Leslie Kernisan, MD, MPH

Making the case for social media to geriatricians and other physicians

Physician

March 19, 2016

Patricia Bach, a geriatric psychology colleague who is active in social media, recently emailed me a question: How to encourage more clinicians in geriatrics and long-term care to use social media?

In particular, she asked me “What do you feel is the ROI for geriatricians to use social media/networking in their professional roles?”

This is an interesting question to consider. After all, we have a limited number of geriatricians available for a growing older …

A tale of two strep throats: Retail clinic vs. PCP

Leslie Kernisan, MD, MPH

Conditions

February 21, 2015

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Six years ago, just after arriving in Baltimore for a winter conference, I fell sick with fever and a bad sore throat.

After a night of feeling awful, I went looking for help. I found it at a Minute Clinic in a CVS near the hotel. I was seen right away by a friendly NP, who did a rapid strep test …

The problem with home health care communication

Leslie Kernisan, MD, MPH

Physician

January 6, 2015

Home health care is in many ways a fantastic service, especially for those Medicare beneficiaries who are essentially homebound due to frailty or illness.

But it often feels surprisingly hard to synergize with home health care.

The main problem, as I see it, is that home health care agencies have set themselves up to provide only administratively required communication with the ordering doc. (There are rules governing home health care, you know!)

Now, …

The Medicare spending we should be concerned about

Leslie Kernisan, MD, MPH

Policy

April 24, 2014

“Do patients care about how much money their doctors make?”

This is the headline of a recently published post by Trudy Lieberman, and was written in response to the recent New Your Times’ coverage of Medicare disclosing payments to individual providers.

Now, I found the Times story fascinating on many levels, but I’ll admit it hadn’t occurred to me that the main value of this data release is that patients can …

Apps used to monitor blood pressure need better design

Leslie Kernisan, MD, MPH

Tech

March 28, 2014

healthvault BP app entry

Here’s a design approach that I really, really dislike: the scrolling wheel that is often used for number entry in iOS apps.

I find that the scrolling wheel makes it very tiresome to enter numbers, and much prefer apps that offer a number pad, or another way to touch the number you need. (Or at least decrease the number at …

The risks of treating high blood pressure in the elderly

Leslie Kernisan, MD, MPH

Conditions

March 6, 2014

When it comes to high blood pressure treatment in the elderly, the plot continues to thicken.

Last December, a minor controversy erupted when the JNC hypertension guidelines proposed a higher blood pressure (BP) treatment target (150/90) for adults aged 60+.

And now this month, a study in JAMA Internal Medicine reports that over 3 years, among a cohort of 4961 community-dwelling Medicare patients aged 70+ and diagnosed with hypertension, those on blood pressure medication …

What I’m looking for in a personal health record system

Leslie Kernisan, MD, MPH

Tech

January 15, 2014

When it comes to the health care of a frail older person, families really need a good personal health record (PHR) system. So I am once again preparing to take a look at what’s available, in hopes of finding something that I can more confidently recommend to the families I work with. (To see what medical info I urge families to track, see this Geriatrics for Caregivers post.)

I have …

How can we reduce friction in the hospital?

Leslie Kernisan, MD, MPH

Physician

November 7, 2013

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

In a 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 …

We need more innovations in caring, not curing

Leslie Kernisan, MD, MPH

Tech

October 17, 2013

I assume by now that you’ve heard the news: Google wants to tackle aging. Specifically, they announced the launch of Calico, “a new company that will focus on health and well-being, in particular the challenge of aging and associated diseases.”

Because, says Larry Page, with some “moonshot thinking around healthcare and biotechnology, I believe we can improve millions of lives.”

“Can Google Solve DEATH?” shrieks a TIME cover.

Google’s goal, it seems …

Real patient engagement depends on defining it correctly

Leslie Kernisan, MD, MPH

Physician

October 3, 2013

What is patient engagement?

Everyone agrees that it’s a good thing, and that we healthcare providers should be fostering it.

