Doug Farrago is a family physician in Maine and the editor of the entertaining Placebo Journal. He uses his Placebo Journal media platform to show his audience what primary care is all about. In this video, “Doug Unplugged,” Dr. Farrago gives us a little taste of that journey. Hollywood, take notice.
*This blog post was originally published at KevinMD.com*
Abraham Verghese is a professor of medicine at Stanford University and one of the most articulate physician-writers today. He recently wrote an op-ed highlighting primary care’s plight, and focuses on the scarcity of time:
The science of medicine has never been more potent – incredible advances and great benefits realized in the treatment of individual diseases – yet the public perception of us physicians is often one of a harried individual more interested in the virtual construct of the patient in the computer than in the living, breathing patient seated on the exam table.Time is the scarcest commodity of all. Patients, particularly when it comes to their routine, day-to-day care, want a physician who has time to understand them as people first, and then as patients.
It’s been frequently discussed on this blog, with solutions ranging from paying physicians per hour to cash-only practices.
There’s no easy answer, and worse, money isn’t even the root of the problem. Often left unaddressed is the burnout that primary care doctors face, practicing in unpalatable environments where the doctor-patient relationship is obstructed by bureaucracy and paperwork. Read more »
*This blog post was originally published at KevinMD.com*
The hospital is never a quiet place. Walk through the wards on a typical day and you’ll hear a cacophony of alarms, bells, and other tones coming from both computers and medical equipment.
American Medical News recently discussed so-called “alarm fatigue.” They cite a study showing find that “16,934 alarms sounded in [a medical] unit during an 18-day period.” That’s astounding, and for those who are wondering, that’s about 40 alarms an hour.
It’s not surprising that doctors become desensitized to these alarms, and that has potential to harm patients, as physicians may miss legitimate, emergent findings. Read more »
*This blog post was originally published at KevinMD.com*
I’ve written previously that many doctors are finding the physical exam obsolete, and are favoring more technologically-advanced, and expensive, tests. In fact, I alluded to traditional physical exam advocates as “arguing for staying with a horse and buggy when cars are rapidly becoming available.”
In a recent piece from the New York Times, internist Danielle Ofri says we need to look past the lack of evidence supporting the physical exam. The benefits of touching the patient, and listening to his heart and lungs, cannot be quantitatively measured:
Does the physical exam serve any other purpose? The doctor-patient relationship is fundamentally different from, say, the accountant-client relationship. The laying on of hands sets medical practitioners apart from their counterparts in the business world. Despite the inroads of evidence-based medicine, M.R.I.s, angiograms and PET scanners, there is clearly something special, perhaps even healing, about touch. There is a warmth of connection that supersedes anything intellectual, and that connection goes both ways in the doctor-patient relationship.
Great point. Read more »
*This blog post was originally published at KevinMD.com*
In their most recent piece at Slate, emergency physicians Zachary F. Meisel and Jesse M. Pines tackle the issue of bouncebacks — that is, the re-admission of recently-discharged hospitalized patients. They bring up good some good points, and point out that until recently hospitals really didn’t have any incentive to reduce bouncebacks:
…hospitals have never had a compelling reason to try to prevent bouncebacks. Hospitals are typically paid a flat sum for each inpatient stay — shorter stays equal higher profits. When patients bounce back, hospitals can charge the insurance company twice for the same patient with the same problem. Many hospitals also view bouncebacks as out of their control: If a patient boomerangs back because she doesn’t follow doctor’s orders, it’s not the hospital’s fault.
With health reform, however, things are changing. In an effort to reduce bouncebacks, hospitals are paid less for re-admissions, and they must publish their bounceback rates. Read more »
*This blog post was originally published at KevinMD.com*
A recent study from the Annals of Internal Medicine found that doctors often discounted a patient’s social situation when making a medical diagnosis.
Lead researcher Saul Weiner “arranged to send actors playing patients into physicians’ offices and discovered that errors occurred in 78 percent of cases when socioeconomic concerns were a significant factor.”
