KevinMD.com

December 15, 2012Dec 15, 20123

Recently, "60 Minutes" (in my view the last bastion of great traditional network news investigative reporting) described a for-profit hospital system that apparently uses percent targets (allegedly 20%) to encourage high admission rates by their ER doctors. In setting up…

Recently, “60 Minutes” (in my view the last bastion of great traditional network news investigative reporting) described a for-profit hospital system that apparently uses percent targets (allegedly 20%) to encourage high admission rates by their ER doctors.

In setting up this report, the reporter commented that as much as 10% of healthcare expenditures in this country were “unnecessary.”

Actually, most health experts I have read and consulted would put that number much …

Health policy

Motivating employees to meet their wellness goals

Sreedhar Potarazu, MD, MBA

December 15, 2012Dec 15, 20123

A lot of us get health benefits through our workplace, and employers are increasingly turning to wellness programs as a means of reducing costs and improving productivity. In the coming year, as aspects of the Affordable Care Act take effect,…

A lot of us get health benefits through our workplace, and employers are increasingly turning to wellness programs as a means of reducing costs and improving productivity.

In the coming year, as aspects of the Affordable Care Act take effect, many employers will provide even greater incentives for participation in programs that require the employee to achieve certain wellness goals, such as smoking cessation or weight loss.

What this means for the …

Physician voices

Shopping for items in the operating room

Catherine deVries, MD

December 15, 2012Dec 15, 2012

You may have noticed that stores everywhere, and restaurants, too, are getting mobile -- as in mobile technology. In a store like Nordstrom, where thousands of items in many departments must be inventoried and managed, it saves a lot of…

You may have noticed that stores everywhere, and restaurants, too, are getting mobile — as in mobile technology. In a store like Nordstrom, where thousands of items in many departments must be inventoried and managed, it saves a lot of time, personnel, and therefore money, at least for the store. From last season’s belts to the spring’s platform shoes, it is in the system, on the iPod and available for …

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Conditions and diseases

MKSAP: 62-year-old man is evaluated during a routine examination

mksap

December 15, 2012Dec 15, 2012

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 62-year-old man is evaluated during a routine examination. Medical history is significant for a myocardial infarction 3 years ago, dyslipidemia, hypertension, tobacco use,…

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

A 62-year-old man is evaluated during a routine examination. Medical history is significant for a myocardial infarction 3 years ago, dyslipidemia, hypertension, tobacco use, and drinking two alcoholic drinks per day. Medications are an ACE inhibitor, a statin, a β-blocker, and aspirin. He participates in cardiac rehabilitation, exercising four to five times per week.

On …

Health technology

Mobile health technology adoption depends on insurers

David Lee Scher, MD

December 14, 2012Dec 14, 2012

Insurers will also play a pivotal role in the development and adoption of patient-focused mobile health (mHealth) technology adoption for wellness as well as for the management of chronic diseases. 1. Payers hold the purse strings. Insurers will be the…

Insurers will also play a pivotal role in the development and adoption of patient-focused mobile health (mHealth) technology adoption for wellness as well as for the management of chronic diseases.

1. Payers hold the purse strings. Insurers will be the ones paying for the use of mHealth for chronic disease management for the vast majority of patients. They have a vested interest …

Physician voices

Don’t be afraid to ask your radiologist for help

Paul Dorio, MD

December 14, 2012Dec 14, 20124

It used to be that radiologists mainly helped out your doctor so that they could figure out what was ailing you. Such is no longer the case. Nowadays, with the easy access to almost any doctor of any specialty, you…

It used to be that radiologists mainly helped out your doctor so that they could figure out what was ailing you. Such is no longer the case.

Nowadays, with the easy access to almost any doctor of any specialty, you can visit your radiologist, obtain a needed study (or procedure, in the case of an interventional radiologist), and never even see your …

Medical education

How my ER rotation turned me into a primary care doctor

Stella Safo, MD, MPH

December 14, 2012Dec 14, 20125

It's Saturday night at an emergency department (ED) in Boston, MA, and I am faced with a medical student’s dream dilemma: which one of the many interesting cases should I observe? Should I watch trauma surgeons operate on the 17-year-old…

It’s Saturday night at an emergency department (ED) in Boston, MA, and I am faced with a medical student’s dream dilemma: which one of the many interesting cases should I observe? Should I watch trauma surgeons operate on the 17-year-old gunshot victim or work with the ED docs to assess whether a 59-year-old woman is having an acute stroke? That is exactly what I adored about emergency medicine as a …

Health policy

AMA: Patients are vulnerable to health plan monopoly power

American Medical Association & Jeremy Lazarus, MD

December 14, 2012Dec 14, 20123

A guest column by the American Medical Association, exclusive to KevinMD.com. When health plans have merged, they've said that a bigger insurance company would drive down premiums. The casual acceptance of this economic fallacy led to more than a decade…

A guest column by the American Medical Association, exclusive to KevinMD.com.

When health plans have merged, they’ve said that a bigger insurance company would drive down premiums. The casual acceptance of this economic fallacy led to more than a decade of unchecked megamergers that helped health plans cement dominant market positions across the country.

