Patients and caregivers writing on KevinMD about illness and the health care system from the other side of the exam table: navigating care, the doctor-patient relationship, being heard, cost, and what patients want physicians to understand. Physicians who have become patients write here too. For the record of what pain patients and physicians have said to each other about opioids since 2007, with patient authors cited at the same weight as physicians, see Opioids: what physicians and pain patients say, in their own words. For what patients pay and who is left out when physicians leave insurance, see Direct primary care: what physicians say, in their own words. For what patients, families, and physicians have said about dying, hospice, and the decisions families face, see End of life: what physicians say, in their own words. For what physicians and family caregivers have said about growing old, dementia, nursing homes, and caring for aging parents, see Aging and dementia: what physicians say, in their own words.

ACP: Embracing a culture of cost-effective health care

Health Policy
June 25, 2009

The following is part of a series of original guest columns by the American College of Physicians.

by Steven Weinberger, MD, FACP

In his column in the June 1 issue of The New Yorker, Dr. Atul Gawande used the example of McAllen, Texas, to illustrate the widely disparate spending on health care around the country. This oft cited article captured the attention of President Obama, who reportedly has made it required …

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ACP: Embracing a culture of cost-effective health care

Steve Jobs received a new liver, and the ethics surrounding his transplant

Conditions and Diseases
June 22, 2009

Orac, a general surgeon who blogs at Respectful Insolence, writes the most comprehensive entry I’ve seen thus far on Apple’s Steve Jobs’ liver transplant.

For those interested in the medicine behind the transplant, go and read his post in its entirety. I’d like to highlight some of the potentially questionable ethics surrounding the case.

For one, there is the question why Mr. …

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Steve Jobs received a new liver, and the ethics surrounding his transplant

Reflections from the AMA: President Obama’s Speech

Health Policy
June 21, 2009

The following is part of a series of original guest columns by the American Medical Association.

by J. James Rohack, M.D.

We have a historic opportunity for health reform this year and the AMA was delighted to welcome President Obama to our Annual Meeting in Chicago earlier this week. Like the President, we are committed to health-care reform that will provide all Americans with affordable, high-quality health coverage.

I was personally honored …

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Reflections from the AMA: President Obama’s Speech

My reaction to President Obama’s speech to the AMA

Health Policy
June 15, 2009

I was seeing patients during the actual speech, so I had to rely on the transcript.

The points that interested me the most were any language pertaining to malpractice, addressing the AMA’s recent concerns about the public plan option, and reforming the physician payment system.

I think he did pretty well.

Regarding the physician payment system, he again addressed McAllen, Texas, which is fast becoming the symbol of what’s wrong with American …

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My reaction to President Obama’s speech to the AMA

5 top medical comments, June 14th 2009

Patient
June 14, 2009

Here are some of the more interesting comments readers have left recently.

1. Carla Kakutani on how Massachusetts’ health reform won’t relieve ER overcrowding:
Insurance does not equal access (although it’s better than nothing). Nothing changes until every stakeholder recognizes they have to control costs and allow a rebuilding of primary care in the US. That includes doctors and patients, along with everybody’s favorite villains, the insurance companies and big pharma. …

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5 top medical comments, June 14th 2009

AMA: Health information technology help for physicians

Health Technology
June 11, 2009

The following is part of a series of original guest columns by the American Medical Association.

by Joseph M. Heyman, M.D.

Health information technology (HIT) remains a hot button issue for many physicians, and opinions run the gamut. There are physicians and practice managers who are satisfied long-time users and those who question how HIT will benefit their practice and their patients.

My own experience is that of a solo-practitioner using HIT …

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AMA: Health information technology help for physicians

Maggie Mahar: Removing the hazardous waste from healthcare

Health Policy
June 8, 2009

Most of us are now familiar with the estimates that as much as one-third of our health care dollars are squandered on ineffective, often unnecessary, unproven and overpriced products and services. But which third?

The fat in our health-care system is not hanging out conveniently on the edges of the steak, waiting to be trimmed. It will take a scalpel, a keen eye, and a steady hand to remove at least …

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Maggie Mahar: Removing the hazardous waste from healthcare

5 top medical comments, June 7th 2009

Health Policy
June 7, 2009

Here are some of the more interesting comments readers have left recently.

