Last year, Medicare paid $55 billion just for doctor and hospital bills during the last two months of patients’ lives.
And it has been estimated that 20 to 30 percent of these medical expenses may have had no meaningful impact. Most of the bills are paid for by the federal government with few or no questions asked. This statistic is from a 60 Minutes story on “The Cost of Dying” and …
The cost of keeping the terminally ill alive
Several years ago, I spoke at Baylor College of Medicine in Houston, where Michael DeBakey, the legendary heart surgeon, was master of the universe for nearly half a century.
I heard lots of DeBakey stories during my visit, but one in particular really stuck with me. “A few years back,” someone told me in a voice of hushed reverence usually reserved for descriptions of flawless beach days and single …
My father suffered a mild heart attack last year. In his 80+ years, he has never had any indication he had a problem with his heart! A variety of other health issues have arisen over time, but Dad’s heart was always thought to be as strong as could be.
In fact, despite protestations (“I don’t really think these chest pains are a big deal… let me just …
Good patient communication by managing expectations
Raghav Govindarajan, ACP Associate Member, a neurology resident at the Cleveland Clinic Florida, told us about a case he saw in India that has important lessons for clinicians everywhere. The patient was a 65-year-old man who presented with chronic symptoms of burning discomfort and weakness in his left leg.
His symptoms had started about seven years prior and he had been told that he had “neuritis.” He reported that he had …
Social prejudices may limit the accuracy of patient information
I got the call from the ER because I was the “no-doc” surgeon, meaning I was the guy to call when a patient showed up needing a surgeon, and who had no primary care doc to direct the referral. Usually it meant trouble. A drunk who smashed his car and himself, possibly others. Stab-wound, gun-shot. People who don’t have their own doctors include more than those down on their luck; …
Stercoral perforation as a deadly cause of colon rupture
Are patients better off than they were ten years ago?
Just over a decade ago the Institute of Medicine (IOM) released its celebrated report on patient safety, To Err is Human. Many credit that report, which was released with great fanfare, with launching the patient safety movement. So it’s appropriate to assess the movement’s impact eleven years later. How did we do?
On November 25 the New England Journal of Medicine published …
A postmortem on the patient safety movement
B12.
Sounds simple, huh?
1 letter, 2 numbers. One of the B vitamins. It’s important in a number of body functions, particularly the nervous system and blood cell production. It’s in pretty much all meats and vegetables, and multivitamins you can buy.
To me, it’s also a good example of what’s wrong in health care.
Let’s take Mrs. Olde.
She goes to her internist, and is complaining of feeling weak and tired. So he checks …
Redundant tests waste health care dollars
It had been a high-speed motor-vehicle accident. One car. A twenty-something male driver without passengers. No seat belt. And now, this same driver had no movement from his waist down and no sensations below his mid-abdomen.
According to bystanders, he had been driving his sedan dangerously fast, some estimates of nearly 100 m.p.h., before losing control. The car veered off the roadway to the right, flipping mid-air before smacking head-on into …
Priapism is indicative of spinal cord injury in trauma
Year: 1993
Setting: Mendi Hospital, Southern Highlands province, Papua New Guinea
Position: Chief medical officer for Chevron
Chevron is contributing to the budget of Mendi Hospital in the capital city of the Southern Highlands province. Each year, the hospital director sends a financial request to the company’s medical department, and this is my first time to review and approve it. Curious about how the money will be used, I phone the director to …
Waste at hospitals in developing countries
Have you ever discharged a patient from the hospital and had a gnawing feeling that maybe you could have done more to educate the patient about their disease, medications, and plan of care?
Probably so. A recent survey published in the Archives of Internal Medicine tells us that this feeling is based in reality (I’m guessing that you already knew this) and that you are not alone.
The …
Educate the patient about their disease and discharge plan
There are some lessons we learn and keep re-learning in medicine. For me some of these recurring lessons are,
and
I encountered a young patient recently, just at the cusp of adolescence and adulthood, who had undergone a procedure related to a sports injury. Other people had been …
Never forget to advocate for your patient
The life of a general surgeon is one fraught with contingency, soul-crushing doubt, unexpected disaster, and overwhelming stress. I wouldn’t wish it upon my worst enemy. Fortunately, I was brainwashed to a sufficient degree during residency such that I actually don’t mind my job.
One of the reasons general surgery is so tough is that it is nearly impossible to map out your week according to a strict schedule. Maybe at …
There is no routine procedure in general surgery
by Jessica Tekla Les, MD
During my third year of medical school I was performing a routine breast exam, more for practice than anything else. I was trying the concentric-circles-around-the-nipple technique, one of several I’d been taught. About halfway through the right breast I found a lima-bean-sized lump, not far from the breastbone. I took liberties with this particular exam. I poked the lump, tried to …
Breast cancer transforms a doctor in training to patient in an instant
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by Lyle Denniston
Hospitals know that medical care decisions often have legal consequences, which makes it all the more important to know what the law requires. But when judges can’t agree, and there also is some ambiguity in the way government officials see a legal issue affecting care decisions, hospitals may need to go to the ultimate authority – the U.S. Supreme Court – for an …
When does the duty to provide emergency medical care end?
The electronic medical record, the EMR, is upon us.
For those of us who learned medicine entirely with paper charts, some have enthusiastically embraced the EMR and some have refused, to the extent they can, to deal with it at all. But most of us have plowed ahead into learning how to use it as best we can. It seems to me that the degree of enthusiasm physicians show for the …
EMR is here to stay, which will be good for doctors and patients
On my drive in to work this past week I came across this:
A bus-side advertisement for a local hospital (sadly, not mine) claiming that it was “home to the city’s best transplant outcomes.” Normally I drive right by these moving billboards without paying much attention. But this time I immediately got excited, whipped out my cell phone and snapped …
How the health care industry competes for patients
by Steve P. Sanders, DO, MBA
Are hospitals coming clean? An article recently published in Health Affairs reveals details of a government–required survey conducted in 2008 and 2009.
The Hospital Consumer Assessment of Healthcare Providers and Systems survey or CAHPS is required of all hospitals receiving and hoping to continue to receive federal funding. Analysts compared CAHPS responses between 2008 and 2009 and gleaned what they believed …
CAHPS measures are as important as profit and loss for hospitals
President Bush once said something along the lines of, “We do have universal health care in this country — just go to the emergency room.”
EMTALA. The law requiring emergency rooms to treat everyone’s emergent conditions, a well meaning act that has had disastrous consequences for hospitals’ bottom lines. A disgustingly flawed law on many levels.
How do you prove it is not an emergency condition? You work it up. …
EMTALA threatens the safety net of community care
There are very few oncologic emergencies. Neoplastic epidural spinal cord compression is one of them. The delay in diagnosis and treatment is often explained by the non-specific nature of the presenting signs and symptoms.
The patient developed urinary retention a couple of weeks prior to presentation. On the morning of admission he was fully functional. Later he sat down to have a cup of coffee and boom – he couldn’t feel …
Neoplastic epidural spinal cord compression is an oncologic emergency
by James Merlino, MD
The patient experience is the right thing to do, and a business necessity. But improving it is not necessarily easy.
The fact is, large medical centers are at a real disadvantage when it comes to performing well on HCAHPS. The Centers for Medicare & Medicaid Services (CMS) do not discriminate or differentiate the scores of small community hospitals from those of large academic tertiary care …
The patient experience needs to be improved: here’s how
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