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What can physicians expect from Obamacare in 2014?

Bob Doherty

Health Policy

January 7, 2014

Tthe ACA will now begin to transform how millions of Americans get health insurance coverage. Most of us will find that the plans offered by our employers are mostly unchanged because they measure up to federal standards. To the extent that some employers are imposing “negative changes, which include higher premiums, co-pays and deductibles, they’ve all been happening for more than a decade” because of employers wanting to …

A dying breed: When the perfect consultant retires

Hans Duvefelt, MD

Physician

January 7, 2014

Marc Lachance is the perfect consultant. Ten years my senior, he had more than mastered his specialty by the time I came to the area. He had also established himself as a mentor to Cityside Hospital’s residents and many young physicians who sent him referrals or called him for curbside consultations.

Marc used to live in a rambling farmhouse not far from where I live. But then his elderly father, widowed and …

How EHR design can affect patient safety

Michael Chen, MD

Health Technology

January 7, 2014

Besides the importance of physician happiness when using an EHR, using design principles that maximize user intuition and presentation of relevant information, there is one aspect of health care information systems that should never be overlooked: patient safety.

Scot Silverstein, MD, blogging at Health Care Renewal as InformaticsMD, frequently brings to light issues surrounding health care IT implementations that compromise patient safety. Reading his posts should be sobering and concerning to both …

When medical literature mislead journalists and the public

Paul Marantz, MD, MPH

Physician

January 7, 2014

Perhaps you’ve seen some of the media coverage reporting that “an apple a day” would save as many lives as statins do, with fewer side effects. Or perhaps not — thankfully, this tongue-in-cheek “study” didn’t get the intense coverage received by the new statin guidelines (an issue I recently addressed on this blog). But I think this is a glaring and important …

Is a single patient representative in a group sufficient?

Jessie Gruman, PhD

Patient

January 7, 2014

What can we learn from an experiment conducted on a single person? That is, when the subject population (N) is a single person, aka N=1? How and how much do such findings contribute to knowledge about the experimental intervention? How relevant are results to other patients or populations or diseases? In assessing what is known about a phenomenon, how are these findings treated in comparison to studies with 30 or …

5 health care resolutions to make in 2014

Robert Pearl, MD

Physician

January 7, 2014

This is the time many of us make resolutions about our lives — often tied to our health and wellness.

As the health care industry enters a new era of consumerism, people are seeking more and more ways to take ownership over their health and health care. While data about doctors, hospitals and health outcomes are becoming more available and transparent, we still have a long way to go.

Perhaps in a …

Solving the high rates of hospital readmissions

Suneel Dhand, MD

Health Policy

January 6, 2014

Statistics show that about 1 in 5, or 20 percent of all Medicare patients are readmitted to hospital within 30 days of discharge. That’s a staggering number, not to mention all those patients that are readmitted frequently during the course of a year, but not necessarily within 30 days.

The problem of frequent hospital readmissions is actually one that exists all over the world and not just in the United States. …

On the heels of the Obamacare rollout comes ICD-10

Kevin R. Campbell, MD

Health Policy

January 6, 2014

Due to the ineptness of the Obamacare team and the debacle that has ensued, the botched rollout of the Affordable Care Act has dominated the political and medical headlines since October.

However, other health care changes are on the horizon (and have gone virtually unnoticed by the public) that have the potential to further disrupt our ability to treat patients. In fact, the technical and time consuming aspects of …

Are we successfully moderating health care spending?

Janice Boughton, MD

Health Policy

January 6, 2014

David Blumenthal and others recently published a paper in the New England Journal of Medicine entitled “Health Care Spending — A Giant Slain or Sleeping?”

In it they look at the ongoing, and rarely discussed, phenomenon of slowing of health care spending, which has persisted over several years. Health care spending grew remarkably after the establishment of Medicare and Medicaid in the 1960’s, resulting in the fact that health care …

Doctors and patients: Always thank your nurses

Maria Yang, MD

Physician

January 6, 2014

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As I noted earlier, hospitals permit around-the-clock observation of patients. If you don’t need around-the-clock monitoring, you don’t need to be in the hospital.

