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Value-based care: Bad for doctors, bad for patients?

Policy

September 11, 2014

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Value-based health care is antithetic to patient-centered care. Value-based health care is also diametrically opposed to excellence, transparency and competitive markets. And value-based health care is a shrewdly selected and disingenuously applied misnomer. Value-based pricing is not a health-care innovation. Value-based pricing is why a plastic cup filled with tepid beer costs $8 at the ballpark, why a pack of gum …

What’s it like to be an oncologist? This is just one day.

James C. Salwitz, MD

Physician

September 10, 2014

7:00 a.m. Lights on.

Coffee, black and a banana. Paperwork. 27 patient visits, 3 emergencies, 35 phone calls. Lots of computer time. Some laughs and a few tears. Paperwork. Last family meeting. Coffee, black. In between: Thursday.

Was not completely successful in explaining to my frantic patient with the multi-page lab printout, how the problem was not that her tests were bad, but that the computer had used the wrong “normal” range …

Appreciate your NICU nurse: A letter from a neonatologist

Sue Hall, MD

Physician

September 7, 2014

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Dear NICU nurse,

I couldn’t have done what I do without you, and the time to thank you publicly for all the ways you have helped me is more than overdue.

Thank you for teaching me how to handle 500 grammers when I was a medical student and had no clue. This showed me your tolerance and good nature.

Thank you for speaking up …

Want to become a doctor? 5 criteria you should consider.

Robert Centor, MD

Education

September 4, 2014

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While running several times over the past week, I have thought carefully about our profession. I cannot imagine having chosen any other profession than medicine, nor any specialty other than internal medicine.

But that is me, is it you?

A medical tweeter than everyone should follow @medicalaxioms had these tweets recently:

If you become a doctor for wealth or prestige, you are going …

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Want to become a doctor? 5 criteria you should consider.

Beware your doctor’s knee-jerk reflex: 3 questions to ask

David L. Katz, MD

Physician

September 3, 2014

We are, I trust, all but universally familiar with the knee-jerk, or patellar, reflex. A doctor taps the patellar tendon with a rubber mallet, and our leg kicks forward in response.

The reaction is famously unthinking. In fact, it is literally so. What makes a reflex a reflex is that the brain is substantially uninvolved. The stretch of a tendon by the mallet …

Lying to receive pain medications hurts patients in true pain

Kenneth Lin, MD

Conditions

August 28, 2014

My patients lie to me every day. Some tell me that they have been taking their medications regularly when they haven’t. Some say that they have been eating a healthy diet and exercising for at least 30 minutes every day and don’t know where the extra pounds are coming from. Some lie that they are using condoms every time they have sex, that they have quit smoking, and if they …

Solving the mid-level dilemma: Call them what they really are

Jim Pagano, MD

Physician

August 26, 2014

Dr. Michael Pappas hates it when a nurse practitioner is called a mid-level provider: “Stop calling nurse practitioners mid-level providers.” So do I, though my reasons are a bit different. In order to understand them it will be necessary to revisit those dark ages, a time when such individuals were few and the roles played in the drama we know …

DNR/DNI: More code than status

Dan Chen, MD

Physician

August 25, 2014

“If a tree falls in a forest and no one is around to hear it, does it make a sound?”

Chances are that many of you have duked this out with your college roommates back in the day, but how about this one? “If a doctor and a patient make an advance care plan, but when an emergency happens, nobody can find a copy of it, the proxy doesn’t know what’s …

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DNR/DNI: More code than status

Direct primary care and concierge medicine: They’re not the same

Samir Qamar, MD

Physician

August 24, 2014

Direct primary care (DPC) and concierge medicine are rapidly growing models of primary care. Though the terms are used interchangeably, both are not the same. Such liberal use of terms, many times by even those within the industry, confuses those who are attempting to understand how these primary care models operate. As former concierge physician for the Pebble Beach Resorts, and subsequent founder of one of the nation’s largest direct …

MKSAP: 59-year-old man with intermittent itching

mksap

Conditions

August 24, 2014

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

A 59-year-old man is evaluated for a 3-month history of intermittent itching on the forearms. He describes the itch as deep, with a burning or tingling sensation. Scratching helps somewhat, but over-the-counter topical corticosteroids have not helped. Cooling the skin soothes the itch. He did not notice a rash until he started …

MKSAP: 21-year-old man with a heart murmur

mksap

Conditions

August 23, 2014

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

A 21-year-old man is evaluated during a medical examination for health insurance. The patient is a weight lifter. He has no medical problems and takes no medications or illicit drugs.

