I’m sorry, Mrs. Lewis, for not making it to the hospital to see you yesterday.
Yesterday was one of those days when I felt like I could never catch up. My wife was going downtown for work, and we had to get up early. While she prepared, I helped my two-year-old son get dressed. We walked my wife to the train, then waited for the nanny. She was running late: I …
An apology to a terminal patient with colon cancer
by Sam Wainwright
There’s a fascinating blog post over at the New York Times math blog that has the health policy program here at New America scratching our heads, sharpening our No. 2 pencils, and dusting off our calculators.
Turns out, German mathematicians have been studying how and why the human brain seems to struggle with comprehending risk. We find it difficult to translate the …
Why the human brain seems to struggle with comprehending risk
July is the month that new resident physicians begin their training all across the United States.
Our future family physicians and pediatricians, neurosurgeons and emergency physicians, plastic surgeons and laser tattoo removal specialists (ok, not really a specialty, just a side-line) will begin learning how to be physicians, having completed four years of expensive college and four years of even more expensive medical school.
Anxiety-filled and debt-ridden, they will embark on …
Practical tips for new July resident physicians
Meet Elaine.
We lost touch for a while, but caught up with each other recently.
Like most girlfriends, we shared adventures of love, travel, and work. I told Elaine that I left assembly-line medicine. Now I host town hall meetings-inspiring citizens nationwide to design ideal clinics and hospitals.
Elaine shared: “If I’m kept waiting, I bill the doctor. At the twenty-minute mark, I politely tell …
Patients who bill their doctor for being late
The creation of consumer-driven health plans (CDHPs), health insurance policies with high deductibles linked to a savings option and with more financial responsibility shouldered by patients and employees and less by employers, was completely inevitable.
The American public likes to have everything, whether consumer electronics or other services, as cheap as possible. With escalating health care expenses rising far more rapidly than wages or inflation, it’s not surprising employers …
Consumer driven health care will only shift costs if implemented poorly
American health care information technology is undergoing two enormous leaps.
First, it is moving onto Web-based and mobile platforms – which are less expensive and facilitate information exchange – and away from client-server enterprise-centric technologies, which are more expensive and have limited interoperability. In addition, more EHR development activity is headed into the cloud, driven by large consumer-based firms with the technological depth to take it there. Both these trends …
How might we think about EHRs globally while acting locally?
It strikes me that in developing payment reform related, compensation driven cost-containment strategies aimed at constraining the cost of emergency care, policy makers, emergency physicians, and health insurers should adhere to certain principles.
The American College of Emergency Physicians should be at the forefront when it comes to establishing these principles, which I hope will be focused on protecting our patients first, and our specialty second.
The concept and practice of …
Cost containment strategies for emergency care
I bet you didn’t know that the war for independence is being fought on a daily basis throughout our glorious country. From the time we are born until the time we die, each of us strives to assert our independence. Once the toddler learns to run, he insists on running wherever he wants to. As he ages, we foster his need to be independent and teach him …
When the parent becomes child and child becomes parent
Although Jack Kevorkian was only a few years older than I was, and we both practiced pathology in southern California for many of the same years, I never met Dr. Kevorkian.
I found him from a distance to be a deeply odd character, and a profoundly flawed messenger but with a profoundly correct message.
I can’t improve on the quick summary of Jack Kevorkian by an unnamed author that the New …
Why Jack Kevorkian had a profoundly correct message
Brenda Bryant learned she had breast cancer while she was sitting alone in her car in the parking lot of her grandson’s day care center. It was early evening on a Friday two years ago, and her surgeon called to tell her the results of a biopsy. “He just gave me my results and that was it,” says Bryant, who lives in Northern Virginia. “It was like there was …
Use the National Cancer Institute’s Cancer Information Service
Much is being written about the ever increasing cost of health care in the US, especially compared to the rest of the developed world.
As a nation, we spend nearly 16% of our GDP on health care. All estimates predict that this amount will continue increasing unless costs can be controlled now. Hence the passage of the Affordable Care Act. Not only was it designed to extend coverage to more …
Cost of care is related to the advancements in medicine
Three recent studies point to the continued presence and increasing importance of genomic information to improving health care.
We have discussed the power of personalized medicine in multiple posts and highlighted the potential of genomics and though this movement is really still in its infancy it is a burgeoning component of medicine.
The first study, published in the American Journal of Gastroenterology, explores Helicobacter pylori, a common …
Using genomic data to understand disease entities
A major megatrend in medicine will be the use of vaccines to prevent or treat (non infectious) chronic illnesses.
Although we tend to think of vaccines for preventing infections there are now two vaccines that prevent cancer (via preventing the infections that are in part causative), one vaccine on the market to treat residual cancer and many vaccines in development to prevent or treat other cancers …
Vaccines to prevent or treat non-infectious chronic illnesses
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Do doctors have any business asking patients about whether or not they own a handgun?
Like many other paternalistic inquiries with which doctors routinely harass their patients (car seats, bicycle helmets, smoke alarms, etc), my answer to this question is “no.’”
There is a fairly well delineated sphere of knowledge which is medical in nature and in which I have some expertise and other topics which are purely personal, moral, or lifestyle considerations and in …
Why HB 155 undermines the trust doctors have with patients
Everyone liked him. Though his later years (the only ones in which I knew him) took away his ability to do most things, and though he was in great pain every day, it was easy to see the mischief in his eyes. The subtle humor was still there, coming out of a man who was weak, in pain, dying.
She lived for him. She was always telling me of his pain, …
Death is inevitable, but it is almost always seen as tragic
by Barry Massie, MD
It’s not that I am fixated on death, but recently, the CMS (Medicare) has decided not to pay for discussions with patients about prognosis and planning end of life care.
Reimbursement for such discussions was a key aspect of the health care reform legislation passed this year, and was widely mischaracterized as establishing “death panels.” I cannot imagine a legitimate justification …
Not engaging in end of life discussions is grounds for malpractice
The following op-ed was published on June 1st, 2011 in the New York Times’ Room for Debate blog.
Medicare should stop paying for prostate cancer screening in men over the age of 75.
You may be surprised to hear that, especially coming from a primary care doctor. But evidence is mounting that screening for prostate cancer is not only ineffective in older men, but may actually be harmful.
The cornerstone of …
Medicare should stop paying for prostate cancer screening in men over age 75
The interaction of humans and technology will always be unpredictable. A few months ago this thought was driven home to me in a rather malodorous manner.
I have obstructive sleep apnea (OSA) and use a CPAP machine every night to sleep comfortably. With OSA your airway collapses when you fall asleep. A CPAP machine is a small technological marvel, quietly delivering heated, humidified air under gentle pressure through a …
Medicine and the examples of unintended effects of technology
The issue of social media being used by the pharmaceutical and health care industry has raised a variety of concerns from consumer groups and industry critics. Most recently, several consumer groups filed a complaint with the Federal Trade Commission (FTC) alleging that the pharmaceutical industry’s use of social media was deceptive and unfair.
Consequently, a recent article in the New England Journal of Medicine also covered the issue of social …
The FDA needs to issue guidance on the use of social media
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 69-year-old woman is evaluated for a 5-day history of pain and swelling in the right knee that developed after a prolonged period of gardening in her backyard. Her pain worsens when she walks and is relieved with rest. She has no morning stiffness.
On physical examination, …
MKSAP: 69-year-old woman with pain and swelling in the knee
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