KevinMD.com

Are e-Patients expert in their own diseases?

Patient

September 28, 2010

As an e-Doctor, one with some IT literacy, I welcome the e-Patient movement.

I think patients should be equipped, enabled, empowered, engaged, equals, and emancipated, as Wikipedia explains. The link also adds “and experts” and here I have a problem, not because I don’t think patients should have access to knowledge or know a lot about their own disease, but because knowing one pattern of pathology, i.e. your own, does not make you an expert.

No more …

How a medical student can exacerbate the high cost of health care

Suchita Shah

Medical Education

September 28, 2010

Even as a medical student, I’m already complicit in exacerbating the problem of the high cost of health care.

It hit me one day, during my medicine rotation. We were working up a patient, and I was ordering tests with my resident. The patient had liver disease and perhaps some ascites.

He came in for another issue, and this wasn’t of primary concern to us, and we really wouldn’t have …

Can a pharmacy profit from gouging patients without insurance?

WarmSocks

Medications

September 27, 2010

It just shouldn’t be hard to get a refill on the medicines I’m taking:

phone the pharmacy to refill prescriptions
show up the next day to pick up refills
pay

Simple, right?

Note that this is about my old pharmacy, not the new one. For quite a while the pharmacy had been having difficulties, which is why I never trust the pharmacy. Between the distance and the frustrations I had dealing with them, …

A system based on units of activity encourages more units of care

Stephen C. Schimpff, MD

Health Policy

September 27, 2010

Today we mostly have prepaid medical care insurance with some co-pays and deductibles – both with commercial insurance and with Medicare.

In other words, our insurance covers essentially everything from basic and routine care to the catastrophic. And the insurance pays out based on units of care – a visit, a test, a procedure, a hospitalization, a prescription. This creates a system in which providers (physicians, …

The story of vitamin D and its association with other diseases

PalMD

Conditions and Diseases

September 27, 2010

Vitamin D is a fascinating molecule with a fascinating story.

Historically, “vitamins” were defined as chemicals that humans required from their environment that were “vital” to human health. These chemicals were needed only in very small amounts to prevent disease; an absence of a particular vitamin in the diet led to a specific deficiency disease: vitamin C, scurvy; thiamine, beri beri. Other vitamin deficiencies were found …

Health and well-being hypocrisy in the health care industry

Kevin

Patient

September 27, 2010

by Edward Stevenson

One of the things that drew me towards medicine was the fact that I personally value health and the sense of well being.

I would expect that if I inquired of my colleagues that a similar statements of values would echo this fact. Yet despite this near universal affirmation of value for health and well-being, a considerable amount of hypocrisy exists in the …

Why good doctors give useless answers

Doctor D, MD

Physician

September 27, 2010

Before he tells you how to get a straight answers from physicians, Doctor D is going to stall for time by explaining why doctors give vague answers.

Why would a good doctor give useless answers?

1. There is an answer, but your doctor doesn’t know it. Don’t be hard on doc for this one. There is no MD in the world that knows the entire breadth of medical knowledge. Some docs pretend …

Read more…

Why good doctors give useless answers

Why unnecessary cesareans is a misnomer

Nicholas Fogelson, MD

Physician

September 26, 2010

One thing I have learned by being active in the obstetrics and birthing blogosphere is that there are a whole lot of people out there that think that most cesarean deliveries are unnecessary. While most of them will admit that some cesareans are medically required, its pretty rare that the ones that have had a cesarean looks at their cesarean that way.

A popular term bandied about is “Unnecesarean”, a catchy …

Read more…

Why unnecessary cesareans is a misnomer

What’s the difference between family practice and med-peds?

Lucy Hornstein, MD

Physician

September 26, 2010

I like Dr. Rob, the one with the distractible mind. And although I thoroughly agree with the stance he takes in his recent post against cholesterol screening in kids, I must take issue with his opening statement:

I have a unique vantage point when it comes to the issue universal cholesterol screening in children, when compared to most pediatricians. My unique view stems from the fact that …

Read more…

What’s the difference between family practice and med-peds?

Doctor appointment tips every patient can use

Michael Aaronson, MD

Physician

September 26, 2010

Doctors, both generalists and specialists, have constraints on their time. New practices and new approaches need to happen in order to maximize everyone’s time. In addition to bringing your co-payment, you should “invest” in the visit and do your part, so that by the time the visit has ended, a successful plan of care is developed.

Here are some helpful tips to make the most of your medical appointments.

