KevinMD.com

October 4, 2012Oct 4, 20124

Trying to figure out whether Medicare vouchers are a good idea for patients and their physicians? Then consider these two basic questions: 1. How much will the federal government contribute? 2. Who is at risk for health care cost increases?…

Trying to figure out whether Medicare vouchers are a good idea for patients and their physicians? Then consider these two basic questions:

1. How much will the federal government contribute?
2. Who is at risk for health care cost increases?

How much will the government contribute? The traditional Medicare program has no set limit on how much the federal government will contribute to a beneficiary’s health care, although there are limits on how …

Conditions and diseases

Talk about hepatitis C screening at your next scheduled visit

Steven Reznick, MD

October 4, 2012Oct 4, 2012

The Center for Disease Control and Prevention (CDC) has requested that all individuals born between 1945 and 1965 be tested for the presence of the hepatitis C virus. This is a clear cut change in their policy which had previously…

Hepatitis C is a viral infection usually transmitted by blood to blood transmission. High risk patients include intravenous drug users who share needles, …

Physician voices

When patient histories start to blur

Greg Smith, MD

October 3, 2012Oct 3, 20122

I am guilty of neglect. I’ll admit it. I’ll own it. I’ll embrace it. When I am doing a consult now for one of many hospital emergency rooms, I am sent a pretty standard package of history, nurses notes, doctor’s…

I am guilty of neglect.

I’ll admit it. I’ll own it. I’ll embrace it.

When I am doing a consult now for one of many hospital emergency rooms, I am sent a pretty standard package of history, nurses notes, doctor’s assessment, physical exam report, lab results and other information that I review prior to actually seeing the patient on the screen and doing my own assessment. Now, on a day like today, …

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When patient histories start to blur

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Physician voices

Can the airline industry teach customer service lessons to medicine?

Michael Kirsch, MD

October 3, 2012Oct 3, 20124

"Your call is important to us. Please listen carefully because our options have changed." During your current or any prior lifetime, has any phone menu option ever changed? I have more than once experienced an option not offered on the…

“Your call is important to us. Please listen carefully because our options have changed.”

During your current or any prior lifetime, has any phone menu option ever changed?

I have more than once experienced an option not offered on the robotic phone menu option choices – a dead phone line after a 30 minute wait.

Have you tried this customer plea as I have? Could you pretty-please jot down my cell phone number in …

Health policy

To fix health care, we need to be screwed

Peter Ubel, MD

October 3, 2012Oct 3, 20125

“We need to be screwed!” Not altogether surprising words to spill out of a college student’s mouth. But this particular student was not talking about sex. She was discussing the U.S. healthcare system—more specifically what she thought it would take…

“We need to be screwed!”

Not altogether surprising words to spill out of a college student’s mouth. But this particular student was not talking about sex. She was discussing the U.S. healthcare system—more specifically what she thought it would take for our two political parties to come together to find a reasonable way to control our nation’s healthcare costs.

It was the last day of the semester, the last class discussion in …

Physician voices

What is your doctor worth per hour in the open market?

Wes Fisher, MD

October 3, 2012Oct 3, 20125

Recently I was asked to serve as a consultant on a medical matter. Interestingly, they requested my hourly price for my services. I thought about this and wondered, "What am I worth per hour in the open market?" It is…

Recently I was asked to serve as a consultant on a medical matter. Interestingly, they requested my hourly price for my services. I thought about this and wondered, “What am I worth per hour in the open market?”

It is an interesting question to ponder.

I have decided to ask the blog-o-sphere. Call it a bit of “free market economics.” For the record, 100% of my hourly wage for my services will …

Physician voices

How well does your doctor play with others?

James C. Salwitz, MD

October 3, 2012Oct 3, 2012

How do you choose a doctor? Perhaps you start with a recommendation from a friend or a trusted physician, then you look at factors such as training, experience, board certification, access, online reviews and of course that vital issue, how well you like the doctor when you meet him or her. Tough thing, picking a person you barely know to whom you trust health and life. To this list, I …

Health policy

How the surplus of patients will impact primary care

Dike Drummond, MD

October 2, 2012Oct 2, 20129

I believe the projected shortage of physicians caused by the Affordable Care Act will drive primary care into two opposite tracks. Each is a distinct and logical response to the patient overload and each points out gaping holes in our…

The Association of American Medical Colleges estimates that there will be a shortage of 63,000 doctors by 2015 and 130,600 by 2025 in the wake …

Physician voices

Spinning medicine into soundbites hides the facts

Suzanne Koven, MD

October 2, 2012Oct 2, 2012

Medicine, like politics, sports, and everything else, has gotten sucked into a 24/7 sound bite culture in which the most complex issues are spun into a few provocative words on news sites, TV, and radio shows. Enraged readers and listeners…

But three recent stories involving medicine are worth a closer look, and cooler heads.

