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Bedside manner may need to include cost of care discussions

Dennis Grace

Patient

November 29, 2010

by Dennis Grace

For years, if you asked for a recommendation for a physician, the answer included some mention of bedside manner.

I mean, we’re human beings first and patients second, so we think it’s great that she’s a brilliant doctor, but is she pleasant? Is she respectful and patient? Nobody wants to work with a know-it-all, especially one who gets to hear about our bowel movements …

The malpractice system doesn’t improve patient safety

Kevin Pho, MD

KevinMD

November 29, 2010

There has been significant media attention on a New England Journal of Medicine case report where a surgeon, Massachusetts General Hospital’s David Ring, described how he operated on the wrong hand of a patient.

Here’s a summary of the case:

Ring, along with colleagues at Massachusetts General and Harvard Medical School, detailed the series of missteps that led to the wrong operation in the patient whose ring finger on her …

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The malpractice system doesn’t improve patient safety

Antibiotics need to become controlled substances and regulated

WhiteCoat, MD

Medications

November 29, 2010

Antibiotics for viral infections are a big pet peeve of mine. No. Make that a huge pet peeve.

Some doctors prescribe antibiotics for coughs and stuffy noses because the patients want them. If you’re one of those patients who think that antibiotics make your coughs go away, or clear up your stuffy noses, or somehow make your sinus headaches vanish, or if you’re a doctor who prescribes antibiotics for these symptoms, …

Electronic health records (EHR) to improve medication compliance

Robert Rowley, MD

Health Technology

November 29, 2010

A recent report in the Annals of Internal Medicine on the characteristics of prescriptions that are abandoned at the pharmacy raise the question of (1) how to ensure that people actually pick up their prescriptions, and (2) how to make sure that people actually take the medications that are prescribed.

What role does modern Electronic Health Record (EHR) technology play in this question?

A study by the non-profit New England Healthcare Institute …

How your medical practice can manage vendor relationships

Kevin

Physician

November 29, 2010

by Rosemarie Nelson, MS

Everyone is trying to “do more with less” and concerns about the economy add fuel to that fire! But, when done with purpose and thoughtfulness, you can manage vendor relationships so that you’ll deliver successful negotiations that will get the most bang for the buck for any medical practice, small or large, multispecialty or single specialty.

Preparation and setting objectives well before contract …

Scribes lead to unintended consequences from electronic medical records

Douglas Perednia, MD

Health Technology

November 29, 2010

Recently, Dr. Scot Silverstein over at Health Care Renewal published this update to the ongoing story of electronic medical records that are so simple, intuitive and easy to use that doctors and hospitals everywhere are being forced to hire “scribes” to run them.

We’d looked at the resurgence of scribes in a previous post, and Dr. Silverstein’s article seems to confirm that the phenomenon is is here to stay for …

Paying for access to medical journals

Josh Herigon, MPH

Physician

November 28, 2010

I’m not sure about the validity of this study: Free Access to U.S. Research Papers Could Yield $1 Billion in Benefits.

Quantifying how much money will be saved by increased efficiency due to open access seems like fuzzy math at best. However, we do need better access to medical journal articles. As a researcher, I’ve constantly fought the battle against firewalled journals. I am fortunate to be part of a university …

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Paying for access to medical journals

Shifts and making switches in the ER

ER Stories, MD

Physician

November 28, 2010

Everyone one knows ER docs work shifts. Many places though have each doc doing a set schedule. Such as 1 day, 1 evening, 1 overnight or one week with days, one with evenings, and one with nights.

Others, like my hospital, it is a mass jumble. We work all sorts of random shifts at random times, so long as it evens out at the end of the 6 week block that …

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Shifts and making switches in the ER

Working at the student care center in college

John Schumann, MD

Patient

November 28, 2010

For five years I worked at GlassHospital’s Student Care Center.

I don’t get no respect, neither.

One of the great things about GlassHospital is that it sits on the campus of a well-known and fairly well-respected former Big Ten university.

Like all colleges and universities, our place acts in loco parentis to the students that grace its campus. This means responsibility for our students’ health and well-being.

I loved working at the Student Care …

Colds teach the immune system how to fight future viruses

Michael Gonzalez, MD

Conditions and Diseases

November 27, 2010

Viral upper respiratory illnesses, or common colds, are by far the most frequent illness I see in my office.

