KevinMD.com

May 5, 2010May 5, 201010

A major criticism leveled at the health reform law is that it doesn’t do enough to control costs. Yet experience with a similar breed of health reform in Massachusetts indicates that the cost control issue will come to the fore…

Recent stories have reinforced my conviction about this:

Massachusetts health plans have sued the state and stopped issuing new policies to small businesses and individuals after the …

Health policy

Maternal death rates improve but hurts fund raising

MedPage Today

May 5, 2010May 5, 2010

by Mike Himowitz When you’re advocating for a health cause, can good news be bad news? It’s entirely possible -- when science threatens fund-raising, and at the worst possible time. Consider a study of worldwide maternal death rates by a…

by Mike Himowitz

When you’re advocating for a health cause, can good news be bad news?

It’s entirely possible — when science threatens fund-raising, and at the worst possible time.

Consider a study of worldwide maternal death rates by a team from the University of Washington that appeared online recently in The Lancet.

The group, led by Christopher Murray, of the school’s Institute for …

Physician voices

Quality hospital care deserves to be celebrated

Brian Klepper, PhD

May 5, 2010May 5, 2010

Last week my wife and best friend, Elaine, had massive abdominal surgery. We fully expected her to be an inpatient for a week, but she was home in four and half days. To watch her recover was to see what happens when everything converges: the deep knowledge and skills of excellent, humane physicians; a capable, caring clinical staff; wonderful new technologies; and a lifetime of eating right, being fit and …

Real physician voices, twice a week

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Health policy

Health reform may mean meaningful changes for physicians

Aldebra Schroll, MD

May 4, 2010May 4, 20106

Jim called me late on a fall afternoon to report our mutual friend was in the local emergency room. “It looks like he had a stroke”. I immediately asked to speak to the ER doctor for the results of the…

It has been over two years since my friend died. He was among the millions …

Health technology

Problem list problems with electronic medical records

Hans Duvefelt, MD

May 4, 2010May 4, 20104

In family medicine it has been common to keep a “Problem List” in patients’ paper charts. Usually placed on the left hand side, on top of the Medication List, it has given doctors like me an instant thumbnail sketch before…

A typical Problem List would include diagnoses like diabetes, hypertension, high cholesterol or rheumatoid arthritis. It would list prior surgeries, like …

Physician voices

Malpractice fears influence cardiology decisions

MedPage Today

May 4, 2010May 4, 20105

by Charles Bankhead For nearly a quarter of cardiologist respondents, malpractice concerns influenced their decisions to order tests or treatment for hypothetical cases included in a national survey. Almost 30% of cardiologists acknowledged ordering cardiac catheterization because colleagues did so…

by Charles Bankhead

For nearly a quarter of cardiologist respondents, malpractice concerns influenced their decisions to order tests or treatment for hypothetical cases included in a national survey.

Almost 30% of cardiologists acknowledged ordering cardiac catheterization because colleagues did so in the same situation, according to an article published online in Circulation: Cardiovascular Quality Outcomes.

Concerns about malpractice had a significant association with regional use of tests and treatment, Frances Lee Lucas, PhD, …

Physician voices

Avoiding the ER and arranging a direct admit is not easy

Kevin

May 4, 2010May 4, 201016

Are emergency departments solely responsible for the bulk of unnecessary tests? Most would like to believe so, but emergency physician Edwin Leap says that's not the case. He cites an instance involving a primary care doctor and hospitalist: Local physician,…

Are emergency departments solely responsible for the bulk of unnecessary tests?

Most would like to believe so, but emergency physician Edwin Leap says that’s not the case.

He cites an instance involving a primary care doctor and hospitalist:

Local physician, who does not admit to the hospital, sees patient in the office. Patient has uncontrolled hypertension and is having some chest pain and shortness of breath. Local physician contacts hospitalist.

…

Physician voices

Defensive medicine worsens patient care and raises costs

Roy Benaroch, MD

May 3, 2010May 3, 2010

Health care in the United States costs too much, and it doesn’t look like that’s going to change. Recent health care reform legislation doesn’t take any meaningful steps towards reducing or controlling costs. In fact, it explicitly forbids states from…

How does a fear of lawsuits increase costs? The most direct way is …

Medical education

Residency team changes can improve education and patient care

Robert Wachter, MD

May 3, 2010May 3, 2010

In the early 90s, I had the privilege of directing UCSF’s exceptional internal medicine residency program. It was a time of transition. A decade earlier, residency accreditation requirements (dictated by the Accreditation Council for Graduate Medical Education, ACGME) were fairly benign and largely ignored – marquee programs like ours were generally given carte blanche to organize our residents’ experience as we saw fit.

When I took over our residency in 1992, …

Physician voices

Money prevents patients from seeking timely heart care

MedPage Today

May 3, 2010May 3, 2010

by Crystal Phend Lack of insurance and financial concerns keep patients from treating a heart attack like the emergency it is, researchers affirmed. A delay in getting to the hospital for treatment of acute MI was 38% more likely among…

by Crystal Phend

Lack of insurance and financial concerns keep patients from treating a heart attack like the emergency it is, researchers affirmed.

A delay in getting to the hospital for treatment of acute MI was 38% more likely among the uninsured and 21% more likely among insured patients with financial concerns, reported Paul S. Chan, MD, MSc, Mid America Heart Institute in Kansas City, Mo., and colleagues.

More than two in every …

Health policy

How health care reform will affect mental health

Diana E. Lee

May 3, 2010May 3, 20104

by Diana E. Lee The cost of therapy and medication for underinsured people are common barriers keeping people from getting treatment for a mental health problem. Although there are community mental health centers that provide treatment for many people, their…

by Diana E. Lee

The cost of therapy and medication for underinsured people are common barriers keeping people from getting treatment for a mental health problem.

