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The co-location of mental health care services in pediatric practices

Physician

April 7, 2013

Patricia Wen’s front page story, “Children’s Access to Mental Health Care is Growing,” in which she describes the “co-location” of mental health care services in pediatric practices, brought me back to the summer of 2011 when I attended a meeting of a working group of the Massachusetts Chapter of the American Academy of  Pediatrics (MCAAP.) The task of this working group, a subgroup of the MCAAP task force on …

Why you need a population health management IT system

Rosemarie Nelson

Physician

April 7, 2013

Why do you need a population health management (PHM) IT system? In our last column we discussed the fact that reimbursement tied to outcomes will demand a greater level of patient management. Greater, perhaps, than your EHR can deliver. The early focus of new pay-for-performance and bundled payment systems is on preventive care for top chronic illnesses.

The 15 most expensive health conditions account for 44% of total …

Explaining the rise in the autism rate

Sanjay Gupta, MD

Conditions and Diseases

April 6, 2013

A recent report stating that one in 50 school children carries an autism diagnosis appears to confirm anecdotal evidence that we are experiencing an increase in the autism rate.

But there are a number of things that should be considered in a discussion of these findings — and leading that discussion should be methodology.

These new data from the CDC’s National Center for Health Statistics (NCHS) are culled from a …

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Explaining the rise in the autism rate

4 ways asynchronous learning can benefit medical students

Karan Chhabra

Medical Education

April 6, 2013

Dr. Chris Nickson recently asked, if a Martian landed on Earth and looked at how we do medical education, what would she think?

Could it really be true that so many dedicated, brilliant people with the same objectives could be doing exactly the same thing at the same time without sharing their resources? … That they could put so much work put into teaching sessions that so few actually …

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4 ways asynchronous learning can benefit medical students

Resolving medical liability claims with disclosure, apology and offer

Michael Matray

Physician

April 6, 2013

An apology can be a powerful statement that influences how another responds to a perceived wrong. This can be especially true within the context of a doctor-patient relationship. Yet, most physicians have been conditioned to employ a “deny-and-defend” approach to adverse medical outcomes, avoiding apologies because they believe it could imply an admission of guilt or ultimately initiate a lawsuit.

Apology in medicine is neither new or a fringe concept (currently …

Being sued for malpractice launches a mix of overwhelming emotions

Victor Waters, MD, JD

Physician

April 6, 2013

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Just as Sherry Gorman describes in her compelling post, being sued for malpractice can launch a complicated mix of often overwhelming emotions so debilitating that personal and professional lives are never the same.

Since so many physicians are sued at some point during their career—some estimates say as many as 9 out of 10 —becoming educated about the malpractice process …

America is experiencing a crisis of grief

Natasha Deonarain, MD, MBA

Physician

April 6, 2013

Politicians, financial experts, pundits and main street America would love to predict what’s going to happen to America in the next five years. But we don’t have to dust off the Dow Jones or the S&P, or even wonder what the Feds are going to do about Medicare, taxes, the debt ceiling or Afghanistan.

All we have to is understand the five stages of grief first developed by Dr. Elizabeth Kubler-Ross.

Elizabeth …

Blaming others for their health problems helps no one

Jennifer Middleton, MD

Physician

April 5, 2013

I inherited motion sickness from my father’s side of the family. I can’t sit in the back seat of a car for more than 10 minutes without becoming sick. I take meclizine before every plane flight.

I inherited asthma from my mother’s side of the family. Exposure to perfume, 90+ degree temps with 90+% humidity, or even a good laugh will all prompt me to cough.

These two maladies of mine have …

Our medical education system does not tolerate emotional cracks

Shara Yurkiewicz

Medical Education

April 5, 2013

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When we told the patient and his family that the mass in his lung was highly concerning for cancer, he didn’t say anything. His daughter asked about his symptoms. His son-in-law asked when and how he could get a definitive diagnosis. His wife asked when he could go home. Finally, he spoke.

“I’m sorry for being so much trouble.” The tone was casually apologetic, …

Let patients be their own people inside the system of care

Zackary Berger, MD, PhD

Physician

April 5, 2013

The more I try to help people in this field of mine, the more I realize that it doesn’t take a village. It takes a huge industrialized city, all its wires and arteries humming with constant activity, just to try and make one woman better. In this case, one smiling woman in her 50s, ethnicity I couldn’t figure and of dubious relevance, who came to our clinic seeking advice about …

Why physicians should sympathize with federal employees

Bob Doherty

Health Policy

April 5, 2013

“Physicians care more about their pocketbooks than taking care of patients. They are self-interested and overpaid. They want to control everything. They don’t know what life is like in the real world of patients.”

