“Here is a prescription for pain medication. Don’t drive if you take it. Call your surgeon if you have a temperature or are worried about anything. Go see your doctor in two weeks. Do you want a flu shot? I can give you one before you leave. If you need a wheel chair to take you to the door, I’ll call for one. If not, you can go home. Take care of yourself. You are going to …
Hospital discharge planning: Involve the patients
Physicians who liberally prescribe empiric antibiotics are often maligned as irresponsible or unthinking by condescending colleagues and policy wonks. But are these doctors actually courageous and prudent, saving countless thousands of lives every year by refusing to bend to misguided pressure from antibiotic-conserving paper-pushers?
As antibiotic resistance has emerged, many hospitals have begun requiring physicians to provide a rationale for every antibiotic dose prescribed. The Centers for Medicare and Medicaid (CMS) …
Doctors who prescribe too many antibiotics: It’s not that simple
More than 80 percent of the United States supply of heparin, a commonly used blood thinner, originates from pigs reared in farm co-ops in China. Farmers scrape mucus from the intestines and send it to central processing facilities, where heparin is extracted and purified before being sold to U.S. pharmaceutical companies.
But in 2007, blue-ear pig disease, causing a respiratory syndrome, became endemic in Asia—leading to a shortage of pigs …
Why the drug shortage is leading to desperate measures in hospitals
A guest column by the American Medical Association, exclusive to KevinMD.com.
Since the American Medical Association launched our National Health Insurer Report Card in 2008, there has been noticeable progress by health insurers in response to the AMA’s call to improve the accuracy, efficiency and transparency of their claims processing.
The AMA has been working constructively with insurers, and as a result the …
AMA works to reduce administrative burden for physicians
Mr. Omer had once held a position of social prominence, a moral influence on the lives of individuals and communities. Until one year ago. A construction accident changed everything. He suffered injuries that left him in control of only one side of his body and his mind functioning as a 5-year old child.
Most recently, he had resided in an extended rehabilitation nursing facility, until yesterday.
When the nurse tried to arouse …
We have kept Daddy out of heaven with what we have already done
Encouraging patients to be more engaged, may also encourage more people to go beyond assertive to demanding care unsupported by good clinical judgment. Of course, physicians worry that saying “no” to a patient increases their risk of being disliked, dismissed, or even sued for medical malpractice.
Greater transparency in health care means patients are more aware of options for screening, testing, procedures, and medications—often via direct advertising or public service campaigns. …
Why always saying yes could be dangerous for you and your patient
Several years ago I had dinner with a woman who had served in the late 1990s as the national Chief Medical Officer of a major health plan. At the time, she said, she had developed a strategic initiative that called for abandoning the plan’s utilization review and medical management efforts, which had produced heartburn and a backlash among both physicians and patients. Instead, the idea was to retrospectively analyze utilization …
Why medical management is critical to health reform
What if there was an infection that can cause permanent nerve damage and pain? What if the virus could affect the eye and cause blindness or affect the brain and cause meningitis? What if the burning rash attacks almost half of all Americans sometime in their life? If you knew there was a vaccine which could protect you from that malady, would you get the shot? The disease is called …
Do I need the shingles vaccine? A doctor explains
The patient satisfaction industry needs to be disrupted.
This old, legacy industry, with it’s outdated and overpriced technology needs a serious makeover. I work for a large physician group that uses a well-established patient satisfaction vendor. And I have had no end of frustration trying to figure out how the data I get back can be used to actually improve my practice and the overall patient experience.
Don’t get me wrong; I …
Patient satisfaction in the age of social media
On a recent afternoon, Hansel Tookes stood on a sidewalk in downtown Miami, peering into a thicket of scraggly weeds. “I found a bunch over here,” he said, edging toward an overpass. A small orange plastic cap came into sight, and next to it two slender insulin syringes, with the needles exposed. Scattered about were tiny plastic zipper bags — evidence that the needles had been used to inject heroin …
Used needles on the sidewalks: Why we need needle exchange programs
The selection of Wisconsin congressman Paul Ryan as the running mate for presumptive Republican Presidential nominee Mitt Romney could have serious consequences for the Medicare program.
Ryan, Budget Committee chair for the House of Representatives since Republicans gained control of the chamber 2 years ago, is best known for budget proposal, which includes a plan to overhaul Medicare and transform it …
How will Paul Ryan change Medicare?
Recently New Yorker staff writers and best-selling authors Malcolm Gladwell and Atul Gawande addressed the question of whether the problem in health care is that patients are too reliant on doctors and don’t have the ability to make decisions. In reading between the lines, is that the reason health care is not affordable and care not commoditized or consumer driven like other industries?
At a conference for America’s Health Insurance Plans, …
For health care to be better, doctors must lead the change
Unless you’ve lately returned from a retreat at a remote Cistercian abbey, if you’re interested at all in women’s issues you’ve probably read Anne-Marie Slaughter’s recent article in the Atlantic, “Why Women Still Can’t Have It All.” The author eloquently tells how she left her dream job in the State Department as the first woman director of policy planning in order to return to her husband, her …
Work-life balance in medicine: Is it possible?
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As odd as this might sound, my mother was upset when I declared my intention to go to medical school.
It wasn’t the mountain of debt I was sure to incur since I’d already figured out how to get Uncle Sam to pick up the bill (a small deal that put me in a military uniform for a decade). It wasn’t the …
Why are so many doctors complete jerks?
We all know that the use of baby oils and baking in the sun for hours on end is probably not a good idea. We know that increased sun exposure correlates with increasing skin cancer rates. We know that it can cause accelerated skin damage in the form of pigmentation changes, wrinkles, and increased skin laxity. Don’t believe me? Check out this picture! Truck drivers tend to get increased sun …
Should I get a spray tan? A doctor discusses whether it’s safe
“The best defense is a good offense.”
This folk wisdom is variously attributed to Sun Tzu, Carl von Clausewitz, Mae Zedong, and the heavyweight prizefighter Jack Dempsey. Regardless of origin, it deserves its place in the pantheon of behavioral truths.
During a recent conversation with a patient about her irritable bowel syndrome, I asked about possible stressors.
“So, tell me, I know it’s hard to manage both full time school and a part …
Apply folk wisdom to your family practice patients
In today’s China, both eastern and western medical philosophies and practices exist relatively harmoniously. Patients with minor, usually self limited problems are treated initially with a seven day course of seven liquid herbal preparations taken each day. If symptoms subside, usually treatment is discontinued. If improved but not resolved, formula may be modified. If worse, regimen can be changed and/or referral to specialists arranged. There are hospitals that practice purely …
An American oncologist looks at health in China
I’ve written about this before, but some recent encounters with medical students have me thinking about it again. I went off to medical school thirty-eight years ago. For the era, I went to what folks regarded as a very progressive place. It had a curriculum that was quite revolutionary for the time. Among other things, we started having interactions with actual patients during our first year, rather than the third …
The need to watch medical students interact with patients
Do you feel connected with your doctor or other health care providers? Do you partner with your providers? How important is patient engagement to you? What words do you use to define patient engagement? Do you consider yourself an empowered patient or health care consumer?
What is patient engagement?
Here is how I define patient engagement.
Patient engagement is a connection between patient, caregiver and health care provider. An empathetic and trusted relationship …
How I define patient engagement
Does your doctor use a computer in the exam room? Some people think that computers are a great way to keep track of patient information. Others see some advantage, but problems in the implementation. There are also a few Luddites who oppose this change simply on principle. I’ve had good experiences, and bad experiences, and believe we have a long way to go before computers are as helpful as they could be.
There …
Computers in the exam room: Good and bad setups
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