KevinMD.com

June 27, 2011Jun 27, 20117

It was supposed to be a routine office visit for my patient. Unexpectedly, it turned into a real-world health economics lesson for me, the treating physician. The old adage "listen to your patients; they will always give you the answer"…

It was supposed to be a routine office visit for my patient.

Unexpectedly, it turned into a real-world health economics lesson for me, the treating physician. The old adage “listen to your patients; they will always give you the answer” became exceedingly true in this case, even when it dealt with an issue beyond a medical diagnosis, such as lack of transparency regarding insurance coverage …

Health policy

A transparent process to allocate resources based on evidence

Bob Doherty

June 27, 2011Jun 27, 20113

The New York Times reports on Washington state’s efforts to "to determine which medical devices and procedures Washington will cover for state employees, Medicaid patients and injured workers, about 750,000 people in all." An expert panel, appointed by the state,…

The New York Times reports on Washington state’s efforts to “to determine which medical devices and procedures Washington will cover for state employees, Medicaid patients and injured workers, about 750,000 people in all.”

An expert panel, appointed by the state, is getting national attention, writes the Times, “in part because its process is public and open. . . [and] provides a living laboratory of the complexities of applying evidence-based …

Health policy

Should doctors be scared of government mystery shoppers?

Kevin Pho, MD

June 27, 2011Jun 27, 201182

The government is going to find out about the primary care physician shortage for themselves. They're resorting to "mystery shoppers," used frequently in other industries, to see what the wait times really are for a new primary care doctor. As…

The government is going to find out about the primary care physician shortage for themselves.

They’re resorting to “mystery shoppers,” used frequently in other industries, to see what the wait times really are for a new primary care doctor. As mentioned before, come 2014, there will be over 30 million newly insured patients looking for a doctor. This will further stress a system short of primary care resources.

Doctors, as …

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Health technology

One more thing: Works for Apple, but killed Google Health

Kevin Pho, MD

June 27, 2011Jun 27, 20114

Google Health is dead. There have been plenty of post-mortems as to why, ranging from the fact that it's not social enough (uh ... no), to the realization that only a minority of practices have electronic medical records, yet alone…

Google Health is dead.

There have been plenty of post-mortems as to why, ranging from the fact that it’s not social enough (uh … no), to the realization that only a minority of practices have electronic medical records, yet alone a patient portal that can incorporate PHRs like Google Health.

I’ll chip in with my own reason — it suffered from “one more thing” syndrome.

PHRs today aren’t seamlessly incorporated into …

Patient voices

Closing the communication gap between patients and physicians

Howard Luks, MD

June 27, 2011Jun 27, 20118

I lived in Japan in 1991. When I was having a conversation with someone, they would always nod their head as if they completely understood the message I was trying to convey. It turns out that was not the case.…

I lived in Japan in 1991. When I was having a conversation with someone, they would always nod their head as if they completely understood the message I was trying to convey.

It turns out that was not the case. The nodding was a sign of respect. When I began to inquire if they understood what I was trying to say — it became clear that the answer was usually no.

Many …

Medical education

Reasons why medical students burn out and become depressed

James Haddad

June 27, 2011Jun 27, 201143

As I finished my 24-hour call recently, I was reminded of a 2009 study revealing a decline in empathy as medical students transition from their mostly-didactic second year to third year, which is essentially an apprenticeship in the hospital with lecture as an afterthought. I began my third year with what most would argue is the most difficult rotation, surgery, and my experiences …

Health policy

How doctors can shape the health reform narrative

Maggie Kozel, MD

June 27, 2011Jun 27, 20114

With the roll out of the Affordable Care Act and perhaps more significantly the approach of the 2012 elections, public discussions of healthcare reform has been drowning in an alphabet soup of ACOs (not to be confused with the above…

The challenge is twofold. Most of these plans/systems/agencies deal with how to better pay for a seriously flawed system. …

