I was listening to the news on my way to work recently, and heard a story about the review conducted after the well-publicized security breach at the White House. Like many people, I was shocked when the story of the fence-jumper first broke. How was it possible that some guy with a knife managed to get over the fence, cross the lawn, enter the White House and get deep into the …
What medicine can learn from the Secret Service failure
In my administrative role, I have the great pleasure of signing thank you letters to patients and family members who have acknowledged the great care they have received by one of our physicians or other caregivers. It is a nice way to tell the patient “we got your note” and to simultaneously recognize the provider by copying her or him. The best part is that I get to read the …
Patient complaints: Sometimes sorry is all it takes
I had a recent conversation with an old friend about her elderly father that encapsulates a lot of what is both great and terribly wrong with health care in America today.
Here are the basic facts: the man is in his mid-80s, retired from teaching school, and is active and vigorous, living in the community; he is cognitively intact. He has a …
A case that illustrates the good, the bad and the ugly of American medicine
About a year ago, I shared details of my own out of pocket medical expenses and concluded that we have to have to be more transparent with our patients (and potential patients) about the costs they will face for our services. The urgency of price transparency as a business imperative and a professional responsibility has only increased since then.
Consider that we are now a year in to the implementation of the …
Doctors should be challenged to explain what they are charging and why
There is an old gag about an intensely optimistic child whose bright outlook on life is so irrepressible that when he is presented with a room full of manure for Christmas, he screams with delight, convinced that there “must be pony in there someplace.”
I was reminded of that when I read the recent research report and the accompanying editorial in the Annals …
The suspect quality improvements of the medical home
I have a love-hate relationship with practice guidelines. Love because it is often helpful to refer to a set of evidence-based recommendations as part of clinical decision-making; hate because of all of the shortcomings of the guidelines themselves, as well as the evidence upon which they are based.
A recent piece in JAMA and the editorial that Read more…
A love-hate relationship with practice guidelines
I have long been a fan of the Case Records of the Massachusetts General Hospital, which is published weekly in the New England Journal of Medicine. For many years, I made a point of recommending them to medical students and internal medicine residents as a model of concise yet comprehensive case presentations.
No wasted words, no missing information, and none of the filler that trainees often added when they presented cases, such …
Be personable and make a huge difference in a patient’s recovery
I recently got back from a brief trip to Florida. I went down there to celebrate my mother’s 85th birthday. As you might expect, her social circle has shrunk in recent years, but she did get a number of cards and calls from friends and family members. The cards were on display in her kitchen, and a few calls came in while I was there. One in particular pointed out some …
The patient offered a diagnosis, and the doctor missed it
I recently served as a preceptor for first year students at our Hofstra-North Shore LIJ School of Medicine who were doing one of their RIA (reflection, integration and assessment) sessions. The students do these sessions every 12 weeks, and are generally scheduled with the same preceptor over time. It may be routine for the students, but I found it absolutely remarkable.
Each student is responsible for doing a complete history and …
Medical students today are getting richer clinical training
I felt a little sad when I read a piece in the New England Journal of Medicine about the introduction of point-of-care ultrasound in medical education.
In it, two cardiologists from the Brigham and Women’s Hospital review the promise and some of the challenges of incorporating hand held ultrasonography into medical education and, more broadly, into medical practice. For those of you unfamiliar with the technology, this is not …
Why this cardiologist mourns the death of the stethoscope
It has been freezing cold in much of the country for the last two months, but things have been heating up in the controversy over the implementation of ICD-10. First, a quick primer for those of you who have not been following this.
The “ICD” in ICD-10 stands for International Classification of Diseases. The “10” refers to the version of the taxonomy, which is maintained and revised periodically by the World Health …
The real reason doctors hate ICD-10
I have been thinking a lot about cancer screening tests. It seems that there has been a constant stream of articles about screening in both the lay press and professional journals — as well as the inevitable stories in the lay press about the reports in professional journals — but this is more personal. I have had two recent experiences that …
Cancer screening comes down to personal preferences
I trained in internal medicine and cardiology at the tail end of the era of lifetime board certification by the American Board of Internal Medicine. In fact, my timing was perfect — I was “boarded” in medicine in 1987, and in cardiovascular disease in 1989, which (I am pretty sure) were, respectively, the last years that the ABIM offered certificates without an expiration date in those disciplines.
Late last year, I …
Board certification: Valid indefinitely is no longer rings true
I was talking to a colleague recently about his practice, and remarked that he was still keeping a paper medical record. Without hesitation, he made it clear that he not only liked the paper record, but he positively dreaded switching to an electronic record. He said sadly that he thought it was inevitable that he would be forced to switch, but hoped that the day would be far into the …
Fixing EHRs requires changing the way we pay for care
I was invited to give a talk about patient satisfaction at a recent grand rounds. I have written previously that satisfaction is a pretty low bar, and so I spoke instead about the patient experience.
I opened my talk with the cartoon above.
As I anticipated (and intended), it got a few chuckles from the audience, and I pointed out …
Performance measuring tools aren’t up to the task
I recently participated in a small conference devoted to “physician alignment in the academic medical center.” The meeting was sponsored by a health care consulting firm, and drew about a dozen participants from around the country. The title refers to ways in which academic centers figure out how to work with their traditionally autonomous if not completely independent physicians to advance the institutional mission. An informal format allowed us to …
Academic medical centers: Should we continue to feed the beast?
I think I am like many practicing physicians in my love-hate relationship with clinical practice guidelines.
On the one hand, it is often helpful to look up a set of evidence-based recommendations on a particular clinical issue, and I feel particularly fortunate that the American College of Cardiology and the American Heart Association have collaborated to produce high quality guidelines on a wide-range of subjects relevant to my practice.
On the other …
A solution for clinical guideline overload
I have been thinking more about the price of health care services. I have already shared some thoughts about this, but this time I have a more personal story to tell.
I recently had an echocardiogram. I would score the indication as “uncertain” (not clearly appropriate or inappropriate) according to professional guidelines. As a cardiologist myself, however, I would have ordered one in similar circumstances without hesitation. …
Understand the financial demands we are making on patients
Get free updates delivered free to your inbox.
