There was a memorable scene in the movie “The Graduate” from 1967. You may know it or have heard of it, when the older man turns to the college graduate and says the future is all about one word: “plastics.”
Well, plastics may have been then, but this is now. And the core themes I keep hearing these days there are two central …
The promise and the peril of big data in health care
I recently attended a meeting in which a public intellectual spoke with boundless enthusiasm about the wonderful future medical technology will inevitably deliver to human beings.
His lecture went something like this: “Since the dawn of civilization, we humans have sought to transcend the limits of our condition. While we’ve long worked at this enterprise of empowerment, the arrival of the scientific method has radically accelerated the pace of change. With …
Technology alone won’t solve the suffering in our world
American Medical News reported earlier this year the wonderful story of CareFirst BlueCross BlueShield, which covers patients in Maryland, Virginia and the District of Columbia. They have come out and claimed that their patient-centered medical home program is benefiting everything it hoped to help: its own bottom line, patient care and physician pay.
Am I wrong to be skeptical when an insurance company says anything? Philosophically, I love the medical …
Medical homes: Taking what an insurer says at face value
In the New Yorker blog entry, Lisa Rosenbaum wrote about a topic dear to my heart: shared decision making (SDM). It refers to doctors empowering patients to make medical decisions based on their values and preferences when there is more than one reasonable path. Many researchers have found that shared decision making (with the help of decision aids) leads to more informed decisions and may even lower health care costs.
As Lisa points out, …
Shared decision making has value beyond its literal practice
The medical board of the state of Oklahoma recently sanctioned a physician for using Skype to conduct patient visits. A number of other factors add color to the board’s action, including that the physician was prescribing controlled substances as a result of these visits and that one of his patients died. This situation brings up several challenges of telehealth — that is, using technology to care for patients when doctor …
Using Skype for patient visits: A doctor is sanctioned
What does access to care look like in a patient-centered medical home?
To answer this we first have to see what access looks like now, under our current system.
What happens now?
A patient wakes up in the morning with abdominal pain, cannot reach us, and so turns to the computer and types “abdominal pain” into Google. He or she is rewarded with multiple catastrophic and deadly diagnoses, most of which they assume …
Access to care in a patient-centered medical home
A recent story about Penn State’s new penalty-based approach to employee wellness is another reminder that programs relying on incentives aren’t going anywhere — even though incentive-based programs don’t work.
The traditional wellness model incentivizes people to participate in healthy behaviors—with the promise to employers of healthcare cost reductions—in exchange for discounts on their insurance premiums. However, the “carrot” is not working, to use the “carrot or stick” …
3 problems with incentive based wellness programs
Healthcare markets are complex and confusing places. But one fact is simple and straightforward: all else equal, hospitals and emergency departments are a lot more expensive than outpatient clinics. Which makes it all the more bewildering that so many low income patients prefer hospitals over primary care clinics.
Bewildering until now. Shreya Kangovi and colleagues at the University of Pennsylvania interviewed low income patients and discovered some fascinating reasons why they aren’t …
Don’t blame low income patients for seeking care from hospitals
A recent post observed that the “highly charged scope-of-practice” fight between the medical and nursing professions has resulted in social media hate speech — too often, from physicians directed at other physicians. “Like bees to nectar, a post on the topic is sure to draw dozens of anonymous, hate-filled comments” write the authors. They propose the following “principles for civil discourse” which I believe should apply more broadly to all social media …
Renewing the dialogue between the medical and nursing professions
I have a vague recollection, a memory shrouded in mist, where I pondered what seemed like a radical question: What would a health record look like if my only concern was patient care? This was a radical question because in my previous life I was an electronic health record aficionado. I was good at EMR, which meant that I was really good at finding work-arounds:
Creating a truly meaningful and useful patient medical record
The Centers for Medicare and Medicaid (CMS) sets the rates all physicians get paid and insurance companies base their rates on the same formula. So who creates the formula? Well, it’s the doctors, silly! Or at least some of the doctors. Here’s how it works.
A 31-member committee formed by the American Medical Association is made up of representatives from the various specialty societies. This Relative Value Update Committee (RUC) meets …
The relative value of how physicians are paid needs to change
My institution recently switched from its home-grown electronic medical record (EMR) to EPIC, a system for which many great things have been promised. Indeed, it is a considerable improvement over the past one. A number of hopes have been pinned on the latest-generation EMRs, not the least of which is the idea that finally, with this newest generation of tools, a nexus can be created and sustained among comparative effectiveness …
Addressing the disparities in those using patient portals
I was naive when I decided to enter medicine. My impressions then were that doctors always “did” stuff — for patients, and to patients. We would do stuff to you (examinations, blood tests, scans, surgeries) in order to help you.
A lot of time and education later, I’ve learned that that straightforward paradigm is far from the only way that doctors help people. In fact, following that mostly simple formula (you come to us, we do stuff to …
Being good doctor requires bearing witness
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So what exactly do we want a patient-centered medical record to look like?
What is the point of a patient’s medical record? Historically it has served many functions. Perhaps the time has come to reassess what it needs to be, what it can and should be.
If a healthcare provider from one or two generations ago were to look into a patient’s chart today, would they recognize what they saw? Would they …
How can we revise the patient medical record?
I always wanted to become a medical doctor to cure the sick and save lives. In fact, most doctors I know chose the profession for the same reason. This fundamental desire among physicians to treat patients is because our beliefs have been deeply rooted in the concept of disease management rather than the provision of health care.
As an aspiring physician and student of health care, I often catch myself heading to …
We need health care instead of disease management
Several studies have explored the experience of grief that physicians feel when they lose a patient. But what about when the patient loses a physician — when the doctor dies?
Dr. K was a well-known child psychiatrist, a loving husband, a father of two, and an irreplaceable support and friend for a number of children suffering from trauma, schizophrenia, bipolar disorder, autism and other challenging psychiatric conditions. Earlier this year, …
What happens to patients after their doctors die?
My new glasses were years overdue. The eye doctor understood perfectly my request that the focal point and pupillary distance for my iPad reading glasses had to match my habitual reading style – right under my nose. The result couldn’t be more pleasing.
The other day my wife squinted over her iPad and said “I don’t know if I’m getting a cataract or if I just need new glasses. My right …
Balance bedside assessment with high-tech testing
She was the first Michigan Wolverine I met who taught me their college fight song “Hail to the Victors,”and demonstrated their rabid pride anytime football or basketball season rolled around. (If you know people from the University of Michigan, you know what I mean). She was also one of the smartest and hardest working doctors in our family medicine residency program and one of our two chief residents.
So …
This is the grim reality of starting a private primary care practice
Medical science is making such remarkable progress that soon none of us will be well.
-Aldous Huxley
The recently completed conference, “Preventing Over Diagnosis,” was easily the most important meeting I ever attended. Sponsored by the British Medical Journal, Consumer’s Reports, and Dartmouth and Bond Universities, the goal was to identify the excesses in medical care and to figure out how to correct them.
The evidence is compelling that we in the developed countries …
Defeating overtesting: Right sometimes does bring might
This column was published in USA Today on September 9, 2013.
More patients are coming to my primary care clinic with forms from their employer, asking me to measure their blood pressure, or check their sugar and cholesterol levels. Companies requesting medical data drive employee wellness programs, a booming $6 billion business, with approximately half of large employers offering such plans.
Coaching and financial incentives are often offered to help employees meet certain health metrics, …
Corporate wellness programs fail both companies and patients
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