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People accuse doctors of not doing enough, or doing too much

Physician

July 28, 2011

Medicine is never an easy field. People accuse doctors of not doing enough, or doing too much.

There are no easy answers. We’re caught between doing what’s best, without putting the patient through too much, and doing what’s needed to protect ourselves from legal action.

Let’s take Mrs. Summer. She’s a nice 78 year-old lady I saw in the office last week.

Earlier this month she hurt her back. So she saw …

Why primary care is due for a renaissance

Dave Chase

Physician

July 28, 2011

At a time when half of primary care doctors say they’d leave medicine if they had an alternative and the NY Times reports on a family physician who can’t give away his practice this hardly seems like the obvious time to claim that primary care is positioned for a renaissance. However, if there’s one thing savvy investors have demonstrated, when everyone says to invest in something that is usually the time to …

Political approaches on how to slow Medicare’s escalating costs

Roger Collier

Health Policy

July 28, 2011

How to slow Medicare’s escalating costs has been the big health care policy issue recently, with Republicans and Democrats offering competing proposals, each part of broader plans for reducing the federal deficit—projected to be $1.5 trillion this year, with the government borrowing 40 cents for every dollar it spends.

Unfortunately, neither the Medicare proposal of Representative Paul Ryan’s House Budget Committee, nor that offered in response by President Obama, can …

How telemedicine helped a stroke patient

Matthew Gibson, MD

Conditions and Diseases

July 28, 2011

My attending doctor (a neurologist) and I were sitting at the nurses’ station discussing a patient who had presented with a seizure when his pager beeped.

“Hold on, I have to call this in”, he said. I listened to snippets of the conversation. “How long has he been like that?” “How far away is the helicopter?” “Alright, let me run to my office and set up my equipment.”

He hung up …

Implications of Nebraska’s ill-conceived fetal pain law

Naomi Freundlich

Health Policy

July 27, 2011

Danielle and Robb Deaver are living proof of the awful reality of Nebraska’s ill-conceived “fetal pain” law. The law, which took effect last October and is the only one of its kind in America, prohibits abortions in the state after the 20th week of pregnancy. It is based on the discredited notion that a fetus may feel pain at that stage of development. Physicians who break the law face …

Celebrity endorsements of prescription drugs

Richard Meyer

Medications

July 27, 2011

Boniva continues to use Sally Field as a celebrity spokesperson for their product but as John Mack pointed out, should any prescription drugs be paying celebrities to endorse their products? Well, according to an Ace Metrix study the answer to that is “probably no.”

The Ace Metrix study found of more than 2,600 ads that celebrity ads do not perform any better than non-celebrity ads and in some case …

How a doctor learned how to suture

Fizzy, MD

Physician

July 27, 2011

One of the skills I really wanted to learn in med school was how to suture. It’s just one of those things that I felt like you’re supposed to know if you’re a doctor. How can you be a doctor if you don’t know how to suture?Anyway, by fourth year of med school, I had totally failed at my goal. I had already done a surgery rotation, but while …

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How a doctor learned how to suture

How secure messaging helps this doctor connect with patients

Jeff Livingston, MD

Health Technology

July 27, 2011

I commented on a blog post recently that cited a recent study called “Secure web messaging between patients and doctors: Not well received.” I was pleased to see that other professionals who left comments had the same reaction I did to the study: it is simply not accurate. I have 4,900 patients and five other physicians in our practice who can attest that secure messaging, when used the …

What is your expectation when you visit a physician?

Paul Dorio, MD

Patient

July 27, 2011

As a physician, and as an interventional radiologist, I consult with many patients. Similar to anyone who sees and talks with many people, I encounter a significant diversity of personality types, cultures and attitudes. One thing I have noticed is that each person has a certain level of expectation regarding their care, illness, and our potential interaction.

I have visited with many people who are simply happy to have someone …

What a hospital can do to be more comfortable for patients

Kathy Kastner

Patient

July 27, 2011

Although filled to the brim with patients, hospitals were created to support doctors, not us patients. Historically, their organizational structure focused on doctors’ needs and doctors’ requirements. The concept of centering hospital care on patient needs and requirements is a relatively recent development.

