KevinMD.com

November 10, 2010Nov 10, 20102

The patient experience is the right thing to do, and a business necessity. But improving it is not necessarily easy. The fact is, large medical centers are at a real disadvantage when it comes to performing well on HCAHPS. The…

The patient experience is the right thing to do, and a business necessity. But improving it is not necessarily easy.

The fact is, large medical centers are at a real disadvantage when it comes to performing well on HCAHPS. The Centers for Medicare & Medicaid Services (CMS) do not discriminate or differentiate the scores of small community hospitals from those of large academic tertiary care referral centers. They …

Conditions and diseases

MKSAP: 44-year-old man with chronic joint pain

mksap

November 10, 2010Nov 10, 2010

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 44-year-old man is evaluated for a 2-year history of joint pain in the wrists, hands, knees, ankles, and feet. He also has a…

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 44-year-old man is evaluated for a 2-year history of joint pain in the wrists, hands, knees, ankles, and feet. He also has a 12-year history of plaque psoriasis. His current medications include acetaminophen for joint pain, topical hydrocortisone and calcipotriene ointments, and a …

Patient voices

Patients seeing the visit notes their primary physicians entered

Dave deBronkart

November 10, 2010Nov 10, 20106

This item has nothing to do with OpenNotes itself – it’s what I’m seeing now that I’ve started accessing my doctor’s notes. In short, I see the clinical impact of not viewing my record as a shared working document. Here’s…

This item has nothing to do with OpenNotes itself – it’s what I’m seeing now that I’ve started accessing my doctor’s notes. In short, I see the clinical impact of not viewing my record as a shared working document.

Here’s the story.

In OpenNotes, patient participants can see the visit notes their primary physicians entered. Note – primary, not specialists. I imagine they needed to keep the study design simple.

So, …

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Health technology

Understand your options before monitoring Internet use

Peter J. Polack, MD

November 10, 2010Nov 10, 20104

As medical practices become more advanced, staff members gain improved access to the Internet during work hours. Cyber-slacking is a well-known problem in corporations; in fact, one study found that over thirty-five percent of employees admit to using the Internet…

The New York Times cited that twenty-five percent of Net use on work computers isn’t actually work-related. Although it is unknown how severe the problem is …

Health policy

Will the new Congress allow the physician Medicare cuts to pass?

Dan McCoy, MD

November 10, 2010Nov 10, 201012

Well it's that time of year again. No, not Thanksgiving or Christmas, or even the venerable Interim Meeting of the AMA. It's the time that physicians nationwide anticipate another mandatory cut in Medicare reimbursement rates. This time the recurrent temporary…

Well it’s that time of year again.

No, not Thanksgiving or Christmas, or even the venerable Interim Meeting of the AMA. It’s the time that physicians nationwide anticipate another mandatory cut in Medicare reimbursement rates.

This time the recurrent temporary fix will result in a cut of 23.6 percent on December 1st. Assuming political gridlock the rate will fall another fraction of 6.5 percent on …

Health technology

How EMRs are failing nurses

Jared Sinclair, RN

November 9, 2010Nov 9, 201010

Among the litany of complaints about the (un)usability of EMRs, it’s easy to lose sight of the big picture. More than the poor design choices and overall ugliness of existing software, by far the single biggest failure of HIT companies…

There is a huge opportunity being wasted here. Other industries have been able to incorporate computers …

Read more…

How EMRs are failing nurses

Health technology

Patient safety suffers when doctors are forced to learn multiple EMRs

angienadia, MD

November 9, 2010Nov 9, 201010

As a new intern at a well-endowed medical institution, I was disappointed despite the flurry of excitement that comes with orientation. I was disappointed despite the brand new privilege to save lives and relieve human sufferings. And the disappointment was…

What has happened in the past two days? As I will be working at two separate hospitals, for the past two days …

Health policy

Uninsured Americans cannot afford many medications

Brad Wright, PhD

November 9, 2010Nov 9, 201031

I went to the doctor recently and got a new prescription. The doctor was kind enough to give me some free samples, and a voucher that I could redeem to fill the prescription once at no cost. In the future,…

I went to the doctor recently and got a new prescription.

The doctor was kind enough to give me some free samples, and a voucher that I could redeem to fill the prescription once at no cost. In the future, it will cost me $50 if I decide to refill it. If I didn’t have pharmaceutical benefits through my insurance coverage, the medication would set me back about $500 for a …

Physician voices

Why patients are leaving our practices

Jordan Grumet, MD

November 9, 2010Nov 9, 20107

She was like ... Superwoman. A strapping medical visionary probably in her forties. Gray long coat falling below the knees. She strode confidently down the hallway towards the elevator, a father hurrying beside her with his young lanky daughter cradled…

She was like … Superwoman. A strapping medical visionary probably in her forties. Gray long coat falling below the knees. She strode confidently down the hallway towards the elevator, a father hurrying beside her with his young lanky daughter cradled in his arms. The girl’s head nuzzled into her father’s shoulder. She was old enough to walk by herself…but clearly she was sick. Unable.

Undoubtedly they were headed from the medical …

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Why patients are leaving our practices

Health policy

An ACO may or may not reduce health insurance premiums

Paul Levy

November 8, 2010Nov 8, 20103

Is the move towards accountable care organizations (ACOs) and capitated (aka, global) payments likely to reduce health care costs and insurance premiums, or will it do the opposite? Being an economist, my answer will be, "On the one hand ...…

Is the move towards accountable care organizations (ACOs) and capitated (aka, global) payments likely to reduce health care costs and insurance premiums, or will it do the opposite?

Being an economist, my answer will be, “On the one hand … On the other hand …”

On the one hand, ACOs offer the potential for a better integration of care across the spectrum of primary care, hospitalization, skilled nursing, rehabilitation, and hospice. If …

Conditions and diseases

Is your child’s behavior due to ADHD?

