Once upon a time people only went to the doctor when they felt sick. For most of human existence there was not much the doctor could actually do when you got there. Yet somehow the human race managed to get through to the second half of the twentieth century when things changed completely.
As technology advanced exponentially we developed a range of treatments so that conditions, which used to be fatal …
We are overdosing on medical tests
I don’t know how many of you readers are old enough to remember the frequent use of open chest cardiac massage, first successfully performed in 1901. It began as a way to resuscitate suddenly dead people, assuming that their hearts had arrested or fibrillated.
The surgeon would open the chest between ribs 5 and 6 and rhythmically squeeze the heart to move the blood and re-establish life. Sometimes it worked; usually …
CPR is less effective than we think
All of us hate waiting in lines. Our society breeds a “me-first” attitude. Often the lines in which we wait are slow to move and, we become irritable and angry. Somehow there is always someone who is able to outsmart the system and get served ahead of their place in the queue. In the typical queue at the grocery store, (or at the apple store genius bar) we become impatient because …
How families cope with the surgical waiting room
There was a very important article written in the New York Times recently. It highlighted a common medical scenario in my world—the defibrillator (ICD) world.
I am going to talk about ICDs here, but the big picture inherent in this story illustrates the important issue of how best to apply invasive therapy to elderly and sicker patients.
The Times piece delved into medical decision-making when patients present with battery depletion of their …
Start the difficult conversation with ICD patients
While reading the New York Times I stumbled upon an article by Pauline Chen addressing issues with doctor patient communication.
In the article, Dr. Chen describes a highly educated, articulate patient who was unwilling to speak up and discuss care related issues with her doctor. The reasons given for not wanting to speak up included not wanting to anger the physician and not giving the perception of questioning judgement.
I immediately began …
Patients must speak up at the doctor’s office
There is enormous waste in American healthcare delivery. One estimate is anywhere from 20% to nearly 50% of total expenditures are frankly unnecessary. What is this waste? Is it real? Could it be eliminated or at least reduced? How difficult would such a reduction be to achieve? And what would be the unintended consequences?
Donald Berwick, the former administrator for the Centers for Medicare and Medicaid Services, along with Andrew Hackbarth …
Reduce health costs by reducing waste
I am employed by a hospital, and have health insurance through my job. The coverage is comprehensive, and the cost has an employer contribution and employee contribution. I still get confused (though I have the hospital’s own plan) about what is covered and what is not. I can only imagine how hard it must be for my patients.
The prescription plan that comes with this insurance is straight forward: $40 for …
The impact of prescription drug costs on health spending
There’s a push-pull happening right now in the evolution of health care and it’s all about you. The question under debate is simple: can you handle being the first to know your own test results?
Are you smart enough to read the results? And are you emotionally capable of handling the situation?
Do you need someone next to you when an over-the-counter test tells you whether or not you have a disease? Can …
Can you handle being the first to know your own test results?
I’m sweating and silently wondering how the chewing gum in my mouth has chemically changed to sand. My mouth is so dry I can barely speak. I may be silent, but thank goodness my patient is talking to me, because all his monitors and machines seem to be bleeping and bopping and malfunctioning at once.
I reach for my eyeglasses, which have become hopelessly entangled among pens, alcohol wipes, and other …
When teamwork takes more than the usual share of effort
“Oh, by the way” are four simple words that cause most docs to shudder. Yes, shudder. Your patient signed in for a sore throat, congestion, and cough. The nurse did her job. She’s recorded the patient’s chief complaints. She’s taken the patient’s vital signs and readied the patient to see me, the doc.
I take a history, asking questions about the problems that brought the patient to the office. I ask pertinent …
What patients think is not trivial
Guidelines for care increasingly help guide medical decision-making. If you’ve followed top health news over the past several years you’ve read conflicting statements about the utility of various medical procedures and tests. As a general internist I’ve devoured these reports with particular interest trying to wade through bias to formulate views that I believe will be of most benefit to my patients.
Recently I put together a talk about recommendations for …
The problem of conflicting professional medical guidelines
As I like to remind my women’s heart health presentation audiences, I am not a physician. I’m not a nurse. I am merely a dull-witted heart attack survivor. I also warn them that a lot of what I’m about to say to them is already available out there, likely printed on some wrinkled-up Heart and Stroke Foundation brochure stuffed into the magazine rack at their doctor’s office.
So when the organizer …
The power of engaging peer-to-peer health care
I share this post here to point out the discrepancy in physicians’ average salaries based on their specialties. In particular, I would like to highlight that the three lowest-paid specialties are the three primary care specialties: pediatrics, family medicine, and general internal medicine.
This post is not written to argue that physicians must be paid more. I would submit that if …
We must redesign our health care payment systems to value primary care
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“Doc, I’m going to the Olympics do I need anything?” It happens every 4 years. Millions of people converge upon a city to watch athletes compete. It seems easy enough, but did you know that this year there is a concurrent UEFA soccer championship in Poland and the Ukraine too? So how do you help your patients prepare to be in close contact with thousands of people from all over the …
How do you prepare your patients for travel to the London Olympics?
Are you a frustrated patient because you get little time with your physician each visit? Are you a frustrated physician who would like to spend more time but can’t make it work financially? Here are some developing approaches.
Reimbursement rates for primary care visits are low, so primary care physicians (PCPs) need to see many patients to cover office expenses. There are many ways that PCPs are using to escape the …
Primary care does not need to be expensive
It seems that study after study has been touting the benefits of chocolate – eat more of the (delicious!) dark stuff and you might find yourself losing weight, suffering fewer or less severe heart attacks, possessing cleaner arteries, and having a lower blood pressure. Despite the theoretical explanations for chocolate’s health benefits, it is usually found packaged and processed along with some other not so healthy ingredients including saturated fat, …
Is chocolate really associated with better health?
Nine months ago I saw a new patient, a delightful 86-year old male. His past medical history included lymphoma many years ago, a stroke five years ago, dyslipidemia and hypertension. Medications included aspirin, a generic statin, and a non-generic ARB-HCT combination, which he had been on for years. He lived alone with a lot of support from his loving and attentive family. The patient looked great. I refilled his meds …
Who pays for the cost of switching medications?
Any new technology necessarily has a phase in which unnoticed bugs as well as unforeseen challenges crop up. In its early stages, the snail’s pace of a dial-up connection often made using the Internet onerous: before completing an email, one was often interrupted by pop-ups, viruses, cryptic 404 error messages, and a cacophony of sounds from the modem as the line repeatedly disconnected. Yet, as technology matures, the ability to …
We must get past the complaints doctors have about EMRs
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 59-year-old man is evaluated for tachycardia and hypertension six hours after undergoing an uncomplicated open cholecystectomy under general anesthesia. The patient had intraoperative high blood pressure and was treated postoperatively with metoprolol, 5 mg every 4 hours by intravenous bolus. The patient underwent repair of …
MKSAP: 59-year-old man with tachycardia and hypertension
As a patient who was asked to speak at the Association of Health Care Journalists 2012 conference, I felt a bit covert. I wasn’t in a “backless gown,” rolling my IV pole down the hall of some hospital’s cardiac care unit. I wore an official lanyard and badge and mixed among health care journalists, yet I felt more like a dugout mom than savvy reporter.
My goal was to present the …
Health care journalists have tendencies similar to those of doctors
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