Ever since the days of William Osler, annual physical examinations with one’s doctor have been an accepted and expected part of health care. But recently the practice has come under some criticism. Given the dearth of studies showing that physicals lower the risk of death and hospitalization, some experts and organizations state that the annual physical should be abandoned.
I appreciate the effort here to question tradition and to consider if …
In earlier columns I wrote about two initiatives to promote physicians providing the best possible care by reducing or eliminating the use of tests or treatments that have little or no value to patients. They are ACP’s High Value Care and ABIM Foundation’s Choosing Wisely. I …
At the International Conference on Communication in Healthcare, which I just returned from, there was a discussion continuously coursing beneath the surface and bubbling up every once in a while. If we, acolytes of shared decision making, whether patients or providers, want to encourage decision making that has the person involved at the center, recognizing their preferences and values, does the kind of decision in question have anything to do …
Recently, the chairs and ranking members of the Senate Finance and House Ways and Means committees released a bipartisan, bicameral plan to repeal the Medicare SGR and reform physician payments. And this time, it looks like the effort could actually succeed: never before has there been agreement between the House and Senate, Republicans and Democrats, on a plan to repeal the SGR, never mind on what they would replace it …
If you are a healthcare provider — physician, administrator, or some other leader at a healthcare site — then you know that you face many challenges. Some seem overwhelming and you may be thinking that you may not be able to handle some of them well. Perhaps the transition to ICD-10 coding is your main concern right now.
The solution to difficult challenges begins with the first step. I am taking …
Providers in all parts of the health care system recognize that troublesome social conditions drive much of their work and costs. Major challenges in people’s social circumstances — layoffs, foreclosures, accidents, violence — can create horrific health care needs, many of which become chronic and carry high price tags. These extreme needs are omnipresent in the nation’s hospitals, which care for about 37 million admissions at a medical expense of …
My Swedish medical school curriculum was 5 1/2 years, but I remember during a third-year class trip to the Soviet Union hearing that some doctors over there had a much shorter education. My classmates and I were at first surprised to see physicians staffing ill equipped ambulances, riding the streets of Moscow with critically ill patients and no equipment to deliver care. We concluded that physician labor was cheap and …
Everyone agrees that the US healthcare system is too costly. The challenge of public policy is deliver higher value by improving quality while reducing costs by eliminating waste and increasing efficiency. Historically physician compensation has been tied to productivity, which encourages procedures and over-utilization.
How can we motivate physicians to provide preventive, cost effective and quality care without incentive programs? Alfie Kohn in 1993 published ”Incentive Plans Cannot Work.” Clearly, poorly …
As someone who has recruited a very large number of physicians over the years, I am quite sold on the benefit of a “letter of intent” or “LOI” as a tool for physician recruitment.
While physicians are highly familiar with medical/surgical concepts and while many are in no way intimidated by dissection within the human body, many to most are not qualified or really desirous of dissecting a complex legal document …
I grew up in a solidly middle class family. Our home was safe, loving, and we never wanted for anything. My parents believed in hard work and instilled in me the importance of a college education. I was the first kid on the block to have a computer. That Radio Shack TRS-80 was a marvel of modern technology and made me the envy of my friends. Today, a TRS-80 is …
As I sat in my orthopedist’s exam room, the discussion quickly turned from my chief complaint to his: “I don’t know why I’m doing this anymore,” he said. “Medicine is just not what it used to be, and I don’t enjoy my work anymore. The bureaucracy and regulations are bad enough, but what really gets me is the hostility. My patients …
There are many reasons to be dismayed by the error-filled and managerially incompetent rollout of the federal health insurance exchanges that are in many ways the linchpin of President Obama’s Affordable Care Act. I sympathize with commentators who have called for the resignation of Department of Health and Human Services Secretary Kathleen Sebelius. It’s hard to imagine Franklin Roosevelt not firing someone in his cabinet had social security stumbled this …
I can hear the case coordinator clicking her fingernails against the desk through the telephone line. I admit, I forgot to specify to the nurse, when she called me ten minutes before midnight, that this was a full admission and not an observation. In the absence of my order, a nurse manager reviewed the chart and decided that the 95-year-old woman with congestive heart …
The lack of access to primary care physicians is a well known problem impacting our healthcare system. The problem sends all sorts of negative ripples through the system, not the least of which is increasingly crowded emergency rooms packed with patients whose conditions could have been addressed earlier and cheaper had primary care been available.
What is less talked about is the mixed reaction of primary care physicians to the kinds …
As we grapple with provider shortages, the surge in chronic illness and the quality to price (QPR as they say in the wine business) challenge in US healthcare delivery, it’s hard to imagine a future that does not include some sort of guideline or algorithm-driven care. As providers take on more financial risk, one common strategy involves team-based care, and the attendant increase in decision-making and care delivery by non-physician …
Beginning in 1964 the Journal of the American Medical Association (JAMA) started publishing full color images of art on its cover accompanied by insightful essays. JAMA’s former editor, George Lundberg, wrote that this was part of an initiative to inform readers about nonclinical aspects of medicine and public health, and emphasize the humanities in medicine. Now after almost 50 years of covers …
For anyone hiding under a rock the last year or so, the latest recommendations about prostate cancer screening have changed from earlier iterations of “screen everyone with a prostate with a PSA (prostate specific antigen) and a DRE (digital rectal exam, where the “digital” equipment referred to is a finger) every year” to don’t do it at all.
The United States Preventive Services Task force reviewed the literature and …
Have you ever taken note of how much you or a colleague says “I” versus other pronouns? The pronoun that you choose in conversation may very well provide insight into your psyche and may determine your effectiveness as a leader. Current research has indicated that the frequency at which an individual uses the pronoun “I” speaks volumes about their self confidence, level of empathy and perceived status within an organization …
I think I am like many practicing physicians in my love-hate relationship with clinical practice guidelines.
On the one hand, it is often helpful to look up a set of evidence-based recommendations on a particular clinical issue, and I feel particularly fortunate that the American College of Cardiology and the American Heart Association have collaborated to produce high quality guidelines on a wide-range of subjects relevant to my practice.