On physical examination, blood pressure is 128/73 mm Hg, pulse rate is 56/min, and respiration rate is 16/min; BMI is 30. Increased skeletal …

Top 10 ways to know it’s time to quit your job as a doctor

Pamela Wible, MD

Physician

August 21, 2014

Attention all doctors: The first three are mine. The rest are from miserable colleagues. All true. And common. If you’re a doctor and you recognize anything on this list, please quit your job.

10. You feel nauseated when you see your clinic logo; you alter your commute to avoid streets with your clinic’s billboard.

9. Discouraged by the general despair among staff, you …

Oncologist pay and chemotherapy: Buy and bill needs to stop

Robert Pearl, MD

Physician

August 19, 2014

Today’s article highlights the lingering problem of physicians buying and selling prescription medications to patients — at a profit.

The medical profession has struggled with this controversial practice for more than 150 years.

In George Eliot’s 1874 novel “Middlemarch,” an idealistic young doctor named Tertius Lydgate questions the ethics of fellow physicians who make handsome profits prescribing and dispensing their own remedies to the townsfolk. His medical colleagues shun him for it.

Around …

Vaginal video games: What to make of mobile Kegel apps

Jennifer Gunter, MD

Tech

August 18, 2014

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There are two new high-tech ways that aim to help you with Kegel exercises, both with Kickstarter campaigns. There is the Skea (Smart Kegel Exercise Aid), basically a video game that proposes controlling the avatar with a vaginal probe that uses the pelvic floor muscles and kGoal, a vaginal insert that is meant to connect wirelessly with your smart phone and measures your squeeze …

The blonde minority: Sexism is alive in medicine

Elizabeth Horn, MD

Physician

August 18, 2014

While demographic data may suggest otherwise, I still consider myself a minority, albeit a less common one. I am a young woman in medicine, and I am a natural blonde.

I barely qualify for a prescription for eyeglasses, but I have found they give credence to my words and patients seem to take me more seriously. Perhaps three years of residency training …

The unhealthy behaviors of physicians

Elaine Khoong, MD

Physician

August 17, 2014

As a fourth-year medical student, it was fairly easy to maintain a healthy lifestyle. When you have much leisure time and are relatively stress free, you can eat healthy, stay physically active and maintain quality mental health. However, as I begin the journey called residency, it is clear that the task of maintaining my own health will be much more difficult.

But the importance of this task should not be overlooked. …

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The unhealthy behaviors of physicians

MKSAP: 57-year-old woman with decreased exercise tolerance

mksap

Conditions

August 16, 2014

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

A 57-year-old woman is evaluated for a 2-week history of decreased exercise tolerance and substernal chest pain on exertion. She also has an 8-month history of macrocytic anemia.

On physical examination, temperature is 36.7 °C (98.0 °F), blood pressure is 137/78 mm Hg, pulse rate is 104/min, and respiration rate is 17/min. BMI …

Consider the messages that tattoos are sending

Edwin Leap, MD

Physician

August 15, 2014

Ink is everywhere these days, and I don’t mean on newspapers or in magazines. Tattoos are far more pervasive than I can ever recall in my fifty years. There was a time, when I was young, that boys were awestruck by the old Navy veterans, whose arms bore anchors, and the Marines with Semper Fi across their battle-scarred chests. Occasionally, when …

Are American doctors paid too much or too little?

Kevin Pho, MD

KevinMD

August 15, 2014

A version of column was published in USA Today on July 2, 2014.

There are some who think that I’m overpaid as a physician, and that my salary fuels rising health costs. I can understand their point: A May 2014 survey released by the Medical Group Management Association found that internal medicine doctors like myself have a starting median annual salary of $190,000, …

Chest pain and what we can learn from changing flat tires

Davis Liu, MD

Physician

August 14, 2014

“Daddy, I think we have a flat tire.”

I just rolled out of the garage with my 4th grade daughter. It was Tuesday morning. Usual daily routine. Drop her off at school then go to work. A little different today as I was to lead an important meeting.

How could she possibly know what a flat tire sounds like? Now? Right now? She’s …