Although there are community mental health centers that provide treatment for many people, their resources are stretched far too thin to help everyone who needs treatment on the level someone with a more serious issue may need. One of the most positive changes that will arise …

Conditions and diseases

Medical device security may be vulnerable to hackers

MedPage Today

May 2, 2010May 2, 2010

by Kristina Fiore Although no such attacks have yet been reported, medical devices could be susceptible to hackers, and a thorough security analysis should be done as part of FDA approval, researchers argue. Premarket regulatory evaluation should include a risk-based…

by Kristina Fiore

Although no such attacks have yet been reported, medical devices could be susceptible to hackers, and a thorough security analysis should be done as part of FDA approval, researchers argue.

Premarket regulatory evaluation should include a risk-based security assessment depending on the nature of the device and the perceived threat of a security compromise, said William H. Maisel, MD, MPH, of Beth Israel Deaconess Medical Center, in Boston, and …

Drugs and prescribing

Free prescription drug samples cost patients more money

Leslie Ramirez, MD

May 1, 2010May 1, 201025

Free is good, right? If you have to pay out of pocket for medicines, free prescription drug samples from your doctor's office might seem like a godsend. But nine times out of ten, these free samples end up costing you…

Free is good, right? If you have to pay out of pocket for medicines, free prescription drug samples from your doctor’s office might seem like a godsend. But nine times out of ten, these free samples end up costing you more money. Here’s how.

First of all, pharmaceutical reps only get paid to give out brand new medicines that their companies are trying to promote. They are giving out these drugs …

Health policy

Medicare reverses a brain tumor drug decision

John Fauber

May 1, 2010May 1, 20107

Paula Oertel's brain tumor disappeared for nine years while she was on a drug not approved for her condition. The tumor returned when a move to a new home triggered a Medicare review -- and subsequent denial of coverage for…

Paula Oertel’s brain tumor disappeared for nine years while she was on a drug not approved for her condition. The tumor returned when a move to a new home triggered a Medicare review — and subsequent denial of coverage for the experimental treatment.

Now Medicare officials have decided she will be allowed to go back on the drug.

“I am hoping that it …

Physician voices

Doctors need more eye contact with patients, not computers

Lisa Gualtieri, PhD

April 30, 2010Apr 30, 201017

I had an interesting juxtaposition of events. While waiting in Peets, a coffee shop in Lexington Center, I watched the friendly discussions between the baristas and customers. I then went to a doctor’s appointment, where a nurse stood typing at…

I had an interesting juxtaposition of events. While waiting in Peets, a coffee shop in Lexington Center, I watched the friendly discussions between the baristas and customers.

I then went to a doctor’s appointment, where a nurse stood typing at a laptop asking me a series of questions, including “Are you in pain?” and “Do you feel safe at home?” She didn’t look at me once as she read and typed.

Eye Contact

…

Physician voices

Healthcare reform and the new role of hospitalists

MedPage Today

April 30, 2010Apr 30, 20102

by John Gever With growing pressures on hospitals from the new healthcare reform law and from the stakeholder community to become more efficient and effective, administrators may find they already have the necessary expertise under their own roofs, a prominent…

by John Gever

With growing pressures on hospitals from the new healthcare reform law and from the stakeholder community to become more efficient and effective, administrators may find they already have the necessary expertise under their own roofs, a prominent hospitalist said.

“Some organizations with hospitalist programs need look no further than these programs to chart a course toward more effective physician-hospital integration,” wrote Robert M. Wachter, MD, of the University of …

Health policy

Physician supply trends for primary care doctors and specialists

William R. Yates, MD

April 30, 2010Apr 30, 20104

Health care reform continues to be a key political topic of discussion in the U.S. Physician supply and specialty training are important elements in designing an efficient system that provides the highest quality of care. To understand where U.S. physician…

To understand where U.S. physician supply and specialty training is headed, I examined the U.S. trends from 1990 to 2007 (latest year data is available).

Physician supply has been growing during this period. In 1990, there were …

Physician voices

Internal medicine is dead, will concierge physicians thrive?

Steven Knope, MD

April 29, 2010Apr 29, 201034

For the last several years, writers in the New England Journal of Medicine and the Journal of the American Medical Association have authored doomsday editorials about the prognosis of primary care medicine. There has been much discussion about the fact…

For the last several years, writers in the New England Journal of Medicine and the Journal of the American Medical Association have authored doomsday editorials about the prognosis of primary care medicine. There has been much discussion about the fact that internists and family practitioners cannot keep pace with rising overheads and falling reimbursement under the traditional third-party payment system.

Paraphrasing a recent story published in …

Physician voices

Cardiac arrest resuscitation, with wife as witness

StorytellERdoc, MD

April 29, 2010Apr 29, 201012

The patient arrived in cardiac arrest. He had been brought to our emergency department in the middle of the night. Although he had a significant cardiac history, he was only in his late-forties. His transport from his house to our department had been less than ten minutes and, along the way, the pre-hospital team had done an excellent job of intubating this patient and establishing an IV.

His wife was with …

Drugs and prescribing

Statins for heart disease prevention, is the luster fading?

MedPage Today

April 29, 2010Apr 29, 20105

by Peggy Peck First, my disclosure: I've written at least one news article about every major statin trial since 4-S, and I've been mightily impressed with almost all of the statin data. So, I was also impressed when the JUPITER…

by Peggy Peck

First, my disclosure: I’ve written at least one news article about every major statin trial since 4-S, and I’ve been mightily impressed with almost all of the statin data. So, I was also impressed when the JUPITER results were reported about a year and a half ago — although I became a little less “impressed” as JUPITER continued to …

Real physician voices, twice a week

Eye Contact

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