The relationship between …
Read more…

Doctor appointment tips every patient can use

What to say to a person who is sick

Lisa Gualtieri, PhD

Patient

September 25, 2010

When I ran into Paul S. not knowing he had cancer, I barely recognized him and struggled with what to say. “What happened?” didn’t seem appropriate, although it was my initial reaction. I believe I said, “I barely recognized you,” which was true. I’ve been in many situations where I wasn’t sure what to say to someone who was ill or in distress; I wanted to be supportive …

Read more…

What to say to a person who is sick

Many doctors order tests rather than do a history and physical

Robert Centor, MD

Conditions and Diseases

September 25, 2010

“Take a good history, do a good exam.”

I have not contributed to my treasure of quotes with this title. No one reading the headline well hit their head and mutter, “Wow!” Yet one can wonder about the lack of careful history taking and basic physical examination skills.

This delightful new blog post written by an internal medicine resident says it well: Defensive medicine supersedes quality medicine.

You should read the …

Wanting better health care shouldn’t be conservative or liberal

Aaron E. Carroll, MD

Health Policy

September 25, 2010

I remember this one moment back in the midst of health care reform when I was sitting in a radio studio, feeling pretty glum about the whole ordeal, and I mused aloud, “I wonder if anyone is enjoying this at all.”

For some of us, improving the health care system is more than a passing fancy. I’m a health services researcher. It’s my job. Those people on the TV pay attention …

Why health IT usability matters to patients

Dave deBronkart

Health Technology

September 24, 2010

It’s widely rumored that a health IT industry executive was unhappy about suggestions that systems have to be usable in the eyes of employees who use them while caring for us. (Us. The patients. Your mother.)

According to the rumor, the exec said, “Over my dead body.” As if he ran the agency.

Whether or not the rumor’s true it’s not funny. So when I was asked to represent the patient perspective …

Converting paper charts to electronic medical records tips

Peter J. Polack, MD

Health Technology

September 24, 2010

We are a little over two years into our electronic medical records implementation at the time of this writing. Since we have been performing a gradual rollout, the entire process has been relatively uneventful. Most of the credit for this goes to our chief information officer (technospeak for the head of our IT department) and our practice administrator.

One of the biggest challenges we have been facing is how to convert …

Physicians deserve to be compensated for time spent on email

Jared Sinclair, RN

Health Technology

September 24, 2010

Dr. Wes, a blogging cardiologist, posted a follow-up to his recent post on e-mail correspondence between physicians and patients.

The majority of emails he receives tend to be for very simple things like checking a lab result.

Current EMRs don’t make reviewing and sharing lab values efficient. Dr. Wes writes:

[O]ur current model of the electronic medical record sending every single result to our inbasket, even though it contains …

Read more…

Physicians deserve to be compensated for time spent on email

10 reasons why doctors over-order tests

Kevin

Conditions and Diseases

September 24, 2010

by Neel Shah, MD

What are the top reasons doctors over-order tests?

1. How we’re taught. Doctors are taught to consider whether a procedure is safe and whether it’s likely to work. We’re almost never taught to consider cost — it’s considered taboo.

2. Trying to do our best for the patient. We’re worried. Often we over-order because of our personal risk aversion.

3. Pre-emptive ordering. For residents, who do much of …

Read more…

10 reasons why doctors over-order tests

The $100 question about patient empowerment

Kevin

Patient

September 24, 2010

by Devin Gross

Here’s a question. It’s not a 5¢ or $5 question that anybody can solve on their own without much thought or effort. It’s a $100 ask-an-expert or think-about-it-for-a-second question.

What’s the point of patient empowerment?

Much of the current discussion of empowerment deals with patients who for one reason or another have had to fight for their care. CNN’s Elizabeth Cohen opens her book, …

Should reduced ER use be a measure of health reform?

Brad Wright, PhD

Health Policy

September 23, 2010

In making the case for health care reform, inappropriate utilization of emergency rooms is frequently cited as an example of our inefficient system and an important factor behind the staggering cost of U.S. health care.

At first, the logic makes sense: emergency rooms have to treat people, so the uninsured often turn there for care, including primary care, which is very expensive to provide in an emergency room, and would be …

A difficult time for health insurance companies in Massachusetts

Paul Levy

Health Policy

September 23, 2010

This has to be a very difficult time for insurance companies in Massachusetts. Notwithstanding that they are non-profits, they are under a lot of scrutiny with regard to reserve margins and profitability. Much of this is unfair, but I think that is just a sign of the times. Hospitals face a similar issue, too. Doctors are certainly next in line.

But the Massachusetts insurers have an additional problem. They have been …