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5 critical elements of patient-centric care

Health Technology

May 7, 2013

I would like now to delve into what I consider critical elements of patient-centric care. They all involve technology to various extents.

1. There must be buy-in from providers. I am including payers, healthcare systems as well as clinical providers in this category. While I realize that much of healthcare is devoted to satisfying legal and regulatory mandates, there is great opportunity to improve the care experience (and dare I say …

Independent nurse practitioners are not the primary care solution

Reid Blackwelder, MD

Physician

May 7, 2013

In her post, “The only thing that truly separates doctors from nurses,” Dr. Leng is right that our current system creates a great deal of confusion for patients. Clothing, titles and even the word “Doctor” are no longer clear enough for people to understand which member of the health care team is caring for them. However, her suggestion that ultimate responsibility for the patient is the only distinguishing feature …

Health insurance exchanges will be hampered by choice overload

Peter Ubel, MD

Health Policy

May 7, 2013

Now that states have decided what they are going to do about health insurance exchanges—those new shopping carts created by Obamacare to help consumers find health insurance who do not get it through their employers—the really tough part begins. State and federal governments need to make sure that consumers understand their health insurance choices.

You probably thought that the tough part was behind us. You see, states had a difficult decision …

ACCP: Updated lung cancer guidelines

W. Michael Alberts, MD and Frank Detterbeck, MD

Conditions and Diseases

May 7, 2013

Lung cancer causes more deaths in the United States, 160,000 estimated in 2012, than the next three most common cancers, colon, breast, and prostate, combined.

More than 1.6 million people worldwide were newly diagnosed with lung cancer, comprising 13% of all new cancer diagnoses, and 1.4 million died of lung cancer, which was 18% of all …

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ACCP: Updated lung cancer guidelines

As I sit by my father in the hospital, there is a choice to be made

Miranda Fielding, MD

Physician

May 6, 2013

With gratitude to Doctors Rafael Espada and Michael Madani, for fixing my father’s heart, twice.

When Michael Phelps was interviewed during the Beijing Olympics, the world first learned about the extraordinary amount of food needed to fuel the swimmer with the wingspan of a pterodactyl. He said that he ate 12,000 calories a day, and no one believed him except for me. I believed him because I too was a swimmer …

Reflections on medical education, medical practice and the underserved

Cedric Dark, MD, MPH

Health Policy

May 6, 2013

I recently spoke at the Student National Medical Association’s (SNMA) Annual Medical Education Conference in Louisville, KY. Accompanying me was former SNMA President Bryant Cameron Webb, MD, JD. We covered three main topics in our workshop: medical education, the practice of medicine, and the underserved.

Medical education

Many people believe that there is, or soon will be, a physician shortage. There are nearly 1 million physicians scattered across America representing a ratio …

Should primary care limit its scope of work?

Joshua Freeman, MD

Physician

May 6, 2013

The shortage of primary care physicians in the U.S. has become a national theme. A common proposed solution to this shortage – and a central component of the patient centered medical home – is team-based care that utilizes various non-physician health care professionals as well as electronic communication. The idea is that many functions carried out by physicians can be done by nurse practitioners, physician assistants, nurses, and others on …

Female feticide: The ethical issues of ultrasound in India and China

Janice Boughton, MD

Physician

May 6, 2013

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The use of ultrasound has had a large impact on health care in resource poor countries. This article details some of the research that has been done overseas to look at the impact on bedside ultrasound by caregivers to deliver more appropriate care for injured and ill patients in Africa, Asia and Mexico.

Using an ultrasound to determine how dehydrated a child …

Thoughtful recommendations of health apps

Leslie Kernisan, MD, MPH

Health Technology

May 6, 2013

If I were asked “Why should a clinician prescribe an app?” I would answer as follows:

Because it’s likely to help the patient reach his or her most important health goals, and is a good fit within an over-arching medical management plan.

In other words, if the goal is to provide sensible medical assistance to patients and families, the use of an app should be likely to:

Help a patient work towards the …
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Thoughtful recommendations of health apps

Is there still sexism in medicine?

