KevinMD.com

June 23, 2011Jun 23, 2011

A guest column by the American College of Physicians, exclusive to KevinMD.com. by John Tooker, MD, MBA, MACP Recently, I commented on cost saving, quality, and care coordination requirements in the proposed rule that physician practices will likely need to…

A guest column by the American College of Physicians, exclusive to KevinMD.com.

by John Tooker, MD, MBA, MACP

Recently, I commented on cost saving, quality, and care coordination requirements in the proposed rule that physician practices will likely need to meet to be eligible for additional Medicare payments.

The public comment period on the proposed rule for the creation of ACOs has ended. CMS has pledged it will …

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ACP: ACOs – On to the final rule

Drugs and prescribing

Bias in top tier academic journals

Derek Lowe, PhD

June 23, 2011Jun 23, 20116

Venture-capital guy Bruce Booth has a provocative post, based on experience, about how reproducible those papers are that make you say, "Someone should try to start a company around that stuff": The unspoken rule is that at least 50% of…

Venture-capital guy Bruce Booth has a provocative post, based on experience, about how reproducible those papers are that make you say, “Someone should try to start a company around that stuff”:

The unspoken rule is that at least 50% of the studies published even in top tier academic journals – Science, Nature, Cell, PNAS, etc… – can’t be repeated with the same conclusions by an industrial lab. In

…

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Bias in top tier academic journals

Health policy

2 changes to cut Federal health care expenditures

Joseph Paduda

June 23, 2011Jun 23, 20118

If we're serious about cutting Federal health care expenditures over the long term, here are two changes that will do just that. 1. Requiring HHS to negotiate with pharma for Part D drug costs would reduce annual expenditures by over…

If we’re serious about cutting Federal health care expenditures over the long term, here are two changes that will do just that.

1. Requiring HHS to negotiate with pharma for Part D drug costs would reduce annual expenditures by over $20 billion.

As I’ve noted repeatedly(but unfortunately few in the mass media have), Part D’s perhaps the biggest deficit problem we have – the ultimate unfunded liability is now over $20 trillion. …

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Drugs and prescribing

The future of vaccines for infectious diseases

Stephen C. Schimpff, MD

June 23, 2011Jun 23, 20116

In concert with sanitation and clean water supplies, vaccination has been the most cost effective means of preventing infectious diseases. Most vaccines have been inexpensive, easy to administer (albeit objected to by the recipient’s arm!), safe and effective. From when…

In concert with sanitation and clean water supplies, vaccination has been the most cost effective means of preventing infectious diseases.

Most vaccines have been inexpensive, easy to administer (albeit objected to by the recipient’s arm!), safe and effective. From when I was a child until today the number of new vaccines has multiplied dramatically. This will only continue at an accelerated pace in the coming years. In the future many …

Medical education

Matters of the heart

Katherine Ellington

June 23, 2011Jun 23, 2011

She whispered to me with bulging eyes of urgency, "something is not right, I’ve been in pain all night." Her chief complaint was chest pain. She had a routine work-up and some care with little relief. The news came that…

She whispered to me with bulging eyes of urgency, “something is not right, I’ve been in pain all night.”

Her chief complaint was chest pain. She had a routine work-up and some care with little relief. The news came that all of her test results were normal. Her body appeared tense, she looked panicked and afraid. At bedside, the attending suggested endoscopy offering that her pain …

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Matters of the heart

Physician voices

Why the annual physical exam is essential to both doctors and patients

Steven Reznick, MD

June 22, 2011Jun 22, 201143

I have listened to health economists debate the value of an annual physical exam. Is it cost effective? Does it prevent disease? It doesn’t matter. It is an essential part of the development and continuation of the doctor patient relationship.…

The annual physical exam is a form of benchmarking. It allows the doctor and patient to review all the pertinent aspects of your health history …

Health policy

A new organization for primary care

Paul Fischer, MD

June 22, 2011Jun 22, 201119

Recently, the Board of the American Academy of Family Physicians (AAFP) announced that, for now, it would continue participating in the Relative Value Scale Update Committee (RUC), the secretive American Medical Association committee that, through a longstanding relationship with the…

At nearly the same time, Medicare announced that it will go broke in 2024, a decade sooner …

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A new organization for primary care

Physician voices

Difficult testing decisions for parents with premature babies

Jennifer Gunter, MD

June 22, 2011Jun 22, 2011

Many people think that tests (blood work, x-rays, scans, etc.) mean their doctor is doing something constructive and working hard to figure out what is wrong. But tests are a double-edged sword. When I trained most diagnoses were derived from…

Many people think that tests (blood work, x-rays, scans, etc.) mean their doctor is doing something constructive and working hard to figure out what is wrong. But tests are a double-edged sword.

When I trained most diagnoses were derived from careful history and a physical exam. Perhaps because our province did not have funds to have enough CT scanners and we didn’t have an MRI, those tests were on a …

Health policy

5 strategic tools to solve our healthcare woes

Joe Flower

June 22, 2011Jun 22, 20114

It’s getting scary. We are facing, before the end of this decade, a bifurcated future. The way things are going now—with the economy wheezing, doctors bailing, chronic disease rising fast, boomers sliding out of the Viagra years into the Depends…

It’s getting scary.