Orly Avitzur, MD

November 8, 2010Nov 8, 20103

When my oldest son was 13 he began to do poorly in school. He often forgot to do his homework, or he did it but forgot to hand it in. He had difficulty paying attention during tasks, was extremely disorganized, and his teachers said he was easily distracted. They suggested that his behavior fit with many of the symptoms of attention deficit hyperactivity disorder (ADHD), but since this was mostly …

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Is your child’s behavior due to ADHD?

Physician voices

Primary care private practice will die, will patients benefit?

Kevin Pho, MD

November 8, 2010Nov 8, 201017

Having more primary care physicians doesn't necessarily improve the quality of care. That may come as a surprise to regular readers of this blog, but that's one of the findings that came from a recent analysis of the Dartmouth Atlas.…

Having more primary care physicians doesn’t necessarily improve the quality of care.

That may come as a surprise to regular readers of this blog, but that’s one of the findings that came from a recent analysis of the Dartmouth Atlas.

As reported by the WSJ’s Health Blog,

having regular primary-care visits isn’t a guarantee of receiving recommended care. There was “no relationship” between rates of breast cancer screening for women age 67-69

…

Conditions and diseases

Coping with frightening circumstances after a cancer diagnosis

Bruce Campbell, MD

November 8, 2010Nov 8, 2010

For myself I am an optimist — it does not seem to be much use being anything else. -Winston Churchill Even before I met him, I could tell that his cancer was extensive. His problems had started several months before…

For myself I am an optimist — it does not seem to be much use being anything else.
-Winston Churchill

Even before I met him, I could tell that his cancer was extensive. His problems had started several months before with a cough, a voice change, and some trouble swallowing. His primary doctor had not spotted anything but had kept an eye on him. Antibiotics and cough medicine had not helped. After …

Conditions and diseases

Alzheimer’s disease: 5 reasons why awareness matters

Dennis Fortier

November 8, 2010Nov 8, 2010

by Dennis Fortier More so than with any other major disease, our near-term progress in the battle against Alzheimer’s will be determined largely by our ability to improve awareness about several aspects of this encroaching threat. Summarized here are five…

by Dennis Fortier

More so than with any other major disease, our near-term progress in the battle against Alzheimer’s will be determined largely by our ability to improve awareness about several aspects of this encroaching threat.

Summarized here are five reasons why greater awareness about Alzheimer’s disease, and a deeper public understanding of risks and prevention strategies, will play a key role in the nation’s ability to triumph against the prospect of …

Conditions and diseases

Questions about the early diagnosis of Alzheimer’s disease

Juliet K. Mavromatis, MD

November 8, 2010Nov 8, 20106

Alzheimer's disease made headlines recently, first with news about a new biomarker test that is able to diagnose the disease with increased accuracy, then with a follow-up story detailing the collaborative model of data-sharing that contributed to the success of…

Alzheimer’s disease made headlines recently, first with news about a new biomarker test that is able to diagnose the disease with increased accuracy, then with a follow-up story detailing the collaborative model of data-sharing that contributed to the success of recent research.

As I read the news with interest I couldn’t help but feel that in our current climate, the manner in which it was reported was …

Physician voices

Expanding hepatitis B vaccine recommendations for adults

William Schaffner, MD

November 7, 2010Nov 7, 2010

My colleagues at the Advisory Committee on Immunization Practices (ACIP) are examining a proposed policy for hepatitis B vaccination for diabetic patients. If accepted, this would be the next in a series of baby steps expanding hepatitis B vaccine recommendations for adults. While we are taking these baby steps, HBV incidence rates among U.S. adults remain pretty flat, and they haven’t changed much since 2006.

We know the vaccine works. We …

Conditions and diseases

Why total body scans are a scam

Michael Kirsch, MD

November 7, 2010Nov 7, 20109

Folks across the country are paying hard cash for total body scans, abdominal aortic aneurysm testing, CAT coronary artery scans and carotid artery evaluations to prevent disease or find important lesions early. It’s a seductive argument, and it’s a scam.…

Ordinary patients don’t understand about pre-test probability and positive and negative predictive values. Indeed, all physicians were taught to consider Bayesian theory when ordering diagnostic tests. This is very tough concept for …

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Why total body scans are a scam

Drugs and prescribing

Avandia, Actos and behind the scenes of study 175

Matthew Mintz, MD

November 7, 2010Nov 7, 20102

Though I am not going to say that the New York Times lied, they either purposely and grossly misrepresented the truth or did a horrible job of reporting. In their article, "Diabetes Drug Maker Hid Test Data, Files Indicate" the…

Though I am not going to say that the New York Times lied, they either purposely and grossly misrepresented the truth or did a horrible job of reporting.

In their article, “Diabetes Drug Maker Hid Test Data, Files Indicate” the Times states that Avandia maker GSK “secretly began” a study which “provided clear signs that it (Avandia) was riskier to the heart.”

In fact, the study in question, called study …

Physician voices

How fear may lead to infidelity

Srini Pillay, MD

November 6, 2010Nov 6, 20103

When we think of infidelity as "mere cheating" we are often overlooking the many fears that go along with this. Infidelity may be due to fears and fears themselves may lead to infidelity. Why is this, and what can you…

When we think of infidelity as “mere cheating” we are often overlooking the many fears that go along with this. Infidelity may be due to fears and fears themselves may lead to infidelity. Why is this, and what can you do about this?

1. Fear of being trapped. One of the greatest fears of commitment is the fear of being trapped. When people feel trapped, their primitive brains start to rebel. …

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How fear may lead to infidelity

Real physician voices, twice a week

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