1. David Block on the ACP’s guest column, A practice model for increasing the appeal of General Internal Medicine:
Weinberger talks about the efficiency of Care. Our commentators talk about the efficiency of Consumption. Weinberger assumes the one-on-one of two individuals, known to each other, who together negotiate the terms of personhood. Medicine is “spiritus”; no wonder he became …

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5 top medical comments, June 7th 2009

ACP: A practice model for increasing the appeal of General Internal Medicine

Physician
June 1, 2009

The following is the first in a series of original guest columns by the American College of Physicians.

by Steven Weinberger, MD, FACP

Much is written and discussed these days about the importance of care coordination by a primary care physician, not only to facilitate patient-centered quality of care, but also to curb the unsustainable growth in the nation’s health care tab. Yet, we hear that the current shortage of …

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ACP: A practice model for increasing the appeal of General Internal Medicine

6 top medical comments, May 31st, 2009

Health Technology
May 31, 2009

Here are some of the more interesting comments readers have left recently.

1. Dr. Grumpy on the art of medicine and electronic medical records:
I do use an EMR, but patient’s routinely tell me I’m good at listening. I think it’s an individual basis. Some doctors are technophiles, and put that first. That ain’t right. Some doctors are so intent on listening, that they may forget a detail, and then it …

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6 top medical comments, May 31st, 2009

How much time do doctors spend on paperwork?

Physician
May 29, 2009

A common complaint is that doctors these days are spending more time doing clerical tasks.

Examples include filling out pre-authorization forms, talking to health plans for pre-certifications on imaging studies, and spending time jumping through bureaucratic hoops. Generally, you do not need a medical degree to do these tasks.

Bob Doherty points to a study that gives some numbers to back up the claims. Primary care doctors spend about 3.5 …

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How much time do doctors spend on paperwork?

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AMA: Curbing the rise in health care costs is key to health-system reform

Health Policy
May 14, 2009

The following is the first in a series of original guest columns by the American Medical Association.

by J. James Rohack, M.D.

In an unprecedented endeavor aimed at achieving health-care reform this year, the American Medical Association (AMA) stood with President Obama and other key health-care stakeholders Monday to announce efforts to “bend the spending curve” on health care. U.S. health-care …

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AMA: Curbing the rise in health care costs is key to health-system reform

6 top medical comments, May 10th, 2009

Physician
May 10, 2009

Here are some of the more interesting comments readers have left recently.

1. Anonymous on whether emergency physicians best served to staff urgent care centers:
As an ED doc, I understand the problem. We are taught to always rule out the emergencies, and I am constantly worrying about the worst case scenario, and likely will order more tests since they are at my disposal, which is …

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6 top medical comments, May 10th, 2009

6 top medical comments, May 3rd, 2009

Medications
May 3, 2009

Here are some of the more interesting comments readers have left recently.

1. Carla Kakutani on the lack of primary care access in Massachusetts:
So we have a chicken and egg problem. Do we wait health care reform until we have revived US primary care, or is that even possible without health care reform to create the disruption needed to change our entrenched fee-for-service, procedure-happy payment …

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6 top medical comments, May 3rd, 2009

Reader take: Patients should be allowed to access their entire medical record

Health Technology
April 28, 2009

The following is a reader take, in response to a post on whether patients should own their medical records, by an anonymous nurse.

Dear Dr. Pho,

I wish to respond to your position on patient access to their medical records both as a patient and a nurse.

If a doctor or other health professional believes their documentation would be inappropriate or too sensitive for …

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Reader take: Patients should be allowed to access their entire medical record

How the primary care doctor shortage threatens Obama’s health reform plan

Physician
April 27, 2009

Top story in The New York Times.

Excellent.

There’s hope that maybe, just maybe, we’re getting through to the decision makers in Washington.

The article itself is old news to regular readers of this blog, and regurgitates many of the arguments impeding health reform, as well as the problems in solving them.

“Obama administration officials, alarmed at doctor shortages, are looking for ways to increase …

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How the primary care doctor shortage threatens Obama’s health reform plan

6 top medical comments, April 26th 2009

Social Media in Medicine
April 26, 2009

Here are some of the more interesting comments readers have left recently.

1. Mediaslackers on the UK’s proposed 48-hour physician workweek:
I agree there are significant dangers inherent with limiting the number of hours a doctor can work in a week, but I don’t think they are totally insurmountable or all that much greater than when a doctor is working 30 hours straight, getting a divorce …

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6 top medical comments, April 26th 2009

HealthHarbor: Health IT stimulus leads to more questions than answers

Health Technology
April 25, 2009

The following is a reader take from the staff at HealthHarbor.

We had a chance to attend the HIMSS conference two weeks ago. HIMSS is healthcare’s premier annual tech expo, and was in Chicago this year. The undeniable theme of this year’s conference was the anticipated expansion of Health Information Technology (HIT) via the Economic Recovery Act. …

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HealthHarbor: Health IT stimulus leads to more questions than answers

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