We are facing, before the end of this decade, a bifurcated future. The way things are going now—with the economy wheezing, doctors bailing, chronic disease rising fast, boomers sliding out of the Viagra years into the Depends years, reimbursements getting squeezed ever tighter, Medicaid sputtering on fumes, and 30 million or more new people soon swarming our doors with insurance cards—if we don’t pull a rabbit out …

Medical education

A medical student doing clinical rotations at the VA

Jessica Gold

June 22, 2011Jun 22, 20112

I do my clinical training at the VA. It is an interesting population because the people are all pretty similar (this will likely change as the army changes, but for now, its just a lot of old guys, and a…

In our last few weeks, we finally switched to doing histories and physicals on patients (this really just means that we …

Patient voices

Using video games to fight childhood obesity

Ricky Choi, MD

June 22, 2011Jun 22, 2011

"I don't study because it gets in the way of my video game time" -15 year old patient. Sorry mom and dad, video games are here to stay. In my clinic, this is a topic of discussion every day: "How…

“I don’t study because it gets in the way of my video game time”

-15 year old patient.

Sorry mom and dad, video games are here to stay. In my clinic, this is a topic of discussion every day:

“How many hours of screen time does Mikey get every day?” I ask.
“Tell the truth”, Mom says looking at Mikey.
“brmfbr mbbrm,” says Mikey looking away.
Mother turns to me with the familiar look that

…

Patient voices

Make the most of the time spent with a doctor to minimize patient frustration

Melanie Lane, MD

June 22, 2011Jun 22, 20114

A lot of people express frustration when visiting their doctor’s office. They don’t feel they are listened to, cared about, or have their issues adequately addressed. If this sounds familiar, it could be that your doctor is evil, or what’s…

Due to decreasing reimbursement and increasing expenses, many doctors are forced to see more patients just to keep their …

Patient voices

When TV news departments partner with local medical centers

Gary Schwitzer

June 21, 2011Jun 21, 2011

It's not a new phenomenon. In fact, it's troubling how old and widespread it is. But when TV news departments partner with, and sell news time to local medical centers, you can take the Radio-Television Digital News Association's code of…

It’s not a new phenomenon. In fact, it’s troubling how old and widespread it is.

But when TV news departments partner with, and sell news time to local medical centers, you can take the Radio-Television Digital News Association’s code of ethics and throw it out the window.

Blythe Bernhard reports in the St. Louis Post-Dispatch: “In St. Louis, the latest media/hospital partnership is a campaign from Barnes-Jewish Hospital and local …

Physician voices

Why physicians are not wealthy

Michael Zhuang

June 21, 2011Jun 21, 201123

"Money talks. Mine just says goodbye." A physician client of mine once grumbled to me. He is in good company. Physicians by and large, are horrible wealth accumulators. Thomas Stanley, author of The Millionaire Next Door, found that among all…

“Money talks. Mine just says goodbye.” A physician client of mine once grumbled to me. He is in good company.

Physicians by and large, are horrible wealth accumulators. Thomas Stanley, author of The Millionaire Next Door, found that among all high income groups, physicians have the lowest tendency to accumulate substantial wealth.

This finding is not at all surprising to me. My wealth management practice focuses on physicians, so I’ve seen …

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Why physicians are not wealthy

Physician voices

Hospitalists should limit the number of patients they see

S. Irfan Ali, MD

June 21, 2011Jun 21, 20112

I was talking to a fellow physician and he inquired, "how many patients do you see in a day?" I said, "maybe around 20." He smirked and replied, "20 only! I can see around 40 in a day and still…

I was talking to a fellow physician and he inquired, “how many patients do you see in a day?” I said, “maybe around 20.”

He smirked and replied, “20 only! I can see around 40 in a day and still have time to hit some balls.” There is something fishy here at Smallville.

A few years ago I used to work for this company. I had no option but to see a …

Conditions and diseases

Explaining how an EKG works

Edward Pullen, MD

June 21, 2011Jun 21, 2011

What is an EKG? EKG stands for electrocardiogram. It should probably and sometimes is abbreviated ECG, but EKG seems to have stuck as more popular. Scientists have known for over 120 years that the heart gives off electrical currents when…

What is an EKG?

EKG stands for electrocardiogram. It should probably and sometimes is abbreviated ECG, but EKG seems to have stuck as more popular.

Scientists have known for over 120 years that the heart gives off electrical currents when it beats, but it was the Dutch scientist Willem Einthoven in the early 20^th century who discovered the nature of this phenomenon and who developed the electrocardiogram as a tool to …

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Explaining how an EKG works

Physician voices

Medical practice career choices commonly become medical business failures

Curtis G. Graham, MD

June 21, 2011Jun 21, 201115

Never in the history of medicine have doctors faced such a ruthless gauntlet of threats, financial debts, and practice restrictions than they do today. These factors, among others just as crucial, don’t begin to tell the story about why 40% of medical doctors readily admit to intense frustration in their practices, in addition to the percentage of doctors quitting medical practice completely.

They’re not retiring. They’re adapting. Extended hours to see …

Physician voices

How physicians should deal with angry patients

Steve Wilkins, MPH

June 21, 2011Jun 21, 201119

I highly recommend you take a look at "10 Dumb things you do at the doc’s office." Be sure to scan the article, but what you really need to look at is the comments, all 700+ of them. While by…

I highly recommend you take a look at “10 Dumb things you do at the doc’s office.” Be sure to scan the article, but what you really need to look at is the comments, all 700+ of them.

While by no means a representative sample of how we think about physicians, there is a clear pattern to the comments. A lot of people feel disrespected by their doctors, …

Physician voices

Shifting procedural work to midlevel providers

Janice Boughton, MD

June 21, 2011Jun 21, 201113

It is entirely clear that too few medical graduates go into primary care. Although the number of family physicians is increasing modestly, there are very few internal medicine residents becoming primary care doctors. This year there will be only about…

It is entirely clear that too few medical graduates go into primary care.

Although the number of family physicians is increasing modestly, there are very few internal medicine residents becoming primary care doctors. This year there will be only about 200 new internal medicine doctors entering the workforce from training programs, which will not even begin to cover the attrition of older and more efficient physicians, and due to improvements …

Real physician voices, twice a week

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