …

For the medical home to be successful, listen to the patients

Fred N. Pelzman, MD

Physician

January 12, 2014

Standing in the middle of a massive hotel convention center hallway with thousands of people wearing name tags.

Not where I usually spend my days.

I have been asked to join senior management at a national client conference for the company that is providing patient survey data to our institution, those surveys patients get in the mail asking about their “experience” during their visit to our practice.

Everybody here wants the same thing, …

MKSAP: 68-year-old man with exertional chest pain

mksap

Conditions and Diseases

January 12, 2014

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

A 68-year-old man is evaluated for exertional chest pain of 3 months’ duration. He describes the chest pain as pressure in the midsternal area with no radiation that occurs with walking one to two blocks and resolves with rest or sublingual nitroglycerin. No symptoms have occurred at rest. Medical history is significant …

Medical students should get excited about direct primary care

Brian Lanier

Physician

January 11, 2014

You’ve heard the story before: a young man or woman with idyllic dreams of practicing primary care goes off to medical school, only to have their dreams crushed by the realities of 7-minute visits, “production goals,” and unstable reimbursement — you’ve heard of the Medicare sustainable growth rate, or SGR, right? Every time you turn around, there is someone talking about primary care physician burnout or complaining about practicing on …

Why does Medicaid increase emergency department use?

Dr. Saurabh Jha

Health Policy

January 11, 2014

The interpretation of results of a policy study lies in the political inclination of the beholder.

If one likes the results they are “ground breaking.” If they are not in line with our world view there are “nuances” of hypothesis testing that detractors have overlooked, it’s too “premature” to draw conclusions and “further research” is needed. Statisticians, like lawyers, can be recruited to argue any point of view to meaningless insignificance.

This …

The stigma of becoming a psychiatrist

Angela Marie Andrich, MD

Physician

January 11, 2014

I’m coming out, but it isn’t what you’re thinking. I’m writing this to finish answering a question that I was asked 25 years ago by an attending physician. He was a Scotsman with a ruddy complexion and it was early in my third year of medical school. I had been up since 4am rounding on patients and then assisting on a general surgery case.

Answering the esoteric questions the Scotsman posed had …

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The stigma of becoming a psychiatrist

Intellectual doping: Stimulant abuse in medical students

Aimee Merino, PhD

Medical Education

January 11, 2014

No one can deny that medical students today face an increasingly competitive environment with a strong focus on board scores and class grades as strong requirements for entrance into competitive specialties. Mirroring the trends in both primary and secondary school, a standardized test has become the yardstick by which all physicians-in-training are compared.

The most recent survey reported by the National Resident Matching Program, showed that scores on Step 1 of …