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Pay for performance: Not everything that can be counted counts

Health Policy

October 17, 2013

There is a lot of talk these days about changing our health care system from “pay for volume” to “pay for value.” The idea is that we currently reimbursement doctors and hospitals according to the number of services delivered rather than how well they make us. This perverse system of incentives results in runaway health care spending that doesn’t necessarily result in a more healthy citizenry.

There is certainly truth in …

Don’t be foolish enough to think you control outcomes

John Mandrola, MD

Physician

October 17, 2013

Let’s be honest. If you are bold enough to hit the “publish” button, it’s normal to care what readers think. I write about medicine: I like doctors, I respect doctors. So it matters how colleagues react to my words.

I was both proud and concerned when the Greater Louisville Medical Society decided to republish my “Changing the Culture of American Medicine” piece in their monthly journal, Louisville Medicine.

The reaction of my colleagues has …

Health IT will dictate how health is provided in the future

Margalit Gur-Arie

Health Technology

October 16, 2013

Health IT is booming, or so they say. The hotly debated and highly politicized health care reform, a.k.a. Obamacare, has been shining bright lights on a segment of our economy that is quickly approaching $3 trillion per year, and is in dire need of improvement, or so they say. Depending on who you ask, some say that health care resources must be redistributed in a more equitable manner, while others …

Not all adverse events are preventable

Skeptical Scalpel, MD

Physician

October 16, 2013

Medical errors are a real problem. I won’t deny that.

It was bad enough when the often-quoted Institute of Medicine figure that 98,000 deaths per year in the US are caused by medical errors was in vogue, but now a paper in the Journal of Patient Safety states that adverse medical events result in 210,000 to 400,000 deaths per year and 10 to 20 times those numbers of serious …

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Not all adverse events are preventable

Had I met her anywhere but the hospital, I would have helped her

Ilana Yurkiewicz

Medical Education

October 16, 2013

Had I met her anywhere but the hospital, I would have gone to her side. I would have asked her what was wrong. I would have offered to help.

She was 99-years-old and about to undergo surgery. Pre-operative holding is generally a busy place. Patients lie in gurneys, spending some last moments with loved ones and fielding questions from various players of the surgical team as they come to the bedside. No, …

Patient engagement is the blockbuster drug of the century

Dave Chase

Health Policy

October 16, 2013

Historically, the “do more, bill more” fee-for-service model of healthcare measured success by increased billings. In the fee-for-value era, we need a new framework for assessing healthcare results. Quality indicators are logical but they are mostly geared towards measuring actions taken. We can borrow a concept from the energy sector for an additional metric. We need a concept for removing waste and unnecessary care that could be inspired by a concept …

I no longer wanted to be a surgeon

bongi, MD

Physician

October 16, 2013

It was a battle. Looking back I don’t think we ever had a chance, but you don’t just give up on a young man in the prime of his life. We had to try. He was my patient.

He was a foreigner, on a gap year in Africa where he was going to learn all sorts of things about conservation and African wildlife. Up until the accident, all had apparently gone …

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I no longer wanted to be a surgeon

ACP: Making the most of opportunities to get people immunized

Yul Ejnes, MD

Conditions and Diseases

October 16, 2013

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

It seems to begin earlier and earlier each year — displays are up in stores in late July, newspaper and radio ads start appearing in August, and the media reports on it before the kids even go back to school. Yes, flu vaccine season is in full motion. Last year I …

3 products that your dermatologist won’t like

Val Jones, MD

Conditions and Diseases

October 15, 2013

As a light skinned, be-freckled woman with a history of pre-melanoma, I have been sternly instructed to keep my dermatologist on speed dial. Every six months I dutifully return to his office for inspection — nervously eyeing the biopsy tray as I sweat through my paper gown, legs dangling from a vinyl exam table.

In preparation for my most recent trip, I decided to be “an empowered patient” and …

Should medical school be shortened by a year?

Christopher Johnson, MD

Medical Education

October 15, 2013

We have been training physicians the same way for a century, ever since the famous Flexner Report of 1910. That report was commissioned by the Carnegie Foundation in an attempt to improve medical education. Up until then many medical schools were simply terrible. Many were proprietary schools, owned by doctors and run for profit rather than education. Many doctors met their first actual patient after they graduated.

