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Doctors leaving the clinical practice: The fear of being irrelevant

Physician

August 10, 2012

I’m always surprised at the number of physicians I work with who worry about, discount, or do not see their relevance outside of clinical practice. I do, of course, recognize their relevance – the trick is to get the docs to.

For many physicians, venturing into positions of leadership, becoming a Department Chair, VP Medical Affairs or even Chief Medical Officer) is a logical step for those looking to expand their skills …

In pediatrics, no visit is a wasted one

Denise A. Somsak, MD

Physician

August 10, 2012

The last patient of the day rushed to the office before closing time. When I entered the room, the dad was texting as the nurse finished recording the child’s temperature. He shook his head in disbelief and confessed that he just sent his wife this message, “I feel stupid. No fever here.”

Parents apologize to me everyday because they feel like they wasted my time and/or their co-pay. Coordinating a doctor’s …

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In pediatrics, no visit is a wasted one

The bias behind narcotic prescribing

Jennifer Middleton, MD

Medications

August 9, 2012

Narcotic pain medication prescribing is an issue heavily laden with emotion these days. I have observed that most doctors tend to fall on one side of a spectrum bordered by these two extremes:

“Undertreated pain is worse than addiction.”

On one end is the doctor who is deeply, morally troubled by patients in pain. This doctor is not unaware of the risk of addiction but is willing to risk being taken advantage …

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The bias behind narcotic prescribing

The moments when we recognize the brevity of life

Danielle Rosenman, MD

Physician

August 9, 2012

Recently I learned that my friend Hester had been suddenly diagnosed with Stage 4 cancer. She had been focused on daily living, her long road stretching out to the horizon, attending to friends, creativity, work, and related pleasures and struggles. Within days, her life abruptly made a hairpin turn into a new path, narrow and poorly lit, and short. One week after I spoke to her, she died.

It is at …

Are ACOs merely repackaged HMOs?

Michael Kirsch, MD

Health Policy

August 9, 2012

During my college years, we loved the album Bat Out of Hell by Meat Loaf. We would wail along with Meat Loaf as he screamed out his passionate interpretation of Paradise by the Dashboard Lights. Another memorable song on that album was Two out of Three Ain’t Bad, which offers an important lesson to those of us interested in health care reform.

No, Meat Loaf was not a medical policy wonk …

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Are ACOs merely repackaged HMOs?

You’re seeing the wrong gynecologist: 6 red flags

Jennifer Gunter, MD

Physician

August 9, 2012

As a doctor, I appreciate that I am at an advantage when I seek medical care. Knowing terminology and basic medical principles helps a lot. In addition, when you’ve been practicing medicine for a while you get a feeling from how a doctor discusses options if the care seems valid or if a second opinion is in order. Other things I look for are board certification and a doctor …

As a doctor, I’m going to keep asking about guns

Suzanne Koven, MD

Physician

August 8, 2012

Let’s set aside for the moment the question of whether it’s appropriate to talk about gun control in the wake of the shootings in Aurora, Colorado (though I can’t think of a more appropriate time to talk about it). And let’s not consider whether it makes sense that it’s legal to buy thousands of rounds of ammunition on-line in the U.S, without any background check (though could it, really?) And …

Is the death of Rory Staunton really the result of a simple mistake?

Skeptical Scalpel, MD

Physician

August 8, 2012

If you pay attention at all to news about medicine, you must have heard about the tragic death of a 12-year old boy who was seen and discharged from the emergency department of the prestigious New York University Medical Center. He had developed sepsis from what appears to have been a small cut and the diagnosis was missed. When he eventually returned to the ED and was admitted, it …

Teaching the cost of tests in medical education

Vineet Arora, MD

Medical Education

August 8, 2012

Last week, I tried something new with our residents. We tried to talk about why physicians overuse tests. This is the topic of the moment, as the American College of Physicians (ACP) just dropped their long-awaited new High Value Cost Conscious Curriculum for what has now been dubbed the “7th competency” for physicians-in-training.