By now, I am sure that physician readers of this blog can feel their blood boiling, for good reason. Why would I, as the principal staff advocate for internal medicine physicians, put such pernicious, unfair, inaccurate quotes …

How a doctor’s online reputation survived a front page newspaper story

Kevin Pho, MD

KevinMD

April 5, 2013

The Boston Globe recently had a front page story on how a neurosurgeon sued a patient’s husband for a blog critical of the physician.

According to the story, the patient underwent a complicated back operation as a result of her bone cancer. She tragically had a stroke post-operatively, and that’s where the situation between the family and doctor deteriorated. On the advice of his psychiatrist, the patient’s husband wrote a …

The simple act of truth in the face of incurable cancer

Elaine Waples

Patient

April 5, 2013

Most of us have spent some time thinking about our own deaths. We do it with a sense of dreadful curiosity, but then we push it aside with “well, we’ve all got to go sometime.”

Unlike most people, I probably know the how, the why, and maybe even the when of that event. It is profound information that turns the world upside down for us, our families, friends and caregivers.

I have …

What patients want from mobile apps

Jessie Gruman, PhD

Health Technology

April 4, 2013

Dear mobile health app developers,

We—patients and caregivers—need your help to reduce the demands of self care. Mobile health (mHealth) apps have enormous potential to lessen our burdens. But our needs are often only loosely related to what clinicians and/or the evidence expect us to do. Most mobile app developers have ignored this fact by designing tools that primarily reflect the imperatives of …

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What patients want from mobile apps

Sexual health in women treated for cancer

Don S. Dizon, MD

Conditions and Diseases

April 4, 2013

As an oncologist who also runs a sexual health clinic for women treated (or under treatment), I am discovering that my perspective on both issues of cancer treatment (and survival) and life after cancer (and quality of life) is somewhat unique. I am conscious of how difficult it is to bring up cancer therapy and survivorship (let alone sexual health) within …

I let my hope and optimism interfere with accurate communication

Peter Ubel, MD

Conditions and Diseases

April 4, 2013

Andrews was easily the most anxious patient I took care of that month, a gray Michigan February (is there any other kind?) which I spent in the hospital caring for patients admitted to the general medical ward at the Ann Arbor Veterans Affairs Medical Center. (Andrews is a pseudonym, as are all the patients I blog about, unless otherwise indicated.) He had plenty to be anxious about, too. His leukemia …

The quality and quantity of calories both count

David L. Katz, MD

Conditions and Diseases

April 4, 2013

Among others, Gary Taubes has famously argued that calories don’t count. Perhaps the more nuanced version is that the quality of calories, not the quantity, is what counts. Mr. Taubes and I have discussed this, and agreed to disagree. Leaving aside Newton and laws of thermodynamics, there is the Twinkie Diet on my side: evidence that weight can be lost when calories are restricted, no matter how truly dreadful the …

Lawmakers shouldn’t care about the personal hardships of doctors

Anonymous

Health Policy

April 4, 2013

A response to Dear lawmakers: This is what it’s like to be a doctor today.

With a family and financial background that eerily matches Dr. Moeller’s, please count me as one soon-to-be physician who does not share the notion that lawmakers should spend their time being overly concerned with the demands placed on physicians or physician compensation. In fact, I …

A reminder to slow down and focus on the human being

Audrey Cortez, RN

Patient

April 4, 2013

Years ago I worked as a registered nurse in a busy surgical pre-admission clinic, preparing patients who’d been scheduled for surgery for the upcoming operation and hospital experience.

My workdays were packed with back-to-back, hour-long appointments. Whatever surgery the patient was facing–oral, orthopedic or anything else–every interview followed the same format. I would greet the patient, who’d often bring along a family member, and quickly escort them both into my small …

The only thing that truly separates doctors from nurses

Shirie Leng, MD

Physician

April 3, 2013

Academic Medicine, a journal of the American Association of Medical Colleges, has sent out a recent call for articles addressing the 2013 question of the year: “What is a doctor? What is a nurse?” Thirty years ago this would have been an absurd question. Not only would it have been absurd for doctors and nurses, but for patients too. Roles were …

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