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The hallucinations that psychiatric patients experience

Greg Smith, MD

Conditions and Diseases

October 24, 2013

Once upon a time I saw a patient for followup, a woman I had seen for several visits in the past. She had voiced the usual oft-heard complaints about insomnia, changes in appetite, lack of energy, diminished interest in pleasurable activities, and other associated symptoms of chronic depression. Most of these had been addressed and had gotten at least partially better, to the point that her overall quality of life …

David and Goliath lessons for doctors and our health system

Davis Liu, MD

Physician

October 24, 2013

October 1st was a special day. The Affordable Care Act (ACA) also commonly known as Obamacare became official. The federal government shut down because Republicans and Democrats disagreed around Obamacare funding. Most importantly, October 1st was when I could finally read Malcolm Gladwell’s new book David and Goliath.

Gladwell ponders why do underdogs succeed when we least expect them to? Is it possible that advantages a Goliath has can be a disadvantage? …

How do hospitals feel about locum tenens?

Val Jones, MD

Physician

October 23, 2013

I recently wrote about my experiences as a traveling physician and how to navigate locum tenens work. Today I want to talk about the client (in this case, hospital) side of the equation. I’ve had the chance to speak with several executives (some were physicians themselves) about the overall process of hiring and managing temporary physicians. What I heard wasn’t pretty. I thought I’d summarize their opinions in the form of a mock composite …

Tales of two nights before hip surgery

Hans Duvefelt, MD

Physician

October 23, 2013

On a hot afternoon in July Harold “Junior” Bray walked around his small farmhouse one last time before it was time to leave for the hospital. Everything was in order — the coffee maker was unplugged, the windows secure and the message on his brand new answering machine informed callers that he would return their call as soon as his health permitted.

Every step was deliberate, slow and painful. Whenever he …

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Tales of two nights before hip surgery

The idea of RVUs disgusts me

Robert Centor, MD

Health Policy

October 23, 2013

Blaming the American Medical Association’s Relative Value Scale Update Committee (RUC) for everything has become the latest fashion. The RUC is causing climate change. The entire health care cost problem comes from RUC decisions. Alex Rodriguez took performance enhancing drugs because of the RUC.

But the RUC did not create the system. They try hard to balance a system that is designed to achieve the wrong outcomes. The RUC has become …

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The idea of RVUs disgusts me

Finding out the price of health care should be a realistic expectation

Jessie Gruman, PhD

Patient

October 23, 2013

“Health care costs are sky-rocketing!” “The percentage of the U.S. GDP devoted to heath care costs is the highest in the world.” “The cost of Medicare is unsustainable.”

For most of us, the cost of health care (i.e., the dollars required by the system to produce and deliver care) isn’t what brings us the most anxiety.

It’s when we’re patients or helping a loved one find care that so many of us are deeply …

What’s the best way to keep up with medical literature?

Paul Bergl, MD

Medical Education

October 23, 2013

As a resident, probably the most common piece of feedback one receives is, “Read more and expand your clinical knowledge base.” This critique is a standard and generic piece of feedback to encourage the younger generation to never quit in the endless pursuit of knowledge. As our erudite attendings know, medical knowledge always evolves and often reverses course. Thus, the trainee is reminded to establish the habit of keeping up …

Emergency departments will remain a safety net for decades to come

Edwin Leap, MD

Health Policy

October 23, 2013

Former South Carolina Senator, and current Heritage Foundation president, Jim DeMint recently angered supporters of the Affordable Care Act by stating that uninsured patients will “get better healthcare just going to the emergency room,” than they will receive through Obamacare.

That’s a sweeping assertion. However, the ACA supporters offended by Sen. DeMint need to understand the supreme irony that without America’s emergency departments and their dedicated personnel, the ACA will fall …

Getting health insurance is not about your ideology

Manoj Jain, MD, MPH

Health Policy

October 22, 2013

Standing in the dimly-lit cave-like radiology reading room, I was looking at a CT scan which was done in the emergency room on a man in his 40s who had a testicular mass — likely a cancer — which had spread through out his body. It wasn’t that the man did not know the mass was present — earlier CT scans from the emergency room clearly showed the mass in …

Admit when you fall short: The power of “I don’t know”

Kevin R. Campbell, MD

Physician

October 22, 2013

Recently I read an interesting article on leadership published at Inc.com. Although most of the journal is focused on those in business, many of the pieces on leadership are very applicable to those of us in medicine. In this article, author Curt Hanke writes about the inspiration and leadership positives found in the three simple words: “I don’t know.”