How can a hospital switch from being provider-centered to patient-centered? Shifting such a complicated and cumbersome behemoth a full 180 degrees is a huge undertaking.

I believe it …

Screening for mental disorders in children and adolescents

Kelly J. Kelleher, MD

Conditions and Diseases

July 27, 2011

For many academics and researchers, the debate is over: The use of mental health screening questionnaires in a routine fashion in primary care offices greatly increases the detection of mental disorders among children and adolescents. With such information, the American Academy of Pediatrics, Bright Futures, the US Preventive Services Task Force and others have weighed in. Screening is the order of the day, at least for adolescent depression. The remaining …

ASCO: Making e-visits work for cancer patients

Douglas Blayney, MD

Patient

July 27, 2011

In early February, my new patient was a middle-aged woman from here in Silicon Valley with a self-discovered 2 cm right breast mass. Her internist was all over this. She quickly had a core needle biopsy, was evaluated by one of our breast surgeons, and was referred to me for an opinion regarding pre-operative (neo-adjuvant) chemotherapy. I saw her …

What is defensive medicine in obstetrics?

Amy Tuteur, MD

Physician

July 26, 2011

Consider the explosion in the rate of C-sections and inductions. They satisfy the requirements of assurance behavior.

Reducing adverse outcomes? Check.
Deterring medical malpractice claims? Check.
Pre-empting liability? Check.

Consider the precipitous decline in the rate of VBAC. That’s avoidance behavior: malpractice insurers have forced providers and hospitals to refuse to participate in VBACs.

There’s an important subtext that undergirds defensive medicine that often goes unrecognized and therefore unanalyzed. Defensive medicine is driven …

Medical schools need to better recognize mental illness in students

Eric Lu

Medical Education

July 26, 2011

At lunch recently, a few of us got into the topic of mental health in medical school. The conversation started when someone brought up the fact that a Harvard College senior and a Harvard Law School student had both recently committed suicide.

We all worried that the medical school wasn’t doing an adequate job caring for students who may be suffering from mental illness. To be fair, University Health Services …

What would an ACO would look like if it was truly patient centered?

Kent Bottles, MD

Health Policy

July 26, 2011

Health care leaders are busy talking to attorneys and consultants about how to set up Accountable Care Organizations (ACOs). A recent Advisory Board survey found that 73 per cent of hospital finance executives said that creating such an organization was a top priority for their health system.

Last year my most popular keynote topic was patient-centered medical home creation; this year everyone wants a presentation on ACOs.

However not …

Perfect is the enemy of good when it comes to work-life balance

gcs15, MD

Physician

July 26, 2011

Over the years, I have come to the painful realization that I am not perfect.

Ok, all you other surgeons, close your eyes and ears, because to admit to being less than perfect is a sign of weakness (like asking for help). Don’t read this, patients, because you wish even more than I do that I were perfect (especially when I’m operating on you). But it’s true.

Long ago, I remember feeling …

Why healthcare is a responsibility, not a right

Mitchell Brooks, MD

Health Policy

July 26, 2011

There is no “right” answer to the healthcare reform issue. There are facts, opinions, myths, politics and reality, all in no particular order of magnitude. Unfortunately, thus far and likely in the future, the reform will be political and thus costly and painful and will not address the core issues involved in fixing the inherent systemic problems.

There have been many things written with regard to this topic and I …

Passing along the cost of health care to consumers won’t save money

Shadowfax, MD

Health Policy

July 26, 2011

Republican budget guru Paul Ryan had a plan to end Medicare as we know it to be replaced with a series of less-generous vouchers. The House of Representatives has voted to implement this plan. The political side of this has been written about a lot, and I am not going to rehash what has been better covered elsewhere. I do want to address what seems to be a persistent …

A medical student’s first day of clinical training started on the bus

Ron Li

Medical Education

July 26, 2011

It happened on a bus on my way to work. I got on and sat in the only available seat, which I quickly realized was next to a disheveled looking man who smelled faintly of urine and had a dry hacking cough that could be heard throughout the entire bus. He was leaning against the window and did not seem to notice me. I was less than pleased with my …

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