KevinMD.com

July 27, 2011Jul 27, 20119

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…

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 …

Patient voices

What is your expectation when you visit a physician?

Paul Dorio, MD

July 27, 2011Jul 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 …

Patient voices

What a hospital can do to be more comfortable for patients

Kathy Kastner

July 27, 2011Jul 27, 201110

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…

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 …

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Conditions and diseases

Screening for mental disorders in children and adolescents

Kelly J. Kelleher, MD

July 27, 2011Jul 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 …

Patient voices

ASCO: Making e-visits work for cancer patients

Douglas Blayney, MD

July 27, 2011Jul 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 …

Physician voices

What is defensive medicine in obstetrics?

Amy Tuteur, MD

July 26, 2011Jul 26, 20113

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…

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 education

Medical schools need to better recognize mental illness in students

Eric Lu

July 26, 2011Jul 26, 20112

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…

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 …

Health policy

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

Kent Bottles, MD

July 26, 2011Jul 26, 20114

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…

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

However not

…

Physician voices

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

gcs15, MD

July 26, 2011Jul 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…

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 …

Health policy

Why healthcare is a responsibility, not a right

Mitchell Brooks, MD

July 26, 2011Jul 26, 201134

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…

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 …

Health policy

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

Shadowfax, MD

July 26, 2011Jul 26, 20118

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 …

Medical education

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

Ron Li

July 26, 2011Jul 26, 20113

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…

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 …

Physician voices

How to be a star intern, from a former nurse

Albinoblackbear

July 26, 2011Jul 26, 20113

This is another installment on how to ingratiate yourself with your new colleagues as a freshly minted MD intern (or medical student, for that matter). These are just observations on behavior that nurses tend to notice, which can really make a difference on how you’ll be received. I hope some of my suggestions are helpful in making you appear like the Star Intern that you know you are.

Introduce yourself. There is …

Physician voices

If I could pick patients, they would be Native American Guatemalans

Chris Porter, MD

July 25, 2011Jul 25, 201110

Spent a sweaty week operating in a hilltop Hospital Nacional in Guatemala a while back. A patient gave me a hat in thanks for her surgery. It’s a full-brimmed canvas safari number – I’m sure Hemingway shot a rhino in…

Spent a sweaty week operating in a hilltop Hospital Nacional in Guatemala a while back.

A patient gave me a hat in thanks for her surgery. It’s a full-brimmed canvas safari number – I’m sure Hemingway shot a rhino in one. I’m just mature enough now to value sun protection and always grateful, sometimes to the point of pain, for gifts from those who have almost nothing. I was also …

Patient voices

Can health coaches help fix our healthcare system?

Monique Brouillette

July 25, 2011Jul 25, 20114

Simply put, habits are hard to break and bad habits like smoking, drinking, sedentary lifestyle and overeating are making our population sick. Who in the healthcare system can tackle these issues before they manifest into chronic disease? Doctors are trained…

Doctors are trained to diagnose and treat, but they aren’t trained to help people change their behavior, nor should they be since most physicians, particularly general practitioners, are already severely overloaded. Nurses provide …

Health policy

Executive compensation and the rising cost of health care

Roy Poses, MD

July 25, 2011Jul 25, 20117

The revelations about the huge golden parachute given the outgoing CEO of ostensibly non-profit Massachusetts Blue Cross Blue Shield induced some public discussion about the disconnect between executive compensation and the mission of health care organizations. First, new proxy statements…

First, new proxy statements revealed the compensation of executives of two large for-profit health care insurers/managed care companies.

Cigna

As reported by the AP, via ABC News, the CEO got a big raise:

Cigna Corp. CEO David

…

Physician voices

Are psychiatrists rushed, uncaring, and in it only for the money?

Dinah Miller, MD

July 25, 2011Jul 25, 20113

Perhaps you've heard the news: psychiatrists no longer have time to listen to their patients. It's all about writing prescriptions for medications and the days of "tell me about your mother" are long gone, or so we're told. The current…

Perhaps you’ve heard the news: psychiatrists no longer have time to listen to their patients. It’s all about writing prescriptions for medications and the days of “tell me about your mother” are long gone, or so we’re told. The current perception is that large volume practices where patients are seen in a matter of minutes are now standard and acceptable in psychiatry; that it’s how many — if not …

Health policy

Policy makers aren’t doctors, and why that’s a problem

Stewart Segal, MD

July 25, 2011Jul 25, 201110

Sometimes you just don't want to be right. Over the past 5 years, I have seen an alarming pattern arise in my profession. Many of my patients have heard me talk about Soylent Green, an old Charleton Heston movie. The…

Sometimes you just don’t want to be right. Over the past 5 years, I have seen an alarming pattern arise in my profession. Many of my patients have heard me talk about Soylent Green, an old Charleton Heston movie. The premise of the movie seems absurd. Can you imagine the government of the United States providing for all the needs of its people including healthcare, food, clothing, and even death?

David …

Physician voices

Being a primary care doctor is an utter privilege

Wendy Sue Swanson, MD

July 25, 2011Jul 25, 20114

Being a primary care doctor is an utter privilege. Think of this post as part proclamation and part journal entry. Yesterday afternoon I sent out this tweet: It was a spontaneous tweet in the middle of my 15 minute "lunch…

Being a primary care doctor is an utter privilege. Think of this post as part proclamation and part journal entry.

Yesterday afternoon I sent out this tweet:

It was a spontaneous tweet in the middle of my 15 minute “lunch break” when I realized I still had hours to go in my clinical day. The motive was incredulity, not remorse or a …

Physician voices

Why receptionists are integral to the health care team

Kevin Pho, MD

July 25, 2011Jul 25, 20112

Health care is a team sport, and one of the most important members is the office receptionist. Receptionists are often the first people patients see when the visit the clinic. And those first impressions count. In a recent piece from…

Health care is a team sport, and one of the most important members is the office receptionist.

Receptionists are often the first people patients see when the visit the clinic. And those first impressions count.

In a recent piece from the New York Times, Pauline Chen notes a study of the responsibilities of the medical receptionist, and finds they impact …

Real physician voices, twice a week

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