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How a family conference affects the decision for surgery

Kevin

Physician

April 29, 2011

by Chris Porter, MD

“Treat your patients as you would your own loved ones,” is advice taught throughout training in health care.

Great advice. I use it constantly. Mr. Davis is dying of multiple organ failure in the ICU after exploratory abdominal surgery. His siblings and children trickle in from Florida and Montana.

I’m always sorry for the last to arrive, who visits his dying brother’s bedside minutes before …

How a patient’s organs could live on and be life saving to a recipient

Jim deMaine, MD

Patient

April 28, 2011

Sam was late and Ella was furious. “Now why isn’t that man back by now? He knows it’s time to leave for church.”

The hours began to pass and Ella became frightened. Sam had gone out for his usual two mile run and had simply disappeared. Ella called friends and neighbors but no one had seen him. Panic began to set in so Ella called 911 who connected her to the …

Why depression continues to go undiagnosed and untreated in primary care

Steve Wilkins, MPH

Conditions and Diseases

April 28, 2011

What medical condition is the most costly to employers? I’ll give you a hint. It is also a medical condition that is likely to go unrecognized and undiagnosed by primary care physicians.

If you guessed depression you are correct. If you mentioned obesity you get a gold star since that comes in right behind depression for both …

Social workers can reduce preventable readmissions

Vineet Arora, MD

Physician

April 28, 2011

I just finished another 2 weeks on service. This time, I had also had a shadower, but one of a different kind. As part of our Institute for Healthcare Improvement (IHI) Open School, we are making an effort to have collaborative learning opportunities for our medicine and health administration program students. Achieving true interprofessional learning is challenging for schools like ours without …

Alcohol does not discriminate when it destroys the human body

The American Doctor, MD

Physician

April 28, 2011

There was a time when Herb was living the American dream in the sunny state of California. He was married with 2 children, a big house in the suburbs, a golden Labrador retriever, and a well-paying job as an executive in a book publishing company.

His two sons were stellar athletes and students, both moving on to attend nationally ranked colleges upon graduation from high school. They were the pride and joy …

How doctors can use Facebook responsibly

Kevin Pho, MD

KevinMD

April 28, 2011

I was quoted recently in the New York Times’ Well blog, in a Danielle Ofri piece on Facebook and doctors.

There’s no question that Facebook has been a minefield of sorts for the medical professions, with infractions ranging from unprofessional conduct by medical students to patient privacy violations by attending physicians.

One solution would be for doctors to simply avoid …

9 websites that savvy medical practices use

Rosemarie Nelson

Physician

April 28, 2011

It’s easy to get caught in the surf on the Web. But plug these URLs into your browser and explore some simple tools that can help not only keep your practice above water but help it ride high.

www.digitalassent.com

Digital Assent automates the patient intake process with a PatientPad instead of the clipboard and an online tool for advance registration. It does integrate with EMR systems, but it provides another strong operational …

Health advocacy organizations and the lack of transparency

Kevin

Medications

April 28, 2011

by Patrick Fitzgerald, MPH

Health advocacy organizations (HAOs) are typically organizations of prominent, trusted stakeholders who conduct campaigns to promote disease awareness, update members to new diagnostic tests and drugs, facilitate physician referrals, deliver health care services, and advocate for policies believed to be in their member’s best interest.

They range in size from national organizations with many thousands of members focused on widespread disease to smaller …

The advance directive is only a part of end of life decision making

Richard N. Fogoros, MD

Physician

April 27, 2011

On January 1, the White House announced a new policy that would have paid doctors for discussing end-of-life planning during their Medicare patients’ annual wellness visit.

Under this policy, physicians would be paid to encourage their patients to establish an advance directive, which would guide medical care if the patient became incapacitated from illness, and could …

Advances coming in medical science that will have a high impact

Stephen C. Schimpff, MD

Physician

April 27, 2011

There are a series of medical megatrends outlined in my book The Future of Medicine – Megatrends in Healthcare that will profoundly affect health care in the coming five to fifteen years and beyond. Some are due to the explosion of basic understandings of cellular and molecular biology. Others are related to advances in engineering and computer science. Here is a very brief overview.

