KevinMD.com

Why doctors need an EHR, and why they should buy it now

Health Technology

October 3, 2010

The regulators have completed their work. CMS has defined how you should use technology in your practice or hospital (Meaningful Use) and technical requirements for EHRs have been finalized.

Centers for Medicare & Medicaid Services (CMS) and Office of the National Coordinator for Health IT (ONC) have removed all ambiguity regarding Government financial assistance to those purchasing EHRs, and ONC certified EHRs will start appearing shortly.

A national network of federally funded …

Can accountable care organizations lower costs and improve quality?

Jaan Sidorov, MD

Health Policy

October 3, 2010

Somewhere in the Obama Administration, there is an elitist central cabal that operates with the support of the highest organs of our central government. It conspires in windowless basement rooms to plot the gun control, mass vaccinations and the nationalization of key U.S. economic sectors like automobile and chardonnay manufacturing.

Healthcare, however, is its maximum target. Much like pieces on a chess board, and with the support of renegade organizations like …

Children who are difficult may not be simply toxic

Claudia M. Gold, MD

Conditions and Diseases

October 2, 2010

As a pediatrician I have listened to many parents speak of their child in very negative terms. Dr. Richard Friedman, in his New York Times article entitled Accepting That Good Parents May Plant Bad Seeds shares his patient’s description of her “rude and defiant” teenage son. Like the parents in his piece, the parents of my patients have other children with whom they have had no such …

Heavy sleep debt extracts a price for patients

Kevin

Patient

October 2, 2010

An excerpt from The Twenty-Four Hour Mind: The Role of Sleep and Dreaming in Our Emotional Lives.

by Rosalind D. Cartwright, PhD

We live in a culture that values speed; fast foods, fast cars, fast service, and fast decisions.

All of this takes a toll. Fast food is blamed for the epidemic of obesity, fast cars for motor vehicle accidents, and the wish for fast service and decisions …

The benefit of a drug cannot be measured by the law of averages

Arya M. Sharma, MD

Medications

October 1, 2010

One of the topics that I have often thought about (especially in light of our seeming inability to develop zero-risk obesity drugs) is the problem of averages. Our entire medical philosophy of “evidence-based” medicine seems built on the “Gaussian” assumption that averages can reflect the true benefit (or risk) of a drug, when in real life (or medical practice) there is no such thing as the truly average patient.

Clearly, a …

Finding a doctor using ratings is a sound idea, but poorly executed

Eric Van De Graaff, MD

Physician

October 1, 2010

Let’s say you develop some heart problem and get sent to me for an evaluation. You show up to the office, check in, get ushered into an exam room, then you wait and wait and wait. When I finally come into the room I seem terse, impatient and rushed, and you end up visiting with me for less than 5 minutes. I provide you with a diagnosis, order a couple …

How much staff should a doctor have?

Rosemarie Nelson

Physician

October 1, 2010

“How many staffers should we have per doctor?” That’s a question I’m asked at almost every seminar I present. Of course, like many good consultants, I almost invariably respond “it depends.”

One of the factors that needs to be considered is what jobs we’re talking about — clinical or front office. It’s staffing in the clinical area that will do most to enhance a physician’s productivity, so that’s what we’ll focus …

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How much staff should a doctor have?

Coping with the culture clash between nurses and IT

Kevin

Health Technology

October 1, 2010

by John Rossheim

IT professionals are great at coming up with nifty tools for bringing clinical data to clinicians – as long as nurses are willing to memorize lots of byzantine paths to that information.

Nurses are dedicated to providing direct care for their patients and advocating for them in every way – as long as it doesn’t mean having to adapt to ever-changing computer systems.

These two stereotypes …

Should social justice matter when choosing medical students?

Kevin

Medical Education

September 30, 2010

by James Gaulte, MD

Should medical student applicants be chosen less for their demonstrated ability to master large amounts of knowledge and solve problems and more for their social consciousness and desire to push forward with social justice?

That appears to be the suggestion of a panel of experts from the AMA in a project called the Initiative to Transform Medicine (ITM) who believe an …

How judging doctors by the numbers may be meaningless

Richard Reece, MD

Health Policy

September 30, 2010

How do you judge how good a doctor is? By personal interaction? By what relatives and friends say? By whether he or she is on time when you go for your visit? By doctor rating websites on the Internet? By patient satisfaction surveys conducted by doctors themselves or rating agencies?

