First, this piece is not a how-to guide for getting into medical school.
But I use this ploy for good, and not for evil. Through conversations with a number of non-medical colleagues, I’ve been forced to think a bit more about premedical and medical education. A letter from a reader (which is presented in a highly altered version below) made me decide to more thoroughly and …
Making the decision to go to medical school
How can patients get a straight answer from a doctor?
The answer is really very simple: Don’t accept a non-answer answer from a doctor on a question that really matters to you!
If you get a dodgy, vague, or useless answer don’t take it lying down. Politely insist that the doctor elaborate and clarify until you get a reply that you understand.
We doctors are totally scary, but if you have to have …
Get a straight answer from your doctor
I like reading Maggie Mahar’s Health Beat.
She usually gets it, from the function of insurance to the complexities of assorted payment systems, I get the sense that she is generally rational when it comes to paying for health care. This doesn’t mean there aren’t times when she gets it wrong. Her embrace of primary care provided by nurse practitioners shows a truly spectacular …
Preventive care as a cost saving measure is a fallacy
Here’s the scenario: on the 2nd of the month, a patient with diabetes on metformin and high blood pressure on benazepril sees her family physician for a routine follow up.
The patient’s blood pressure is elevated and the decision is made to add carvedilol to help get the blood pressure to goal. The patient’s metformin and benazepril “drop” (are renewed) at the pharmacy on the 18th of every month, a date …
Help patients synchronize their prescription drugs
When one is a medical student, pretty much everything one does is directly supervised. Though a student is allowed to assess patients and make recommendations, rarely is a student given the autonomy to make decisions that will affect patients. They practice these decisions, but there is always someone more senior ratifying them.
Once a student becomes a resident, things start to change. As residents are physicians, they have the power to write …
Autonomy versus supervision for residents is a fine line
The New England Journal of Medicine analyzed Medicare statistics from the beloved Dartmouth Atlas of Health Care study revealing a wide disparity in the number of coronary bypass procedures in Golden Colorado compared to other areas.
The report reveals a 60% reduction in the number of procedures as compared to Miami, Florida. The Dartmouth Atlas Study has been used to justify changes in payment systems by Medicare. The study has …
Why patients in Grand Junction, Colorado have better health outcomes
Diana Cole told me, “The internet saved my life,” and recounted a story about using the internet to identify a bat bite and learn about rabies in bats, leading to an emergency room trip.
She later introduced me to her sister, Carolyn Kingston, who attributed her successful outcome from hip replacement surgery to her use of the internet. I asked Carolyn about her general use of the internet for health, her …
Using the internet for health information before surgery
A guest column by the American Medical Association, exclusive to KevinMD.com.
Medicare physician payment cuts are once again looming in the immediate future, with a cut of 25 percent now threatening to hurt access to care for seniors and military families. As many doctors know all too well, the looming cut is forcing physicians to make difficult decisions about the continuing role Medicare can play in their practices.
The AMA is working on …
AMA: Patients and physicians call on Congress to stop Medicare cut
I spend much time talking with medical students. It is part of my job, but more than that I like medical students.
What should be the goal of medical schools? I believe we have an obligation to help our students grow into great physicians. What philosophical principles should we use?
Perhaps the answer to success is Servant Leadership. As I learn more about this concept, I hope that have become a servant …
Using servant leadership to teach medical students
I’m going to take the time to review a topic that is one my pet peeves, one you hear bandied about all the time in discussions of more consumer directed health care. It’s a topic I came back to repeatedly on my old blog – the moral hazard.
Basically, the moral hazard is the idea that people insulated from risk behave differently than people exposed to risk. For instance, …
Why moral hazard fails in health care
The bipartisan debt commission appointed by President Obama recently released its recommendations on how to pare the country’s debt.
Of interest to doctors is the suggestion to change the way doctors are paid. Physician lobbies have been advocating for removal of the Sustainable Growth Rate formula — the flawed method by which Medicare, and subsequently private insurers, pays doctors.
According to this method, physicians are due for a pay cut of …
Medical malpractice reform in exchange for paying doctors less
Many fellow medical students are eager to improve “the system.”
However, an overeager attitude offers both promise and peril — promise that budding physicians are inspired to improve the inner workings of their chosen field, peril in that our naiveté may simply clutter the very complexities we seek to improve.
How do we strike a balance between getting involved and getting in the way?
I found guidance in law professors Raustiala’s and Sprigman’s …
How medical students can improve our health system
by James Merlino, MD
The patient experience is the right thing to do, and a business necessity. But improving it is not necessarily easy.
The fact is, large medical centers are at a real disadvantage when it comes to performing well on HCAHPS. The Centers for Medicare & Medicaid Services (CMS) do not discriminate or differentiate the scores of small community hospitals from those of large academic tertiary care …
The patient experience needs to be improved: here’s how
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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 44-year-old man is evaluated for a 2-year history of joint pain in the wrists, hands, knees, ankles, and feet. He also has a 12-year history of plaque psoriasis. His current medications include acetaminophen for joint pain, topical hydrocortisone and calcipotriene ointments, and a …
MKSAP: 44-year-old man with chronic joint pain
This item has nothing to do with OpenNotes itself – it’s what I’m seeing now that I’ve started accessing my doctor’s notes. In short, I see the clinical impact of not viewing my record as a shared working document.
Here’s the story.
In OpenNotes, patient participants can see the visit notes their primary physicians entered. Note – primary, not specialists. I imagine they needed to keep the study design simple.
So, …
Patients seeing the visit notes their primary physicians entered
As medical practices become more advanced, staff members gain improved access to the Internet during work hours. Cyber-slacking is a well-known problem in corporations; in fact, one study found that over thirty-five percent of employees admit to using the Internet for personal surfing at work.
The New York Times cited that twenty-five percent of Net use on work computers isn’t actually work-related. Although it is unknown how severe the problem is …
Understand your options before monitoring Internet use
Well it’s that time of year again.
No, not Thanksgiving or Christmas, or even the venerable Interim Meeting of the AMA. It’s the time that physicians nationwide anticipate another mandatory cut in Medicare reimbursement rates.
This time the recurrent temporary fix will result in a cut of 23.6 percent on December 1st. Assuming political gridlock the rate will fall another fraction of 6.5 percent on …
Will the new Congress allow the physician Medicare cuts to pass?
Among the litany of complaints about the (un)usability of EMRs, it’s easy to lose sight of the big picture. More than the poor design choices and overall ugliness of existing software, by far the single biggest failure of HIT companies is that none of them has yet to produce an EMR that nurses actually need.
There is a huge opportunity being wasted here. Other industries have been able to incorporate computers …
As a new intern at a well-endowed medical institution, I was disappointed despite the flurry of excitement that comes with orientation. I was disappointed despite the brand new privilege to save lives and relieve human sufferings. And the disappointment was made clear to me over the past two days.
What has happened in the past two days? As I will be working at two separate hospitals, for the past two days …
Patient safety suffers when doctors are forced to learn multiple EMRs
I went to the doctor recently and got a new prescription.
The doctor was kind enough to give me some free samples, and a voucher that I could redeem to fill the prescription once at no cost. In the future, it will cost me $50 if I decide to refill it. If I didn’t have pharmaceutical benefits through my insurance coverage, the medication would set me back about $500 for a …
Uninsured Americans cannot afford many medications
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