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Why primary care is like air traffic control

angienadia, MD

Physician

August 18, 2010

Recently I had an interesting conversation with a few young doctors regarding the new health care reform that had been passed in the United States. One future specialist asked me why primary care doctors should receive more money than they have in the past.

And this is an important question that I think sheds light on the suboptimal state of our current health care system. It is important to specialists because …

Teaching family practice residents is rewarding

Jill of All Trades, MD

Medical Education

August 17, 2010

Can the field of family medicine truly become monotonous?

I never thought I’d ever find myself in a repetitive routine when selecting family medicine as my specialty. I spent eleven years after high school studying what I know. How can eleven years of material really become mundane? In a way, it’s a great thing – it means I am feeling comfortable and confident in my job.

And I am fortunate enough to …

Heart health depends on healthy behaviors

John Mandrola, MD

Conditions and Diseases

August 17, 2010

Everyone knows that the heart health of Americans is dismal. Obesity, diabetes, and high blood pressure are all on the rise.

For now, technological advances in cardiac care continue to maintain, or in some cases, lower the death rate from heart disease. Squishing blockages, ablating abnormal heart tissue, and installing cardiac devices have successfully kept the abysmal lifestyle habits of so many at bay. Despite all the fury of modern technology …

Consider the family’s perspective in the treatment plan

Kevin

Physician

August 17, 2010

by John Trahanas

She was not my patient.

Actually, she was nobody’s patient, she was just a wife; she was “the family.” She was a rough, stern looking woman, and with good reason as she had weathered many difficult times. Her husband had been severely demented for many years; however, it was only in the past few months that he required such intensive inpatient care.

He was not conscious or communicative, but he …

Doctors need to become whistleblowers after medical error

Dr. Martin Young

Physician

August 17, 2010

Perhaps the most important principle in practicing medicine, drummed into medical students and junior doctors time and time again, is to do no harm. Our medical interventions and treatments can be given either too early, too late, or inappropriately, with sometimes terrible and tragic results.

Unfortunately, when doctors have harmed patients, the guidelines of what to do thereafter are not as clear, raising the question, “What should doctors do in these …

“I’m a patient, not a consumer”

Jackie Fox

Patient

August 17, 2010

I’ve been hearing and reading a lot lately about how the doctor-patient relationship is under siege. There are many reasons for this, ranging from care decisions increasingly being made by insurers to the shortage of primary care physicians, to patient empowerment. I didn’t quite understand how patient empowerment could be a threat, until I started thinking about the recent perceptual shift from patients to health-care consumers.

I agree with the consumer …

Read more…

“I’m a patient, not a consumer”

The emotional state of doctors can affect patient care

Jeffrey Knuppel, MD

Patient

August 16, 2010

Great doctors listen to their patients.

They start out by asking open-ended questions, and unless patients get too far off-track, they don’t typically interrupt them. Despite having limited time for appointments, they have an unhurried manner. They make eye contact with their patients and do not bury their heads in charts and computer screens. Their patients leave their appointments feeling respected and heard.

Of course no doctor is likely to be able …

Congress is actually increasing physician Medicare pay

Maggie Mahar

Health Policy

August 16, 2010

Recently, the 21 percent cut in Medicare physician reimbursements was replaced with a 2.2 percent pay hike.

Later this year, Congress will have to consider the matter once again, just as it has ever year since 2003. This is the third time this year that Congress has averted Draconian cuts to physician’s payments. What, you might wonder, is going on?

Here is the back-story. In 1997, Congress enacted a so-called “sustainable growth …

Will pilot programs really lead to innovation and save money?

Roger Collier

Health Policy

August 16, 2010

As might be expected of reform legislation, the Patient Protection and Affordable Care Act (PPACA) places a lot of emphasis on innovation.

Reasonably enough, most of the potential changes—at least in Medicare—are to be preceded by pilot or demonstration projects designed to test their feasibility. In fact, according to one health care blogger with time on his hands, PPACA includes no less than 312 mentions of demonstrations and 80 mentions of …

Why radiology should become more like McDonald’s

Paul Dorio, MD

Physician

August 16, 2010

For years, I have been progressively beating a louder and louder drum — one where my colleagues know that I liken radiology to McDonald’s.

Most of the bad press out there, it seems to me, has to do with poor customer service. Our health care system is often inefficient, and delivers limited, incomplete care. The root of the problem, in my opinion, is that there aren’t enough doctors or hours in …

Stop calling doctors fleas and teaching professionalism

Vineet Arora, MD

Physician

August 15, 2010

At the recent AAMC meeting on how to integrate quality into teaching hospitals, the question that kept popping up from speaker after speaker was how to address the fact that doctors in teaching hospitals don’t get along.

