This question was what drove me to graduate school for an MPH degree a few years ago. I was finishing up my family medicine residency at, arguably, one of the top residency programs in the nation. I had been well trained in both medical science and doctor-patient relationship skills. Yet my patients still consistently did not adhere to my advice.
I was not disappointed in my MPH studies. It turns out …
Why don’t our patients do what we tell them?
What does the 21st century physician look like?
I’ll admit that the question on the face of it struck me as a bit absurd, especially when juxtaposed with the term “tomorrow’s doctor.”
Tomorrow’s doctor needs to be doing a much better job of dealing with today’s medical challenges, because they will all be still here tomorrow. (Duh!) And the day after tomorrow.
(As for the 21st century in general, given the speed at …
The skills that tomorrow’s doctors will need
A crunchy friend of mine on Facebook re-posted something from an even crunchier friend of hers who was shocked to find that many naturopaths sell supplements. Actually, she feels that selling them is okay; so is prescribing them. But selling what they prescribe apparently tips her ethics meter over into “unacceptable”.
As I read her screed against the ND who conducted a cursory history and exam before checking off $750 worth …
The ethical shortcomings of selling supplements
Even stronger controls have just been set out for HIPAA. They come in the final regulations for the Omnibus Health Insurance Portability and Accountability Act, or the HIPAA rule. The new rules became effective March 26. However, medical offices and business associates have until September 23 to comply.
Mostly, the changes affect patient requests and approvals, breach reporting, and business associates. Along with that, the penalties for noncompliance have gone up. …
The new HIPAA regulations: Do you know the rules?
Ensuring that Americans who live in rural areas have access to healthcare has always been a policy priority. In healthcare, where nearly every policy decision seems contentious and partisan, there has been widespread, bipartisan support for helping providers who work in rural areas. The hallmark of the policy effort has been the Critical Access Hospital (CAH) program– and new evidence from our latest paper in the Journal of the …
Access to care isn’t enough: It’s about access to high quality care
I’ve been going about this all wrong.
It’s not my dumping of the payment system so I can focus on care over codes, my use of technology to connect better with patients, or my vision of the “collaborative record” that is wrong. It’s the fact that I am doing this without my most important resource: my patients.
I realized this while driving in to work this past week. My first patient was …
Building a true collaborative health record: Ask your patients
Newtown. Aurora. Oak Creek.
A year ago, I’d never even heard of these places, and now those names are permanently imbedded in my mind along with the graphic images of suffering and death.
And now, people are finally talking about it. What can we do to prevent these tragedies? How can we protect our society from senseless bloodshed? I can’t help but think, though, that all of the arguing over guns misses …
Why violence is an infectious disease
A front-page Boston Globe article on a neurosurgeon suing a caregiver for a harsh blog post is exciting but unrepresentative of the overall state of online doctor reviews. However it caused me to take another look at online physician ratings from the perspective of someone trying to find a doctor.
Conclusion: we are still in the early days and there is plenty of opportunity for better, more useful information. …
The state of online doctor ratings: It’s still early
Several months ago, as I was in the last few months of my private practice, I watched the Joy Luck Club with my wife. I had seen the movie many times before, but somehow at that moment in time, when I was grieving for my practice and my profession, I began to have some startling clarity.
Specifically, I was particularly struck by this dialogue:
I tell you the story because I was raised …
Primary care has lost its self-esteem
A little over a year ago, I found myself burning out and realized that my worklife was unsustainable.
I’d been working at an FQHC clinic, and had become the site’s medical director a few months before. I was practicing as a primary care doc, trying to improve our clinical workflows, problem-solving around the new e-prescribing system, helping plan the agency’s transition from paper charts to electronic charts, and working on our …
How my geriatric practice works
The medical arena, like society at large, is permeated with self-interest. This reality makes me very skeptical that comparative effectiveness research, which I support, will get airborne. In medicine, every heath care reform, new medicine, new medical device or revised medical guideline is at some constituency’s expense. Recognizing and dismantling conflicts of interests is one of our greatest challenges and threats.
When I …
Are the days of screening colonoscopies numbered?
An excerpt from Too Big to Ignore: The Business Case for Big Data (Wiley and SAS Business Series).
Unstructured and semi-structured data is, by its nature, largely text based. Even numbers are often surrounded by words, like an article on a company’s stock. This section describes some of the tools that translate what is often a bunch of gobbledygook into meaningful information, the result of …
How natural language processing can help EHRs
We recently marked the third anniversary of the passage of the Affordable Care Act by reflecting on the positive changes it has brought about and by mulling over the multifaceted challenges that stymie our efforts to build more accessibility, equity, quality, safety, and cost-effectiveness into one of the most complex healthcare systems in the world.
Reining in healthcare costs, a central element in the reforms we seek, is inextricably linked to …
Are we ready to creatively destroy medicine?
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I recently wrote about some of the unintended, but positive, consequences that could result from employers dropping employer-sponsored health insurance (ESI). Following that post, many weighed in about various other consequences of such behavior from employers and what that means for health care coverage for millions of families in the US. One issue in particular caught my attention; not only because of the touching stories associated with …
A creative way to meet our health needs: Direct practices
Research shows numerous benefits to meditation: it reduces stress, increases positive emotion, and even treats acute pain. Commonly, meditation involves focusing on one’s breathing as a way to anchor one’s attention in the present moment. Practitioners are also frequently taught to separate their experiences (breathing, pain, thoughts) from their judgments about them. Thus, with respect, for …
What being mindful will reveal to us
A version of this column was published in USA Today on April 1, 2013.
Prescription drug abuse is a growing national tragedy. One of the biggest culprits is opioid painkillers, such as Oxycontin and Percocet. Shockingly, more than 200 million of these types of drugs are prescribed annually, and they account for more than 16,000 deaths a year. And for every death, significantly …
Curb prescription drug abuse by following Mayor Bloomberg
It feels like part of me is dying. I am losing something that has been a part of me for nearly 20 years.
I bought in to the idea of electronic records in the early 90′s and was enthusiastic enough to implement in my practice in 1996. My initial motivation was selfish: I am not an organized person by nature (distractible, in case you forgot), and computers do much of the …
Let’s mourn the death an EMR evangelist
In 2006, Governor Mitt Romney signed Chapter 58 of the Acts of 2006 entitled “An Act Providing Access to Affordable, Quality, Accountable Health Care.” It has been described by many names, including Massachusetts Healthcare Reform (MHR), Romneycare, or simply, as the template for the Affordable Care Act. The goal of the act was straightforward: to ensure near-universal access to health insurance for citizens of the Commonwealth of …
Our healthcare system is far more resilient than we think
The ICU hummed as the tech guy waltzed in at two in the morning. A key designer of the EMR himself, the night shift nurses had his mobile and were not afraid to use it. There was a problem reconciling Mr. Jones med list after his emergency bypass surgery that evening. Patients first.
The next one in the door was the young CEO …
EMR designers: Your actions can kill
The baby boomers are strictly identified as being born between 1946 and 1964. The boom lasted 19 years and delivered 76 million total births. “Leading edge” boomers were between 1946 and 1955. They were the generation that were the wealthiest, most active, and most physically fit generation that had ever lived. They were special and expected to have better lives than their parents.
Well, those leading edge boomers are now middle …
Baby boomers need to save themselves
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