Ira Nash, MD
Ira Nash is a cardiologist who blogs at Auscultation.
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Latest articles
Physician voices
Applause every evening, volunteers sewing masks, personal phone calls, and check-ins – these are a few examples of the support that helped us get through the initial, brutal onslaught of COVID in New York City last spring. A year later,…
Applause every evening, volunteers sewing masks, personal phone calls, and check-ins – these are a few examples of the support that helped us get through the initial, brutal onslaught of COVID in New York City last spring.
A year later, many hospitals across the country are full to bursting, the staff is exhausted, and medical science is still unable to save thousands of patients from dying in isolation. And we know …
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In the midst of our COVID crisis, we must learn to take care of ourselves. And each other.
Physician voices
Our organization, like most health care providers, is working hard to improve the care we provide to our patients, while also striving to improve the lives of our physicians. All too often, a narrow view of the former can create…
Our organization, like most health care providers, is working hard to improve the care we provide to our patients, while also striving to improve the lives of our physicians. All too often, a narrow view of the former can create conflict with the latter. For example, a reductionist view of clinical quality, which equates good care with performance on a small number of “objective” measures like mammography rates and hemoglobin …
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Let’s stop trying to change what doctors do
Health technology
I had the opportunity to participate in a day-long meeting sponsored by the Heart Rhythm Society (HRS). The goal was to help HRS develop recommendations for physicians and industry on providing patients access to information generated by wearable and implantable…
I had the opportunity to participate in a day-long meeting sponsored by the Heart Rhythm Society (HRS). The goal was to help HRS develop recommendations for physicians and industry on providing patients access to information generated by wearable and implantable cardiac electronic devices. The organizers invited me to provide the viewpoint of an educated patient.
I can’t say how HRS will ultimately craft the guidance (and I am not involved …
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Keeping up with the rapid developments in mobile health technology
Physician voices
A colleague recently sent me a link to the American College of Cathopathic Physicians a new organization whose mission “is to protect the professional autonomy and advocate for a full, broad scope of practice for DNPs as a ‘cathopathic physician’…
A colleague recently sent me a link to the American College of Cathopathic Physicians a new organization whose mission “is to protect the professional autonomy and advocate for a full, broad scope of practice for DNPs as a ‘cathopathic physician’ completely equal in every way to our MD and DO counterparts.”
I was, I admit, so stunned by the statement that I thought the whole thing might be an elaborate joke. It was only …
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Not all doctors are physicians
Health policy
I am a terrible coder. I think I am a pretty good doctor, but when it comes to coding, the process of figuring out which billing code to pick to assign to a bill for an office visit, I am…
I am a terrible coder. I think I am a pretty good doctor, but when it comes to coding, the process of figuring out which billing code to pick to assign to a bill for an office visit, I am hopeless. No matter how many times I have had the rules explained to me, or how much feedback I have been given about specific visits, or which “pocket guide” to …
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A physician contemplates Medicare blended rates
Health technology
When I was a cardiology fellow back in the 1980s, I learned about a variety of early tools for evaluating heart health that had been displaced by the modern standards of electrocardiography (ECG, or EKG for the Deutschephiles) and echocardiography.…
When I was a cardiology fellow back in the 1980s, I learned about a variety of early tools for evaluating heart health that had been displaced by the modern standards of electrocardiography (ECG, or EKG for the Deutschephiles) and echocardiography. One such technique – ballistocardiography – stuck with me, and may be making a comeback.
Ballistocardiography is based on the observation that the mechanical action of the heart leads to subtle …
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An old technique to detect atrial fibrillation via smartphone
Physician voices
Every clinician knows that “framing” -- how we present information to patients -- has a big impact on decisions they make about their care. Even something as simple and apparently transparent as talking about survival versus mortality is important, with…
Every clinician knows that “framing” — how we present information to patients — has a big impact on decisions they make about their care. Even something as simple and apparently transparent as talking about survival versus mortality is important, with “a 90 percent chance of living” sounding a lot better than “a 10 percent chance of dying” even if both phrases convey the same estimate of risk.
Things get even dicier …
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Doing what’s best for patients may be worse for populations
Physician voices
Physician burnout has received a lot of well-deserved attention lately. Characterized by emotional exhaustion and professional frustration, it's tied to an array of adverse consequences, from physician suicide to poor patient outcomes. Organizations are waking up to the need to…
Physician burnout has received a lot of well-deserved attention lately. Characterized by emotional exhaustion and professional frustration, it’s tied to an array of adverse consequences, from physician suicide to poor patient outcomes. Organizations are waking up to the need to measure its prevalence and ameliorate its impact.
There seems to be two broad schools of thought about the causes — and by extension, the fixes — of physician burnout.
The first focuses …
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What’s at the root of physician burnout?
Physician voices
A recent story in Crain’s New York Business cited the difficulty small independent medical practices face coping “with declining reimbursement rates from insurers, rising overhead costs and a torrent of new regulations that have come into play in recent years.”…
A recent story in Crain’s New York Business cited the difficulty small independent medical practices face coping “with declining reimbursement rates from insurers, rising overhead costs and a torrent of new regulations that have come into play in recent years.”
According to the article, only 26 percent of New York state physicians now own their own practice, compared with national rates of physician ownership of 76 percent thirty years ago. …
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Is independent practice better for doctors or patients?