Conditions and diseases

ACS: The breast cancer screening debate continues

J. Leonard Lichtenfeld, MD

June 27, 2011Jun 27, 20115

I am sitting here wringing my hands that so much has been made of some studies reported recently at a major radiology conference which suggest that the impact of the breast cancer screening guidelines released by the United States Preventive…

Conditions and diseases

MKSAP: 75-year-old man with a draining chronic ulcer on the foot

mksap

June 26, 2011Jun 26, 2011

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 75-year-old man with type 2 diabetes mellitus is evaluated in the emergency department for a draining chronic ulcer on the left foot, erythema,…

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 75-year-old man with type 2 diabetes mellitus is evaluated in the emergency department for a draining chronic ulcer on the left foot, erythema, and fever. Drainage initially began 3 weeks ago. Current medications include metformin and glyburide.

On physical examination, he is not ill appearing. Temperature …

Conditions and diseases

Differences between obstructive and central sleep apnea

Steven Y. Park, MD

June 26, 2011Jun 26, 2011

In sleep disorders, obstructive sleep apnea is the most common condition that’s seen, but a significant number of people with obstructive sleep apnea will also have central sleep apnea. Central sleep apnea is thought to be a condition that’s associated…

In sleep disorders, obstructive sleep apnea is the most common condition that’s seen, but a significant number of people with obstructive sleep apnea will also have central sleep apnea.

Central sleep apnea is thought to be a condition that’s associated with a number of different neurologic problems, as well as heart or kidney failure. During the night, people with central sleep apnea stop breathing when signals in the brain that …

Physician voices

How a day in the emergency department is a microcosm of real life

StorytellERdoc, MD

June 25, 2011Jun 25, 20115

I imagine the world as a vast, boundless frontier weathered by our swirling human emotions and complicated energies--hurricanes of intense heartbreak and tornadoes of joyous, unbridled celebrations, with every weather pattern in between. Sunshine and rain included. If I could…

I imagine the world as a vast, boundless frontier weathered by our swirling human emotions and complicated energies–hurricanes of intense heartbreak and tornadoes of joyous, unbridled celebrations, with every weather pattern in between. Sunshine and rain included.

If I could gather this world, foolishly believing that I could sweep my arms and hands through the unsuspecting air to collect a smaller, more-contained version of reality, I know with absolute sureness that …

Health policy

Team based care in health reform needs patient involvement

Kevin Pho, MD

June 25, 2011Jun 25, 201123

The following op-ed was published on June 7, 2011 in USA Today. More than ever, I find myself fielding questions from patients about the health care reform law. The most common one is, "How will reform affect me?" It's a…

The following op-ed was published on June 7, 2011 in USA Today.

More than ever, I find myself fielding questions from patients about the health care reform law. The most common one is, “How will reform affect me?” It’s a complicated question, with a different answer for each patient. But as the law’s full effects unfold, one of the more significant changes will be in how patients interact with their …

Physician voices

Frustration when a government does not provide the necessary health care

Yann Meunier, MD

June 25, 2011Jun 25, 20113

Year: 1988 Setting: Electricite de France clinic at Daya Bay, China Position: Resident physician A Japanese encephalitis epidemic has struck southern China and I am in its midst at Daya Bay where Electricite de France is building a nuclear plant…

Year: 1988

Setting: Electricite de France clinic at Daya Bay, China
Position: Resident physician

A Japanese encephalitis epidemic has struck southern China and I am in its midst at Daya Bay where Electricite de France is building a nuclear plant for the Chinese government. As the resident physician for the company, I see the local employees and their families. They all get immunized against the disease with the inactivated virus Biken vaccine, …

Physician voices

New fields in general surgery and the rise of the surgical hospitalist

Skeptical Scalpel, MD

June 24, 2011Jun 24, 20116

As medicine adapts to the 21st century, new specialties arise. General surgery is seeing two new fields emerge. One is "Acute Care Surgery," which encompasses three facets of general surgery — emergency surgery, critical care and trauma care. The other…

As medicine adapts to the 21st century, new specialties arise.

