Why more primary care may not improve health care quality

Health Policy
February 22, 2011

The emphasis on primary care as the “key” to lifting the quality of U.S. healthcare may be exaggerated according to a report by Dartmouth’s Institute for Health Policy & Clinical Practice.

“Primary care forms the bedrock of a well-functioning, effective health care system,” the researchers observe. But– and this is an important caveat- “simply increasing access to primary care, either by boosting the number of primary care physicians in an area …

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Why more primary care may not improve health care quality

ACP: High value, cost conscious care

Physician
February 22, 2011

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

by John Tooker, MD, MBA, MACP

There were two reports from the recent 2011 International Stroke Conference that got my attention.

One report noted the sharp increase in the incidence of strokes in children and young adults.  The second, in the Los Angeles Times (“Mild strokes may …

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ACP: High value, cost conscious care

Medical students should not be liable for malpractice

KevinMD
February 21, 2011

Should medical students receive immunity from malpractice liability?

That’s an interesting question that’s raised in a bill from Arizona.

According to the Arizona Daily Sun,

State lawmakers are moving to keep patients injured by medical students from being able to sue them.

But proponents said that won’t leave victims without recourse.

SB1429, awaiting full Senate action, would spell out that students are not liable for malpractice if they are under the supervision of a …

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Medical students should not be liable for malpractice

How powerful a few words can be in the exam room

Physician
February 21, 2011

Recently, I was reminded of the power of wellness. From the other side. And it came wrapped up in sound. Five words, to be precise.

I was instantly reminded how powerful a few words can be in the exam room.

We all want to feel wellness. The freeing kind, as in the way you feel when towered over by big objects. You know what I mean, the wide open wellness you feel …

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How powerful a few words can be in the exam room

The biggest problem faced by pilots and obstetricians alike is nature

Physician
February 21, 2011

It’s a bit ironic that pilots, the people who spend the most time traveling above the magnificent landscape that is our planet earth, spend very little time appreciating the scenery.

That’s because they are trained to always be on guard for unexpected emergencies. While the passenger in a jumbo jet traversing the continent can admire the majesty of the Rocky Mountains, the desolation of the Great Salt Lake or the endless …

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The biggest problem faced by pilots and obstetricians alike is nature

Every patient is an immigrant in the doctor’s office

Patient
February 21, 2011

One of my favorite conferences is The Conference on Practice Improvement hosted by the  Society of Teachers of Family Medicine (STFM) and American Academy of Family Physicians (AAFP).

For all the upset and negativity there seems to be toward doctors, these family docs are in it — each and every one that I’ve met — for the good of their patients.  And that is why I think every one of them …

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Every patient is an immigrant in the doctor’s office

Exercise to prevent cancer

Conditions and Diseases
February 21, 2011

by Karen Basen-Engquist, PhD

The next time you’re on your couch contemplating whether to watch your favorite sitcom or get up and exercise, remind yourself that being active for at least 30 minutes every day can help reduce your chances of getting certain types of cancer.

Physical activity fights cancer because it reduces body fat, and lowers hormone levels that raise breast and endometrial cancer risks. It also keeps the digestive system …

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Exercise to prevent cancer

Patients do not voluntarily search for health information online

Patient
February 21, 2011

As a marketer it’s important to be able to take a step back and look at the marketing environment from a patients perspective.   Over the last couple of weeks, for example, consumers have read:

  • That up to 40% of all published clinical trial studies may have omitted key information on drug effectiveness and side effects.
  • That long term use of some medications may lead to new health problems.
  • That in order to …

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Patients do not voluntarily search for health information online

Aging is a blessing, a gift to be treasured

Patient
February 20, 2011

I was enjoying lunch at a local café when I overheard one staffer say to another that she was facing her twenty fifth birthday soon. She went on to say, 25 is the last “real” birthday, after that “you’re just getting old”. I had to laugh, since I’m well past that age and holding up. Sure, there are some wrinkles and gray hair to contend with, that’s life.

I remember my …

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Aging is a blessing, a gift to be treasured

Electronic medical records and usability affect implementation

Health Technology
February 20, 2011

by Mark Hendrickson

One sport that really bothers me is Major League Baseball. Why? It seems as though the hard-headed people calling the shots, and games for that matter, would rather keep their pride than make the right call.