It is called the common cold because it is, well, common. I typically can make the diagnosis with a high degree of certainty based on the pattern and the timing of the symptoms. Deciphering cold symptoms and knowing when to worry is what a pediatrician does more often than anything else, and …

Ethics of placebo in cancer treatment clinical trials

Wendy S. Harpham, MD

Conditions and Diseases

November 27, 2010

The New York Times recently ran an article tackling a complex ethical dilemma in cancer care: the withholding of treatment in clinical trials. Because I was treated in 3 clinical trials in the 1990s, the topic is close to my heart.

Scientists have advanced the treatment of disease using the scientific method. By that, I mean they have tested a theory using rigorous methods that give a reliable and reproducible answer. This …

Travel tips for a panic free vacation

Kevin

Conditions and Diseases

November 27, 2010

by Stephen R. Blumberg, PhD

If you are like many Americans, you are planning or getting ready to take a summer vacation. Sounds very exciting. Aruba. A cross-country jaunt. Or a short trip overnight to the coast!

What is exciting for the panic-free community can be agony for a panic sufferer. Why?

The core fear is being trapped far from safety

Whether it is traveling on a cruise ship, airplane, highway driving, …

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Travel tips for a panic free vacation

Concerns about long term acid suppressive therapy

Chris Rangel, MD

Medications

November 26, 2010

Physicians hate acid. But, hey, who doesn’t hate acid? It burns things. It corrodes. It’s that after-pizza punishment.

We prescribe antacid medications by the ton in this country, not because people’s stomachs have developed increased acidity, but because people in our modern society are generally overweight, like to eat large meals, and prefer fatty foods and things like alcohol, chocolate, and tobacco, all of which tend to worsen acid reflux.

Physicians like …

Should patients be charged for no shows?

Brandon Betancourt

Physician

November 26, 2010

No shows. It seems that no matter what we do, we always have them.

Despite the fact that we call every single person on the schedule to remind them of their appointment the day before (the staff personally makes the call. We don’t use an automated system) we found that in 2009, we had 389 no-shows.

Slicing the data

Is 389 a high number of no-shows? I guess it depends on the size …

How small private practices can still thrive

Susan Giurleo, PhD

Physician

November 26, 2010

Health care is changing at lighting speed. If you don’t know this, or worse, don’t accept it you’re doomed. No. Really. It’s change or close shop. Whether you like it or not, health care reform is going to change the way we practice from now on.

Many physicians are choosing to work for large group practices to buffer themselves from directly dealing with change. Mental health providers could do the same, …

Talk with your family about their end of life wishes

Kevin

Potpourri

November 25, 2010

by Alexandra Drane and the Engage With Grace team

For three years running now, many of us bloggers have participated in what we’ve called a “blog rally” to promote Engage With Grace – a movement aimed at making sure all of us understand, communicate, and have honored our end-of-life wishes.

The rally is timed to coincide with a weekend when most of us are with the very people with whom we should …

Bedbug rashes, and how to prevent and get rid of bedbugs

Michele R. Berman, MD

Conditions and Diseases

November 24, 2010

There’s a new bunch of bloodsuckers running rampant in cities all over the country.

No, they’re not on a new vampire TV show or in a Twilight sequel. They’re bedbugs, and they’ve been showing up in droves in more and more cities across America. And despite what is commonly thought about them, bedbugs do not exist only in the poorest sections of town, they are showing up at 5-star hotels.

That means …

Never forget to advocate for your patient

Anesthesioboist T., MD

Patient

November 24, 2010

There are some lessons we learn and keep re-learning in medicine. For me some of these recurring lessons are,

Listen to your “gut.”
Pay attention to the clues.
Listen to your team.
Don’t be afraid to call for help.

and

Stick to your guns when advocating for your patient.

I encountered a young patient recently, just at the cusp of adolescence and adulthood, who had undergone a procedure related to a sports injury. Other people had been …

Penicillin and the Cocoanut Grove fire in Boston

MedPage Today

Medications

November 24, 2010

by Nancy Walsh

The recent report of the deliberate infection of Guatemalans with syphilis in the 1940s to see if penicillin could cure and prevent transmission of the disease was a reminder of just how short the time has been since most infectious diseases were untreatable. Penicillin — discovered by Scottish biologist Alexander Fleming in 1928 but not available for clinical use until the 1940s — …

Drug reps know what doctors are prescribing

Kevin

Medications

November 24, 2010

An excerpt from White Coat, Black Hat.

by Carl Elliott

[Michael] Oldani worked as a rep in the late 1980s and the 1990s, a period when the drug industry was undergoing key transformations. Its ethos was changing from that of the country-club establishment to the aggressive, new-money entrepreneur.

Impressed by the success of AIDS activists in pushing for faster drug approvals, the drug industry increased pressure …