Who is doing this around-the-clock monitoring? Nurses.

Therefore, whether you are a patient or a physician, one of the best things you can do is get on the good side of the nurses.

If you are a patient, a nurse watches over …

My cancer shows how our world is ruled by love

Elana Miller, MD

Physician

January 6, 2014

elanacancer

I recently wrote about how our world is ruled by love, and circumstances conspired to show me just how true that really is.

Love is when I go to the ER at UCLA, where I work, for a cough and feeling that “something isn’t right,” and even though my complaints are mild, I’m brought right in and treated respectfully.

Love is when the chest x-ray comes …

Putting the humanities back into medicine

Andrew Boozary, MD, MPP

Medical Education

January 5, 2014

The dream was that reason, in the form of the arts and sciences, would liberate humanity from scarcity and the caprices of nature, ignorance and superstition, tyranny, and not least of all, the diseases of the body and the spirit.
-Paul Starr, The Social Transformation of American Medicine

In a local bookshop just outside of Boston, a small group made their way to their cherished celebrity bookclub. Tucked away on a foldable chair …

We must rise up against the hospital-industrial complex

Gene Uzawa Dorio, MD

Health Policy

January 5, 2014

In his farewell address to the nation on January 17, 1961, President Dwight D. Eisenhower warned the American people about the looming “military-industrial complex” which would sway public mindset and enhance money flow from government to the defense industry. This concept persists today with the practice re-adapted and launched against the health and welfare of the American people through the “hospital-industrial complex.”

Health care organizations like the California and American Hospital …

Patients lose when resident physicians are afraid to unionize

Flávio Casoy, MD and Joanne Suh, MD

Medical Education

January 5, 2014

Just about thirteen percent of the 100,000 plus resident physicians in the United States are union members — and many more would choose to join if it weren’t for the fierce pressure exerted by some teaching hospitals, chairs and program directors. Although it is illegal to threaten resident physicians with retaliation for expressing their desire to form a union, the law is difficult to enforce. Ought medical educators examine …

Doctors cannot predict when the end of life truly comes

Christine A. Garcia, MD, MPH

Physician

January 5, 2014

“For someone who went into medicine to ‘help people,’ you sure do talk about dying a lot,” my mother told me one day on our brief weekly phone call. I try to get in a phone call to my mother once a week so she knows I’m alive, surviving my intern year. I had been on medical intensive care unit (MICU) service and it had been a rough week. Being …

A large part of healing is listening, caring, and imparting hope

Afshine Ash Emrani, MD

Physician

January 5, 2014

As the year comes to a close, we physicians feel tremendous uncertainty with the rain of change from Washington. As I approach my third decade of medical practice, I feel more distant from the patient who desperately seeks my attention. I struggle daily to reconnect with her, recalling the fading reasons I embarked on this field, trying to resuscitate the patient-physician relationship which is central to our broken medical system.

Often …

A call to retract the JNC-8 hypertension guidelines

David K. Cundiff, MD

Conditions and Diseases

January 4, 2014

JAMA published the long-awaited Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure-8 (JNC-8) guidelines December 18, 2013. They recommended blood pressure lowering drug treatment for patients 60 years old and over with systolic blood pressure (SBP) 150 or higher or diastolic blood pressure (DBP) 90 mm Hg or higher. For patients under 60 years old, they recommended medications for DBP 90 mm Hg or …

Real market reforms for health care

Duncan Cross

Health Policy

January 4, 2014

Whatever the problems with the roll out of Healthcare.gov, the fact is that the government take-over of health care has been happening for more than a century. If we want a truly free market for health care, we have to think in broader and bolder terms than simply rolling back the ACA. With that in mind, here is a short list of patient-focused ways to get the government out of …

Read more…

Real market reforms for health care

Medicine should welcome the fact that it’s a business

Richard Bottner, PA-C

Health Policy

January 4, 2014

At the end of each day during my primary care rotation, my preceptor and I sat together and reviewed patient charts. Simon Craig, MD*, built his internal medicine practice from the ground up and is a pillar of the Connecticut community he has served for more than two decades. He is a physician, a clinician and a scientist. While he manages the day-to-day operations of his practice, he avidly denies …

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