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A hospital board needs to understand generative thinking

Physician

September 29, 2011

Hospital systems and physician groups are faced with unprecedented change demanding decreased per-capita cost and increased quality in American health care. Boards of directors are underutilized resources that must be tapped more effectively in order for such organizations to survive in a time of industry consolidation. Generative thinking is a tool that can help organizations innovate in order to improve patient care and the financial bottom line.

Generative thinking is …

Lethal injections are not good medicine

Katherine Ellington

Patient

September 29, 2011

Recently, two executions by lethal injections were carried out in America. One ended the life of Troy Davis in Georgia, the other with too much hate Lawrence Russell Brewer in Texas. Death and dying offer complexity and complications in the profession medicine bound by policies, mandates and laws driven by internal (e.g. professional associations, medical boards) and external (e.g. federal, state, medical center) forces.

Lethal injections involve delivering a fatal dose …

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Lethal injections are not good medicine

An MRI for back pain may only confuse the diagnosis

Kerrie M. Reed, MD

Conditions and Diseases

September 29, 2011

“Doc, my back is killing me! I think I need an MRI.”

I don’t know if you’ve ever uttered those words, but I can tell you I’ve sure heard them … more times than I can count. And believe me, I get it. When you’re in pain, all you care about is finding out what’s causing it as soon as possible so you can get rid of it as soon as possible. It’s quite tempting to …

It is a rare medical news story that gets high marks

George Lundberg, MD

Physician

September 29, 2011

Like you, I receive a whole bunch of breaking medical news every day, from television, radio, newspapers, direct mail, email alerts, press releases, and multiple websites.

Is any of it worth my time, my attention, or even a change in my knowledge, attitude, behavior, or medical practice? How can I quickly tell?

A medical journalist from Minnesota named Gary Schwitzer recognized this problem many years ago and created a service that …

Patients generally seek attorneys out of anger rather than greed

Jessica Scott, MD, JD

Patient

September 28, 2011

Patients often pursue litigation simply to obtain information that has not been forthcoming. Research shows that the three things patients want most in the face of medical error are: information about what happened; a sincere apology; and measures to prevent the error from happening to someone else. Financial compensation is lower on the list. Patients generally seek attorneys out of anger rather than greed. When unanticipated adverse outcomes occur, error …

A bride who wants to register at the Mayo Clinic

Meredith Gould, PhD

Patient

September 28, 2011

I’m getting married in November and am not “registered” anywhere. Doing so hadn’t even occurred to me until people started asking, “where are you registered?”

At first, I simply laughed. Dan and I have enough for two households. Now I’m re-thinking the bridal registry thing.

Here comes the under-insured, chronically-ill bride going on two years without primary medical care … and I want to register at the Mayo Clinic.

My bridal registry wish list …

Physicians need to be part of the overall wellness process

Joseph Boffa, DDS, MPH

Health Policy

September 28, 2011

After nearing the brink of political collapse, Congress and the President reached agreement on a plan for deficit reduction. Part of the agreement is that a “super committee”will cut an additional $1.5 trillion from the federal budget. Cuts are being considered for a range of programs, including Medicare. As director of a wellness program for retirees, however, I remain acutely concerned about the impact Medicare cuts will have on …

Doctors with great bedside manner can also provide great clinical care

Davis Liu, MD

Physician

September 28, 2011

The New York Times recently published an article titled, Finding a Quality Doctor, Dr. Danielle Ofri an internist at NYU, laments how she was unable to perform as well as expected in the areas of patient care as it related to diabetes. From a New England Journal of Medicine article, Dr. Ofri notes that her report card showed the following – 33% of patients with diabetes have glycated hemoglobin …

Honesty between doctors and patients goes both ways

Stewart Segal, MD

Physician

September 28, 2011

Yesterday, someone asked me, “Can I be perfectly honest with you?” I wanted to reply, “No, just be dishonest, I like it better that way!” “Can I be” implies that, in past conversations, my patient has been dishonest. Dishonesty is a relationship breaker. Dishonesty leads to distrust and if I cannot trust what a patient is telling me, I cannot be effective; the doctor-patient relationship is terminated.