First, consider the …

Patient voices

There is no app for patient engagement

Steve Wilkins, MPH

October 2, 2012Oct 2, 20125

Physicians, hospitals and other providers are being misled by industry pundits claiming that more health information technology (as in EMRs, PHRs, smartphone apps, and web portals) is the key to greater patient engagement. It’s not. If health information technology were…

If health information technology were all that was needed to “engage” patients then patient and member adoption rates of provider and payer web portals offering personal health records (PHRs) and electronic health records (EHRs) would not …

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There is no app for patient engagement

Physician voices

Humility and humanity is required of us to best respect our patients

Meghana Gadgil, MD

October 2, 2012Oct 2, 2012

Several days ago, I had the opportunity to listen to a lecture by a visiting physician who practices narrative medicine, a medical humanist. She is well-known for bringing a voice to the interactions between doctor and patient, the healing relationship, the unparalleled bond formed between these two individuals. In her talk, she spoke of the “turmoil” that ensues when caring for a patient, caused by the interaction of deep concern …

Physician voices

Thank you for setting me on the road to practice medicine

Emily Gibson, MD

October 1, 2012Oct 1, 2012

All of us come to the study and practice of medicine through different pathways: some because of family members who were doctors or patients, some out of our own illness or woundedness, some out of intense drive to achieve and…

I came to medicine because of my grade school classmate Michael.

My grade school represented a grand social experiment of the early 1960’s. It was one of the first schools to …

Physician voices

Doctors are notoriously awful about dealing with death and dying

Miranda Fielding, MD

October 1, 2012Oct 1, 20129

Some things are just so damned hard to write about. People often ask me, "Why do you have so many animals?" The current count is 4 dogs, two horses and a cat. I used to say, "Because it’s good for…

Some things are just so damned hard to write about. People often ask me, “Why do you have so many animals?” The current count is 4 dogs, two horses and a cat. I used to say, “Because it’s good for my children to learn responsibility. Having a dog, whose life is so much shorter than our own, teaches them about love, and about death. They get to practice parenthood, before …

Physician voices

How many times have you done this procedure, doc?

Max Berry, MD, PhD

October 1, 2012Oct 1, 20122

Questions such as this from proactive, increasingly knowledgeable patients place a physician on the horns of an ethical dilemma. Although fellows are closely supervised and trained under a gradually increasing responsibility principle (based upon subjective evaluation), a time will come…

Fact: Someone has to be a physician’s first case of any given type. However, no one really …

Health policy

What happens if Medicaid expansion is undermined

Erin Marcus, MD

October 1, 2012Oct 1, 20123

He was a "frequent flyer" -- a patient with multiple health problems who gets admitted to the hospital repeatedly. It was usually because he hadn't taken his medicine correctly, if at all. When he left the hospital 10 days earlier,…

He was a “frequent flyer” — a patient with multiple health problems who gets admitted to the hospital repeatedly. It was usually because he hadn’t taken his medicine correctly, if at all. When he left the hospital 10 days earlier, he told his physician that he wouldn’t have problems filling his prescriptions, because he had Medicaid. But when he arrived at his local drug store, it wasn’t so easy.

“I was …

Physician voices

Speak the truth, document the truth: To do otherwise is malpractice

Edwin Leap, MD

October 1, 2012Oct 1, 201210

I remember a short lecture I received in my medical officer's course when I joined the Air National Guard around 1988. The room was full of young medical students, physicians, nurses, and other health care folks who were beginning their…

I remember a short lecture I received in my medical officer’s course when I joined the Air National Guard around 1988. The room was full of young medical students, physicians, nurses, and other health care folks who were beginning their service. The topic was appropriate documentation in the medical record.

Among the notable examples of what not to do was this gem, written by a medical officer about another officer’s wife: …

Drugs and prescribing

ADHD medications: Performance enhancing drugs of the mind

Dr. Joe Kosterich

September 30, 2012Sep 30, 201218

There are interesting double standards that we apply to different fields of human endeavor. In sports the use of performance enhancing drugs is forbidden. Whilst that does not necessarily stop athletes using them at least it is not condoned. Efforts…

The rationale behind this is that sporting contests are meant to be about who …

Physician voices

Why doctors need to be better social workers

Arvin Akhavan

September 30, 2012Sep 30, 20124

Doctors are already busy, but do they need to do more in a day? If you think a physician’s job is to take the best possible care of patients, then the answer is a resounding yes. But additional responsibilities do…

It doesn’t take unique insight to understand that doctors, in many ways, act as social workers. They help patients schedule follow-up appointments, …

Drugs and prescribing

Taking medications in the middle of the night can be risky

Barbara Bronson Gray, RN

September 30, 2012Sep 30, 20125

You may have heard that veteran NBC News correspondent Tom Brokaw was hospitalized recently after he reported feeling lightheaded after making an appearance on MSNBC's "Morning Joe." He's fine. Brokaw tweeted, "All is well. Early a.m. I mistakenly took a…

You may have heard that veteran NBC News correspondent Tom Brokaw was hospitalized recently after he reported feeling lightheaded after making an appearance on MSNBC’s “Morning Joe.”

He’s fine. Brokaw tweeted, “All is well. Early a.m. I mistakenly took a half dose of Ambien and made less sense than usual.”

And that’s what you’ve got to be careful not to do.

Any time you get up in the wee hours …

Real physician voices, twice a week

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