In addition to the ACP curriculum, which I served as one of the reviewers for, I also …

I am a physician and guns are a disease

James C. Salwitz, MD

Physician

August 8, 2012

I feel guilty about the killings in Colorado. As a doctor, those horrid events are a personal failure. I have spent a career fighting illness, often investing hundreds of hours in a single cancer case, yet in minutes, a dozen people vanish and 58 are grievously wounded. Another 32,000 will die this year from gunshots, over 76,000 will be crippled and …

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I am a physician and guns are a disease

Stop designing studies around outcomes that don’t matter to patients

Eve Harris

Patient

August 7, 2012

I recently returned from four days of training in evidence-based healthcare (thank you, AHRQ and Colorado School of Public Health). I was honored to work side by side with journalists and decision makers as we learned to ferret out systematic bias in medical research.

Before I went to the workshop I re-read “Lies, Damned Lies, and Medical Science,” a 2010 article from the Atlantic which begins, “Much of …

How are biosimilar drugs affected by health reform?

Donald J. Palmisano, MD, JD

Medications

August 6, 2012

The section of the Affordable Care Act, which calls for the creation of the biosimilar pathway, was recently upheld by the Supreme Court. While not as headline-worthy as the news surrounding the individual mandate, the fact that the Biologics Price Competition and Innovation Act (BPCIA) provision survived the process was significant for the biotech world.

Biologics are some of the best treatment options for serious medical conditions such as cancer, autoimmune …

Moral professionalism should include advocacy and duty

Vivian E. von Gruenigen, MD

Health Policy

August 6, 2012

Across the nation, the medical calendar starts in July, not January. Every July 1, hospitals are infused with new, eager interns who have just graduated from medical school. To get off to a good July start, I give a talk to the obstetrical and gynecology interns and residents about medical professionalism. It is mandated (and rightly so) by the ACGME (Accreditation Council for Graduate Medical Education) that we teach, mentor …

Beating the 30 day readmission: Why there’s little to celebrate

Shabbir Hossain, MD

Physician

August 6, 2012

30 day hospital re-admission rates.

It’s a statistic that keeps hospital administrators up at night. Whether you agree or disagree with the use of this statistic as a quality and reimbursement metric, if it creates change, reduces hospital re-admissions and improves patient care, then in theory I support it.

I’m reminded of Mrs G. She is emblematic of today’s chronic disease patient. She was admitted to our hospital for a congestive heart …

Patients who receive test results instantly: Doctors need to be ready

Emily Gibson, MD

Physician

August 6, 2012

Patients are increasingly demanding, and understandably so, that since they pay for their medical tests, they should receive results directly and immediately without waiting for physician review or interpretation. Recent articles in the lay press about this issue are accompanied by scores of online patient comments insisting that physician reporting and interpretation is too often unreasonably delayed, often inaccurate, or just plain unhelpful, so why bother waiting at all?

Dr. Google …

Making poor choices by misjudging the level of risk

Steven Kussin, MD

Patient

August 5, 2012

Risks are not certainties. They are the possibility that an activity will end badly. Risk is a handmaiden to almost everything we do.

Life itself is risky. Every decision is associated with the possibility of harm. Risk can’t be avoided, but it can be managed. Let’s talk today about the chances we take while living our everyday lives.

Risks are subject to a variety of misconceptions. What’s risky and what’s not is …

Changing health care delivery at academic medical centers

Michael K. Magill, MD

Health Policy

August 5, 2012

At academic medical centers (AMCs) all over the country, health care delivery and payment reform are becoming reality. AMCs need to think in a new way about the markets they serve. Timing for AMCs transforming care delivery is critical. We need to find the perfect middle ground, or what I like to call the “Goldilocks Factor.” AMCs need to transform delivery, definitely not too slowly, but not too fast for …

MKSAP: 37-year-old woman undergoes preoperative evaluation

mksap

Conditions and Diseases

August 5, 2012

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

A 37-year-old woman undergoes preoperative evaluation prior to a hysterectomy for worsening menstrual bleeding of several years’ duration caused by uterine fibroids. She has a recent history of recurrent epistaxis and bleeding after recent dental work but denies thromboembolism and a family history of unusual bleeding. The patient is otherwise healthy. Her only medication …

Health care is fundamentally about social interactions

Steve Wilkins, MPH

Patient

August 4, 2012

Turns out that while most of us (90%) would like be able to make a doctor’s appointment and check lab results online. 85% of us also still want the option of be able to talk to our physician face-to-face. These are the finding from a recent 2012 study conducted by Accenture.

These finding will no doubt come as a surprise to many of those high tech newcomers to health care looking …