With roughly 1 billion in Medicare reimbursement dollars being tied to patient satisfaction, it’s no wonder the focus on patient experience is swelling. Of course there are other factors fueling the focus — the proliferation of online physician ratings websites, ACOs, and CG-CAHPS to name a few.
Over the past decade I have visited 100+ different inpatient and outpatient practices. Ironically, …
3 guaranteed ways to improve patient satisfaction
Any health care provider can tell you that clinical knowledge isn’t the only thing that determines how well you care for your patients. We’ve all seen — many times — the patient that can’t afford the correct antibiotic, doesn’t get preauthorization for the necessary CT scan, and can’t find a specialist who will take his or her insurance. Making the correct diagnosis is only the first step in helping a …
Medical schools fail to teach students about the health care system
There is little to say once you’ve said this before. Although the sadness brings fresh tears, they are also old tears. The grief becomes familiar and so too the inevitable resumption of everyday life. The pain bores to the soul but settles in the subconscious, where it rests, privately born and quietly hidden, lest Read more…
Ferguson: What should physicians do?
We’ve all heard or used the phrase, “Leave it to the professionals.” It certainly applies to me as the only tools that I can use with competence are the scopes that I pass through either end of the digestive tunnel. Yeah, I have a toolbox at home, but it is stocked similarly to the first aid kit that your new car …
Get help: Most physicians are not good at business
There are times when who you are and what you do are inseparable. A photographer views a scene from the camera’s point-of-view even when the camera is not in hand. A police officer assesses situations with an “on duty” reaction, even when off-duty. And a health care professional rarely turn off the knee-jerk reaction to assist when someone requires help.
That immediate …
A walk in Central Park: Contemplating physician burnout
A few months ago I assessed a patient with dementia. I dutifully ordered the appropriate blood testing and MRI. As I delved further into the history, I was concerned that there may be a component of depression. Pseudodementia (memory disturbance and dementia like symptoms caused by depression) can often mimic classic Alzheimer’s disease, but resolves with proper treatment. The best way to differentiate these two syndromes is neuropsychological testing. I decided to send my patient to a colleague …
Why does the government fail to bend the cost curve?
As a graduating senior resident I’m scared to practice outpatient medicine. In a community of patients and physicians crying out for primary care doctors, what are we doing at a training level to foster and promote confidence and independence at doing this?
Many bright eyed freshly graduated medical school students enter residency understanding the need and embodying the hope of pursing outpatient …
After residency: I’m scared to practice outpatient medicine
You know the story. It goes something like this:
On an ordinary September morning in 1928, Alexander Fleming, a Scottish bacteriologist working at St. Mary’s Hospital in London, came back from vacation to find that one of his Petri dishes containing Staphylococcus aureus growing in culture had been contaminated by greenish mold.
Instead of throwing a fit, Fleming grew curious over this finding. After …
Can serendipity be engineered?
A rash could be leukemia or idiopathic thrombocytopenic purpura. A sore throat could be glossopharyngeal neuralgia or a retropharyngeal abscess. A blocked ear could be Ramsay-Hunt syndrome, a self-limited serous otitis or sudden sensorineural hearing loss with an abysmal prognosis if not treated immediately with high doses of steroids. A headache or sinus pain could be cancer, and a cough could …
Physicians are treating the well, and nurses are treating the sick
As a doc, I need to take care of the whole child. I do this with respect for every kiddo; and with their parent’s consent, presence, and permission. Sometimes the job includes discussing or examining a child’s genitals.
In the past, it was not thought of as appropriate to allow children to speak openly about sensitive anatomical areas (“private parts.”) Growing up as kids, we may have …
Why teaching anatomically correct words matters
Middle-aged lady, twenty pounds overweight.
Doing everything I can, doctor. Everything imaginable. Diet: I eat practically nothing. Exercise: all the time! Weight Watchers doesn’t work. Jenny Craig, South Beach, the Zone; I’ve tried it all. Nothing works. Have to lose weight. Have to lose weight.
Yada, yada, yada.
Oh look: A few years back I diagnosed you as hypothyroid and gave you some Synthroid. …
Two patient result letters: Which one did this physician send?
“There was one time when I wasn’t here for seven months in a row,” ”Pam” told me.
I sat with Pam in her third floor hospital room — the floor on which she always stays when admitted to the inpatient medicine service — as nurses, doctors, and janitors poked their heads in the door to say friendly hellos and “Nice to see you again, Pam!” A dining facility staff member entered …
Hotspotting: The power of storytelling cannot be underestimated
CMS recently announced it would begin next January to pay physicians for care coordination activities. It’s about time. As physicians have been saying for some time, any payment system that hopes to encourage value (better patient outcomes) has to start by paying physicians to coordinate the care of their patients. When physicians follow up on referrals or communicate with patients outside of the office, healthoutcomes improve, costs shrink and the patient …
Medicare will pay for care coordination. Should doctors take the money?
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You treat a disease: you win, you lose. You treat a person, I guarantee you win – no matter the outcome.
– Patch Adams
Health care reform sounds like a great idea, in theory. Get more people the access they need. Improve the quality of health care provided. Get doctors on electronic health records so they can more easily coordinate care between specialists. …
Regulations are changing the very heart of medicine
If a foreign government took the United States surgeon general hostage, I’m confident we’d be pretty upset. I think we would be working on reprisals, and maybe even prepping a SEAL team.
I don’t know if it’s better or worse that we need no help from a foreign power to take our surgeon general hostage. Our own political system manages, all on its own.
Admittedly, it’s not quite the surgeon general who …
The surgeon general in limbo: It’s time that he be freed
The lipstick sign is an underutilized physical examination finding which can assist in the evaluation and assessment of the elderly female patient. While poorly applied lipstick can result in considerable embarrassment and anxiety in this patient population, those who present with properly applied lipstick demonstrate mastery of multiple domains of functioning.
Fine motor skills and concentration can be correlated with a positive …
Consider the lipstick sign in your next physical exam
Not too long ago before I was unexpectedly dismissed by my organization, I had the audacity to complain and request change for the betterment of my patients. Forgoing the traditional route of a solo practice, I wanted to join a large organization which supposedly provides a worry free investment that normally comes attached with starting an independent medical practice. I agreed to the terms and conditions of any large …
When joining a medical practice: The importance of autonomy
A sleeping dragon awakes.
At our weekly health policy colloquium recently, the presenter described plans for our organization to form its own accountable care organization, or ACO.
The idea behind an ACO is to find patients who get the majority of their primary care within our system, and then “attribute” their health care and all of its attendant costs to that system, making the providers ultimately responsible for providing both high-quality and …
ACOs: Another layer of oversight for physicians?
Making primary care better for doctors currently in practice and attractive to medical students and residents is critical given the needs of our health care system. It also has been a major focus of the health care organization where I work. A few colleagues and I noticed that many primary care doctors still stayed later than others despite lowering patient panel responsibilities and the implementation of the nation’s most robust …
Improve the lives of primary care doctors. Here’s how.
It is well known that Medicare expenditures threaten the financial solvency of the U.S. government. And it is pretty well agreed upon that some of our Medicare spending goes towards wasteful medical care.
But which medical care is wasteful and how much is such care costing us? A study in JAMA Internal Medicine provides a sneak peek at answers to these important questions. The research, led by Aaron Schwartz, a graduate student …
We waste a lot of dollars on unnecessary medical care
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