General surgery is seeing two new fields emerge. One is “Acute Care Surgery,” which encompasses three facets of general surgery — emergency surgery, critical care and trauma care. The other is the concept of a surgical hospitalist. That is, a surgeon works only in a hospital and has no office or private practice. The idea is similar to the medical …

Physician voices

Doctors are asking whether the physical exam is becoming a lost art

Jan Henderson, PhD

June 24, 2011Jun 24, 201114

The physical exam – looking into the eyes and throat, taking the blood pressure, sounding the chest – is part of the process of medical diagnosis. It’s one way a physician attempts to determine the cause of a patient’s complaint.…

In recent times, doctors have asked themselves whether the physical exam is becoming a lost art. It’s been replaced by an array of laboratory tests and high tech machines that …

Drugs and prescribing

The tragic irony of pharmaceutical coupons

Chris Lillis, MD

June 24, 2011Jun 24, 201132

As a primary care physician in private practice, I have my own little taste of celebrity. Every day attractive people come to my office seeking time to speak with me and collect my autograph. They fawn over my partners and…

As a primary care physician in private practice, I have my own little taste of celebrity.

Every day attractive people come to my office seeking time to speak with me and collect my autograph. They fawn over my partners and I, and bring us food for lunch, and will invite us to the nicest restaurants in town for dinner. These people also used to bring gifts, until they were barred from …

Physician voices

Reasons why your doctor is running late

Emily Gibson, MD

June 24, 2011Jun 24, 201162

It may not be rabbit season or duck season but it definitely seems to be doctor season. Physicians are lined up squarely in the gun sights of the media, government agencies and legislators, our health care industry employers and coworkers,…

It may not be rabbit season or duck season but it definitely seems to be doctor season.

Physicians are lined up squarely in the gun sights of the media, government agencies and legislators, our health care industry employers and coworkers, not to mention our own dissatisfied patients, all happily acquiring hunting licenses in order to trade off taking aim. It’s not enough any more to wear a bullet proof white coat. …

Read more…

Reasons why your doctor is running late

Physician voices

Tips to make the most out of your national medical meeting

Christian Sinclair, MD

June 24, 2011Jun 24, 2011

Here is the latest edition of Handy Hints for a National Meeting. The original version was written in 2005 (editions have been more often than yearly). My first national medical conference was a whirlwind of new ideas and experiences some…

Here is the latest edition of Handy Hints for a National Meeting. The original version was written in 2005 (editions have been more often than yearly).

My first national medical conference was a whirlwind of new ideas and experiences some of which I was not necessarily prepared for.

General

If you are bringing family or a significant other, spend some time with them.
If you don’t bring family or a significant other, leave something nice for

…

Medical education

Resident responsibility at a Level 1 trauma center

Colin Son, MD

June 23, 2011Jun 23, 20114

Debates over resident autonomy are nothing new. Informed patients are sometimes reasonably concerned about just how much responsibility for their care will be delegated to their doctor’s trainees. Care within academic medicine, especially acute inpatient care in a public system, can and does sometimes mean going a whole admission without meeting the attending physician presumably responsible for your care as a patient. At least in my limited experience. This as …

Health policy

Physician consolidation places health reformers in an ironic dilemma

Kevin Pho, MD

June 23, 2011Jun 23, 20117

One of the major efforts of the Affordable Care Act is to consolidate physician groups, so they can be modeled after integrated health systems like the Minnesota's Mayo Clinic or California's Kaiser Permanente. According to health reformers, these integrated systems…

One of the major efforts of the Affordable Care Act is to consolidate physician groups, so they can be modeled after integrated health systems like the Minnesota’s Mayo Clinic or California’s Kaiser Permanente.

According to health reformers, these integrated systems can reduce variation in care, which improves quality, and potentially reduces costs.

There’s been a major effort to re-organize hospitals and physicians under guises of Patient Centered Medical Homes and …

Real physician voices, twice a week

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