Instant replay is no secret. It isn’t a new, untested technology—its been around since the mid 50’s and every professional sports league uses it with game-changing results, except the …

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Electronic medical records and usability affect implementation

Change of culture in a rapidly evolving health care environment

Health Policy
February 19, 2011

When a health system asked me to facilitate a Board discussion on physician alignment and integration on November 12, 2010, I was already committed to giving a keynote on the future of health care for the American Institute of CPAs in Las Vegas on November 11. Although I usually fly Delta or USAir where I have priority frequent flyer status, the only way I could get to the Board meeting …

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Change of culture in a rapidly evolving health care environment

Social medicine and its role in medical school curriculum

Medical Education
February 19, 2011

This semester is coming to an end and we are almost halfway done with first year. I say semester, but technically we use the block system. What’s the block system? Here, it refers to dividing the academic school year into single subject blocks. Instead of taking concurrent, year-long courses, we spend several weeks on one course. For instance, we started off with 5 weeks of only biochemistry, then 8 weeks …

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Social medicine and its role in medical school curriculum

Tragedy of cancer in a small child

Conditions and Diseases
February 18, 2011

The OR was hushed on Friday.

Normally, it is a loud, busy place. The staff and surgeons are almost like a big family; we chat with each other and banter cheerfully with patients to help get their minds off the imminent ordeal of surgery. Chaplains pray with patients and families. Sometimes there are disagreements, as in any workplace. But everyone cares about everyone else.

Because of that caring, it was hushed. Instead …

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Tragedy of cancer in a small child

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US medical education is in moral crisis

Medical Education
February 18, 2011

We recently discussed the plight of young medical faculty.  It appears that their plight is even worse than we imagined.

Recently, an abstract was presented at the Annual  Conference on Research in Medical Education at the Annual Meeting of the Association of American Medical Colleges, in a session entitled, “Your Career is More than Your Specialty.”

The authors described a large survey, of over 5000 faculty at 26 US nationally representative …

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US medical education is in moral crisis

Every American deserves the right to have a death with dignity

Patient
February 18, 2011

My old Canadian friend toxicologist Cliff Walberg was right when he famously said, “there is absolutely no limit to how revolting things can be.”

Remember that. It comes in handy, in addition to strong swear words, when stuff happens.

Case in point: I believe that every American deserves the right to choose to have a death with dignity and as pain-free as medical science and practice can provide.

To achieve that, patients and …

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Every American deserves the right to have a death with dignity

ER and internal medicine docs, arguing over a patient admission

Patient
February 18, 2011

Dr. Erdoc happened to look up when the internist walked into the emergency department.

“Oh no,” he murmured under his breath. The consulting psychiatrist was sitting next to him, typing a note. She looked at him and raised an eyebrow.

“I hoped it wouldn’t be him. Unlike his colleagues, Dr. Internist seems to have a deep loathing for us emergency docs,” Dr. Erdoc explained as he stood up. Dr. Internist was frowning …

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ER and internal medicine docs, arguing over a patient admission

The care was futile, and the patient’s wishes

Physician
February 18, 2011

“We have a patient on a ventilator here who is stable enough to transfer to your ICU, if that’s OK with you.”

This call, coming from the transfer coordinator, is emblematic of an insurance generated “medical care” coverage issue. I am salaried under the patient’s insurance carrier so the insurer wants this patient back under its wing as soon as possible.

The community hospital has been keeping Stella Norris (not her real …

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The care was futile, and the patient’s wishes

Why Watson makes board certification exams obsolete in medicine

KevinMD
February 17, 2011

Like most everyone else, I took a break from my evening chores the past few nights, and watched Jeopardy!

IBM’s super-computer, Watson, was taking on Jeopardy! phenoms Ken Jennings and Brad Rutter.  [SPOILER] The computer won handily.

After watching, I began to study for my upcoming board re-certification exam.

But, then, I wondered.  Why?

In the New York Times, applications for Watson are …

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Why Watson makes board certification exams obsolete in medicine

How medical students should present patients to their attendings

Medical Education
February 17, 2011

I just finished another inpatient service stretch at our community hospital with some great cases and lots of good medicine.  While attending rounds may have changed a lot in the last 40 years as highlighted in a recent Annals of Internal Medicine article, some things have not changed – the focus on medical student presentations during attending rounds.

Students spend hours through their call nights preparing for …

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How medical students should present patients to their attendings

Let Me Down Easy and facing illness and death

Physician
February 17, 2011

Every illness is unique, and every person faces illness in his or her own way.

Anna Deveare Smith, in her one-woman Broadway show “Let Me Down Easy,” slips into the persona of twenty individuals who have faced an aspect of illness or death. In ninety minutes, Deveare Smith takes the audience on an existential scavenger hunt, allowing us to observe, and occasionally pluck, insights from this gathering of individuals.

These individuals do …

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Let Me Down Easy and facing illness and death

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