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The cost of health care is different from its price

Health Policy

October 8, 2012

“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 …

Watch team based primary care in action

Kirsten Meisinger, MD

Physician

October 8, 2012

When I walked into the exam room, the mom was almost crying because her son’s fever wouldn’t go down. I already knew that this was a simple virus – the kind that gives a high fever for a few days and then a rash. This mom was from Brazil, however, where this sort of infection is barely seen. In Brazil, a high fever that won’t go down equals a good chance …

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Watch team based primary care in action

In the OR during an appendectomy, an unexpected visitor

Jim deMaine, MD

Physician

October 8, 2012

It was Trevor’s first weekend to relax since moving to Seattle. He was out in a park walking Bailey, his year old lab, when his pager unexpectedly beeped. He called in to the operating room office, where the frantic head nurse told him he had to come in. The scheduled anesthesiologist was very ill with the flu, and no one else was available. He had to come in for at …

What if the patient’s choice is frustratingly ill advised?

Michael Todd Sapko, MD, PhD

Physician

October 7, 2012

My mother is stubborn. She occasionally approaches me for medical advice and, since I owe her more than words can adequately describe, I am happy to do what I can. Unfortunately, she is a stoic. She is also no fan of pharmaceuticals. She believes in baptism by fire, that pain purifies the soul, and what doesn’t kill you makes you stronger. So while she sometimes wants my medical advice, she …

Want to be a physician executive? 8 things you need to know

Kent Bottles, MD

Physician

October 7, 2012

1. You will have to move a lot. I went to medical school in Cleveland and did my pathology residency in San Francisco at UCSF. I was on the medical school faculty at UCSF, Iowa, Allegheny University of the Health Sciences, and Michigan State.

Since leaving academic medicine, I have worked at a bio-tech start up in Cambridge, an educational and research institute in Grand Rapids, a $2 billion integrated delivery system …

How America’s healthcare system will keep you sick

Natasha Deonarain, MD, MBA

Physician

October 7, 2012

Have you ever worried about how you’re going to get healthy these days? Has your doctor recommended diet and exercise? Well, if you’re like millions who are struggling to find health, you’re going to need a lot more than just diet and exercise. You’re going to have to fight like crazy against a mind-set of disease that’s paradoxically disguised as health care.

America’s healthcare system – health insurance companies, government health …

MKSAP: 40-year-old woman with a symmetrically distributed rash

mksap

Conditions and Diseases

October 7, 2012

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 40-year-old woman is evaluated for a 4-month history of symmetrically distributed, severely pruritic, grouped erosions on her elbows, knees, back, and buttocks. The skin lesions began as red spots that developed into papules and then vesicles, which broke down as she scratched them. She reports normal bowel habits. She has no other medical …

Why going to a board certified plastic surgeon is important

Usha Rajagopal, MD

Physician

October 6, 2012

The popularity of plastic surgery today is no secret; 13.8 million cosmetic procedures were performed in 2011 alone. Unfortunately, however, an increasing (and unsettling) number of people in the United States are undergoing procedures conducted by unlicensed, so-called “underground,” individuals these days—individuals who have no business billing themselves as plastic surgeons.

The primary factor leading people to the doors of these backdoor doctors is, of course, cost. There’s no way around …

Why health insurance is the problem and not the solution

David Mokotoff, MD

Health Policy

October 6, 2012

Recently a neighbor backed into my car while I was leaving a food store. The damage was minimal, but she offered to have her insurance company pay for the repair. After contacting the company, I was offered several body shops, and chose the one closest to my home. The work was completed in only two days, and while it was in the shop, I decided to also have some dents …

Resilience is critical for a healthy life

Dennis S. Charney, MD and Cheryl De Jong-Lambert

Physician

October 6, 2012

It’s been reported that James Eagan Holmes, more infamously known as the movie-theatre gunman who killed 12 people during a midnight showing of Batman in Aurora, Colorado, sent a text to a classmate asking whether she knew what “dysphoric mania” was. (It is a bipolar condition that in its extremes, can include mania and paranoid delusions.) Did he have it?

