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When the initial reaction to an unusual test result is happiness

Shara Yurkiewicz

December 11, 2012Dec 11, 20123

I pull up a test result for my patient, and the senior resident standing behind me lets out an excited squeal. “I’ve never seen the imaging come back positive for this,” she says. Our two-week-old infant, who already has a…

I pull up a test result for my patient, and the senior resident standing behind me lets out an excited squeal.

“I’ve never seen the imaging come back positive for this,” she says. Our two-week-old infant, who already has a rare infection, also has a rare associated structural abnormality. It’s not benign, but it is fixable. The fix usually requires surgery.

As we walk over to the patient’s room to update her …

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I do not require perfect health to be happy

Ellen Diamond

December 11, 2012Dec 11, 20123

Recently, while reading a post in an online chat group for people with chronic lymphocytic leukemia (CLL), I spotted an intriguing comment. At an important conference, a world-renowned hematologist had referred to a "five-year timeline" for a cure. This took…

This took me back fourteen years, to when I’d just been diagnosed with CLL. There was a Gilda’s Club near my workplace; I’d always passed it quickly on my way home. Now I …

Health technology

Why IT is the core of the healthcare renaissance

James C. Salwitz, MD

December 11, 2012Dec 11, 20128

Warning! I am a practicing doctor who sees real patients using an electronic medical record (EMR). My sole agenda is to provide the best patient care. I have no financial stake in information technology (IT). However, unlike the editorial board at the Wall Street Journal, Mr. Stephen Soumerai of Harvard or Mr. Ross Koppel of the University of Pennsylvania, I have actually …

Mothers who deliver prematurely face serious health risks

Jennifer Gunter, MD

December 11, 2012Dec 11, 2012

Mothers who deliver prematurely face serious health risks that are often neglected when we talk about prematurity. Today, in honor of Savita Halappanavar’s death from sepsis that was a direct result of her previable premature delivery, I would like to…

Many of us have infections. We rupture our membranes prematurely, and for 40% of …

Delivering mental health care in a more rational fashion

Steve Balt, MD

December 10, 2012Dec 10, 201210

Consider the following two clinical scenarios: 1. William, a 62 year-old accountant, has been feeling “depressed” since his divorce 5 years ago. His practice, he says, is “falling apart,” as he has lost several high-profile clients and he believes it’s…

Consider the following two clinical scenarios:

1. William, a 62 year-old accountant, has been feeling “depressed” since his divorce 5 years ago. His practice, he says, is “falling apart,” as he has lost several high-profile clients and he believes it’s “too late” for his business to recover. His adult son and daughter admire him greatly, but his ex-wife denigrates him and does everything she can to keep their children from seeing

…

Drugs and prescribing

Why you should avoid the temptation of drug coupons

Kevin Pho, MD

December 10, 2012Dec 10, 20126

October 24th, 2012 in USA Today. As the cost of prescription drugs soar, more patients are turning to online coupons or discount cards from drug companies or promotional offers in magazines. In the past year, it is estimated that 19…

A version of this column was published on October 24th, 2012 in USA Today.

As the cost of prescription drugs soar, more patients are turning to online coupons or discount cards from drug companies or promotional offers in magazines. In the past year, it is estimated that 19 million Americans whom took prescription drugs used such incentives to save money. The healthcare industry …

Concierge medicine: Winners and losers

Concierge medicine: Winners and losers

John Schumann, MD

December 10, 2012Dec 10, 201223

By now you’ve probably heard of the concept of “concierge medicine.” To me, it’s an idea that’s Win-Win-Lose: Win: Doctors. Those in concierge practices have chosen to forgo the traditional business model in favor of charging annual fees that range…

By now you’ve probably heard of the concept of “concierge medicine.”

To me, it’s an idea that’s Win-Win-Lose:

Win: Doctors. Those in concierge practices have chosen to forgo the traditional business model in favor of charging annual fees that range from $1500 to $15,000 per patient. How much you pay depends on the market, exclusivity factors, and amenities, like comprehensive annual physicals with add-ons like a dermatology appraisal and nutrition consultation. Concierge …

Read more…

HIV screening and the USPSTF: Better late than never

Paul Sax, MD

December 10, 2012Dec 10, 2012

A flurry of coverage recently appeared about the U.S. Preventive Services Task Force’s recommendation for one-time HIV screening for all Americans, ages 15-64. Some might wonder why this is news — um, hasn’t this been recommended now for years? —…

A flurry of coverage recently appeared about the U.S. Preventive Services Task Force’s recommendation for one-time HIV screening for all Americans, ages 15-64.