Health policy
Policy makers who are responsible for shaping how the federal government (the country’s biggest payer of health care services) pays physicians are pushing CMS on a rapid path away from traditional fee-for-service (FFS). As I discussed last year, CMS intends…
Policy makers who are responsible for shaping how the federal government (the country’s biggest payer of health care services) pays physicians are pushing CMS on a rapid path away from traditional fee-for-service (FFS). As I discussed last year, CMS intends to have 50 percent of its payments flow through “alternative payment models” such as ACOs and bundled payments by 2018, with nearly all of the rest of the …
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The shift away from fee for service will be dramatic
Physician voices
The idea that we have to “change incentives” for physicians is all the rage. Oceans of ink are being spilled over the transition away from the traditional fee for service payment model to a menagerie of value-based ones. At the…
The idea that we have to “change incentives” for physicians is all the rage. Oceans of ink are being spilled over the transition away from the traditional fee for service payment model to a menagerie of value-based ones. At the core of much of the discussion about how to make the transition is figuring out how risk-bearing organizations like large physician groups, health systems, ACOs and the like are going …
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It takes more than incentives to engage physicians
Physician voices
The first posting on my blog explained why I chose to name it “Auscultation.” I wrote that I wanted to promote a conversation, and that listening was essential to doing so. I went on to write: “With an obvious nod…
The first posting on my blog explained why I chose to name it “Auscultation.” I wrote that I wanted to promote a conversation, and that listening was essential to doing so. I went on to write: “With an obvious nod to my being a cardiologist, I believe auscultation has long been an act that defines us as physicians and connects us in a profound way with our patients. The act of …
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Listening to the patient is the first part of the physical exam
Physician voices
I spent a couple of hours today discussing a topic that has become increasingly important in the world in which we live, and which would have completely mystified an earlier generation of physicians. The subject was attribution. Simply put, how…
I spent a couple of hours today discussing a topic that has become increasingly important in the world in which we live, and which would have completely mystified an earlier generation of physicians. The subject was attribution. Simply put, how should one decide which patients “belong” to which doctors? On a more technical level, what algorithms should be employed to connect patients, or episodes of care for those patients, or …
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Who’s in charge of the patient? It’s a question increasingly difficult to answer.
Drugs and prescribing
There were several news stories recently that reported that Pfizer had abandoned its efforts to have its Lipitor brand of atorvastatin made available over the counter (OTC), without a prescription. I was never a big fan of OTC statins, but…
There were several news stories recently that reported that Pfizer had abandoned its efforts to have its Lipitor brand of atorvastatin made available over the counter (OTC), without a prescription. I was never a big fan of OTC statins, but I was struck by the reason that Pfizer put out:
The study did not meet its primary objectives of demonstrating patient compliance with the direction to check their low-density lipoprotein cholesterol
…
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OTC Lipitor? Why Pfizer made the right decision for the wrong reason.
Physician voices
I have written previously about some “aha moments” that I have had as a clinician, when something that I knew was coming seemed to arrive with a thud in my own practice. I had another one of those moments a…
I have written previously about some “aha moments” that I have had as a clinician, when something that I knew was coming seemed to arrive with a thud in my own practice. I had another one of those moments a couple of weeks ago.
I was finishing up with a new patient, and had explained to him and his wife my assessment …
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Patients rating doctors on Yelp: It’s better to embrace it
Conditions and diseases
I was driving to work the other day, and there was a story on the radio about the Congressional reaction to the latest recommendations for breast cancer screening from the United States Preventive Services Task Force (USPSTF). Here’s the background.…
I was driving to work the other day, and there was a story on the radio about the Congressional reaction to the latest recommendations for breast cancer screening from the United States Preventive Services Task Force (USPSTF).
Here’s the background. USPSTF published recommendations in late 2009 for the use of screening mammography in different age groups. For women between 40 and …
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This is why it’s so hard to rein in mammogram screenings
Physician voices
I had two experiences recently that reminded me that many doctors and nurses remain resistant to measuring and improving how patients experience the care we provide. One was a face-to-face discussion with a senior physician. The other was reading an…
I had two experiences recently that reminded me that many doctors and nurses remain resistant to measuring and improving how patients experience the care we provide. One was a face-to-face discussion with a senior physician. The other was reading an article by a nurse. Both the doctor and the nurse denounced the growing focus on the patient experience by citing the threat to the quality of care, and I believe …
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In support of measuring patient satisfaction
Health policy
It has been known for a long time that “health care” -- all the stuff that we do, prescribe and provide -- is a minor determinant of how “healthy” any of us is. Overall health, or more technically, the variability…
It has been known for a long time that “health care” — all the stuff that we do, prescribe and provide — is a minor determinant of how “healthy” any of us is. Overall health, or more technically, the variability in health outcomes, is much more dependent on the combination of genetics, personal behavior (think smoking and seat belts), environmental factors and socioeconomic status than it is on health care.
I …
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Why it’s time to improve the social determinants of health
Health technology
A recent piece in the New York Times profiled a young man with a remarkable medical history, and an equally remarkable approach to sharing it. I think it raises some profound issues regarding the self-monitoring movement and the “ownership” of…
A recent piece in the New York Times profiled a young man with a remarkable medical history, and an equally remarkable approach to sharing it. I think it raises some profound issues regarding the self-monitoring movement and the “ownership” of patients’ health information, both of which have the potential to change our traditional practices in a big way.
The guy — Steven Keating — is not your average Joe. He is a …
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Is it time to surrender control of the medical record?
Physician voices
A few years ago, the United States Navy launched a new recruiting and marketing campaign using the slogan: “America’s Navy: A global force for good.” The line was apparently a flop, and the Navy threw it overboard for “protecting America…
A few years ago, the United States Navy launched a new recruiting and marketing campaign using the slogan: “America’s Navy: A global force for good.” The line was apparently a flop, and the Navy threw it overboard for “protecting America the world over,” but I liked it. I thought it captured a deep truth about the Navy, which is that it is undoubtedly a global force and that the force exists for …
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Serving for the Navy: The global force for good
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