Or do you do it by the numbers? The federal …

Chronic cough from laryngeal sensory neuropathy (LSN)

Christopher Chang, MD

Conditions and Diseases

September 30, 2010

Laryngeal sensory neuropathy (LSN) is a recently described condition felt to cause a chronic cough in patients when treatment for everything else (allergies, asthma, reflux, etc) has been evaluated and managed.

Treatment for this condition is with neuropathic medications including Neurontin, Elavil, Lyrica, nortriptyline, etc.

In the past few months, I have seen a few patients referred to me with chronic cough treated with these medications with minimal or no improvement. All …

People live and die by their chronic illnesses by what they do at home

Shantanu Nundy, MD

Physician

September 29, 2010

“You know, what Mr. HD really needs is for his mom or somebody to chain herself to him …” [the ICU team laughs] … “But seriously, he needs to be watched over, he needs to be talked to. He needs someone to give him his medications, someone to take him to his appointments, someone to take care of him. With that somebody he can live for years to come. Without …

How house calls benefit patients and physicians

a medical resident, MD

Physician

September 29, 2010

Physicians used to take care of patients at their homes.

Through the 1960s, patients would make a phone call and the doctor would arrive at the doorstep, black bag in hand, eager to serve. This changed in the mid to late-1960s as doctors developed group practices and as medical care expanded to include technology-based studies and specialty referrals, and thus became more hospital-centered. Prior to World War II, 40 percent of …

Bad lifestyle isn’t a medical issue, it’s a social one

Jay Parkinson, MD

Physician

September 29, 2010

Almost every Sunday night, I walk to this one restaurant in my neighborhood for some comfort food (we’re creatures of habit aren’t we?).

I pass a church on my way where an Alcoholics Anonymous meeting is held almost every night. As I walk through the crowd of smokers, I look at them and they look at me. They don’t know that I know they’re recovering addicts. And they put a smile …

Explaining the critical gap of primary care physicians

David B. Nash, MD, MBA

Physician

September 29, 2010

There is a critical gap in the supply of primary care physicians in the U.S., and it should come as no surprise that our existing primary care delivery and payment models are at the heart of the issue.

The traditional primary care model — medical care provided by a physician and a small support staff, often without benefit of health information technology (HIT) — was developed at a time when the …

Boston Medical Center gets screwed by the Massachusetts government

Kevin Pho, MD

Physician

September 29, 2010

Boston Medical Center has provided care to the underserved and Medicaid population in Boston for almost 150 years. And what’s happening to the venerable institution is gut-wrenching to read.

I trained at Boston Medical Center (BMC), completing my internal medicine residency there in 2002. A recent write-up in Boston Magazine highlights the financial trouble the hospital is going through:

Boston Medical Center is almost broke, perilously close to what …

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Boston Medical Center gets screwed by the Massachusetts government

Nurses expect to be called by their first names, should doctors follow?

Christopher Johnson, MD

Patient

September 29, 2010

I’ve worked in hospitals since I was 16 years old — 42 years ago now. I was first an orderly, then a nurse’s aid, then a practical nurse, and a finally a surgical technician before I became a physician.

When I started, female nurses wore caps, the details of which identified which nursing school they had graduated from, as well as a pin that gave the same information. They wore starched, …

Keeping the terminal patient comfortable is the purpose of comfort care

Ralph Gordon, MD

Patient

September 28, 2010

Dealing with an incurable illness or terminal condition is an inevitable reality of the practice of medicine. Not uncommonly, especially in the intensive care unit, we care for the patient with no chance for recovery and survival. Keeping that patient comfortable and allowing him or her to die with dignity becomes the priority of care.

Occasionally, I hear requests from the family members of the dying patient – “Can you give …

Using denial to control a patient’s anxiety

Alex Lickerman, MD

Patient

September 28, 2010

A few years ago, a patient of mine was diagnosed with lung cancer. A metastatic work up revealed a small mass in his liver that had the radiographic appearance of a benign liver cyst. But in the setting of a newly diagnosed lung cancer, we couldn’t be sure it wasn’t a metastatic lesion, so we decided to biopsy it. Due to scheduling issues, we couldn’t get it done for seven …

Confronting the fear of death takes preparation

Kevin

Patient

September 28, 2010

by Brad Stuart, MD

Atul Gawande’s brilliant essay in the New Yorker sums up the dilemma we face, whether we’re patients, families, and/or clinicians, as we near the end of life. His point is that we have to face it together:

“People die only once. They have no experience to draw upon. They need doctors and nurses who are willing to have the hard discussions and say …