Amid all the political rancor and media hoopla currently surrounding the American healthcare system and the clamor for reform from all sides, one question has gone unasked; what exactly is this thing we call healthcare? Is it the local hospital with its giant façade and ambulances coming and going all hours of the day and night? Is it the clinic where you sit and wait to have your blood pressure …
What exactly is this thing we call healthcare?
Hospitals commonly espouse a commitment to patient-centered care (PCC). Most fail to achieve it. Causative factors are legion. PCC is often considered a strategy or a tactic, for example, when it really should be integral to an organization’s culture, and enabled by a supportive vision. Some organizations appreciate this, yet still struggle. This is understandable. Today’s health care providers were not trained to provide PCC. They lack the requisite skills, …
Is patient-centered care an outmoded concept?
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 78-year-old woman has a 3-month history of increasing fatigue. She has no other medical problems and does not take any medications.
On physical examination, temperature is normal, blood pressure is 130/80 mm Hg, pulse rate is 72/min, and respiration rate is 16/min. The patient appears pale. …
MKSAP: 78-year-old woman with increasing fatigue
It was my first ER shift in charge of the resuscitation area. Needless to say, my adrenaline and nerves were firing like crazy; being responsible for the sickest of the sick that rolls through our doors is a daunting task, especially since we were the local trauma center.
The shift was going relatively well, and with only a few hours left I was beginning to breathe a sigh of relief.
BEEP!
There is …
How Twitter was used in a potential mass casualty scenario
The fundamental challenge in any high-risk industry is balancing “productivity” versus “safety.” The term “protection” is frequently used within the scientific literature to express the role of safety departments within an organization. Described this way, it might sound as if the safety experts are framing the debate to suggest “the evil factory bosses are continually speeding up the assembly line, while the righteous safety-folks are yelling ‘slow down!’” This essential …
The problem of mixing productivity with patient safety
For various reasons our nation’s public health programs have been decimated. This comes at a time when the number of unemployed and health uninsured are at a record high number. Additionally, we are seeing individuals live longer and experience more chronic debilitating illnesses and conditions that stretch the resources of an already under manned and under funded health system. Emphasizing prevention and healthy living should be a lifetime necessity for …
Why we need a National Health Service Corp
Yet another study is out highlighting that kids are getting fatter and they’re hardly moving any more. They get driven to school. They drink soft drinks. They don’t get much milk. They snack a lot. They text and watch video games. The number of obese kids has doubled since the 1970’s, with one in six now officially obese.
But if you really want your kids to be healthy, you have to …
How to create a health culture at home for your kids
I was browsing the now famous mini-lecture website, TED.com, when a certain video caught my eye. The presenter began by naming the various pitfalls of anatomy dissection such as its high cost and noxious chemicals. He whirled through a short demonstration using his brand new Automage Table, a 3D touch screen rendering of the human form. In his virtual dissection, he quickly and effortlessly revealed various organs and vessels. He …
Dissecting a cadaver cannot be replaced by technology
Everyone has heard of a recall of a consumer product such as a component of an automobile, child’s toy, or an over the counter medication. A recall of those types of products often implies taking them off the market as well as replacement or repair (in the case of device or car components).
During my 20 years as a practicing cardiac electrophysiologist, I witnessed firsthand the evolution of how implanted medical …
Why mobile health devices need FDA oversight
When I moved from the news business, writing about crime and investigating corrupt politicians and police officers, to the healthcare industry in the mid-1970s, we measured only the basic hospital performance indicators — including census, staffing, inventory, days in accounts receivable and average length of stay. The data was not in real time by any stretch of the imagination. By the time the information was produced and distributed to managers, …
A simple innovation to improve hospital quality and safety
One advantage of being a surgeon and an MBA is the opportunity to observe different ways of approaching and responding to challenges. My surgical training and 25 years of practice in academic and community hospitals have helped me become more comfortable with making major decisions despite the lack of perfect information. Although I find that it takes longer to bounce back from nights on call, I relish the excitement of …
Why we need physician champions to reform health
Sometimes a patient interaction leaves you speechless. In my experience, that most often occurs when a patient refuses to acknowledge any responsibility for their condition despite massive evidence to the contrary. This is compounded when dealing with caregivers of patients who don’t just drop the ball, they kick it into the next county on purpose.
Here is an actual phone conversation between a fellow physician and a son of her two …
A deficit in caregiver personal responsibility
The U.S. spends far more on cancer care than 10 European countries, but according to a new study, it may be “worth it” as “the value of the survival gains greatly outweighed the costs.”
The study, published this week in Health Affairs, found that U.S. spending on cancer care, in 2010 dollars, increased by 49% from 1983 through 1999, from $47,000 per cancer case to $70,000 per case. Meanwhile, in …
Is our high cost of cancer care worth it?
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Austin Frakt, health economics blogger at The Incidental Economist, has a post up commenting on Kenny Lin’s post about shared decision-making and PSA testing. The following is an edited comment I posted on that article.
I have to disagree with Kenny on this one, despite having written an article in the New York Times Magazine that strongly supported Kenny’s work at the US Preventive Services Task Force, which found …
Don’t discard shared decision making on the basis of PSA testing
We finally broke down and bought floaties. The kids played for a few days in the shallows, but since neither of them are yet proficient swimmers, they dared not wander into deeper waters. Each day they watched as younger kids scooted around the pool wearing wing like contraptions colored with cartoon characters.
I never liked the idea of floaties. Much better, I thought, to let them struggle and build on the …
Are the doctors of tomorrow going to sink or swim?
It’s been said that losing weight is much harder than kicking cigarettes or alcohol. After all, because one doesn’t need to smoke or drink, the offending substances can simply be kept out of sight (if not out of mind). Dieting, on the other hands, involves changing the way a person does something we all must do everyday.
It’s no surprise, then, that reports of problematic doctor interactions with social media are …
How can doctors curb digital distractions?
Over the past few years, insurers and Medicare officials have fostered the idea that physicians should be reimbursed on a pay for performance (P4P) basis. Many articles, both pro and con, have been written regarding P4P. I have been strongly opposed to P4P, believing that the sole purpose of the performance indicators designed by the government and insurers is to reduce payments to docs and hospitals. I also believe that …
Why patients should be paid for good health
In January, when my close friend’s lymph node biopsy came back as a rare form of T-cell lymphoma, I scoured the scientific literature. What was his prognosis?He was 56, a little overweight but otherwise healthy. He had helped us move into our home more than a decade ago, and I was like an uncle to his son and daughter.
In the literature I found jagged graphs plunging downward, indicating that my …
When doctors are incorrect in their prognosis of terminal illness
Sometimes, the simplest tools in medicine are the ones that give us the most useful information.
Take the humble blood pressure machine, for example. It’s been around for years, and it’s cheap, compared with a lot of other medical devices. It’s simple to use, and it doesn’t require a medical or a nursing degree to operate. But the numbers it reports are valuable in helping predict a person’s risk of a …
Tips for successful home blood pressure monitoring
Who better knows how to fix a leak than a plumber?
Who better knows how to repair a cracked doorway than a carpenter?
Who better knows how to solve the conundrum of our leaking cracked health care system than a doctor?
Doctors are an important part of public discussions about health care reform. Our prescriptions drive healthcare costs. We are the crucial middlemen between the biomedical industry and patient health. Sharing our first hand experiences in health care …
Why doctors should drive health reform
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