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Americans will need doctors but physicians are leaving primary care

Davis Liu, MD

Health Policy

August 20, 2010

Everyone understands the need for a robust primary care workforce in making healthcare more affordable and accessible while keeping those in our care healthy. With the aging of America and healthcare reform, even more Americans will need primary care doctors at precisely the same time doctors are leaving the specialty in droves and medical students shun the career choice. So as a practicing primary care doctor, I’ve watched with …

Gifts and money influence physician prescribing

Marya Zilberberg, MD, MPH

Medications

August 19, 2010

It is not a secret that large sums of money have passed from the pharmaceutical and device manufacturers into physicians’ hands.

This money has been paid not only for such socially beneficial pursuits as research and consulting, but also for lavish gifts and junkets. And interestingly, despite disingenuous assertions to the contrary by many a stake holder, these gifts generated a return on investment — surprise! It turns out that the …

Before ordering a test, know what to do with the result

Bruce Campbell, MD

Conditions and Diseases

August 19, 2010

Insanity: Doing the same thing over and over and expecting different results.
– Albert Einstein

As medical students rotating through the wards, we spent a significant portion of each day ordering laboratory tests and then chasing down the results. We wanted to investigate our patients’ illnesses and, just as importantly, we wanted to be prepared for any question with which our professors might surprise us during Attending Rounds.

One day, as I was …

PCMH and retainer fee medicine are primary care solutions

Juliet K. Mavromatis, MD

Physician

August 19, 2010

For years now we’ve been hearing about the trials and tribulations that have evolved in the practice of primary care medicine.

However, the discussion has intensified in recent months with passage of national health reform. Recent publications highlight the problems. A paper in the New England Journal of Medicine by Dr. Richard Baron entitled, What Keeps Us So Busy in Primary Care? discusses the time spent by primary care …

Why nurses need better EMR design to care for patients

Jared Sinclair, RN

Health Technology

August 19, 2010

There’s always a lot of stink from physicians over usability problems with EHRs: too many clicks, too many contextual menus, etc. The gist of these complaints is, “Physicians aren’t data entry clerks!” The computer is getting in the way of their interactions with their patients.

Everybody has a finite amount of mental space available at any given moment. Imagine having to transcribe a conversation in real-time. If half of your mental …

Family doctors cannot be obsolete, for patients’ sake

Kevin

Physician

August 19, 2010

by Pepi Granat, MD

Yesterday, and every day, in my office we had one or two patients we call our “Oldie Goldies”.

People who have been with us since 1971 when I opened my practice, 39 years ago. People whose progress, medical and personal, I’ve shared, and who share mine. We know their parents, kids and cousins either because they call us in crisis, or they’re our ongoing …

Physicians should not be used for FDA ad enforcement

Michael Kirsch, MD

Medications

August 18, 2010

One of the advantages of marrying an immigrant is having intense exposure to another culture. My wife’s Russian heritage, and her family, have enriched my own life immeasurably. The trip that I took with her and my brother to Russia in 1990, where she served as our personal translator, was unforgettable.

During the early years of our relationship, I heard stories about her family that seemed incredible to an American like …

Incentives for switching patients from branded drugs to generic

Matthew Mintz, MD

Medications

August 18, 2010

There’s an interesting video from WCVB in Boston about doctors getting kick backs from the insurance company to switch patients from branded medications to generic medications: New Rules To Protect Prescription Drug Customers.

If people were concerned about undue influence when drug companies used to give physicians pens and other novelties (now currently banned by most companies), they should really be concerned about actual monetary payments.

The patient interviewed in the Boston …

The July Effect and causes of the spike in medication errors

Glenn Laffel, MD, PhD

Physician

August 18, 2010

“An apple a day keeps the doctor away,” or so goes the old adage.

People who believe there’s some truth behind the saying are crunching on a great big Macintosh right now, or at least they will be once they hear about the results of a study from UC-San Diego which showed that every July, there’s a 10% spike in fatal medication errors in hospitals.

The scientists behind the study suggested that …

Creatine causing muscle cramps and how supplements may be dangerous

Orly Avitzur, MD

Medications

August 18, 2010

About a month ago, a 44-year-old insurance executive came to see me with complaints of headaches and muscle cramps. His pain was caused by the typical cluster headache located behind one eye, accompanied by one-sided tearing and nasal congestion, and often triggered by occasional wine or chocolate. The muscle cramps mainly affected the legs and seemed to worsen after exercise.

When I got the results of his lab work, I was …

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 …

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