During the decade following Flexner report these proprietary …

How Medicare can fix the shortage of primary care physicians

Stephen C. Schimpff, MD

Health Policy

October 15, 2013

Primary care physicians (PCPs) have been marginalized by Medicare for decades with low reimbursement rates for routine office visits which has led to the 15-20 minute office visit with 10-12 minutes of actual “face time” and a panel of patients that well exceeds 2000.

Is there a good solution to the Medicare cost and quality issues? Setting aside either the Democrats’ approach to basically enact price controls by ratcheting down reimbursements or …

Some people choose the time of their death

Judith Reishtein, RN

Patient

October 15, 2013

“Did you sell the business yet?”

I marvel at my patient Jack: despite his breathlessness, he’s somehow managed to greet his wife Sara with a complete sentence. Given his condition, it’s truly amazing.

Most of his lung function has been devastated by his forty-year, pack-a-day smoking habit; the rest has been demolished by cancer. The easy, automatic breathing he once took for granted is just a memory. He can’t even lie down …

The majority of patients are stronger than many doctors realize

Robert Pearl, MD

Physician

October 15, 2013

In his beautifully written, recently published novel “And the Mountains Echoed,” Khaled Hosseini presents a series of stories in which individuals are faced with near-impossible choices.

Impossible choices permeate Khaled Hosseni’s latest novel. Studies show many doctors struggle to help their patients through their most difficult choices.

As difficult as the decisions in the book seem, it turns out the …

Medical training is a product of willful preparation

David L. Katz, MD

Physician

October 15, 2013

I have been a loyal patron of the Karma Hair Salon in New Haven, Conn. for at least the past 15 years. Whenever my hair looks good, it is thanks to Karma and owner Cheryl McMahon’s expert attention to my unruly head (the thickness of my hair — a good problem, I know! — could give a yak envy; and I have more cowlicks than several small countries). If ever my hair doesn’t look …

Why schools shouldn’t report obesity

Keith-Thomas Ayoob, EdD, RD

Conditions and Diseases

October 14, 2013

Most of us know schools as institutions of learning, usually associated with “the three Rs,” but now schools in 19 states are reporting progress on another subject: “BMI” — body mass index.

These schools are measuring the heights and weights of students to determine BMI, a measure of weight based on height, then sending home letters to inform parents of their children’s BMI status. As a pediatric nutritionist, I am not pleased.

Child obesity …

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Why schools shouldn’t report obesity

Hostile dependency: The real reason for physician burnout

Wes Fisher, MD

Physician

October 14, 2013

A piece recently appeared in the New York Times entitled “Who Will Heal the Doctors?”

The piece is written by Donald Borstein and I encourage all to read it. Mr. Bornstein offers a solution to the doctor burnout problem in health care, a course called “The Healers Art,” now being promoted in US medical schools that uses “mindfulness” as his means of creating compassionate, caring doctors as a way forward.

I should say …

Is it worth it? A question providers need to be asking

John Ly, MD

Physician

October 14, 2013

“Will you charge me?” he asked quietly, between labored breaths. He sat in the hospital bed with his legs over the side in what is known as a “tripod” position — his elbows resting on a nearby stool to prop his chest up as much as possible. His head was hunched over, with his eyes pointed down; clearly he was in agony.

He had been admitted to the hospital two weeks …

Pediatric stroke is not uncommon

Natasha Burgert, MD

Conditions and Diseases

October 14, 2013

Our hearts are heavy after learning about the loss of a talented high school athlete in our community. Recently, Andre Maloney died after suffering from a stroke caused by a blood clot in his brain.

As the details are continuing to emerge, it is beginning to become clear that the stroke Andre suffered from was not a result of a traumatic hit on the field, nor a concussion event. Sadly, …

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Pediatric stroke is not uncommon

Communication about prognosis and goals of care is still lacking

Alex Smith, MD

Conditions and Diseases

October 14, 2013

Advanced dementia is a terminal illness needing palliative care. Unfortunately, there is a great divide between this statement of the world as it should be, and the current reality of the world as it is. Rates of pain and shortness of breath are high for patients with advance dementia. Patients with advanced dementia often reside in nursing homes, and few nursing homes offer specialized palliative care services.

And, as we can see from an …

Acknowledge the human aspect of our medical experiences

Joyce Ho, MD

Medical Education

October 14, 2013

Recently, a lot of my classmates have been passing around a New York Times article titled “Medicine’s Search for Meaning,” a piece detailing the high burnout rates of doctors-in-training and the inadequacies of medical education to address physician wellness. What I found to be of the most saddening paragraphs in the article goes as follows: