KevinMD.com

July 21, 2010Jul 21, 201014

A recent comment raised a minor controversy about the strategy of minimizing tests. I actually do not think that the disagreement is that great, but I feel like exploring the issue. This is the sentence that triggered the comment, courtesy…

A recent comment raised a minor controversy about the strategy of minimizing tests. I actually do not think that the disagreement is that great, but I feel like exploring the issue.

This is the sentence that triggered the comment, courtesy of primary care physician Rob Lamberts:

Order as few tests as possible. No test should be ordered for informational purposes only; the question, “What will I do with these results?” should always

…

Health policy

Understanding balance billing, a primer for patients

Lucy Hornstein, MD

July 21, 2010Jul 21, 201014

The topic of balance billing has arisen once again, this time in this post by Movin’ Meat about the new health care insurance bill and emergency medicine. Without further explanation, “balance billing” is generally thought of as a bad thing;…

The topic of balance billing has arisen once again, this time in this post by Movin’ Meat about the new health care insurance bill and emergency medicine.

Without further explanation, “balance billing” is generally thought of as a bad thing; a way for rich doctors to squeeze even more ill-gotten gains from their poor beleaguered patients. And that’s without even realizing what it is. So …

Can Shrek and Dora combat the junk food epidemic?

MedPage Today

July 21, 2010Jul 21, 2010

by Michael Smith Can Dora the Explorer help kids find a taste for carrots? It may be possible that licensed characters such as Dora, Shrek, and Scooby-Doo can tilt the balance away from junk food and toward healthy snacks, according…

by Michael Smith

Can Dora the Explorer help kids find a taste for carrots?

It may be possible that licensed characters such as Dora, Shrek, and Scooby-Doo can tilt the balance away from junk food and toward healthy snacks, according to Christina Roberto, MS, and colleagues at Yale University.

In a study of 40 preschoolers, the presence of a licensed character on a package influenced the children’s perception of taste and their preference …

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Physician voices

Data and transparency is needed to reduce medical mistakes

Kevin

July 21, 2010Jul 21, 20102

An excerpt from On the Mend: Revolutionizing Healthcare to Save Lives and Transform the Industry. by John Toussaint, MD, and Roger Gerard, PhD Admitting Error In a lean environment, doctors and nurses must allow mistakes to be visible in order…

An excerpt from On the Mend: Revolutionizing Healthcare to Save Lives and Transform the Industry.

by John Toussaint, MD, and Roger Gerard, PhD

Admitting Error

In a lean environment, doctors and nurses must allow mistakes to be visible in order to perform root-cause analysis and fix the process. But showing mistakes hits most medical providers in a vulnerable place—right in the collective fear of lawsuits and a highly conditioned need to be …

Patient voices

Participatory medicine and evidence from medical journals

Dave deBronkart

July 20, 2010Jul 20, 20104

I’ve only been studying healthcare for two years and I hesitate to be overly assertive. But I have, finally, reached the point where I feel confident in citing cases where people are simply being unscientific: ignoring evidence. That’s always hazardous,…

I’ve only been studying healthcare for two years and I hesitate to be overly assertive.

But I have, finally, reached the point where I feel confident in citing cases where people are simply being unscientific: ignoring evidence. That’s always hazardous, and it becomes insidious when it’s caused by a blind, unquestioning belief in our institutions.

Case in point:

Julie Thoren is an active practitioner of Participatory Medicine who’s seen first-hand the tremendous value …

Health policy

Health care needs public acceptance of evidence based medicine

Brad Wright, PhD

July 20, 2010Jul 20, 201011

Although a majority of Americans probably couldn't give you an accurate description of the differences between fascism, socialism, and communism, they have no trouble applying--and often interchanging--those labels to any effort by government to reform health care. And, based on…

Although a majority of Americans probably couldn’t give you an accurate description of the differences between fascism, socialism, and communism, they have no trouble applying–and often interchanging–those labels to any effort by government to reform health care.

And, based on their efforts, one might conclude that the defining characteristic of any government involvement in health care is rationing. As if we don’t already ration, but will as soon as the government …

Physician voices

5 principles of self-care for health professionals

Lisa Chu, MD

July 20, 2010Jul 20, 20104

As trained caring professionals, often we think of self-care as “selfish” or something that we do after we’ve taken care of our other “duties”, “responsibilities” and “obligations”. Just for a moment, I invite you to think of self-care in a…

As trained caring professionals, often we think of self-care as “selfish” or something that we do after we’ve taken care of our other “duties”, “responsibilities” and “obligations”.

Just for a moment, I invite you to think of self-care in a different way. I invite you to consider that your knowledge and practice of self-care is essential to creating a healing relationship with your patients and creating a healing environment in your …

Health policy

The value of comparative effectiveness reviews is locally based

Craig A. Umscheid, MD, MS

July 20, 2010Jul 20, 20103

by Craig A. Umscheid, MD, MSCE In its 2010 comparison, the Commonwealth Fund has rendered the verdict yet again: the United States leaves other nations in the dust when it comes to healthcare costs -- and yet provides its residents…

by Craig A. Umscheid, MD, MSCE

In its 2010 comparison, the Commonwealth Fund has rendered the verdict yet again: the United States leaves other nations in the dust when it comes to healthcare costs — and yet provides its residents with the worst outcomes overall. In the study, the U.S. underperformed on virtually every front in comparison to Australia, Canada, Germany, Netherlands, New Zealand, and the United Kingdom.

