A new primary care payment model with health savings accounts

Health Policy
July 18, 2010

by Charles Smith, MD

Everybody seems to be dissatisfied with the current model of primary care.

Concierge and retainer practices are all the rage, but they serve too few patients. While some highly integrated systems (Mayo Clinic, maybe Kaiser Permanente) may be thriving, they are difficult to replicate. Most primary care physicians are demoralized by a system that overburdens them with administrative hassles and liability while providing insufficient revenue to improve …

Read more…

A new primary care payment model with health savings accounts

How doctors can discuss advance directives with patients

Patient
July 17, 2010

A recent blog post and series of responses on KevinMD.com aroused my interest.

Dr. Kevin Pho posed the question: Why are doctors so reluctant to discuss end-of-life care? Responders, including patients, doctors, nurses, and even a veterinarian highlighted the stress inherent in this discussion for patients and for medical professionals alike.

To me, the real issue is not whether the discussion should occur, because clearly it should, but when and how? …

Read more…

How doctors can discuss advance directives with patients

ER visits rise because of prescription drug abuse

Medications
July 17, 2010

by Michael Smith

The number of emergency room visits for nonmedical use of prescription painkillers more than doubled between 2004 and 2008, according to a CDC estimate.

The increase was part of a trend that saw emergency room visits for nonmedical use of all prescription and over-the-counter medications reach the same level as those for abuse of illicit drugs, the agency said in the June 18 issue of Morbidity and Mortality Weekly …

Read more…

ER visits rise because of prescription drug abuse

Unnecessary testing needs more than tort reform to cure

Conditions and Diseases
July 17, 2010

Recently, while covering for one of my partners on a weekend, I was consulted by a physician to do a procedure.

The doctor wanted his patient to undergo an EGD, which is a scope test that examines the esophagus, stomach and first portion of the small intestine called the duodenum. We gastroenterologists do this test routinely to search for an explanation for a patient’s symptoms, or to determine if these organs …

Read more…

Unnecessary testing needs more than tort reform to cure

Why general internists are quitting clinical medicine

Health Policy
July 16, 2010

The Association of American Medical Colleges predicts that by 2025, the US health system will have 46,000 fewer primary care physicians than it needs.

If the prediction proves correct and we fail to develop effective mitigation strategies, the manpower shortage will create quite a mess. Ironically, the health reform law signed by President Obama in March will exacerbate the problem by increasing demand for services provided by primary care physicians.

The American …

Read more…

Why general internists are quitting clinical medicine

Facebook friend issues between doctor and patient

Social Media in Medicine
July 16, 2010

My friend and colleague Katherine Chretien has a provocative op-ed in USA Today entitled, “A doctor’s request: Please don’t ‘friend’ me,” which asks the question whether doctors and patients should interact in social networking sites such as Facebook.

Social networking has huge potential in health care regarding the sharing of information and ideas, and could possibly even enhance communication between doctors and patients. However, as Dr. Chretien points out, many …

Read more…

Facebook friend issues between doctor and patient

Echocardiogram reading by cardiologists needs to improve

Conditions and Diseases
July 16, 2010

by Crystal Phend

Insufficient training among cardiologists in reading echocardiography results is wasting healthcare dollars and subjecting patients to unnecessary procedures, researchers said.

A review by sonographers of cardiologist-interpreted echocardiography findings at a Milwaukee medical center during a period of just over a year indicated major discrepancies in 29% of cases, leading to unnecessary further diagnostic testing or treatments for the wrong indication, according to a study presented here at the American …

Read more…

Echocardiogram reading by cardiologists needs to improve

Poliomyelitis doesn’t make the health reform cut

Health Policy
July 16, 2010

Early in paralytic poliomyelitis, the patient exhibits weakness; hyperesthesia; muscular pain, frequently quite severe; antalgic (reflexive) immobilization (spasm) of involved muscles; and normal or accentuated tendon reflexes.

This phase is rapidly followed by loss of motor function, which is usually asymmetric and noncontiguous: one or both legs in 60 percent of the cases; one or both arms in 25 percent. Involvement of the diaphragm and intercostal muscles reduces ventilatory capacity. Cranial …

Read more…

Poliomyelitis doesn’t make the health reform cut

Why doctors run late and how patients can help

Physician
July 15, 2010

A friend recently asked me in great frustration after her visit to her doctor why doctors “always run late.”

Why do doctors make their patients “dance around” the office, getting moved around to different spots in the clinic, but still having to wait and wait at each location? Instead of explaining what really goes on at the doctor’s office, I ended up emailing her a couple of links to some of …

Read more…

Why doctors run late and how patients can help

Stents to treat blocked heart arteries are not an easy fix

Conditions and Diseases
July 15, 2010

Cardiologist Richard Fogoros — aka DrRich — has put out an incredibly timely and pertinent piece of advice concerning the common practice of stenting blockages in the coronary arteries.

He succinctly summarizes a small retrospective study that showed an increased risk of cardiac events after non-cardiac surgery in patients who have recently undergone either a bare metal or drug-eluting coronary stent.