Some might wonder why this is news — um, hasn’t this been recommended now for years? — and I think I’ve figured it out.

Let me start by relaying that every ID/HIV specialists can tell some version of the following sad story, which is still repeated on a regular basis …

DTC genetic tests and the wilds of personal medical information

Tia Powell, MD

December 10, 2012Dec 10, 2012

The other day I landed on the website of 23andMe. To my surprise, I learned that if I wanted to send the company a sample of my DNA, I’d have to swear under penalty of law neither to collect my…

The other day I landed on the website of 23andMe. To my surprise, I learned that if I wanted to send the company a sample of my DNA, I’d have to swear under penalty of law neither to collect my sample nor mail it from New York State. That’s because New York State requires a laboratory license and direct interaction with a physician for mail order DNA testing.

New York, it …

Don’t overwhelm patients with unnecessary detail

Peter Ubel, MD

December 10, 2012Dec 10, 201212

It is not an easy time to be a physician in the United States. Attempt to order an expensive test for a patient and an insurance company is likely to second guess your decision. Try upholding the bottom line for your medical practice and the government will probably start questioning whether you are overcharging for your services. To make matters worse, …

The unintended consequences of boilerplate guidelines

David Mokotoff, MD

December 9, 2012Dec 9, 20127

I recently saw a 90-year old patient in my cardiology office practice. She was demented, but cooperative with the exam. A devoted daughter, with whom she lives, accompanied her to the appointment. Her dementia was severe enough to make a cogent history from the patient impossible. However, the daughter had something on her mind, and it had nothing to do with her mother’s heart condition.

“My mother’s primary care doctor wants …

Do we really have the world’s best cancer care?

Samuel Metz, MD

December 9, 2012Dec 9, 20124

Those who resist health care reform point to America’s great cancer care – instead, we should protect “the best health care system in the world.” After all, if we’re the best, other countries should change, not us. Do we really…

Do we really have the world’s best cancer care?

A good indication is the American survival rate for breast cancer, the world’s longest. But …

Why doctors should have clean and organized desks

Neil Baum, MD

December 9, 2012Dec 9, 20127

What is your impression of an airlines when you sit down and open the tray on the back of the seat in front of you and find food and coffee stains on the tray? You may just worry if the…

What is your impression of an airlines when you sit down and open the tray on the back of the seat in front of you and find food and coffee stains on the tray? You may just worry if the same attention that was given to tray tables carries over to the maintenance of the engines. Or what is your opinion …

MKSAP: 42-year-old with pain and swelling of the knee

mksap

December 9, 2012Dec 9, 2012

A 42-year-old woman is evaluated for recurring pain and swelling of the left knee and right ankle that began 5 months ago. At that time, she also had an episode of conjunctivitis as well as dysuria, both of which resolved…

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

4 essential elements of true health reform

Timothy Johnson, MD, MPH

December 8, 2012Dec 8, 20127

I recently said I would describe the essential elements of "true reform." I realize others might add or subtract from my list, but here it is – at least for today: Payment reform. I put this first because no matter…

I recently said I would describe the essential elements of “true reform.” I realize others might add or subtract from my list, but here it is – at least for today:

Payment reform. I put this first because no matter what form or structure healthcare takes, without payment reform it will be doomed to failure. And by “payment reform” I mean switching from the “fee for service” model I discussed in …

Sreedhar Potarazu, MD, MBA

Price transparency is no longer a luxury, but a necessity

December 8, 2012Dec 8, 20122

The growing concern about reducing the cost of healthcare delivery is the major focus in revamping the U.S. healthcare system. There have been numerous attempts to better understand the key drivers contributing to rising healthcare costs, yet the ability to…

The growing concern about reducing the cost of healthcare delivery is the major focus in revamping the U.S. healthcare system.

There have been numerous attempts to better understand the key drivers contributing to rising healthcare costs, yet the ability to successfully control the rising trend has been met with consistent challenges.

A key motivating factor of the Affordable Care Act was to drive …

Hurricane Sandy’s profound impact on population health

David B. Nash, MD, MBA

December 8, 2012Dec 8, 20122

Of all the complex, costly, and downright intimidating issues in U.S. healthcare today, Super Storm Sandy tops my list as the scariest. Even though hospitals from the Carolinas to Maine deployed their emergency plans and had extra providers on site…

Of all the complex, costly, and downright intimidating issues in U.S. healthcare today, Super Storm Sandy tops my list as the scariest.

Even though hospitals from the Carolinas to Maine deployed their emergency plans and had extra providers on site to deal with the expected influx of patients, those in the hardest hit areas couldn’t withstand such a powerful storm surge.

Like many …