by Jeffrey L. Cohen
Patient centeredness, fragmentation and value based purchasing are just a few of the terms that are peppered throughout the newly proposed regulations for accountable care organizations (ACOs).
The healthcare reform law established the Medicare Shared Savings Program for Read more…
After the ACO regulations: Accountable care organization answers
It was a dimly lit room, up on the sixth floor. I am not sure why they would not fix the light in that corridor. Even during the day, I would find this area poorly lit.
Maybe it was not the light but the grim atmosphere of oncology floor. Some of the patients there had terminal illnesses but they would still act like they had decades to live. You would be …
Doctors are trained to prevent death, but not deal with death
First do no harm.
Treat every patient with respect and dignity.
These are values I try to live by and incorporate into my daily work. Treatment of chronic pain is the scenario that puts me and every practicing primary care physician in a no-win situation regularly in the office. To try to make physicians feel more comfortable treating pain most states have tried …
Treatment of chronic pain puts doctors in a no win situation
So I’m watching the 6 pm local news last night and see a piece on KARE-11, my local NBC affiliate, about “a new buzzword called ‘cyberchonrdria'” — used to describe people who “Google their symptoms online and then worry over the multitude of results and possible diagnosis …”
But it’s clear from what they posted online that this was not …
Cyberchondria repackaged as new local TV health news
by Dennis Grace
Recognize the title? It’s from Steve Martin’s 1978 stand-up album, Wild and Crazy Guy. Martin lists How to Make Money Off the Mentally Ill as one of the many books he’s written. The joke is supposed to be on Martin himself, inviting us to ask, “What kind of disreputable jerk takes advantage of the mentally ill?”
But it’s just a …
How to make money off the mentally ill
Here’s something little known outside of the small circle of industry marketers, academic docs, PR flacks, and medical journalists: pharmaceutical and device companies (or their PR agencies) regularly offer to arrange interviews with well-known academic physicians to talk about new trials, drug approvals, and other items of obvious interest to the companies involved.
I receive these sort of invitations all …
How academic physicians are being used as live bait for journalists
Accountable Care Organizations (ACOs) have received considerable attention recently, and are the new “hot topic” in healthcare delivery policy circles. They are the latest response to the need to do something to stem the runaway inflation of healthcare costs, while maintaining or improving measurable health care quality.
According to a …
Can ACOs curb health costs and improve quality of care?
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 28-year-old woman has a 3-month history of easy bruising and bleeding gums. She feels otherwise well. Medical and family histories are unremarkable, and she takes no medications.
On physical examination, temperature is normal, blood pressure is 110/70 mm Hg, pulse rate is 64/min, and respiration rate …
MKSAP: 28 year old woman with easy bruising and bleeding gums
In case you have not heard about it, there is a very gut wrenching court case St Louis Park, MN. A doctor in the hospital system is going to court to replace a patient’s wife, Lana Barnes, with a substitute decision maker, claiming that she is making futile and reckless decisions to prolong her near-vegetative husband’s life.
He has …
The futility of prolonging life and the benefit to patients
I read an article in the New York Times that underscores my argument that health care insurance does not and never will equal health care access.
Our federal and state governments are being crushed by debt. There are many reasons for that debt, and addressing the reasons for the debt are a necessary aspect of decreasing the debt. For example, if a family household had overdrawn its checking account by …
Debt prevents health insurance from providing more health care access
Medical guidelines are well on their way to becoming the Law of the Land. Dr. Rich over at The Covert Rationing Blog featured a recent post that highlighted this point.
When a study published in the Journal of the American Medical Association showed that nearly 23% of patients receiving implantable cardioverter-defibrillators (ICDs) received them under circumstances that did not match up with the recommended “guidelines” for doing so, this breach of …
Dangers of strict adherence to clinical guidelines
Skeptical Scalpel writing at KevinMD.com in a post giving some advice to second year medical students nails the problem with medical education on the head:
Rather than forcing [medical students] to memorize information, we should be teaching you how analyze and synthesize it as it relates to your patient.
Our increasingly sophisticated and robust understanding of the pathophysiology of human disease processes coupled with the growth in diagnostic testing power …
Why medical education needs to evolve away from memorization
by Janet Dillione
Are we ready to deliberate on how artificial intelligence will be used in healthcare? While the future role of innovation as part of healthcare is certain, it’s critical that we first focus on achieving what is possible and absolutely necessary today.
There’s been tremendous attention on IBM’s work with Nuance to bring Watson (supercomputer) to healthcare, and rightfully so, it’s a fascinating application of technology. However, …
Artificial intelligence and capturing quality information into your EHR
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It’s strange being on the other side for a change. I remember bringing my son to his first doctor’s appointment. A new mom. No stethoscope around my neck. No patient schedule, replaced instead by the constant grind of breastfeeding.
I knew it was just another routine newborn check for our pediatrician, but every maternal fiber in me believed that my son must be the cutest baby that ever walked through that clinic. …
The relationship between parents and pediatricians
American Medical News published an informative essay by Kevin B. O’Reilly on December 13, 2010, about errors in diagnosis and why doctors make them.
According to Gordon Schiff, MD, associate director of the Center for Patient Safety Research and Practice at Brigham and Women’s Hospital, “The problem of diagnostic errors has gotten short shrift in the broader patient safety movement.” The article focused on …
Diagnostic errors and their role in patient safety
Let me start by confessing I’m something of a gadget freak. I was an early Palm Pilot adopter, loved the iPod from the get-go, and need to avoid CNET, Engadget, Gizmodo, and David Pogue’s columns for the New York Times when deadlines loom.
Not surprisingly, I embraced the shift to electronic medical records (EMRs) enthusiastically. While I acknowledge that sometimes EMRs …
How an EMR can be shockingly inconvenient for prescription refills
Social media is changing how we communicate and how we define “relationship.” I was speaking to someone last week who said to me, “Social media isn’t coming it’s here!” He’s right.
And while many voices in our professional communities are wary about social media, I see positive opportunities at every turn. Here are just 5 ways social media will change …
How social media will change mental health care
by Jeffrey L. Cohen
Healthcare reform used to imply just regulatory change. As time marches on, it also implies market change. Most pundits agree that, whatever happens to the healthcare reform law, whether or not it is found to be unconstitutional, the healthcare business community is unleashed. Change is afoot!
If you follow my naysaying on the …
How primary care will play a central role with health care reform
by Chris Chen
Recently, I stood in the back of a boisterous, packed auditorium as each of our school’s fourth-years received their match letters and proudly announced in front of friends, family, and classmates where they would be headed for residency.
As peers enthusiastically cheered each other, significant …
Why medical students should be passionate about health reform
I woke up in the middle of the night last night and I could not fall back asleep. I had a moment of brilliance laying there in bed. I had discovered a new medical disorder, Wimpy Parent Syndrome (WPS).
For years I have been seeing it in clinical practice, but have been unable to put my finger on exactly what was taking place. Then the idea of WPS came to me and everything …
Wimpy Parent Syndrome, and allowing your child to get mad and cry
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