Recently, I spent a few days in California when both my parents ended up in the hospital with different issues. They’re home, settled and doing well at this point.
Just as when I first wrote about experiencing healthcare with my family, there are important lessons to learn about this trip.
As we strive to achieve meaningful use and create health information exchange in the US, the …
Medication lists need to be shared in a meaningful way
‘Tis the season for upper respiratory infections, and since I couldn’t tell if what I had was garden-variety crud or crud that needed antibiotics, I went to the doctor. I handed over my $20 co-pay at the reception desk, where they have an electric candle burning, a tradition when a soldier is off to war. Their soldier is my family doctor, who’s in Afghanistan as a colonel with the Army …
A $20 co-pay and the value of an office visit
by Chad Hyett
There’s a storm brewing around the regulation of medical apps. The FDA has been skirting the issue for too long and it’s having detrimental effects on the potential for such apps. Recent FDA hearings have revealed that the agency is watching the apps stores for potential alarms and that they are drafting guidance. Whatever that means.
The FDA needs to make a decision quickly if …
Should the FDA regulate medical apps?
A commenter (I believe a physician) on one of my posts wrote the following: “I can prevent heart attacks and strokes (caused by atherosclerosis – “blockage”) in people (minimal cost) who have no symptoms. If I wait for their heart attack or stroke – it costs a whole lot more.”
The implication is that screening and treating high cholesterol saves money in the long run. Unfortunately, the truth is the opposite. …
Does screening and treating high cholesterol save money?
A guest column by the American Medical Association, exclusive to KevinMD.com.
by Ardis Dee Hoven, MD
This week, hundreds of physicians and medical students converged in Washington, D.C., for the AMA’s annual National Advocacy Conference. The current and future physicians learned about and discussed key legislative issues, including how new policy will impact physician practices, and heard from officials including CMS Administrator …
Physicians’ voices heard through AMA advocacy activities in Washington, DC
“I can’t get no satisfaction,” sang the Rolling Stones. And so it goes for many of the physicians who contact me.
I was struck by the fact that the word “satisfaction” in connection with work was used in two separate conversations with physicians recently.
It got me curious. Just what is job satisfaction?
How is it defined by the folks who study this kind of stuff?
And why is it so hard to come …
What is job satisfaction for physicians?
In classic Aristotelian drama, there comes a moment when the main character is presented with an insurmountable obstacle, be it physical, psychological, spiritual, or otherwise. The nature of the obstacle forces the character to make a choice: a critical choice, an act of free will that determines the glide path of the rest of the story, irrevocably altering its arc.
So it is with the arc of illness, a medical drama …
A person’s attitude toward their illness has a huge impact
They say you never forget your first “real” patient. Mine was a woman who didn’t need a pelvic exam, but who got one anyway.
Next door, minutes later, my second patient provided another personal first: a male genital and rectal exam, also, without need. Medical students like me begin training by practicing the basics on one another–listening to heart sounds, and looking into each other’s ears and eyes—but eventually, every clinician-in-training must lay …
Pelvic exam by a medical student for the first time
Anchoring refers to the tendency to latch on, or anchor, to the first symptom or bit of data and fail to consider the full spectrum of information, leading to misdiagnosis. Recently, we have received several cases where an anchoring error was triggered by a mistake in translating the patient’s words into clinical terms.
Case study #1
Henry Solomon, FACP, currently the medical director of Pfizer Global Pharmaceuticals, was for many years a …
How anchoring leads to misdiagnosis
“Doctor Pete” was fifty-one when I started my residency in family medicine. “Family practice” we called it then, and I think I liked that name of our specialty better. It implies continued learning and brings to my mind visions of practicing a down-to-earth craft.
I had interviewed with his predecessor the summer before and was really impressed with him and the program. I ranked it as my first choice in the …
Ode to a family practice mentor
In 2003 our practice had a rare opportunity to build EMR functionality into the floor plan of our new office. I thought I had the perfect design for the EMR-based exam room.
The spring-loaded, cantilevered arms used to hold monitors and keyboards in ICU rooms would be perfect. Fitting a touch screen monitor to a standard PC would allow the provider to work without a mouse. I could turn the screen …
Build EMR functionality into the exam room
As a primary care doc, I have compiled several tips to help patients save money on prescriptions.
All the prices quoted in the following examples are from Costco.
1. Patient assistance programs (PAP). Try to get free meds from the pharmaceutical company that manufactures your medication. Most of the time this service is only offered if there is not a generic available for your medicine. I heartily recommend you check out NeedyMeds.org and …
Tips to help patients save money on prescriptions
An excerpt from Surviving the Emergency Room.
by Ron Clark, MD
With regard to emergency trauma care, a few minutes can mean the difference between life and death. This first hour of definitive medical care is called the “golden hour.” It is usually this first hour where the patient’s medical fate is sealed. In general, the faster that medical care is rendered, the better the medical outcome will be.
The old adage …
The golden hour and the difference between life and death
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Last year’s Mayo Transform 2010 symposium was a two-day excursion into the world of science, data, design, and the secret ingredient to health: love.
Patch Adams, MD, kicked things off in grand style. If you’ve never seen him speak, treat yourself to a hit of his energy:
In 1971, he and …
Love is the secret ingredient to health
“Musta been the ham sandwich,” he said as he leaned onto the operating table and belched a couple of times. We were half-way through a thyroid operation and Doug, my partner, didn’t look all that good. I’d been in practice for all of a year, and Doug, ten years my senior, was my guardian angel, my guide through the vagaries of the world of private practice, and the best surgeon …
Closed loop bowel obstruction in your surgical partner
We were taught in grammar school that plagiarism is wrong. It is stealing someone else’s property.
Imagine in high school asking your mother to buy you “Cliff Notes” so you can copy it word for word. Mother would not have liked that, and it wouldn’t have been right.
To write an essay today, you’ll probably start with a search engine. Instantly, Mr. Google delivers many intelligent commentaries on anything, probably better than …
How to check your scientific paper for plagiarism
by Ray Carlson
Two recent articles posted here at KevinMD.com regarding the inclusion of discussions about the cost of health care services between doctor and patient highlighted the growing emphasis on not only the quality of care but the cost of that care to the patient as well. The first article was written by Dr. Leslie Ramirez, who advocated for a more proactive stance by doctors regarding …
Online tools to help shop for the most affordable health care
Another good paper for a journal club recently appeared in JAMA. What makes this one worth discussing is the research question the investigators posed and how they addressed it. Although this is not focused on cardiac care, the issues are germane to literature in our field and cardiac care certification is also spreading.
The article, titled “Association Between Stroke Center Hospitalization for Acute Ischemic Stroke and Mortality,” focuses on the New …
Do stroke centers improve patient outcomes?
Health reformers propose the proliferation of integrated health systems, like the Mayo Clinic or Kaiser Permanente, which, according to the Dartmouth Atlas, lead to better patient care and improved cost control.
To that end, Accountable Care Organizations have been a major part of health reform, changing the way health care is delivered.
Never mind that patients may not be receptive to the new model, but the creation of these large, integrated physician-hospital …
Integrating doctors and hospitals may worsen cost control in health reform
by Donald Burt, MD
Many hospital CIOs face an uphill battle winning the hearts, minds and fingers of physicians. It’s not because doctors are technology phobic. Quite the opposite: physicians are some of the most ravenous consumers of new information technology. Smartphones and tablets are becoming as ubiquitous as stethoscopes at many hospitals.
The truth is doctors are happy to make screen touches, mouse clicks and keyboard strokes if the application is …
Physicians love a CIO who lets them focus on patients, not technology
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