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What’s needed for an EHR to transform primary care

Health Technology

July 10, 2012

The family medicine residency program where I serve as a faculty preceptor “went live” with their new electronic health record. They posted a sign at the front desk that read in part: “Pardon Our Progress,” as if we were starting a major construction project — which in a way, we were.

Instead of wading through stacks of unruly paper charts, my colleagues and I logged on to a sleek online portal …

Women in medicine: A front line perspective

PalMD

Physician

July 9, 2012

Think about your own experiences—you’re at a party or a restaurant, and someone you’re with says something obviously racist. You cringe, but given the setting, you can’t decide how to react; after a pause, you probably decide to say something. Now imagine you’re at meeting for work, and a senior partner says something racist. You want to say something, and you even know that under some circumstances there are laws …

Patients with arthritis deserve an integrated approach to their care

Dr. Irwin Lim

Conditions and Diseases

July 9, 2012

I was recently invited to present at an international symposium in Germany on rheumatoid arthritis. My brief was to discuss how BJC Health, our clinic, provides integrated patient care for rheumatic disease. As it turns out, I had to turn down the invite due to conflicting commitments.

But I was flattered. Our Connected Care approach is being noticed.

Over the course of the last 24 hours, I’ve been thinking about what I would …

With the ACA, put politics aside and focus on the facts

Manoj Jain, MD, MPH

Health Policy

July 9, 2012

On the day the U.S. Supreme Court delivered its historic decision on the Affordable Care Act (ACA), aka Obamacare, I was rounding on my hospital patients: a man on the ventilator with pneumonia who had private insurance, one elderly woman with abdominal pain going for gall bladder surgery on Medicare, and one middle aged obese woman with a skin infection without any health insurance.

On my patients’ TV screens I watched …

The cerebral work done by a primary care physician should be valued

Kiran Raj Pandey, MD

Physician

July 9, 2012

Primary care is ever the Cinderella-esque tragedy. Ever so maligned, ever engulfed in misery and never really the belle of the ball like she rightfully deserves to be. There may be reasons galore to this. Not least of which is the way primary care work is perceived in this country.

Let me illustrate.

The primary care attending I work with recounted a story from the early 2000s. As is usually the case with visits …

Design a standardized form for all medical reporting

Lucy Hornstein, MD

Physician

July 8, 2012

One single, deceptively simple idea that would vastly improve medical care in this country by immediately streamlining all medical communication.

Design a standardized form for all medical reporting.

Scope of the problem: Despite my exclusive use of an electronic medical record, I still receive dozens of medical communications on paper every day. So be it. Until we get to the utopian ideal of a nationally interactive medical record system, we’re stuck with …

Life somehow leads us exactly to where we are supposed to be

Molly McPheron

Medical Education

July 8, 2012

I grew up with a harsh awareness of my own mortality. Though due in part to my drivers’ ed teacher, who spent most classes telling gruesome tales of the horrors that befall high schoolers who don’t pay attention while driving (you got your money’s worth, Mom and Dad!), I think the reality of cancer was what really struck me. It took my grandfather in his 70’s, and I miss him …

PTSD, stress and anxiety after a major cardiac event

Kevin R. Campbell, MD

Conditions and Diseases

July 7, 2012

Having a major cardiac event can be a stressful, life changing occurrence. Often, the psychological impacts of having a heart attack (myocardial infarction) are underestimated and can be long lasting. In fact, there is evidence to suggest that these that the emotional stressors that occur post-MI are consistent with symptoms of post traumatic stress disorder. PTSD has been shown to be associated with higher rates of recurrent coronary events and …

MKSAP: 38-year-old man with chronic cutaneous lupus erythematosus

mksap

Conditions and Diseases

July 7, 2012

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

A 38-year-old man is evaluated for an 18-month history of chronic cutaneous lupus erythematosus. He has lesions on his face and scalp. He has been using topical sunscreen, but he finds it difficult to remember to apply it before leaving for work. He is also being treated with a corticosteroid lotion, and hydroxychloroquine was …

Tips to be the best intern you can be

Mary L. Brandt, MD

Medical Education

July 6, 2012

Across the country, newly minted doctors have started their internships. The first night on call there won’t be an intern – anywhere in the country – who will sleep. Every new intern is absolutely convinced that the beeper is going to go off and they won’t know what to do. (You get over this by about the 2nd or 3rd call night, by the way).