Evan Falchuk, commenting on the results, provides some context:
It’s hard to expect even the most gifted clinician, trying to make it through yet another week of a hundred or more patient encounters, to get these difficult decisions right. Too much of the context of a patient’s care gets lost in the endless churn of patient visits that the health care system imposes on doctors.I suspect this is enormously frustrating for doctors, although it’s worse for patients. What the researchers call a failure to “individualize care,” a patient might call “not being paid attention to.” It’s a dynamic that anyone who’s been ill has probably seen firsthand.
These findings are entirely unsurprising. Read more »
*This blog post was originally published at KevinMD.com*
Say the words, “Patient-centered medical home,” and you’re bound to get a variety of opinions.
On this blog alone, there are a variety of guest pieces critical of the effort, saying it does not increase patient satisfaction, nor does it save money. And that’s not good news for its advocates, who are pinning primary care’s last hopes on the model.
Medical homes hit the mainstream media recently, with Pauline Chen focusing one of her recent, weekly New York Times columns to the issue. She discussed the results of a demonstration project, showing some positive results. Read more »
*This blog post was originally published at KevinMD.com*
Recently, JAMA published a study concluding that doctors are hesitant to report incompetent physicians or those who were impaired. According to the article:
“…more than a third of docs don’t think they’re responsible for reporting those who aren’t fit to practice, according to the results just published in JAMA. And only 69 percent of the docs who knew about an impaired or incompetent colleague reported them.
To those who advocate that the medical profession self-police, the numbers aren’t encouraging. Read more »
*This blog post was originally published at KevinMD.com*
With medical students graduating, on average, with almost $160,000 of debt, it’s a major reason why they’re choosing more lucrative specialty practice, which can offer salaries multiple times more than those of primary care fields.
In this clip from The Vanishing Oath, medical economist Amitabh Chandra, Professor of Public Policy at the Harvard Kennedy School of Government, discusses that influence, which contributes to a drastic decline of primary care residency slots being filled by American medical graduates.
Of course, it’s not only money. Primary care practice has a litany of obstacles that can contribute to rapid physician burnout, compounded by the fact that good primary care role models are largely absent from academic settings.
But there’s no denying that the salary disparity is an influential factor, and for many students, often a deciding one.
A video excerpt from The Vanishing Oath, a film directed by Ryan Flesher, M.D.:
*This blog post was originally published at KevinMD.com*
There’s little question that medical school debt is rising rapidly, affecting the career choice of medical students.
It’s one of the main reasons why the disparity between the number of specialists and primary care doctors is widening. There have been a variety of proposed solutions — most recent of which are medical schools completely subsidizing their tuition. I think that’s a good step forward, but so far has only been limited to a few schools nationwide. Read more »
*This blog post was originally published at KevinMD.com*
Follow us on Twitter, become a fan on Facebook or subscribe to our RSS feed
I was lucky enough to be asked by one of the local TV stations to talk about some back-to-school issues when it comes to health. I don t know about where you re at but most of the local schools around here started yesterday August rd Keeping up-to-date on immunizations…
Next in our series of posts about our founder Doc Tom. Previous time capsules and Come ye economics buffs and algebra fans Get out your pencils and solve for x n and XX Whatever else the year XX is remembered for it will without a doubt go down in history…
A Biomedical Look At Spaceflight
Book review by Dan Buckland Dan Buckland is an editor at Medgadget and an MD PhD student at Harvard Med MIT whose thesis deals with diagnosing back injury in spaceflight using ultrasound. Mary Roach author of previous entertaining books Bonk a history of sex research and Stiff a history of…
I really didn t expect to like Eat Pray Love. In fact since its publication in I’d been avoiding it like the plague. Typical new-agey Oprah-y girly-book I thought. Nothing in it to speak to me. Then I saw the trailer for the movie and I was hooked probably because…
Will Science Succeed With An Anti-Aging Revolution?
Wouldn’t it be great if we could find a way to prolong our lives and to keep us healthy right up to the end Ponce de León never found that Fountain of Youth but science is still looking. What are the chances science will succeed How’s it doing so far…
Better Health | Health Policy | Video | Audio | Interviews | News | Health Tips | Opinion | Book Reviews | True Stories
Better Health Feeds | Better Health Newsletters | Trusted Sources | Sponsors & Advertising | Contact | Terms of Use | Privacy Policy
Copyright © 2009 Better Health LLC, All Rights Reserved
