I recently said I would describe the essential elements of “true reform.” I realize others might add or subtract from my list, but here it is – at least for today:
Payment reform. I put this first because no matter what form or structure healthcare takes, without payment reform it will be doomed to failure. And by “payment reform” I mean switching from the “fee for service” model I discussed in …
4 essential elements of true health reform
The 2012 Presidential election is over. Obamacare is the law of the land and is certain to remain so. There was tremendous uncertainty not knowing whether the law would be repealed, revised or remain. Many of us opposed the bill, and there certainly are negatives. Like it or not, it is time to “get over it,” and not a second later than now. …
How Obamacare will create a new normal for medicine
An excerpt from Pet Goats and Pap Smears.
I’ve been practicing medicine nearly twenty years, but I’m still a doctor-in-training. Every patient who passes through my life teaches me something. Now doctors-in-training follow me around, but I think I learn more from my students than they do from me.
Today Brooke is here. She is two years away from applying to medical school. She has a degree in natural …
Patients don’t care what you know until they know that you care
I can’t stop thinking about a drive-thru. Not the one for burgers and shakes but the one for ear checks, sports forms, quick med refill visits or a lingering rash. For those things you just want to know fast or need done now, but don’t want to spend 2 hours resolving. For those things that really make you worry as a parent. Instead of the millisecond-mall-type clinic, we all want …
Physicians must innovate to meet the needs of patients
In our practice, doctors have the option to administer influenza vaccines right in the exam room. The truth is, giving the flu shot only takes a couple of seconds. The syringes are pre-filled, so all you have to do is pop on a needle, swipe the patient’s upper arm with an alcohol pad, and jab.
It’s the conversation that precedes the flu shot that takes time.
Take yesterday. A very intelligent middle-aged …
The conversation that takes place before the flu shot
I strolled into our noon-daily resident conference, a little late, my free burrito in hand, and noticed that “cost awareness” was the topic. The conference seemed to have the same format as our other lectures: an attending was presenting a clinical case and asking us what steps we could take to best diagnose and manage the patient. The case seemed straightforward enough—a 65-year-old healthy Caucasian gentleman with right-sided chest pain—and …
Cost should no longer be a dirty word in medicine
Healthy patients think that they are not at risk for serious medical problems. Though maintaining a healthy weight, exercising regularly, not smoking, and eating plenty of vegetables and fruits while limiting meat, fat, and fast foods does decrease the risk of developing diabetes, high blood pressure, heart disease, and cancer, it doesn’t completely eliminate it. The chance is there, just a …
Healthy patients always make the same error
“Doctor’s office; please hold.”
You’ll never hear that when you call me. Never. You’ll also never get an automated answering system (I’m just referring to office hours, of course. Evenings and weekends the phone goes to Google Voice. More on that below.) We are also in the middle of a communication revolution. There are now so many other …
The telephone is obsolete: How my patients contact me today
I recently a session at the Asian American Women Leadership Conference to high school and college students about taking care of our bodies. One the topics is common health myths. Despite our best efforts at debunking them, here are 8 pervasive myths:
1. You can catch a cold from being too cold. Growing up, how many of us have heard this from well-meaning parents and grandparents? It’s easy to see how …
Debunking 8 persistent health myths
The American Academy of Family Physicians (AAFP) took a bold stance in a report regarding the future of primary care in the US by reinforcing its endorsement of the Patient Centered Medical Home (PCMH), specifically led by physicians. The report was supported by other large national physician organizations including the American Academy of Pediatrics, the American Medical Association, and the American Osteopathic Association.
The report took a close look at independent nurse …
Who should lead the patient centered medical home?
Every time someone publishes an article or a paper or a blog post that has anything remotely to do with electronic health records (EHR), there is usually a flurry of reactions in the comments section, now available in most publications, and these always include at least half a dozen anonymous statements, usually from clinicians, decrying the current state of EHR software, best summed up by a commenter on THCB: “It …
The EHR user interface and my personal moment of Zen
You’re using an EHR. You’re e-prescribing. You’ve eliminated pulling the old paper chart (most of the time!). That’s good.
But how about those orders?
Are you still writing on the bottom of your fee slip or encounter ticket that you want the patient to be scheduled for a test or with another physician? That’s not good.
Get the order in your EHR.
Instead of taking the time to write on paper, keep your hand …
Getting your orders online reduces risk in the practice
At the heart of healthcare operations are their processes – processes that must run correctly all the time to avoid unnecessary risk to patients’ lives and health.
Once the healthcare industry acknowledged the fact that we all make mistakes – even physicians – it began to look into methodologies used by other industries to structure more “perfect” organizations.
Two such process improvement methodologies — LEAN and Six Sigma — are now being …
Eliminate waste and reduce variation in your medical practice
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When I was ten I once found myself walking with my brother on a Lake Michigan beach when we came upon a half-empty bottle of beer. Curious, I picked it up and looked inside at the swirling dark liquid. Then, impulsively, I took a sip. It was hot, having baked in the sun for who knows how many hours or days, and tasted awful.
I never took another drink of alcohol …
How I learned to appreciate the struggles of others who don’t fit in
This is my new office. I signed the lease for this property yesterday – another big step in the process of getting my new practice off the ground. I should feel good about this, shouldn’t I? I’ve had people comment that I’ve gotten a whole lot accomplished in the 4 weeks since I’ve been off, but the whole thing is still quite daunting. Yes, there are days I feel good …
Learning to fly and getting my new practice off the ground
As a fan of free markets, I recognize that sometimes intelligent government regulations (not always an oxymoron!) can improve markets by requiring companies to provide consumers with information that will help them make better choices. Informed consumers, after all, are a central ingredient of a successful free market. That’s why even most libertarians support regulations that ban fraudulent advertising.
That’s also why, at first glance, the federal government seemed to be …
Finding the balance in calorie count regulations
Diet and exercise: they were supposed to be the answer to all that ails America’s obesity and health care cost problem.
Signs of this Utopian vision are everywhere. From entire government departments encouraging healthy lifestyles through fitness, sports and nutrition, government websites
What if, believe it or not, …
Should we reconsider the benefits of exercise and weight loss?
Traditionally the patient is supposed to come to the doctor to get some sort of help with a problem. That’s what people pay us for, I guess. Patients bring us their various miseries, we help them figure out what they mean and what causes them and prescribe potions or recommend they do something that will help make them better, if there is such a thing. But in the normal give …
It’s amazing what I’ve learned from patients
It had been about two years since I last saw a primary care doctor. I was still living in New York City. My initial—and only—appointment with that physician lasted nearly an hour.
The front desk clerk had a round, pale face. Behind her was a textured wall over which ran a thin sheet of quiet water. Lush leaves spilled over the brim of the planter onto the marbled countertop.
“I’ll let the …
I remembered again what it was like to be a patient
Now that President Obama has won a second term, discussions about healthcare have seemingly disappeared from the public’s radar.
Big mistake – although I do understand the public’s shifting interest in the General’s sex life and, much more serious, the heartbreaking tragedy of the renewed hostilities between Israel and Gaza.
I do expect that healthcare costs will be back on the radar fairly soon as discussions about the fiscal cliff intensify – …
We will soon be heading for a medical cost fiscal cliff
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