For around four years in a row, starting around 1996, my husband and I rented one of those inflatable bouncy houses for my son’s birthday party every August. We invited a whole bunch of his friends and cousins to bounce in it for a few hours (and let them play in the sprinkler and fed them cake). Nobody got hurt.
Which, in retrospect, …
The problem of bouncy houses and the injuries they cause
Recently, an article was published in the New England Journal of Medicine questioning the utility of mammogram screening for prevention of death from breast cancer.
The authors were research professor Archie Bleyer MD at Oregon Health and Sciences University in Portland, an oncologist who was chief of pediatrics at MD Anderson Cancer Center and H. Gilbert Welch MD, MPH, a professor at …
Should I be screened for breast cancer? There’s more than one answer
A guest column by the American College of Physicians, exclusive to KevinMD.com.
Two years ago, my practice became a patient-centered medical home (PCMH), or more accurately, my practice began the transition towards delivering patient care under this new model. While that process is far from complete at this point, it’s been a positive experience. This month, I’d like to share …
ACP: What I’ve learned from my medical home
The Patient Protection and Affordable Care Act cleared two major hurdles in 2012: the Supreme Court ruling on constitutionality and the reelection of President Barack Obama. However, in 2013 there is a very good chance that Courts will see much more of the health care reform law due to objections regarding the contraception mandate. Despite the bills legal successes in the past, there are (at publication) more than Read more…
The Affordable Care Act still has hurdles before full implementation
Losing weight can decrease the incidence of several chronic and debilitating diseases, as well as their associated complications and risks during the surgical period. Additionally, it can facilitate recovery after surgery. Obesity increases the risk for:
Additionally, obese patients may present special challenges for anesthesiologists:
New Year’s resolution: Get healthy to improve surgical outcomes
”Email is the killer app of patient portals.”
I heard a variation of that quote when interviewing people for the patient-provider communication chapter of the book I’ve been co-editing and writing for HIMSS with Jan Oldenburg, Brad Tritle and Kate Christensen. For the organizations who’ve pushed patient portals the furthest into their patient base, email is always the place where things started. In other words, email is the gateway drug for …
How secure messaging and email benefit patients and improve outcomes
I should be encouraged. I was asked to talk on public radio last week about my new practice, then I was on a panel of “experts” in Washington DC on Monday. Everywhere I talk about what I am doing I get positive reactions. I get very positive reactions, actually. I was approached by someone wanting to work with me “when I get …
Can winning the war of words help my patients?
“You’re not sorry.”
Within two days two different patients said this to me, each with hatred in his voice. Each time I was alone, each time I had known the patient for only a few minutes, and each time the rage was directed at me and only me.
For seven months, I had avoided being the bad guy. When a patient got upset, he accused my superiors, and I hid behind their …
Be the bad guy with good intentions
I am a cystic fibrosis (CF) patient with a complex medical history that either intrigues or intimidates medical providers. At 40, I’ve dealt with a lifetime of progressive lung disease, gastrointestinal complications and other later onset issues from CF such as osteopenia, diabetes and bowel cancer. I often joke that the recessive CF gene that my identical twin sister and I inherited from our Japanese mother and German father is …
Organ recipients need strong partnerships with their doctors
Seven months ago, in Carbondale, Colorado, staff at the skilled nursing facility where my mother had resided for over a year recommended that she be placed on hospice. My mother has severe advanced dementia and can no longer walk, speak, feed herself or recognize her family members.
As much as I know about hospice care for cancer patients here in San Diego, I knew nothing about hospice care in Carbondale for …
Why is Medicare going after hospices?
A recent New York Times headline read that “Medicare Is Faulted on Shift to Electronic Records.” The story describes an Office of Inspector General (OIG) report, released November 29, 2012, that faults the Centers for Medicare and Medicaid Services (CMS) for not providing adequate oversight of the Meaningful Use incentive program. Going after “waste, fraud, and abuse” always makes good headlines, but in this case, the story is …
Trust but verify: Medicare’s approach to detecting EMR fraud
Many older patients fall in the hospital and these falls often lead to injury. Hospitals are under a lot of pressure to reduce falls. Generally, these falls happen when patients transfer such as when an older person tries to get out of bed or get up from a chair. While hospitalized, many patients are weak, dizzy, or confused, and they can be at risk of falling when ambulating …
Bed alarms don’t work and won’t reduce patient falls
Doctors use different standards to judge scientific research depending on who funded it. They judge research funded by industry as less rigorous, have less confidence in the results, and are less likely to prescribe new drugs than when the funding source is either the NIH or unknown – even when the apparent quality of the research is the same.
Those were the results of a study published by Harvard …
Is it justifiable to judge a paper by its author or funding source?
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“Will this case take very long?”
“If the surgery gods are with me we should be done in an hour.”
The above brief exchange took place between me and the anesthesiologist attending to my patient on a recent surgery. The patient was a middle aged woman who was about to undergo surgery to relieve a small bowel obstruction. She had been visiting her husband in a distant city where he was working …
The surgery gods can be your best friend or your worst enemy
The recent hurricane in New York City and the closures of some hospitals requiring the transfer of a large number of patients reminded me of something that happened on 9/11/2001.
I was working at a hospital near New York. You may recall that among the many problems that day was a breakdown in communications. Reliable information on the number of casualties and extent of injuries was hard to determine.
Late on the …
Why can’t we be more proactive in discharging patients?
Medical journals aren’t what they used to be. Just ten short years ago, medical journals were places to report scientific study, interesting cases or clinical updates and reviews. They were, for the most part, about science and discovery.
Now, there is a dramatic shift of scientific content in our journals to politics and policy.
No where is this more evident than the much-heralded and widely read New England Journal of …
Medical journals are shifting from science to politics
If this were a business concerned with bottom lines, cash flows and sustainability, this would be a good time to begin planning one of those posh executive retreats to evaluate current strategy. People would be feverishly working on pulling data for PowerPoint presentations, summarizing market research and deciding whether to select the vegetarian meal or not. If this were a better …
Computers are meaningless in health care without computable data
The role of race in college and graduate school admissions remains controversial in the U.S. In fact, the Supreme Court is currently taking up a challenge to a University of Texas program that considers race in its admission decisions. Critics of race-based admissions question whether educational institutions would serve the goals of affirmative action better by relying exclusively on non-race based criteria, such as socioeconomic status and family …
Why the medical professions should be color blind
Today, I come back to the tragedy of medical economics in this country. And I would apply that word “tragedy” in at least two ways.
The first tragedy is that we are headed for fiscal disaster in this country because of healthcare costs.
We now spend twice as much per person on healthcare as the average per person cost of all developed countries. During the past several decades, the inflation rate for …
The fiscal disaster of healthcare costs has a human toll
Not long after posting a recent column which, admittedly, was somewhat critical of healthcare providers in and around New York City following Super Storm Sandy, I decided to get a clearer picture from someone intimately connected to the disaster – my own brother.
A few months ago, Ira Nash, MD, was appointed Medical Director for Physician and Ambulatory Network Services at North Shore Long Island Jewish Health System (NSHS), a …
After Sandy: Change needs to go beyond traditional disaster planning
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