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Avandia aftermath: winners and losers

How medical practice operations impacts productivity and profitability

Rosemarie Nelson

October 12, 2010Oct 12, 20103

"How many staffers should we have per doctor?" was the opening question in a recent column. We looked at the impact of staff on provider productivity and ultimately practice profitability as an approach to address that question. In that piece,…

“How many staffers should we have per doctor?” was the opening question in a recent column. We looked at the impact of staff on provider productivity and ultimately practice profitability as an approach to address that question.

In that piece, we focused primarily on clinical staff, but in this column, we’ll dig even deeper into medical practice operations, looking at the way a practice utilizes nonclinical support staff for traditionally …

Patient voices

Intimate partner violence an epidemic of grave proportion

Jennifer Gunter, MD

October 12, 2010Oct 12, 20104

October is breast cancer awareness month. There are pink ribbons and wristbands to wear, pink products to buy, and pink races to run -- all to improve awareness about screening and raise money for a cure. And rightly so, because…

October is breast cancer awareness month. There are pink ribbons and wristbands to wear, pink products to buy, and pink races to run — all to improve awareness about screening and raise money for a cure. And rightly so, because breast cancer affects 250,000 American women every year.

Fewer people know that October is also intimate partner violence awareness month. Purple is the color representing the more than 1.3 million women …

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Patient voices

Deal with your triggers when trying to lose weight

Melanie Lane, MD

October 11, 2010Oct 11, 20103

One of the most common complaints that I hear from people attempting to lose weight is, “I don’t know how to deal with my triggers.” Most of us have had the experience of eating just one bite of something and suddenly wanting to devour the entire thing. Sometimes we do, even though we know we won’t be happy with ourselves when we finish.

I am familiar with the experience of insisting …

Drugs and prescribing

Avandia aftermath: winners and losers

Larry Husten, PhD

October 11, 2010Oct 11, 2010

Responses to the Avandia panel have been all over the map, as cleverly noted on the Wall Street Journal's Health Blog. Avandia is “dead” (Forbes), or, perhaps worse, “now a Zombie” (BNET). By contrast, others thought the panel granted Avandia…

Responses to the Avandia panel have been all over the map, as cleverly noted on the Wall Street Journal‘s Health Blog. Avandia is “dead” (Forbes), or, perhaps worse, “now a Zombie” (BNET). By contrast, others thought the panel granted Avandia a “reprieve” (Wall Street Journal and that Avandia would now probably be allowed to stay on the market (Los Angeles Times, Pharmalot).

All …

Read more…

Medicare needs to be more like a credit card

Steven H. Rudolph, MD

October 11, 2010Oct 11, 20109

I live in New York. Last week my daughter in Chicago called to say that a five dollar charge had been refused at a local coffee shop. My credit card company had identified an unusual pattern of purchases, and had…

No similar process exists for the Medicare system, where cost savings could be realized by systems that identify unusual patterns of charges and outright abuse …

How time can be used as a diagnostic tool

Edward Pullen, MD

October 10, 2010Oct 10, 20102

I can’t remember which lecture it was, or even just when in my first two years of medical school the lecture was given, but I do remember how the concept struck me as really important. The gist of the message…

I can’t remember which lecture it was, or even just when in my first two years of medical school the lecture was given, but I do remember how the concept struck me as really important.

The gist of the message was that the timing of onset of a patient’s symptoms is a key part of understanding the nature of the patient’s diagnosis. Symptoms from a neoplasm come on gradually, tend to …

Trust your doctor but review your medical bills

Dennis Grace

October 10, 2010Oct 10, 20106

by Dennis Grace The last time I visited my physician for an epidural injection, as the doctor’s assistant was situating me under the fluoroscope, the doctor was feverishly dictating notes on his previous patient’s procedure. No doubt your physician has…

by Dennis Grace

The last time I visited my physician for an epidural injection, as the doctor’s assistant was situating me under the fluoroscope, the doctor was feverishly dictating notes on his previous patient’s procedure. No doubt your physician has a similar work schedule: when not dashing off notes from one patient or burrowing through medical research to diagnose another, he’s performing delicate medical procedures …

How observation admissions affect Medicare patients

WhiteCoat, MD

October 10, 2010Oct 10, 201019

A revealing article in Bloomberg recently described the latest way in which elderly patients are getting screwed by the system. Medicare reviews all admissions and if the patients don’t meet indications for admission, the hospital doesn’t get paid by Medicare.…

A revealing article in Bloomberg recently described the latest way in which elderly patients are getting screwed by the system.

