Say the words, “Patient-centered medical home,” and you’re bound to get a variety of opinions.
On this blog alone, there are a variety of guest pieces critical of the effort, saying it does not increase patient satisfaction, nor does it save money.
And that’s not good news for its advocates, who are pinning primary care’s last hopes on the model.
Medical homes hit the …
Why patients are wary of the primary care medical home
As originally reported in a New York Times article recently, with more coverage in MedPage Today, the University of Michigan School of Medicine has decided to end all industry support of CME as of January 1, 2011.
According to the dean of the medical school, “the decision was based on a review of literature about the influence on clinical faculty of industry-funded CME.” Apparently the decision was made after a …
How essential is industry funding for university CME?
by Kate Atkinson, MD
Six years ago, I organized a group of female healthcare practitioners for a women’s medical journal club. A multidisciplinary team of doctors and NPs from primary care and sub-specialties regularly attended monthly dinners. Invited speakers presented on a variety of topics and over the course of a meeting we exchanged insights while challenging each other on how best to manage our challenging patients.
Our group grew …
How the Massachusetts gift ban hurts primary care doctors
As we move to electronic health records (EHR), the debates over security and privacy are becoming more frequent and more poignant.
We of course have HIPAA laws on the books and Office of the National Coordinator for Health Information Technology (ONC) has a Tiger team assembled to recommend privacy and security policies to Secretary Sebelius.
CIOs and entire IT departments are all focused on protecting the privacy of patients and their Personal …
Should we worry about physician privacy in the EHR era?
I recently received a call from a mother that made me both want to cry and scream out in frustration.
Several months ago I wrote a post entitled Drugs for Children May Silence Stories, in which I described a young boy who had suffered severe neglect as an infant. His adoptive parents had sought help from me when he was four, but when I recommended intervention for the whole family …
ADHD and how drugs impede meaningful help for children
by Crystal Phend
Mobile phone base station towers boost cell reception, not childhood cancer risk, a British population-based study showed.
Children whose mothers lived near a high-output cell phone antenna mast while pregnant were no more likely to develop childhood cancer than those who lived farther away, found Paul Elliott, MBBS, PhD, of Imperial College London, and colleagues.
Exposure to an intermediate level of cell tower power output was associated with an adjusted …
Cell towers do not increase childhood cancer risk
by Shawn Vuong
Incoming medical students, I know you’re excited about medical school. I was in your same exact position about 2 years ago to the day. Every day I went to sleep and thought about how cool medical school was going to be, how much cool stuff I was going to learn, and how much my life was going to change.
I asked myself many questions. Am I going …
New medical student summer tips
Medical school trains us to deal with a wide range of medical problems.
No matter what our current practice or specialty, at some point during medical school we will have had to study and demonstrate our knowledge and competency in dealing with common disorders like diabetes, hypertension, depression, chronic pain and countless other ailments. In addition, we will have spent hours poring over much rarer disorders, conditions that many of us …
Obesity should not require specialists to manage
by John Fauber
Time is brain. Every minute wasted seeking treatment is measured in neuronal death, which is why stroke specialists were early supporters of certified stroke centers. Getting a stroke patient to the right center — a center that could administer clot-busting therapy quickly, and safely — was considered the surest way to “save brain.”
That was the concept behind the certified …
Certified stroke centers and ischemic stroke treatment realities
You’ve probably had the experience of going to see a primary care physician and wondering about the many aspects of that visit that just didn’t make sense.
Why is it so important for me to arrive on time when, in reality, I won’t be called back until half an hour (or more) later? What’s the point of waiting for another 20 minutes in a chilly examining room for the doctor …
The way we practice primary care doesn’t make sense
My medical school at the University of Utah developed a clever computer program in the late 80s that was meant to both educate medical students and assist in the treatment of patients.
For several years the tech geeks at the school had collected an immense database of information from all the patient admissions at the hospital—presenting symptoms, exam findings, tests, and final diagnoses. They took all this data and crunched …
The art of medicine and whether computers can replace doctors
by Kristina Fiore
Measures designed to prevent postoperative infections work if measured as a package, but looked at individually they provide no improvement, researchers found.
When analyzing the six components of the Surgical Care Improvement Project (SCIP) on an all-or-nothing basis, there was a 15% reduced risk of infection, according to Jonah J. Stulberg, MD, PhD, MPH, of Case Medical Center in Cleveland, and colleagues.
But the three core infection prevention measures taken …
Preventing postop infections need to be implemented as a package
by James Gaulte, MD
A recent publication in the publication Health Affairs has evoked comments and some concern from advocates of comparative effectiveness research and admirers of the Dartmouth Atlas.
A survey of “consumers” found a level of skepticism that is alarming to those folks who are in the business of claiming to know what aspects of medical care should be offered.
The idea that more care and more costly care gives inferior …
Sometimes more expensive care is better treatment
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Everybody knows politics is a balancing act. One must balance promises against reality.
For example, how does government keep Medicare intact for seniors while cutting $500 billion out of Medicare when government has no track record of cutting entitlement spending?
And how one do it without losing the vote of seniors, who hold the key to the balance of power?
The Obama administration and the Democrats hope to keep power by winning the …
How seniors will accept cuts in Medicare from health reform
by Charles Bankhead
Increased emphasis on conflicts of interest has yet to sway physicians’ generally positive attitudes toward drug and device manufacturers’ marketing activities, a survey of almost 600 attending physicians and trainees showed.
More than 70% of respondents saw nothing inappropriate about attending sponsored lunches, and 25% had no problems with accepting large gifts from industry representatives, according to an article in the June issue of Archives of Surgery.
Surgeons, trainees, and …
What doctors think about drug and device marketing
A recent article in US News and World Report, Most U.S. Physicians Practicing Defensive Medicine, claims that physicians are ordering more tests and escalating the work-up of sick patients, all in the name of defensive medicine.
Is it true? Absolutely.
It is especially true in the emergency department, where we have one shot to get things right, or else. Ironically, by practicing defensive medicine we are not practicing …
Defensive medicine forces residents to use test oriented care
My life is wired by Steve Jobs and Apple. When I was a kid, my first computer was an Apple IIc, followed by Macintosh Plus for college. In residency, I used a Newton for a while to take notes on patients. I have a MacBook, an iPod (I’ve actually had 3 and my wife has had 2), an iPhone, iPhone 3gs; an iPhone 4 on order; an iPad, AirPort Express, …
The Apple Genius Bar could learn some bedside manner
“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 that somebody …
Chronic illness needs to be managed at home, not at the hospital
by Kristina Fiore
More than a third of parents who have been tested for genetic breast cancer risk say they’d support similar testing for their children — despite scant evidence of any benefit for young people, researchers have found.
In interviews with 246 parents who were tested for the BRCA1/2 mutation, 37% supported testing minors, compared with 55% who opposed screening, according to Angela R. Bradbury, MD, of Fox Chase Cancer Center …
Parents who want genetic testing for their children
You’ve seen it, somewhere.
Every city in America, and likely the world, has a local magazine. And once a year, that magazine publishes a “Best Docs” issue, usually listing 10 doctors from each specialty who they consider the best of the best.
Dr. Grumpy, for the record, is not biased against this. I’ve been named a “Best Doc” in my field several times.
And I know most of the other neurologists on the …
Best Doc in a magazine, the inside story
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