Similarly we wonder whether a near-death accident in childhood, one that …

MKSAP: 72-year-old man is evaluated for fatigue and dyspnea

mksap

Conditions and Diseases

October 6, 2012

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 72-year-old man is evaluated for fatigue and dyspnea. Over the last several months to a year, he has had increasing fatigue, exercise intolerance, and dyspnea on even mild exertion. He becomes short of breath walking across a room, although he is asymptomatic at rest. He denies chest pain, palpitations, syncope, orthopnea, and lower …

The AAFP picks a fight with nurse practitioners

Brian Klepper, PhD

Health Policy

October 5, 2012

The American Academy of Family Physicians (AAFP) recently issued a new report describing its vision of primary care’s future. Not surprisingly, the report talks about medical homes, with patient-centered, team-based care.

More surprisingly, though, it makes a point to insist that physicians, not nurse practitioners, should lead primary care practices. The important questions are whether nurse practitioners are qualified to …

Cause of death: Defensive medicine

BirdStrike, MD

Physician

October 5, 2012

1. A 40-year-old female sees her family physician for burning chest pain after she eats hot peppers. She had it only once while exercising. Her family physician sends her to the emergency department and she gets admitted for chest pain. Rather than going home with treatment for her GERD, she ends up dead. This never should have happened, but the family never learns what really killed her.

2. A 33-year-old father of …

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Cause of death: Defensive medicine

A reminder of medicine’s main purpose

Laurie Mortara, MD

Physician

October 5, 2012

He had been in the hospital for 3 months. A rocky 3 months, much of it in the ICU. Now, when it looks like he will be leaving on his way to a near full recovery, his wife tells me she can’t thank me enough telling her husband “she never lost faith in you.”

I felt as if my medical practice had suddenly been realigned. All the recent years of practice …

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A reminder of medicine’s main purpose

Gun violence and mental illness: Why I feel sympathy for the devil

Deborah Serani, PsyD

Physician

October 5, 2012

I have mental illness. It’s taken hours of talk therapy, months of finding the right dosage and timing of medication, and years of work to learn how to live successfully with it. I’ve redefined how I think and feel, and learned what kinds of people and experiences to limit or allow in my life. Now in my 50’s, I’ve come to know the textures of my own mental illness and …

The CDC recommends hepatitis C screening: Should they be followed?

Kenneth Lin, MD

Conditions and Diseases

October 5, 2012

Recently, the Centers for Disease Control and Prevention finalized new recommendations for one-time screening for the hepatitis C virus (HCV) in all persons born between 1945 and 1965, a generation better known as the “Baby Boomers.”

The CDC’s new recommendations were published in the Annals of Internal Medicine. Previously, the CDC only recommended that persons with behavioral or medical risk factors for HCV be routinely tested. Its rationale …

The hunger-obesity paradox: Why it’s a modern problem

Chris Rangel, MD

Health Policy

October 4, 2012

It’s a uniquely modern problem. We have the most obese impoverished population in the history of the planet and its been called the “hunger-obesity paradox.” Even the homeless are now more than likely to be overweight with over 32% being officially obese. Think about that.

Then think about every single picture you have ever seen from the Great Depression when 1 of every 4 Americans were out of …

Even when using rankings, differences among hospitals may be subtle

Trudy Lieberman

Patient

October 4, 2012

As a longtime consumer reporter, I’ve always thought the best way to see how the marketplace works is to put yourself in the shoes of someone buying the product or service you’re investigating. After learning recently that I may need cataract surgery, it was time for me to check out the hospitals where that procedure might take place.

To begin my quest for the best, I searched for ratings for four …

Should medical students learn how to use an EHR in medical school?

Ishani Ganguli, MD

Health Technology

October 4, 2012

Outside a patient’s room in the cardiac intensive care unit (CICU), a senior doctor, a nurse, and several residents in various stages of wakefulness cluster for morning rounds. Each resident mans a computer-on-wheels (once called a C.O.W., the acronym was formally abandoned at MGH, legend has it, after a patient thought it was directed at her and took offense).

One of the residents reads off laboratory test results from the patient’s …

Are Medicare vouchers a good idea for patients and their physicians?

Bob Doherty

Health Policy

October 4, 2012

Trying to figure out whether Medicare vouchers are a good idea for patients and their physicians? Then consider these two basic questions:

1. How much will the federal government contribute?
2. Who is at risk for health care cost increases?

How much will the government contribute? The traditional Medicare program has no set limit on how much the federal government will contribute to a beneficiary’s health care, although there are limits on how …

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