Patient engagement is the blockbuster drug of the century

Policy
October 16, 2013

Historically, the “do more, bill more” fee-for-service model of healthcare measured success by increased billings. In the fee-for-value era, we need a new framework for assessing healthcare results. Quality indicators are logical but they  are mostly geared towards measuring actions taken. We can borrow a concept from the energy sector for an additional metric.  We need a concept for removing waste and unnecessary care that could be inspired by a concept …

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Hostile dependency: The real reason for physician burnout

Physician
October 14, 2013

A piece recently appeared in the New York Times entitled “Who Will Heal the Doctors?”

The piece is written by Donald Borstein and I encourage all to read it. Mr. Bornstein offers a solution to the doctor burnout problem in health care, a course called “The Healers Art,” now being promoted in US medical schools that uses “mindfulness” as his means of creating compassionate, caring doctors as a way forward.

I should say …

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Medical students may find themselves without a job

Education
October 12, 2013

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“Well, if medicine doesn’t work out, you can always fall back on waiting tables,” I joked with my waiter, who, like me, happens to be a medical student. We were bonding over completing our first year of medical school — he, in Detroit, and myself, in the Bronx. He liked waiting tables and decided to work during his last summer of …

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What do we do with the extreme elderly?

Physician
October 10, 2013

A 100-year-old woman is brought to the emergency room by a concerned friend because she can no longer get out of bed to get food or go to the bathroom. Other than being unwashed and a little confused, she is fine. Her electrolytes are pristine, her electrocardiogram the definition of normal, her blood count and chest x-ray perfectly mirror the expected physiology for her age. Even her urinalysis is normal. …

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Radiation from x-rays and living in Denver: They’re not the same

Conditions
October 9, 2013

My kids were at the dentist this weekend for their routine cleaning and check ups (yes, Saturday hours!) when the hygienist mentioned x-rays. I smiled and mentioned I’d rather discuss the need with the dentist after his exam. This isn’t a dental x-ray thing, this is what I do for every test that involves ionizing radiation.

My son, Oliver, has had more radiation than most people will have. Ever. In fact, …

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The OR is not a good place for a prank

Social media
October 2, 2013

An anesthesiologist at a California hospital pasted stickers simulating a mustache and teardrops on the face of a hospital employee while she was having surgery on a finger.

According to the Los Angeles Times, the doctor said, “I thought she would think this is funny and she would appreciate it.”

And if that wasn’t bad enough, a “nursing attendant” took a photograph.

The patient, who said she had to quit her job …

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4 myths and truths about milk

Conditions
October 2, 2013

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We’ve heard some interesting things about cow’s milk over the years. I am going to share with you four myths about milk that I continue to hear from my patients’ parents.

Myth #1: Don’t give milk to a child with a fever; the milk will curdle (or some other variant).

Truth: As long as your child is not vomiting, milk is a perfectly acceptable …

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Why solutions to mental health continue to evade us

Physician
October 1, 2013

Another tragedy, another tragic series of errors, another avalanche of debriefings and politicization, and in Washington, DC, there are 12 more dead.  What can we say about this?  It seems that the standard commentary fails.  Aaron Alexis was not an angry white man, nor a conservative.  He carried no assault rifle and he had a secret security clearance. He doesn’t seem to have been motivated by race.  He was a …

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How nurses can help contain health care costs

Policy
September 30, 2013

Due to ever increasing health care costs, stakeholders in the health care system rely heavily upon front-line workers to assist in containing costs to help make health care more affordable. Since nursing is the largest sector of front-line workers, the field has an opportunity to greatly impact cost containment. Currently, there are 2.7 million nurses in the workforce, with an expected growth rate of 26% over the next decade; however, …

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Nurses are too afraid to speak up in their organizations and be vocal

Policy
September 29, 2013

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I recently saw an article about Vanderbilt University Medical Center’s nursing staff.

The administration there came up with the brilliant idea of cutting back on the housekeeping staff and making nurses do some of the cleaning, though it’s not specified how much. Nurses would be expected to take out the trash and linens, and mop up spot cleans on the floors, among other things.

They …

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Improve health care by seeing through the patient’s eyes

Physician
September 27, 2013

Is there a patient who goes through a hospitalization who does not have stories to tell about the obstacles, errors and indignities that they endured? I just wonder sometimes.

A family relative was hospitalized this week with a stroke at a hospital a few hours from me — and his experience left me demoralized about medicine.

Joe (not his real name) is an 82-year-old grandfather, father, husband and one of a kind. …

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Defining the 3 goals of palliative care

Physician
September 26, 2013

After finishing medical school and my residency in internal medicine, I undertook an additional year of training in a field called palliative care.  Patients who notice my background sometimes ask me what exactly palliative care means.  It’s really a simple concept.  Palliative care is helping people with a serious illness have the best possible quality of life.  It’s enabling sick patients to make the most of the time they have left …

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Learn to do other things besides medicine that will engage your brain

Education
September 26, 2013

Three years ago, in the midst of all that was happening with health care reform, I thought about if I’d ever recommend medicine to my daughter.  I thought and thought about that issue and looked deep inside myself for reasons one might still choose this profession, then penned “The Top Ten Reasons to Be a Doctor.”  It is, by far, the most popular post on my blog, having been …

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Why aren’t hospitals more attentive to the needs of patients?

Physician
September 24, 2013

In a recent post, Dr. Ashish Jha raises this issue as he relates his own story of coming to an ED with a very painful dislocated shoulder. Unsurprisingly, prompt treatment of his pain was deferred while staff diligently completed registration, sent him for an x-ray, and waited for a physician to see him.

On the bike path where Jha took his initial tumble, people went out of their way to …

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3 stories of surgeons that I find disturbing

Physician
September 23, 2013

An orthopedic surgeon from New York reportedly has 261 malpractice suits against him. He has been accused of performing “phantom” and unnecessary operations. In one case, he supposedly performed a knee reconstruction, and the patient died of a pulmonary embolism the same day. A post-mortem examination allegedly showed no evidence of a reconstructed knee.

There is also said to be evidence showing that in one day he was doing as many …

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How can we revise the patient medical record?

Physician
September 22, 2013

So what exactly do we want a patient-centered medical record to look like?

What is the point of a patient’s medical record? Historically it has served many functions. Perhaps the time has come to reassess what it needs to be, what it can and should be.

If a healthcare provider from one or two generations ago were to look into a patient’s chart today, would they recognize what they saw? Would they …

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