A fever in an infant can be the first sign of an illness. While a rise in body temperature above 100.4 degrees Fahrenheit is part of a healthy immune system response, it does signal potential danger and need for further evaluation. Since a reading may lead to a call or visit to the child’s doctor or emergency room, accuracy is key. What is the best type of infant thermometer?
A …
What is the best type of infant thermometer?
Recently, I saw one of my sons blithely dipping a chip into salsa, happily munching away while multi-tasking at something else – not a care in the world about his food.
It brought a smile to my face – but there was a touch of sadness with it.
You see, my work has brought me into contact with a number of PWDs (People With Diabetes) who are active on-line. And as I’ve …
Educated online by people with diabetes
When physician blogger Kevin Pho wrote about involving patients in healthcare reform in a recent article in USA Today, one thing he failed to mention is a novel government initiative that has been flying below most of our radar screens — the “Partnership for Patients: Better Care — Lower Costs.”
Why was it necessary to call out patient centeredness as a separate initiative?
Although no one disputes that those of us …
Partnership for Patients to improve patient safety
I recently received a declaration of war from one of the major healthcare insurers. Not happy with its current record profits, this insurer has decided to reduce its reimbursement on immunizations and injectable medications by 40%. I do not have a 40% margin on immunizations and injectable medications. My margin is at most 10%. This means that with a 40% reduction, I will have to pay at least 30% …
Patients lose when insurers cut reimbursement for immunizations
Recently, we marked the 66th birthday of Medicaid, the jointly funded but State-run program that supports health care for the poor. Medicaid plays a huge role in selected populations: 70% of nursing home inhabitants, 56% of low-income children and 42% of adults, and 44% of people living with HIV/AIDS all have their health care paid for by Medicaid. Medicaid is much talked about these days, and the reason is of course …
Can Medicaid be saved with better care coordination?
I’ve noticed a certain dilemma that enters into therapy sessions with mothers over the years. Mothers often feel in a bind and sometimes this bind distorts the way they think about their lives … or is it that their thinking distorts the way they feel? The sequence of events generally runs like this – the strong urge to have a family – the joy of being pregnant – the horror …
What a psychiatrist learned during therapy sessions with mothers
One of the many things I didn’t know about breast cancer before I got a front-row seat was just how many choices it entails. I didn’t realize that so much of the experience wouldn’t have clear-cut, yes/no answers.
You’re confronted by your first choice before you even know you have cancer. When my mammogram revealed suspicious specks, I was presented the choice of a stereotactic or surgical biopsy. I opted for the …
The choices after getting diagnosed with breast cancer can be overwhelming
Pay for performance. It’s a lovely sounding concept. If you’re a good doctor, defined by having healthy patients who meet predetermined quality indicators, then you get paid more.
What could be simpler, right?
Wrong.
Not all patients are created equal. Some are highly educated, highly literate, highly motivated to prioritize health. They have good jobs with health insurance, so critical medical care isn’t prohibitively expensive. They don’t need to choose between paying …
Pay for performance doesn’t work in difficult patient populations
I recently spoke with some people about medical systems—the actual processes involved in providing health care to patients. Story ideas involving systems sparked in my head: What about the guy who makes your sandwich at the deli? What if he had to grow the tomatoes? and cure the meats? and chop down trees to fashion the cutting boards? and weld the freezer parts together? etc.
All the ideas looked much better …
To help patients, physicians must rely on systems
A good screening test is relatively inexpensive and noninvasive. In addition, effective treatment should be available if the disease being screened for is confirmed. Lastly, detecting the disease before a patient becomes symptomatic must be more beneficial than detection after the patient experiences signs or symptoms.
The latter point is often debated in prostate cancer screening, which is done by obtaining a serum prostate specific antigen (PSA) and performing a …
The benefit of prostate cancer screening is controversial
Sports physicals are universally required in the U.S. on an annual or seasonal basis for students wishing to participate in sports. All states have requirements covering public schools. The reason for the exams is to ensure that the athletes can participate safely. These exams are not intended to replace a regular physical. There are no absolute standards for what should be included in these exams. Most would agree that …
Sports physicals often includes no provisions for privacy
This is Lokin. Every morning as I enter the hospital, Lokin sits in the same spot. Last week he was covered in gasoline and set aflame by a man in his village — a dispute over gambling debts.
For the past five days I’ve walked silently past this man, torn apart by not knowing what to do. I could tell him all …
Showing me how much medicine I’ve never even known existed
Medically speaking, what’s a guy to do when there is no right answer? My patient’s solution is often to ask me what I would do given his particular circumstance. He isn’t happy when I respond with, “I truthfully don’t know.”
In reality, I always know what I would do. I’d gather knowledge, see consultants, and explore every possible option to its fullest. Then, most probably, I would still not be …
With cancer, sometimes there is no right answer
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I hate the bouncy houses. I mean, I really hate them; I get a sick, nervous stomach when the boys are inside them. And it’s created a parenting perplexity for me. See the photo? I bet my HR is about 160 and my BP 150/90 (translation: high). I’m not kidding, I have a visceral and then flight-type response when the boys jump … it’s one of those instinctive parenting responses …
Why this pediatrician hates bouncy houses
She was overwhelmed with grief when she walked into the room and saw her mother silently and peacefully dead in the hospital bed. Her death was expected, but as always, no-one is ever quite ready to let go. She started to wail loudly and speak directly to her deceased mother about the pain she was inflicting by dying.
She was compelled to hold her prayer beads and started to dance around …
Embracing different cultures in the service of the dying
Starting a new job can be exciting, a new challenge, while embarking on a new journey. I have the opportunity to meet many new fellow docs, staff, and kind patients. However, I have to admit that it is a tad more challenging in the beginning when starting a new practice from scratch. I do miss the familiar patient faces that knew me and trusted my medical abilities without question. But …
Patient tips for your first office visit
American medicine overuses its technologies and innovation triumphs and way underutilizes old fashioned compassion, discussion and good common sense.
Over the past twelve weeks I have given weekly updates of medical megatrends in the fields of genomics, stem cells, transplantation and vaccines. These advances are the representation of innovations and entrepreneurship in biological, computer and engineering science. They are exciting advances and offer promise of hope …
When to use a new technology and when to die with dignity
Danielle and Robb Deaver are living proof of the awful reality of Nebraska’s ill-conceived “fetal pain” law. The law, which took effect last October and is the only one of its kind in America, prohibits abortions in the state after the 20th week of pregnancy. It is based on the discredited notion that a fetus may feel pain at that stage of development. Physicians who break the law face …
Implications of Nebraska’s ill-conceived fetal pain law
I commented on a blog post recently that cited a recent study called “Secure web messaging between patients and doctors: Not well received.” I was pleased to see that other professionals who left comments had the same reaction I did to the study: it is simply not accurate. I have 4,900 patients and five other physicians in our practice who can attest that secure messaging, when used the …
How secure messaging helps this doctor connect with patients
As a physician, and as an interventional radiologist, I consult with many patients. Similar to anyone who sees and talks with many people, I encounter a significant diversity of personality types, cultures and attitudes. One thing I have noticed is that each person has a certain level of expectation regarding their care, illness, and our potential interaction.
I have visited with many people who are simply happy to have someone …
What is your expectation when you visit a physician?
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