These are the megatrends in medical …

When money gets involved, good medical ideas suffer

Dr. Martin Young

Health Technology

April 27, 2011

I read an interesting link via Reuters about how students have developed a smart phone application with a microscope attachment to diagnose malaria.

The article shows a picture of a child at risk somewhere in Africa.

This is a great idea, and one that can go a long way to help people who really need it. But the last word from the project’s software engineer in the article was the one that was …

A physician assistant writes to the doctors of America

David Mittman, PA

Physician

April 27, 2011

I’m a physician assistant, having graduated from PA school over thirty-six years ago. There is angst in my profession, but many PAs don’t openly voice it. I felt compelled to write to you because I still believe in my profession, and I believe in yours, as well. Sometimes I think it might be time to embrace a new belief system. …

Should a hospitalist be given more information on hospital costs?

David Williams

Physician

April 27, 2011

In Today’s Hospitalist, Jeremy Graham, DO discusses implications of research he’s published about hospitalists and costs: How much is that bed on the ward? Hospitalists are clueless about patient charges.

Not surprisingly, hospitalists, like almost everyone in the hospital, have no idea what anything costs.

That’s no real shock, as Graham points out:

It’s often hard for hospitalists to know these charges, …

Read more…

Should a hospitalist be given more information on hospital costs?

An ACO must make the patient experience meaningful

Patricia Salber, MD

Health Policy

April 26, 2011

Accountable Care Organizations (ACOs) are supposed to be provider-led (physician groups +/- hospitals) and, they are supposed to inject a new accountability, at the provider level, for the value of services delivered.

You know the old equation. Value=Quality/Cost. Those of us inside the health policy “beltway” know this mantra well. We have been talking about it for years (decades, really).

I spent almost …

The exhaustion of emergency physicians, and its toll on patients and family

Jessica Freedman, MD

Physician

April 26, 2011

When I advise students about how to choose a specialty, I suggest that they seek out advice from physicians who are at least 10 years out of residency and leading the type of life they hope to have in the future.

It is difficult, and perhaps impossible, to anticipate in your late 20s or early 30s what practicing a certain specialty will be like when you are 40, 50, or 60.

Find …

How to be heard by your psychiatrist

Dheeraj Raina, MD

Patient

April 26, 2011

How do I get my concerns heard about the direction of my treatment?

On the surface, it seems easy. Just tell your psychiatrist what you want him to pay attention to.

On the other hand, there are many reasons why it not so simple.

Many psychiatrists diagnose a patient’s illness after a 45-50 minute interview, without doing any tests to rule out potential medical causes of …
Read more…

How to be heard by your psychiatrist

Arm amputation from a rare sarcoma

Felicity Billings, MD

Patient

April 25, 2011

Harold was 51 years old and needed his left arm amputated. A year ago he noticed some swelling in his forearm and went to his primary care doctor.

An MRI showed something. It was small and hard to define, hard to categorize, probably a collection of blood, but there was an outside chance it could be a sarcoma, a tumor originating from muscle …

Read more…

Arm amputation from a rare sarcoma

A moral imperative to address the costs of training our doctors

Kevin

Medical Education

April 25, 2011

by Andrew M. Ibrahim and John A. Brockman

Despite the landmark progress of recent healthcare reform, it missed the mark on long term cost control by failing to address medical education.

Radical changes are needed in the way we finance tuition and how we teach our students.

While last month a new graduating class of medical students celebrated their Read more…

A moral imperative to address the costs of training our doctors

A medical malpractice system that reduces errors and improves quality

Kevin Pho, MD

KevinMD

April 25, 2011

The Affordable Care Act does very little to reform the medical malpractice system.

It only allocates $50 million to various pilot projects around the country.

A recent piece in the New England Journal of Medicine provides more detail. It appears that, instead of capping non-economic damages, many of the projects have a quality …

How to discharge a patient from your practice

Adam Alpers, DO

Patient

April 25, 2011

Occasionally, you may encounter patients who you no longer wish to treat. Reasons for ending the physician-patient relationship may include chronic non-compliance, rudeness to office staff, or non-payment of bills.

While these patient behaviors can affect the interactive care-giving process, they may also identify patients with a propensity to file a claim against you. To help reduce the risk …

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