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Onsite clinics within a competitive health care marketplace

Health Policy

February 13, 2011

The recent explosion of interest in onsite clinics – not just by employers, but by health plans, hospital systems, public health programs, and others – is anything but just another health care fad. At once, clinics’ growing popularity signals purchasers’ weariness with an intransigent, self-interested health system, as well as their guarded optimism about a better way.

Today’s best clinics are single-mindedly focused on what works best for the patient and …

What physicians should believe about Accountable Care Organizations

Kevin

Health Policy

February 13, 2011

by Jeffrey L. Cohen

In the 90s, physicians were told “The sky is falling. You have to find a tree to stand under or you will be crushed.” The “trees” were things like IPAs and PHOs. The future outlook was bleak. All patients were going to be part of some system with which the physician would have no input or control. Decisions would be made on purely …

How to become a licensed, board certified doctor

Roy Benaroch, MD

Physician

February 12, 2011

I am licensed to practice medicine and surgery in Georgia. But that doesn’t mean I should, or that you ought to let me—at least not the surgery part. I’m actually pretty good at carving a turkey, but that’s pretty much the only kind of surgery that I’m qualified to do.

Don’t let the license fool ya, I’m no surgeon. So what, exactly, does a doctor have …

Why a patient waited 80 hours in the ER for placement

Kevin

Patient

February 12, 2011

by erdoc85, MD

When I arrived for my shift this am, I was passed off the following patient.

EMS responded to a 50-year old guy laying alongside the Interstate. He had no idea who he was or how he got there. He complained of knee pain and shoulder pain. They were kind enough to tote him to my ER where his evaluation revealed that he had a fracture …

Strategy and support is needed to quit smoking

Erin Marcus, MD

Conditions and Diseases

February 11, 2011

Tobacco is the single biggest cause of preventable death and disability in the United States. But nicotine is highly addictive, and quitting the cigarette habit can be extremely tough.

L.J., a 55 year old man who gave up smoking after 35 years, proves that it can be done. In L.J.’s words, he was “sick and tired of being sick and tired.” But he didn’t do it alone; his success depended on …

Health records need to be online to improve health and save money

Trisha Torrey

Health Technology

February 11, 2011

I exchange thoughts with healthcare IT people on a daily basis over at Twitter. So many of them seem perplexed at why we patients look at putting our medical records on the internet with trepidation.

Then along comes this video from Elizabeth Cohen at CNN. In a matter of minutes, she was able to pull up one of her CNN colleague’s medical records, his …

Medication lists need to be shared in a meaningful way

John Halamka, MD

Medications

February 11, 2011

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 …

A $20 co-pay and the value of an office visit

Jackie Fox

Patient

February 11, 2011

‘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 …

Should the FDA regulate medical apps?

Kevin

Health Technology

February 11, 2011

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 …

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Should the FDA regulate medical apps?

Does screening and treating high cholesterol save money?

Richard Young, MD

Conditions and Diseases

February 10, 2011

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. …

Physicians’ voices heard through AMA advocacy activities in Washington, DC

Kevin

Health Policy

February 10, 2011

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 …

What is job satisfaction for physicians?

Philippa Kennealy, MD, MPH

Physician

February 10, 2011

“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 …

A person’s attitude toward their illness has a huge impact

Richard Barager, MD

Patient

February 10, 2011

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 …

Pelvic exam by a medical student for the first time

Paul B. Kubin, PA-C

Medical Education

February 10, 2011

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 …

How anchoring leads to misdiagnosis

Jerome Groopman, MD and Pamela Hartzband, MD

Conditions and Diseases

February 10, 2011

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 …

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How anchoring leads to misdiagnosis

Ode to a family practice mentor

Hans Duvefelt, MD

Physician

February 9, 2011

“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 …

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Ode to a family practice mentor

Build EMR functionality into the exam room

Mike Koriwchak, MD

Health Technology

February 9, 2011

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 …

Tips to help patients save money on prescriptions

Leslie Ramirez, MD

Medications

February 9, 2011

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 …

The golden hour and the difference between life and death

Kevin

Physician

February 9, 2011

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 …