On a website clearly designed to educate patients, DrRich rightly points …

Read more…

Stents to treat blocked heart arteries are not an easy fix

Why having a primary care physician is important

Physician
July 15, 2010

by Chrysalis

I read a post that disturbed me the other day. It was discussing the value of primary care physicians (PCPs). I was stunned by some of the comments. Surprised that people’s perceptions of what a PCP does would be viewed in such a poor light.

Well, I do value the primary care physician and I’ll tell you why. I am just simply going to state some of …

Read more…

Why having a primary care physician is important

Is the PAP test for cervical cancer screening being overused?

Conditions and Diseases
July 15, 2010

by Kristina Fiore

Physicians do not appear likely to reduce the frequency of cervical cancer screening — not even with the availability of the sensitive human papillomavirus (HPV) DNA test, researchers say.

When given a clinical vignette of a 35-year-old woman with a normal Pap test and a negative HPV test, only 19% of the more than 1,200 physicians surveyed said they would wait three years before conducting another Pap test, Mona …

Read more…

Is the PAP test for cervical cancer screening being overused?

Why this doctor felt compelled to go to Haiti

Physician
July 15, 2010

by David Chong, MD

As the world watched the greatest athletes gather to compete in Vancouver, I was on a plane to Haiti. Just getting on the plane was quite a feat.

After I received an urgent e-mail for volunteer doctors from the University of Miami’s Project Medishare field hospital in Port-au-Prince, Haiti during an overnight shift at New York’s Presbyterian hospital, I began to send frantic requests for coverage for …

Read more…

Why this doctor felt compelled to go to Haiti

ADVERTISEMENT

Rosiglitazone (Avandia) stays on the market, with stronger warnings

Medications
July 14, 2010

by Emily P. Walker

An advisory panel voted 20-12 to recommend that the FDA allow rosiglitazone (Avandia) to stay on the market, but most panelists want to see the controversial diabetes drug carry tougher warnings on its label.

Wednesday’s vote marks the second time an FDA advisory panel has essentially endorsed rosiglitazone. In 2007, a panel voted that while the drug appears to …

Read more…

Rosiglitazone (Avandia) stays on the market, with stronger warnings

Treating intellectual disabilities in patients who can’t talk

Conditions and Diseases
July 14, 2010

Psychiatrists treating patients who can’t talk. Sounds fishy, doesn’t it?

Well, I do it 2-3 days per week, and as strange as it may sound, it makes perfect sense.

Let me explain.

I provide psychiatric consultation services in a facility for people with intellectual and developmental disabilities. (Intellectual disability is the newer term for mental retardation). Some of my patients are short-term admissions from the community, and others are long-term residents of the …

Read more…

Treating intellectual disabilities in patients who can’t talk

Fire in the OR and how hospitals should report medical mistakes

Physician
July 14, 2010

Did you know that if there is a fire in the OR during surgery hospitals in some states don’t have to report the event to anyone?

When I read a recent story in the Cleveland Plain Dealer headlined, “Reporting Surgical Fires Could Improve Patient Safety in Ohio, Experts Say,” I was stunned.

The piece begins:

When fire breaks out and burns a patient during surgery in Pennsylvania, the hospital is required by law …

Read more…

Fire in the OR and how hospitals should report medical mistakes

Free clinics need more government funding

Health Policy
July 14, 2010

by Cole Petrochko

The nation’s free clinics provide medical service to 1.8 million patients annually — more than half of those clinics operate without government funding and serve patients who are almost all uninsured — according to the first census of free clinics in 40 years.

Responses to a national mail survey by 764 free clinics in the U.S., reported in the June issue of the Archives of Internal Medicine, revealed that …

Read more…

Free clinics need more government funding

Pregnant with triplets, and a premature delivery

Conditions and Diseases
July 14, 2010

An excerpt from The Preemie Primer.

There’s a well-entrenched theory that OB/GYNs have the most complicated pregnancies.

In reality most of us probably do not, but doctors remember complications most vividly when they happen to people they know and love. My pregnancy was, unfortunately, a good example of that old adage. Many of my colleagues who looked after me during that time have said, “It was the worst night of my life.” …

Read more…

Pregnant with triplets, and a premature delivery

Final meaningful use rules for electronic health records reaction

Health Technology
July 14, 2010

by Joyce Frieden

The Department of Health and Human Services has released its final rule on “meaningful use” of electronic health records with the goal of making it easier for physicians to comply.

“We want these objectives to be ambitious but achievable,” David Blumenthal, MD, MPP, the department’s National Coordinator for Health Information Technology, said at a press conference on Tuesday announcing the release of the …

Read more…

Final meaningful use rules for electronic health records reaction

What residents and medical students should wear in the hospital

Medical Education
July 13, 2010

At a recent meeting I attended, a vigorous discussion broke out about what medical students, residents and attendings should wear, and more importantly what they should not wear.

Interestingly, patients have been asked to weigh in on this discussion. What to wear is also on the mind of many current second year medical students who may find themselves trying to take study breaks from USMLE 1 to go buy …

Read more…

What residents and medical students should wear in the hospital

1561
pages