Graduating from medical school …

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Tips to be the best intern you can be

Behind every illness, there is a love story

Wendy Sue Swanson, MD

Patient

July 6, 2012

One magical thing I see while working in health care is the love story. Each and every child who encounters a diagnosis or illness spawns a collection of love stories around them. The stories come spontaneously from parents, siblings, friends, nurses, doctors, community, and peers. It all happens organically and sometimes it happens without notice. Babies cling to their parents when they ache; parents cling to their children when they …

After the Affordable Care Act, don’t lose sight of the Medical Home

Lauren Chasin, MD

Health Policy

July 6, 2012

Nothing in life is free.

In the midst of all the turmoil and excitement surrounding the newly passed Affordable Care Act, I believe we should not lose sight of the bigger picture: providing better healthcare at a lower cost for more people. The idea of the Patient Centered Medical Home, although in its trial stages thus far, is what we should be focusing on as physicians and health care providers.

Much has been …

Requiring ID to buy Plan B is ludicrous

Jennifer Gunter, MD

Medications

July 6, 2012

This weekend I tried to buy Plan B over the counter at a Rite Aid and was denied.

Let me explain. It wasn’t for me, I have a Paraguard and my boyfriend had a vasectomy. Basically, the chance of me getting pregnant is so astronomically impossible that we’d be pimping the story out to every tabloid and we would aim for a reality show, which we would call The Second Coming.

What …

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Requiring ID to buy Plan B is ludicrous

What are bath salts and why are they dangerous?

Roy Michael Stefanik, DO

Medications

July 5, 2012

Bath salts are a relatively new group of designer drugs sold as tablets, capsules, or powder and purchased in places such as tobacco and convenience stores, gas stations, head shops, and the Internet.

They are stimulants that mimic cocaine, lysergic acid diethylamide (LSD), methamphetamine, or methylenedioxymethamphetamine (ecstasy). According to a recent article in the Journal of Psychosocial Nursing, the most common bath salts are MDPV, mephedrone, and methylone. These drugs cause …

The functional and professional necessity of detachment

Ilana Yurkiewicz

Medical Education

July 5, 2012

There’s an intersection in Boston outside one of my favorite places to eat. At the corner of two bustling streets is a white bike, chained in place, surrounded by flowers. In loving memory.

***

One evening earlier this month, I was riding the ‘T,’ Boston’s streetcar system, when our train suddenly stopped.

There were the usual sights and sounds of delayed passengers: people fiddled with cell phones, glanced at watches, tapped feet impatiently. …

Take the time to educate yourself before forming an opinion

Alex Lickerman, MD

Physician

July 5, 2012

Student loan debt is at an all-time high at a little over 1 trillion dollars, a figure that now, for the first time ever, exceeds our nation’s credit card debt. Higher education has never cost more, the rate of rise of college tuition having exceeded in recent years the rate of rise of many other services. Perhaps as a result of this, as well as of the difficulty in obtaining …

Do oncologists have an incentive to prescribe expensive treatments?

Peter Ubel, MD

Medications

July 4, 2012

A recent economic analysis concluded that patients with metastatic cancer value their treatments significantly more than regulators recognize, with many expensive new therapies looking like veritable bargains to most patients. Yet the study ignored the values really driving oncology spending—the warped incentives oncologists have to promote their own bottom line by prescribing expensive treatments.

Let’s start with the economic analysis, another in a series of studies by a USC team of …

Applying ADHD lessons to medical marijuana

Steve Balt, MD

Medications

July 4, 2012

An article in the New York Times recently described the increasing use of stimulant medications such as Adderall and Ritalin among high-school students. Titled “The Risky Rise of the Good-Grade Pill,” the article discussed how 15 to 40 percent of students, competing for straight-As and spots in elite colleges, use stimulants for an extra “edge,” regardless of whether they actually have ADHD. I’ve written about ADHD. It’s a real …

Patients and doctors remain connected, even though distance

Don S. Dizon, MD

Physician

July 3, 2012

“Everything must change, nothing stays the same. Everyone will change, no one stays the same.”

Technology is amazing. I love to download random songs on my iPhone and listen to the songs that populate. On one bright early morning, Oleta Adams came on. The song was “Everything must change.” It’s a beautiful and haunting, somewhat sad but at the same time hopeful, song. It stirred up memories, and I found myself …

Customer service has limits in the exam room

Julie Craig, MD

Physician

July 3, 2012

Health reform includes measures to link hospital reimbursement to patient satisfaction measures. Through both public and private insurers, this trend is likely to spill over into the outpatient setting in the very near future.

Aside from creating redundancy in the market (with some very rural exceptions, patients can act as agents of their own satisfaction by voting with their feet), there are serious limits to physicians as agents of pure …

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