The …

Health policy

How Massachusetts can set hospital payment rates

Paul Levy

July 19, 2010Jul 19, 201010

My suggestion last year that Massachusetts move away from the "free market" approach it uses to set hospital reimbursement rates was not well received by the hospital world. But, this year, as people notice that their rates are being set…

My suggestion last year that Massachusetts move away from the “free market” approach it uses to set hospital reimbursement rates was not well received by the hospital world.

But, this year, as people notice that their rates are being set by insurance companies in an unaccountable and unreviewable fashion, more and more are saying, “Well, maybe. What would it look like?”

There is a range of options. Let me lay out …

Health policy

What libraries and community centers have to do with health care

Marya Zilberberg, MD, MPH

July 19, 2010Jul 19, 2010

Our grandparents used to tell us, "if it ain't broke, don't fix it". Management gurus, in their race to the finish line have turned this sentiment on its head by telling us that, if it ain't broke now, it will…

Our grandparents used to tell us, “if it ain’t broke, don’t fix it”.

Management gurus, in their race to the finish line have turned this sentiment on its head by telling us that, if it ain’t broke now, it will be soon, and if you do not fix it before it breaks, you will be behind the competition. This sentiment drives the annual corporate reorganization at every corporation that I or …

Conditions and diseases

Watchful waiting may be appropriate for most prostate cancer cases

MedPage Today

July 19, 2010Jul 19, 2010

by Crystal Phend Deferring curative treatment for low-risk prostate cancer may be a good option for many men ages 70 and younger, a population-based observational study affirmed. In the national Swedish prostate cancer registry, the cumulative 10-year prostate cancer-specific mortality…

by Crystal Phend

Deferring curative treatment for low-risk prostate cancer may be a good option for many men ages 70 and younger, a population-based observational study affirmed.

In the national Swedish prostate cancer registry, the cumulative 10-year prostate cancer-specific mortality rate was only 2.4% for men at low risk who opted for watchful waiting or active surveillance, according to Pär Stattin, MD, PhD, of Umeå University Hospital in Umeå, Sweden, and colleagues.

This …

What bored doctors can do after they retire

Michael Woo-Ming, MD

July 19, 2010Jul 19, 2010

As the baby boom generation nears retirement, there will be a flood of doctors left wondering what to do with their time. Some doctors will continue to work in practice and, although it is certainly rewarding to work hands-on with patients and new staff, after 30, 40, or 50 years in the business many start to explore other options.

The motivation that drives one to medicine often stays with them for …

Physician voices

Prior authorization required by health insurers impedes primary care

Charles R. D'Agostino, MD

July 19, 2010Jul 19, 201025

It strikes fear in the hearts of doctors across the country; it is not the deadly Ebola virus or a new strain of cancer, but its malignancy is equally apparent. It is the dreaded “PA”, which is insurance-speak for “prior…

It strikes fear in the hearts of doctors across the country; it is not the deadly Ebola virus or a new strain of cancer, but its malignancy is equally apparent.

It is the dreaded “PA”, which is insurance-speak for “prior authorization” and it seems that no matter which way we turn it appears, standing between our patients and the care they need.

To their credit, PAs are truly equally opportunity barriers to …

Patient voices

Cancer patients need compassion and balanced information

Bruce Campbell, MD

July 18, 2010Jul 18, 2010

If you have to ask what jazz is, you will never know. - Louis Armstrong The stillness in the meeting room was electric. First, one panelist addressed the audience members who have never experienced a malignancy. She described the unique…

If you have to ask what jazz is, you will never know.
– Louis Armstrong

The stillness in the meeting room was electric.

First, one panelist addressed the audience members who have never experienced a malignancy. She described the unique and powerful bond that exists between cancer survivors. She described how the brush with mortality forces each survivor to renegotiate terms with Life itself. She reminded everyone that the cancer care system too often lets …

Health policy

A new primary care payment model with health savings accounts

Charles Smith, MD

July 18, 2010Jul 18, 20109

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)…

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 …

Patient voices

How doctors can discuss advance directives with patients

Juliet K. Mavromatis, MD

July 17, 2010Jul 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…

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? …

Drugs and prescribing

ER visits rise because of prescription drug abuse

MedPage Today

July 17, 2010Jul 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…

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 …

Conditions and diseases

Unnecessary testing needs more than tort reform to cure

Michael Kirsch, MD

July 17, 2010Jul 17, 201029

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…

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 …

Health policy

Why general internists are quitting clinical medicine

Glenn Laffel, MD, PhD

July 16, 2010Jul 16, 201012

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…

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 …

Real physician voices, twice a week

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