It’s now clear that when health insurers talk about taking over another plan, what they often mean is …

Conditions and diseases

Tips to examine the eardrum of the squirming, angry child

Roy Benaroch, MD

December 14, 2012Dec 14, 2012

Let me tell you a secret. Examining eardrums in a squirming, angry child is really difficult—if not impossible. If the doc in your screaming, struggling child’s ear for a half-second, it’s unlikely that anything useful was seen. Sometimes, it is…

Sometimes, it is just impossible to get a decent exam. But there are ways that parents (and doctors!) can help at least increase the chance …

Patient voices

When there was no hope, I used my imagination to create it

Clarissa Schilstra

December 13, 2012Dec 13, 2012

On November 17th, I celebrated the three-year anniversary of the end of my leukemia relapse treatment. In going through the day, I thought a lot about what I went through. I thought a lot about how I ever survived it all. I remember so vividly those hopeless moments, hours, days, months of nausea, pain, and so many forms of discomfort. What stands out to me was the hopelessness and …

Physician voices

Tiny threads hold a marriage together

Bruce Campbell, MD

December 13, 2012Dec 13, 20123

Chains do not hold a marriage together. It is threads, hundreds of tiny threads which sew people together through the years. - Simone Signoret Allen’s cancer has continued to grow quickly. He raises his chin so I can see. I…

Chains do not hold a marriage together. It is threads, hundreds of tiny threads which sew people together through the years.
– Simone Signoret

Allen’s cancer has continued to grow quickly. He raises his chin so I can see. I check my notes from a month ago and pull out my ruler and make new measurements. I jot down my findings and turn to look him in the eye. We both know this …

Read more…

Tiny threads hold a marriage together

Physician voices

I work at clarifying obscurity about the human condition daily

Emily Gibson, MD

December 13, 2012Dec 13, 2012

-E. B. White As a family doctor, I work at clarifying obscurity about the human condition daily, dependent on my patients to communicate the information I need to make a sound diagnosis and treatment recommendation. To begin with, there is…

Be obscure clearly.
-E. B. White

As a family doctor, I work at clarifying obscurity about the human condition daily, dependent on my patients to communicate the information I need to make a sound diagnosis and treatment recommendation. To begin with, there is much that is still unknown and difficult to understand about psychology, physiology and anatomy. Then throw in a disease process …

Drugs and prescribing

Know which medicines you take and why you take them

Shirie Leng, MD

December 13, 2012Dec 13, 20123

Doctor: What medicines do you take at home? Patient: Something for the diabetes. Doctor: Do you know the name of it? Patient: "Starts with an M. Or a P. Honey, what's the name of that pill? Wife: Well dear, I…

Doctor: What medicines do you take at home?

Patient: Something for the diabetes.

Doctor: Do you know the name of it?

Patient: “Starts with an M. Or a P. Honey, what’s the name of that pill?

Wife: Well dear, I don’t know but it’s a little blue one. You know doc, the little blue one?

Nothing will drive your health care provider more crazy than conversations …

Health policy

Neither political party truly represents doctors or their patients

Karen S. Sibert, MD

December 13, 2012Dec 13, 20126

When you walked into the voting booth on Tuesday, November 6, did you do so with a feeling of calm certainty that the man who would get your vote for President was unquestionably the best choice, or even the only possible choice? Did you feel confident that your candidate’s political party fully supports your political views as well as your personal values?

For many physicians, I suspect that the answer to …

Medical education

To the health professionals during hurricane Sandy: Thank you

Jessica Gold

December 12, 2012Dec 12, 20122

It's 3:30 am and my clock alarm is singing some song that I used to like. I roll over to turn it off all the while thinking to myself: “I am waking up to stand for the next 12 hours…

It’s 3:30 am and my clock alarm is singing some song that I used to like. I roll over to turn it off all the while thinking to myself: “I am waking up to stand for the next 12 hours straight holding a retractor. No one is going to care that I am there, and if I am even acknowledged …

Patient voices

Stop the stigma and give patients a chance

Randy Roberts

December 12, 2012Dec 12, 20123

I would like to start out by thanking all the fantastic health care workers. As a recovering person with diagnosed concurrent disorders – having both addictions and mental health issues – I have seen the challenges and abuse often faced by doctors, nurses, counselors and support staff working within the healthcare system. This article is in no way meant to hurt, …

Physician voices

How do you know if you’re a disruptive physician?

Linda Brodsky, MD

December 12, 2012Dec 12, 201243

Physicians are being attacked in many ways and in many places. It is no longer about how able, available, and affable you are. It is about how well you toe the line when it comes to going along to get along while being watched by an ever increasing line up of watchdogs. Many of whom have sharp teeth.

Here are a few questions that might indicate you are headed for trouble:

Do …

Health policy

ACP: Practice transformation is more than checking off boxes

American College of Physicians & Yul Ejnes, MD

December 12, 2012Dec 12, 20122

A guest column by the American College of Physicians, exclusive to KevinMD.com. Recently, I was invited to speak at an ACP chapter meeting on the topic of shared vision. In the talk, I used as examples Dr. Martin Luther King…

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

Recently, I was invited to speak at an ACP chapter meeting on the topic of shared vision. In the talk, I used as examples Dr. Martin Luther King Jr., John F. Kennedy, and Steve Jobs, leaders whose visions inspired people and helped them to achieve great things. As I wrote the talk, it occurred to me that …

Physician voices

NPO and be merry

Rena Xu

December 12, 2012Dec 12, 2012

It is the holiday season, and all through the hospital, patients are being made “NPO.” This is the medical term for “no eating or drinking allowed.” Mr. T, silver-haired and newly unemployed, is NPO on account of his pancreatitis. "We…

It is the holiday season, and all through the hospital, patients are being made “NPO.” This is the medical term for “no eating or drinking allowed.”

Mr. T, silver-haired and newly unemployed, is NPO on account of his pancreatitis. “We don’t want to upset your pancreas,” the team tells him when we pass through on morning rounds. It is nearly breakfast time. We hover around his bed in a half circle …

Read more…

NPO and be merry

Real physician voices, twice a week

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