The electronic medical record (EMR) is here to stay. Its adoption was initially slow, but over the past decade those hospitals that do not already have it are making plans for implementing it. On the whole this is a good thing because the EMR has the ability greatly to improve patient care. Physicians, as well as all other caregivers, no longer have to puzzle over too often barely legible handwritten …
The EMR is trying to serve too many masters
I grew up in Rochester, NY. Statistically, this means that I probably had a family member who worked at Eastman Kodak, as the company employed over 62,000 people in Rochester at its peak. I did, in fact, have two: my father and my brother-in-law. My brother and I both worked there during two fun and profitable summers of our college years in the delightful “roll coating” division. It actually paid …
What Instagram and Kodak have to do with health reform
In the ancient and oft-told story of the blind men and the elephant, several sightless men seek to learn the nature of the great beast, none of them familiar with it prior to the encounter. One, who feels the trunk, describes the elephant as powerful and snake-like. Another who examines one of the mighty legs, opines that the animal is like a great tree. Still another, having first touched a …
Take advantage of the vision of primary care physicians
Having established that the U.S. spends twice as much per person on healthcare as the average per person cost in all other developed countries – but with no better overall results – it is time to ask how this happens.
Obviously, there are many factors contributing to this dangerous cost escalation, but in my mind two stand out.
The first is our unrealistic expectations as American healthcare consumers. Here are a bunch …
2 C-words that explain the rising cost of health
Vendors talk about partnering with medical practices all the time – especially in the information technology (IT) world of electronic health records (EHRs) and practice management systems. But, ask any physician about their IT solution and most will express dissatisfaction, unhappiness, or harsh complaints.
The reason? For the most part, medical groups are not trained effectively for integrating IT into their work flow.
Ask EHR vendors about their approach to training and …
Make IT vendors your partner for a smooth EMR transition
Thirty percent of health care spending — amounting to $750 billion a year — is wasted, according to a recent report by the Institute of Medicine.
I know. As a doctor, I am party to this waste, and I think doctors can play a major role in recovering it.
In a private conversation, a cardiologist tells me about his partners — “loose guns” he calls them. “At the hint of chest pain …
Doctors can play a major role to reduce waste
In the ongoing battle to gain from our society’s scientific illiteracy, Dr. Oz has nocked another arrow. This time, he as the cure for all fatigue. I hope he’s got this right because this is one of the most common and most difficult problems to treat.
Fatigue is a tough one. Everyone has experienced fatigue at some point, and as a physician, part of my job is to figure …
Selling a cure based on imaginary evidence is immoral
Let’s start with a disclaimer: I am not complaining; I’m just stating the facts.
Honest fact: The morale of doctors in the real world is low–and sinking lower.
I know what you are thinking. “Come on Mandrola, you are nuts if you expect us to feel sympathy for doctors–of all professions.”
Well, you can think that if you wish, but I’m calling it as I see them. And here is why it matters:
Because …
The growing culture of hostile dependency towards doctors
The New York Times recently had an important and provocative piece, “Overtreatment Is Taking a Harmful Toll.”
The title is a bit misleading. The article focuses more on overtesting. We test too much and we treat too much.
The article, while mostly accurate, does not really explain the reasons for the problem. Unless we can accept and understand the underlying reasons for these problems, we cannot successful correct these problems.
Let …
Reasons why doctors overtreat and overtest
Bill M. is a 22-year old college student who has had asthma and diabetes since he was a child. He comes in with trouble breathing because he has no primary care doctor and is out of his inhalers. While he’s in the ER, he also says that his diabetes hasn’t been followed for years, and now his blood sugars are out of control and he has new problems with his …
How the primary care shortage affects the ER
One of the joys of being a physician is learning the patients’ histories. A joy, you say? Isn’t taking the history simply part of the doctoring routine? You’ve all been there.
When did the pain start?
What made it worse?
Did it move around or stay in one place?
I agree that inquiries like these are not intrinsically joyful, but this is not my meaning here. I refer to history here in the conventional …
Seasoned physicians know what questions to ask
Electronic medical records have become an essential backdrop to modern medical practice. Paper charts, not long ago the mainstay of health-care documentation, have become antediluvian. Whereas once doctors used to write notes with pen and paper and insert the paper into a physical binder, doctors now keep track of patients by clicking keys on a keyboard and entering data into a computer software program.
One of the great advantages of the …
Misinformation in electronic medical records has consequences
As both the private and public sector aggressively shift healthcare incentives from a “do more, bill more” to a value and outcome based model, healthcare providers ignore patients role in driving outcomes at their own peril. It is generally understood that patients forget 80-90% of what they are told at the doctor’s office. As incentives no longer reward outcome over activity, this is a disaster financially for health professionals. This …
Make creative use of existing technologies to thrive in the future
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Stockholm syndrome, or capture-bonding, is a psychological phenomenon in which hostages express empathy and have positive feelings towards their captors, sometimes to the point of defending them. These feelings are generally considered irrational in light of the danger or risk endured by the victims, who essentially mistake a lack of abuse from their captors for an act of kindness.
Now, the health care connection. As a result of the billions of …
Stockholm syndrome and Epic’s takeover of medical records
Marc Henderson, a 63-year-old African-American airport executive, isn’t afraid to ask his physician to do a blood test for prostate-specific antigen (PSA), a screening test for prostate cancer. “I’d rather know early on so that it can be treated, rather than sit around in denial until it’s too late,” he said. “If it’s going to help catch something, I have no problems with it.”
Henderson’s views aren’t unusual. For years, doctors …
Do black men need separate prostate cancer screening guidelines?
Much of what passes for debate on health care during this election year is focused on the macro side, on big issues like how do we cover the uninsured or restructure Medicare and Medicaid financing. But for all of the talk about vouchers and block grants and insurance mandates, the candidates are missing the micro issues that really matter most to doctors and their patients, which is how health care …
The micro level of health reform cannot be ignored
The Greek hero of the Trojan war, Achilles, had only one vulnerable area on his body, his heel. Similarly, modern humans also have a vulnerable part of the our anatomy, the upper airway, which simultaneously accommodates for breathing, swallowing, and speaking. The ability to talk, however, came at a price.
Evolutionary biologists have stated that speech and language development was detrimental to our health. Overdevelopment of our speech structures compromised our …
Why speech is the Achilles’ heel of the human race
Generic formulations of drugs using active pharmaceutical ingredients are an immense cost savings to patients and healthcare systems.
On the other hand, questions remain as to whether generics are truly equivalent to brand name pharmaceuticals. Are the pharmacokinetics the same? Are they bioequivalent? While this is a difficult topic to research clinically, I would argue that the vast majority of brand name and corresponding generic drugs are indeed equivalent (though there …
Warn patients that generic pills look different
There is a serious cost problem in USA health care which no one denies.
Yet when it comes to suggested solutions, there is a wide divergence of opinion. Attempts to use experts and evidence based guidelines for care are somehow viewed as government interfering with decisions which should be between the doctor and her patient.
States and insurance schemes have made varying attempts to deal with this. The Oregon Health …
Does Oregon have the answer to rational rationing?
When it comes to public-private partnerships between health organizations and the food industry, there are many shades of grey — but Cheetos orange isn’t one of them. On September 9th of this year, however, the American Heart Association (AHA) Dallas Heart Walk saw Frito-Lay’s Chester the Cheetah riling up the crowd and helping to associate Frito-Lay and Cheetos with the emotions of the day — joy, hope, charity, happiness, spirit, camaraderie, health, …
Big Food is our modern day Big Tobacco
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