Unfortunately, all the specialty bashing that takes place prevents the adoption of a team based culture necessary to advance quality and safety. As one speaker highlighted, how can we really start to address this …

Being a good mother is not about specific mothering choices

Amy Tuteur, MD

Patient

August 15, 2010

shutterstock_131909891

Since the subtext of the natural childbirth and attachment parenting movements is the notion of the good mother, it’s worth asking what makes a good mother. My whole approach to writing about childbirth and mothering choices is based my rejection of currently popular beliefs about good mothering.

Simply put, I believe that good mothering is about choosing mothering and not about mothering …

Competitive parenting and raising children in an opinionated world

Wendy Sue Swanson, MD

Patient

August 15, 2010

Raising children in a world full of accessible opinion is a funny thing.

Everyone seems to have an idea about how to do this right. Stay home, work full time, work part time, return to work, cry to sleep, not cry to sleep, pacifier, no pacifier … the recipe for each of us is different, of course. Often we’re all right in what we’re doing from picking out baby food to …

Practicing medicine as a single parent requires finding balance

Katherine Chretien, MD

Physician

August 14, 2010

A couple of months before my son was born 2 1/2 years ago, we were notified that my husband, an active duty member of the Navy, was getting deployed to Iraq.

His date of departure was exactly one week after my due date. To any wife or family member of a service member, this would be difficult news — a loved one going into a war zone. But, to me, 8-months …

Hospice care and what patients and their families can expect

Aldebra Schroll, MD

Patient

August 14, 2010

I often find, when I talk with patients and families about hospice care, there is a palpable sense of relief; relief that there is another option when facing a terminal diagnosis or end stage disease process.

Families who have participated in caring for their loved one at the end of life are grateful for the guidance provided in hospice care. Patients in turn are grateful to spend their last days at …

Comparative effectiveness research (CER) in patient care

Kent Bottles, MD

Health Policy

August 14, 2010

Recently, I was lucky to be invited to a New England Healthcare Institute discussion entitled “From Evidence to Practice: Making CER Findings Work for Providers and Patients” in Washington, DC.

How to disseminate and implement Comparative Effectiveness Research (CER) so that patient care is really improved was the first topic tackled by the expert panel and the moderator, Clifford Goodman of The Lewin Group.

The target audiences for CER findings include: patients, …

Apple’s iPad on medical rounds, a hands on physician review

Kevin

Health Technology

August 13, 2010

by Felasfa Wodajo, MD

Recently, we had the chance to check in with Dr. Henry Feldman. He had posted a detailed summary of his experiences using the iPad as his main interface while rotating on service for a week as a hospitalist at Beth Israel Deaconess hospital (BIDMC) in Boston. Dr. Feldman is also Chief Information Architect for the Harvard Medical Faculty Physicians.

The summary of the …

Can a health insurer provide affordable care when its CEO makes millions?

Roy Poses, MD

Health Policy

August 13, 2010

In 2005, we entitled a post, “How Can a $124.8 Million a Year CEO Make Health Care More Affordable?”

At that time, we contrasted the enormous compensation given to the then CEO of UnitedHealth, Dr. William McGuire, with the stated mission of his corporation. Since then, we have traced the travails of UnitedHealth and its leadership. Dr. McGuire was eventually accused of receiving backdated stock options (which at one time …

Will the new resident duty hour rules improve patient safety?

Robert Wachter, MD

Medical Education

August 13, 2010

One of the mantras of performance improvement is that caregivers and provider organizations should learn from their experiences. That’s all well and good, but how about policy-setting organizations?

Recently, in the New England Journal of Medicine, two of the Biggest Kahunas in the safety and quality worlds – the Joint Commission (TJC) and the Accreditation Council for Graduate Medical Education (ACGME) – announced bold new policies. To their credit, both organizations …

Depressed elderly at risk for dementia or Alzheimer’s disease

MedPage Today

Conditions and Diseases

August 13, 2010

by John Gever

Elderly people who are depressed may be at twice the risk of developing dementia or Alzheimer’s disease over time — but it’s unclear whether depression causes dementia or vice versa, researchers said.

Among more than 900 participants in the original Framingham Heart Study, almost 22% of those who were depressed when screened between 1990 to 1994 were diagnosed with dementia over 17 years of follow-up, compared with 16.6% of …

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