Am I being too …

Father and son, doctor and grieving family member

Jordan Grumet, MD

Physician

September 28, 2011

The edges of Cameron’s lips rise undeniably toward the clear blue sky. His legs move methodically. One motionless on the scooter and the other periodically kicking to propel himself forward. He weaves in and out dodging my shadow as I jog beside him.

I struggle to keep pace. My breathing unsteady and labored. My joints aching. And my brain foggy from lack of sleep and replaying the events of the day.

***

The …

It is not easy being a patient-consumer, but it can be done

Jeffrey Rice, MD, JD

Patient

September 28, 2011

I would like to share a story about my son’s recent surgery that, while only one simple case, reveals the foundational problem with the U.S. health care system.

I write this story as a father of a 12 year old boy who has cerebral palsy. Jack is fortunate to be healthy and active with minor medical needs. As he has grown he experienced some issues with contractures in his right lower …

If you need to say you’re all about the patient, you aren’t

Sanford C. Sharp, MD

Physician

September 27, 2011

Sir William of Ockham has achieved a degree of mortality via the wide promulgation of an aphorism, now generally known at Occam’s Razor (I’ll use the more economical spelling). There are many iterations of the razor, but my favorite is this: “simpler explanations are, other things being equal, generally better than more complex ones.” That trips off the tongue more easily than, say, “plurality should not be posited without necessity.”

In …

Learning the hard way that there is an art to medicine

Tracy Krulik

Patient

September 27, 2011

In med school budding doctors are told: “When you hear hoof beats, think horse.” The problem is that sometimes when you hear hoof beats, it’s a zebra, and when that “zebra” is a disease, your patient leaves your office misdiagnosed. I’m that patient.

In 1998 I had my first abdominal attack. I vomited for days and walked hunched over like a frail octogenarian. (For reference, I was extremely fit and twenty-seven …

The threats to profit in academic medical centers

Robert Wachter, MD

Health Policy

September 27, 2011

My hospital, UCSF Medical Center, is thriving. Our profits this year will be nearly $200 million. We’re building a sparkling clinical complex – a combined women’s, children’s, and cancer hospital – adjacent to our new downtown biomedical research campus.

We are installing a state-of-the-art computer system. US News & World Report calls us the 7th best hospital in the country. Our students, residents, and fellows have never been better.

Yet angst is in the air, borne …

A hundred shifts in, I have fine tuned my instincts as a physician

Anne K. Merritt, MD

Physician

September 27, 2011

I gather my belongings: stained white coat, stethoscope, pen light, black ballpoint. I stuff the last two granola bars into my canvas bag. I glance at the clock on the microwave, which is three minutes fast.

Twenty-two minutes until my shift begins. One minute before I will lock the door to my apartment.

Precision is critical: ER shifts change fast and blend together, from late nights to early mornings to mid-afternoons. Suns …

How to predict which patients will be hospitalized

Eric Schultz and Andrew Wickerham

Health Policy

September 27, 2011

What’s the most effective way to predict which patients will be hospitalized in the coming year? The Heritage Provider Network, a managed care group in California, hopes to answer this question through its sponsorship of the Heritage Health Prize, a $3 million X Prize-like competition for health care. The contest invites participants to develop a prediction algorithm to identify patients who will spend time in the hospital in …

Doctors can help patients make informed decisions and prevent overtreatment

Davis Liu, MD

Patient

September 26, 2011

There are many tips to saving money on medical costs like asking your doctor only for generic medications, choosing an insurance plan with a high deductible and lower monthly premiums, going to an urgent care or retail clinic rather than the emergency room, and getting prescriptions mailed rather than go to a pharmacy.

How about getting your old medical records and having them reviewed by a primary care doctor? It …

Patient transparency cannot be mandated by a federal agency

Manoj Jain, MD, MPH

Physician

September 26, 2011

Not long ago, when my father was about to undergo a heart procedure, I hinted to the cardiologist, a colleague, that I wanted to be there, too, not just to offer comfort but also to be present for the play-by-play that would lead to a critical decision: whether to open his blocked arteries with a stent or to perform bypass surgery. Draped in an X-ray-shielding body suit over his blue …

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