How to do so, however, depends on just what you believe patient engagement means.

As Dan Munro recently pointed out, the term “patient engagement” is a hot buzz phrase, and — in the best tradition of such phrases — it’s amorphous enough and appealing enough to mean just about anything.

Provided …

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

Leslie Kernisan, MD, MPH

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 …

The future of geriatrics: Questions to consider

Leslie Kernisan, MD, MPH

Physician

September 13, 2013

Recently, the New York Times featured a post about me and my practice. Titled “Walking Away from Medicare,” it describes my decision to opt-out of Medicare and create a different kind of geriatric practice.

It has generated quite a lot of comments. Most of them judge me pretty harshly. It seems that many people feel that I’m doing this for the money. And that I don’t care …

Can technology help individualized medical decision making?

Leslie Kernisan, MD, MPH

Physician

September 1, 2013

Shouldn’t everyone get an individualized assessment of likely benefits, burdens, and risks before making a big medical decision?

I was asked this question recently, during an interview for an Internet radio show on aging.

Per my host’s request, I’d been explaining the practice of geriatrics, and talking about the geriatric approach to addressing the medical needs of older adults. Since I’d mentioned that aging often brings on greater risk of side-effects or …

Physician education: The downside of taking a business approach

Leslie Kernisan, MD, MPH

Education

July 23, 2013

Recently I came across yet another media article with suggestions as to how digital health products can gain more widespread adoption. The writer notes that “we can learn a lot from the pharma and healthcare industries,” and goes on to discuss the importance of engaging the doctor.

This article, like many I read, doesn’t acknowledge the downsides of using pharma’s tactics.

I have to assume that this is because from a business …

Primary care doctors need 35 hour work weeks

Leslie Kernisan, MD, MPH

Physician

July 11, 2013

Jeff Goldsmith recently opined on why practice redesign isn’t going to solve the primary care shortage. In the post, Goldsmith explains why a proposed model of high-volume primary care practice — having docs see even more patients per day, and grouping them in pods — is unlikely to be accepted by either tomorrow’s doctors or tomorrow’s boomer patients. He points out that we are replacing a generation of workaholic boomer …

What being a primary care patient has to do with home renovation

Leslie Kernisan, MD, MPH

Physician

June 28, 2013

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In 2006, as I was starting my geriatrics fellowship, we started renovating our home.

This took almost two years from start to finish. It was a long, arduous, expensive, and often stressful process. And this experience ended up profoundly influencing my philosophy as a primary care physician, and my approach to practicing medicine.

To this day, I’ve had minimal experiences as a primary care …

Most companies don’t consider the older medically complex patient

Leslie Kernisan, MD, MPH

Tech

June 21, 2013

What user personas do healthcare technology designers and entrepreneurs have in mind as they create their products? And how often is it the family caregiver of an elderly person?

This is the question I found myself mulling over as I wandered around the Health Refactored conference recently, surrounded by developers, designers, and entrepreneurs.

The issue particularly popped into my head when I decided to try Microsoft HealthVault after listening to …

Apps to help manage medications in the elderly: What I’m looking for

Leslie Kernisan, MD, MPH

Tech

June 11, 2013

I’ve been interested in apps for the caregivers of elders, but like many physicians, I’ve been too busy to seriously research them or try them out.

Time to change that. No, I’m not going to exhaustively research and review all caregiver apps on the market.

But, as I’ve been invited to give a technology talk to a local group of family caregivers later this summer, I would like to see if I …

The burden of frequent technology transitions

Leslie Kernisan, MD, MPH

Tech

May 29, 2013

I made a big decision recently: I decided to give up my Blackberry smartphone.

Why? Like a good geriatrician, I considered the benefits and the burdens of sticking with the Blackberry. And since the burdens seem to outweigh the benefits, bye-bye Blackberry.

This was a difficult decision for me, however. To begin with, becoming comfortable with a new device for one’s daily work takes time. During the transition phase, one is slower …