After I read this blog on OpenNotes, I struck up a discussion with a radiologist friend. We commiserate over laws and loopholes in laws that cause system abuse. I am so happy that Obama recommended to close the loophole in the Stark Law in his 2015 budget. That loophole has created some rampant abuse.
I worry about and applaud the possible effects of patients being able to read their notes online. …
The promise and peril of OpenNotes
For about 2 years now a tiny ultrasound machine has been part of my standard physical exam tools as I take care of patients in the hospital and in the outpatient clinic. In November 2011, I first picked up an ultrasound transducer in a continuing medical education course on bedside ultrasound for emergency physicians. I am an internist, not an emergency physician, …
Why doesn’t everyone have a pocket ultrasound machine?
For the better part of a decade, I practiced inpatient hospital medicine at a large academic center (the name isn’t important, but it rhymes with Afghanistan … ford).
I used to play a game with the med students and housestaff: Let’s estimate how many of our inpatients actually didn’t need hospitalization, had they simply received effective outpatient preventative care. Over the years, our totals were almost never less than 50%.
For my …
An organic effort to reboot healthcare
Emergency departments in U.S. hospitals see copious patients who aren’t terribly ill, but don’t have insurance and need somewhere to go. I see some of these patients when I moonlight on nights and weekends at a local county hospital. Sadly, these patients run through a gantlet of expensive tests — I’m required by protocol to administer them. The reality is that 80% of what I see in the ER is “family …
A solution to ER overcrowding: Direct care
I’ve always been a people watcher. Now I get paid to spy on folks. I have to ask detailed, personal questions. Sometimes I even snoop around patients’ homes.
In the 1930s nearly half of all patient visits were house calls. Now most patients are rushed through ten-minute office visits. But if I need to know what’s going on with a patient, I …
It’s been almost two years since returned to medicine after a three-year hiatus from practice. I recently finished the longest week of work I have had since starting this job. I had a family emergency and a conference all converge around the same week, and ended up cramming two makeup days into an already full schedule. It was long. It was incredibly tiring. I was very glad when I finally …
The key to physician job satisfaction: Being valued
A long time ago, when I worked in Sweden’s socialized health care system, there were no incentives to see more patients. In the hospital and in the outpatient offices there were scheduled coffee breaks at 10 and at 3 o’clock, lunch was an hour, and everyone left on the dot at five. On call work was reimbursed as time off. Any extra income would have been taxed at the prevailing …
A toxic environment for delivering health care
“Patient-centered.”
It sounds so right, doesn’t it? Right up there with mothers and apple pie. If only family medicine were so simple.
A report by ABC News told the story of a doctor at a VA hospital in Kansas City who claims she was forced to leave her job because she tried to limit prescriptions for opioid pain medications to reasonable amounts. Patients complained, so she was canned.
She claimed that some patients …
We shouldn’t focus exclusively on patient satisfaction
Through three years of medical school, I’ve seen disgruntled physicians repeatedly slam the recent movement toward patient satisfaction. In our family medicine clinic, a copy of Dr. William Sonnenberg’s essay “Patient Satisfaction is Overrated” hangs on the door to remind attendings, residents, and students of the unfair pressure to keep patients happy despite their demand for antibiotics, imaging studies, or narcotics.
The only way to keep the patients satisfied, the argument …
Patient satisfaction is underrated
It’s here. For the first time in 35 years (or 33, depending on which click bait headline you clicked on), the much anticipated release of data on Medicare payments to physicians, has been released to the public, on the historic date of April 9th, 2014.
“Data trove shows U.S. doctors reap millions from Medicare,” according to the distinguished Reuters news service. The Washington Post will tell you “everything you need …
Transparency is here, and it’s hunting season on doctors
“Do patients care about how much money their doctors make?”
This is the headline of a recently published post by Trudy Lieberman, and was written in response to the recent New Your Times’ coverage of Medicare disclosing payments to individual providers.
Now, I found the Times story fascinating on many levels, but I’ll admit it hadn’t occurred to me that the main value of this data release is that patients can …
The Medicare spending we should be concerned about
A guest column by the American College of Physicians, exclusive to KevinMD.com.
On a Thursday in April, my practice upgraded its electronic health record to the next version, the “latest and greatest” with more features, as well as compliance with meaningful uses 2 through infinity. That was the good news. The bad news was that it meant that our EHR …
Lessons learned during an unplanned EMR downtime
I’m no economist. In fact, I have never taken any business or accounting classes in my life. But it doesn’t take a formal education to get this. We are speeding down the wrong path.
The call at three in the morning woke me from a deep sleep. I fumbled and strained to hear the whispered voice of the apologetic nurse. Apparently Mrs. …
Doctors and nurses are being overloaded with menial tasks
ADVERTISEMENT
I know where America’s future primary care physicians are, and more importantly, where we are losing them. I am one of them, and I almost got lost.
Maybe I was naïve. I’d had no math or science classes as an undergraduate, and I’d never really thought about the mechanics of medical education. Even while jumping through all the prerequisite hoops before applying, it never occurred to me how inadequate my non-traditional …
Where are we losing America’s future primary care physicians?
I spend way too much time worrying about “silly” things, things I have no control over. I know this because my wife frequently catches me in the act and urges me to relax, to focus on what I can change. But despite her best efforts, I recently fell off the wagon again and became obsessed with a simple, seemingly innocuous question: Are physicians still …
The relevance of physicians is dwindling rapidly
The howling about the delay of ICD-10 was loud and fierce. It seems the quality of health care in the United States depends on our ability to use 68,000 diagnosis codes. The rest of the world has switched to ICD-10, and we alone insist on using an outdated coding system. Here’s a secret. The World Health Organization’s version of ICD-10 has about 16,000 codes, equivalent to ICD-9-CM. The rest of …
The ICD-10 emperor has no clothes
I asked why physicians were dying by suicide. Here’s what they told me:
“I definitely graduated from med school with PTSD. It has changed me forever. My mom’s friend that I have known since I was born saw me for the first time since I went to med school and she [told my mom], “She has changed so much. Was it worth …
Fifteen minutes. Give or take. That’s about how long a patient typically spends with a primary care doctor during an office visit. If you’re lucky enough to be healthy, maybe that visit comes once every year or two. Or if you’re less healthy, maybe every few months. In either case, it’s not a lot of time. Not a lot of time to share all the relevant developments. Not a lot …
Making the 15 minutes more valuable: It’s time to flip the clinic
I recently published an article on that garnered a lot of attention. It was titled,”The Myth of the Entitled Single Mother Remains as Relevant as Ever.” In it, I reversed the popularized notion that single mothers are a societal liability and suggested that instead, they are powerful forces in our local economies and influential leaders of future generations. I presented the idea that how society …
Addressing the structural forces that perpetuate inequality
Postmodern cultural values have seriously impacted medical care and the patient-physician relationship. Corporate control of medical care, computerization of medical information and consumerism in the clinical encounter, plus the destruction of the myth of the physician are all embodiments of postmodern values.
Postmodern thinkers such as Foucault, Lyotard, Levinas, and Bauman offer powerful insights that can be applied to understand how current values have changed medical practice, including issues such as …
How the postmodern ethos challenges medical professionalism
Get free updates delivered free to your inbox.