Suzanne Koven, MD

Physician

May 6, 2013

When I was growing up in the 1960s, at the height of the Cold War, there was always some smart aleck boy on the playground who had “facts” to share about the Soviets. His recitation was meant to emphasize how weird, how different, how other our arch enemies were. “They make you wear all brown and gray there.” “They eat only boiled cabbage and potatoes.” “They tell you what to …

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Is there still sexism in medicine?

When alternative cancer therapy harms patients

James C. Salwitz, MD

Medications

May 6, 2013

After a terribly painful and debilitating illness, Steve died. He had been treated for Stage 2 Hodgkin’s Disease with a series of intense therapies including German enzymes, American antineoplastins, Mexican naturopathy and Chinese herbs, complemented by focused meditation, innumerable vitamins, extreme diet modification and acupuncture for severe pain. He fought the cancer with every ounce of his being, doing everything to survive, except the one thing that had an 85% …

How I weather the yearly residency cycle

Jennifer Middleton, MD

Medical Education

May 5, 2013

I’ve been a family medicine residency faculty member for nearly 5 years, and I’ve come to observe the yearly cycle of a residency over that time. Reminding myself of that cycle helps me weather and celebrate the peculiarities of each time of year.

July-September: Adjustment

Every resident’s role changes on July 1. For the first-years, it’s their first day of being called “doctor.” Second- and third-year …

The problem with leaping into a gluten-free diet

Sophie M. Balzora, MD

Conditions and Diseases

May 5, 2013

In recent times, it seems as though every newspaper or magazine with a dedicated health section has a focus on the perils of gluten and the benefits that come along with adhering to a gluten-free diet. Or better yet, each week brings a new celebrity touting the dangers of gluten, and how it is an unhealthy ingredient that should be avoided religiously. Is this truly sound advice?

As a practicing academic …

Ordering tests just to reassure patients doesn’t work

Albert Fuchs, MD

Physician

May 5, 2013

Every primary care doctor has been faced with this situation. A patient reports vague symptoms and is very worried that they are a sign of a catastrophic illness. The symptoms aren’t even slightly suggestive of the disease the patient is worried about, but the patient’s neighbor’s brother-in-law was just diagnosed with the same disease, and so the patient is pretty sure that …

Public reporting improves the work of the measured and the measurer

Robert Wachter, MD

Health Policy

May 5, 2013

In the past, neither hospitals nor practicing physicians were accustomed to being measured and judged. Aside from periodic inspections by the Joint Commission (for which they had years of notice and on which failures were rare), hospitals did not publicly report their quality data, and payment was based on volume, not performance.

Physicians endured an orgy of judgment during their formative years – in high school, college, medical school, and in …

Let’s critically examine what residents are doing while in training

Vineet Arora, MD

Medical Education

May 5, 2013

Recently, I was having a discussion with a colleague about being a doctor. She confided in me that if someone asked her about becoming a doctor, she would tell him or her to become a nurse practitioner. After reading the emotional open letter to our policymakers in Washington DC, it may sound like a reasonable suggestion. After all, why go into this much debt and spend so much time in …

How to know if a medical mission is right for you

Olabisi Jagun, MD

Physician

May 5, 2013

I have found that many physicians have a strong desire to serve, yet often don’t know where to begin or if it is the right move for them both personally and professionally. I believe that by answering a few simple questions, a physician can decide if a mission is right for them.

1. Decide where you want to help. Hailing from Africa, I wanted to return to the poorest regions such as …

When it comes to handling cases, good communication helps

Gizabeth Shyder, MD

Physician

May 5, 2013

I saw a thoracic surgeon in the doctor’s lounge today. I have read his cases and frozens for a year or so, but never introduced myself. I still get intimidated in that man’s world of the doctor’s lounge. It’s not just me, my female partner was urged by her male recruiter to eat with him every morning in the lounge when she started seven years ago, and chit chat with …

Dzhokhar Tsarnaev and his right to privacy

Shirie Leng, MD

Physician

May 4, 2013

I am affiliated with the institution where Dzhokhar Tsarnaev is currently hospitalized. I am friends with people who have treated him. I’m trying to stay away from those people; I would be unable to help asking them about him. They might be unable to help talking about him.

There has been a flurry of emails and red-letter warnings cautioning people here not to talk about Mr. Tsarnaev or look him up …