Medicare reviews all admissions and if the patients don’t meet indications for admission, the hospital doesn’t get paid by Medicare. Medicare has also recently implemented a mercenary system called Recovery Audit Contractors (or RAC for short) in which third parties audit hospital charts to see whether Medicare “overpaid” for a patient’s …

Quality programs have social and medical consequences

Douglas Perednia, MD

October 9, 2010Oct 9, 20104

Like it or not, “garbage in, garbage out” is the rule rather than the exception for the vast majority of bureaucratically dictated “quality control” programs that we’re ever likely to launch. There are three primary reasons for this. First and…

First and foremost, there’s Goodhart’s Law:

“Originally, an economic theory stating that if a particular definition of the money supply were to be used as the basis for monetary policy, the stability

…

Medical education

Should the public participate in preparing cadavers for students?

Josh Herigon, MPH

October 9, 2010Oct 9, 20107

The Wall Street Journal's Health Blog carries an interesting piece about a program at Indiana University–Northwest that allows volunteers from the general public to participate in preparing cadavers for first year medical students. This is a brilliant idea for several…

The Wall Street Journal’s Health Blog carries an interesting piece about a program at Indiana University–Northwest that allows volunteers from the general public to participate in preparing cadavers for first year medical students.

This is a brilliant idea for several reasons:

One persistent problem facing physicians is the extremely low health literacy of most patients. Simply put, “health literacy” refers to how well patients can comprehend what their

…

Watchful waiting is underutilized for most men with prostate cancer

John Schumann, MD

October 8, 2010Oct 8, 2010

NPR has a great blog on their website called Shots about current events in health care. Recently, Scott Hensley, the main blogger there, posted a recent article on treatment of prostate cancer from the Archives of Internal Medicine. If you…

NPR has a great blog on their website called Shots about current events in health care. Recently, Scott Hensley, the main blogger there, posted a recent article on treatment of prostate cancer from the Archives of Internal Medicine.

If you look at the article, you may notice a very small subheading above the article’s title. It reads “Less is More.”

Very telling.

The thrust of the article …

When parents should be concerned about a lump on their child

Michael Gonzalez, MD

October 8, 2010Oct 8, 2010

I was recently scanning an online forum about pediatric health concerns. (What can I say? I sometimes need inspiration.) One thread within the forum was significantly longer than any other. Parent after parent posted about how they had noticed a knot on their infant or toddler. This concern parallels what I see in practice. An unexplained knot on the head is a common reason parents bring their child to …

Patient voices

How open medical charts help Healthy Survivorship

Wendy S. Harpham, MD

October 8, 2010Oct 8, 20105

"Our" Chart Does the opportunity for patients to read their medical charts help or hurt patients' ability to become Healthy Survivors? Open notes can facilitate Healthy Survivorship for some patients. Unfortunately, other patients may learn something about their condition that…

[Editor’s note: Please visit part 1 of Dr. Harpham’s take on OpenNotes.]

“Our” Chart

Does the opportunity for patients to read their medical charts help or hurt patients’ ability to become Healthy Survivors?

Open notes can facilitate Healthy Survivorship for some patients.

Unfortunately, other patients may learn something about their condition that makes it more difficult to get good care or live as fully as possible. Or they may experience feelings that threaten the physician-patient …

Why doctors should care about Regional Extension Centers (RECs)

David B. Nash, MD, MBA

October 8, 2010Oct 8, 201020

Over the past year, states across the country have begun to develop Regional Extension Centers (RECs) to help support the broad electronic health record (EHR) initiative passed as part of the economic stimulus package in 2009. Why should physicians care?…

Why should physicians care? With benefit of a little background information, the answer is pretty clear.

The evidence suggests — and it is generally believed — that adoption of EHRs by physicians and other healthcare providers …

How to foster a cycle of excellence in medicine

Ron Li

October 8, 2010Oct 8, 20102

“What does it take to be good at something in which failure is so easy, so effortless?” asks Atul Gawande in his book, Better. For medical students who will soon have responsibility over people’s lives, it’s a daunting question. It draws out our fears of messing up and making mistakes. Of getting a lower grade than our peers on a Structure Function exam. Of answering a question incorrectly and embarrassing …

Medical malpractice and how legal waste increases overall costs

Chris Rangel, MD

October 7, 2010Oct 7, 201021

Dr. Kirsch at MD Whistleblower has written about his recent unpleasant experience with malpractice litigation. Despite having full access to the patient’s chart and medical records, the plaintiffs attorney chose to include Dr. Kirsch in the suit ... apparently ...…

In Ohio – where this case was filed – a plaintiff in a medical malpractice case is required to obtain …

Why doctors have poor customer service

Why doctors have poor customer service

Brandon Betancourt

October 7, 2010Oct 7, 201062

One of my docs was telling us about a patient’s experience at another practice. Apparently, the parent was at her wits end with her crying baby. She called the on call doctor to ask for advice and the doctor told…

It turned out the baby had some gastric condition (not colic) and needed treatment. The patient ended up …

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