On first blush, we may think that a leader speaking these words may no longer …

Is the use of gestational surrogates in India ethical?

Ruth Macklin, PhD

Physician

October 22, 2013

The use of gestational surrogates in India is a booming business, but is it ethical?

This growing practice involves individuals and couples from countries in Western Europe, North America, Israel, Japan and elsewhere who work through brokers to have their genetically related offspring carried through pregnancy and birth by Indian women.

An estimated $500 million to $2.3 billion (U.S.) changes hands among commissioning couples, infertility clinics, brokers and Indian women who choose this way …

When treating male patients, watch the wife

James C. Salwitz, MD

Physician

October 22, 2013

After you finish medical school classes, the night before graduation, they take you to a dark, quiet room. There, among leather bound tomes 300 years old, diseased skeleton trophies swinging behind glass, as you sip 50-year-old port in ancient crystal, they tell you the secrets.

This is the wisdom passed not in lectures, rounds or at the operating table; it is the hallowed legacy of thousands of healers over the millennia; …

A new tagline for direct primary care

Rob Lamberts, MD

Physician

October 21, 2013

He seemed a bit grumpy when he came into the office. I am used to the picture: male in his early to mid-forties, with wife by his side leading him into the office to “finally get taken care of” by the doctor. Usually the woman has a disgusted expression on her face as he looks like a boy forced to spend his afternoon in a fabric store with his mother. …

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A new tagline for direct primary care

Are you dating the person or the patient?

Catherine Spaulding, MD

Medical Education

October 21, 2013

I was 15-years-old the first time I went on a date. Like any rookie, I had no idea what to expect. As my date and I sat at the red-and-white-checkered table at TGI Fridays, I watched his expression slowly change from one of interest to trepidation; after drowning him with endless conversation, I was hardly surprised when he informed me that he would not be calling for a second date. …

Forms do not keep patients out of hospitals

Kathy Nieder, MD

Physician

October 21, 2013

Over one year ago my office implemented an EHR (electronic health record). I’ve not done a note on paper since.

Last week, a Transition of Care (TOC) document was placed on my desk with a sticky note stating: “Dr. Nieder please fill out this form so we can bill a 99496 for your visit with Mrs. Jones yesterday.”

I pick up two sheets of paper with multiple questions including:

discharge Medications: (list)
present Medications: (list)
diagnostic …
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Forms do not keep patients out of hospitals

Insurers should stop paying for robotic hysterectomies

Jennifer Gunter, MD

Physician

October 21, 2013

A new study confirms what previous studies tell us. That a robotic hysterectomy is not a safer or a more efficient way to remove a uterus for non-cancerous (benign) surgery than a traditional laparoscopic approach. This study indicates that there is little difference between the two types of surgery with one glaring exception, a robotic hysterectomy was $2,489 more expensive than a laparoscopic hysterectomy.

Several months ago the American Congress of Obstetricians …

Physicians have lost their backbone

Jordan Grumet, MD

Physician

October 21, 2013

What ever happened to courage?

Jim came through the cholecystectomy beautifully. In fact, he did so well that in no time he was back on the basketball court. Three weeks later he was in my office with a sore, swollen leg. He thought it was from twisting his ankle the day before. And indeed, it had all the appearances of a sports injury. I examined the extremity carefully, and decided to get …

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Physicians have lost their backbone

Saying no to a child requires grit, self-control, and stamina

Alex Lickerman, MD

Physician

October 21, 2013

A few months ago my son asked if he could have a candy bar after dinner for dessert. My wife and I reminded him that he’d already had candy two days before and that we have a “one candy per week rule” in our house, so we said no. So he asked again. So we said no again. Then he asked yet again. And we said no again. Then he …

Emerging enterprises of health care management

Brian Klepper, PhD

Health Policy

October 20, 2013

A new class of health care management organization is emerging that thrives by taking advantage of health care’s rampant and institutionalized waste. These firms mine the market dysfunction that has developed over decades, which will almost certainly yield enough fuel to drive a new way to manage care and cost.

The founders of these organizations have deep health care experience, and they understand the mechanisms of excess. More important, the ones …