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Study Shows That Medicare Pays More For Patients Cared For By Hospitalists

Association of Hospitalist Care With Medical Utilization After Discharge:  Evidence of Cost Shift From a Cohort Study.

That’s the title of the latest medical study making the viral rounds.  I had an opportunity to read the study in full.  I called Happy’s hospital library and Judy had the pdf article in my email in less than 24 hours.  Now, that’s amazing.  Thanks Judy for a job well done.  You deserve a raise.

Presented in the August 2nd, 2011 edition of the journal Annals of Internal Medicine, Volume 155 Number 3 Page 152-159, the study concludes that decreased length of stay and hospital costs associated with hospitalist care are offset by higher medical utilization and costs after discharge.

In summary, hosptitalist patients had an adjusted length of stay 0.64 days shorter and $282 less than patients cared for by primary care physicians, but total 30 day post discharge costs were $332 higher.  These additional charges were defined as 59% from rehospitalization, 19% from skilled-nursing facilities, and 22% from professional and other services.

OK fair enough.  Let’s come to that conclusion.  Let’s say Read more »

*This blog post was originally published at The Happy Hospitalist*

Study Investigates Relief For Chronic Back Pain

The Group Health Research Institute of Seattle, Washington has published a study in Annals of Internal Medicine that showed massage therapy may effectively reduce or relieve chronic back pain.  I am a big believer and supporter of massage therapy and have wondered why it is not a covered benefit for treating back and neck pain.  Even medical benefits savings plans offered by employers (where you put aside your own pre-tax dollars to be used for medical care) do not allow massage. Patients who get massage for musculoskeletal conditions do better and utilize less pain meds, yet is is seldom prescribed and rarely covered by any insurance plan.

This study confirmed what I have known for a long time.  They looked at relaxation massage and structural massage, which focuses on correcting soft-tissue abnormalities.  At 10 weeks they found Read more »

*This blog post was originally published at EverythingHealth*

Does Your Doctor Trust You?

Jessie GrumanMembers of the  American public are frequently surveyed about their trust in various professionals.  Doctors and nurses usually wind up near the top of the list, especially when compared to lawyers, hairdressers and politicians.  Trust in professionals is important to us: they possess expertise we lack but need, to solve problems ranging from the serious (illness) to the relatively trivial (appearance).

How much professionals trust us seems irrelevant: our reciprocity is expressed in the form of payment for services rendered or promised, our recommendations to friends and families and repeat appearances.

So I was surprised to read an article in the Annals of Family Medicine describing a new scale to measure doctors’ trust in their patients.  This scale, based on input from focus groups and validation surveys of physicians, was developed for research purposes on the grounds that trust is a “feature of the clinician-patient relationship that resonates with both patients and clinicians.” Read more »

*This blog post was originally published at CFAH PPF Blog*

Colon Cancer Screening: Guideline Truths And Myths

Colon cancer screening has a particular personal interest for me — one of my colleagues in residency training had her father die of colon cancer when she was a teenager.

No one should lose a loved one to a disease that, when caught early, is often treatable. But for both men and women, colon cancer is the third most common cancer behind lung cancer and prostate cancer in men, and behind lung cancer and breast cancer in women, it’s the second most lethal.

The problem is that patients are often confused about which test is the right one. Is it simply a stool test? Flexible sigmoidoscopy? Colonoscopy? Virtual colonoscopy? Isn’t there just a blood test that can be done? (No.)

In simple terms, this is what you need to know:

All men and women age 50 and older should be screened for colon cancer. Even if you feel healthy and well and have no family history, it must be done. Note that Oprah’s doctor, Dr. Oz, arguably a very health-conscious individual learned that he had a colon polyp at age 50 after a screening test. Left undetected, it could have cut his life short. This wake-up call caused him to abort his original second season premier on weight loss and instead show the country why colon cancer screening matters. He admitted that if it wasn’t for the show and the need to demonstrate the importance of screening to America, he would have delayed having any test done.

The least invasive test is a stool test. If it is to screen for colon cancer, then the test is done at home and NOT in the doctor’s office. Either the fecal occult blood test (FOBT) or the fecal immunochemical test (FIT) are available to screen for unseen microscopic blood that could be a sign of a colon polyp or cancer. Research shows that when a stool test is done annually, the risk of dying from colon cancer can fall by 15 to 33 percent. If you don’t want any fiber optic cameras in your rectum and lower colon, this is the test for you. You must do it annually.

The next two tests are similar but often confused: The flexible sigmoidoscopy and the colonoscopy. Read more »

*This blog post was originally published at Saving Money and Surviving the Healthcare Crisis*

Narrative Medicine: Healing Through Storytelling

More in the evolving meme of narrative medicine: Researchers at the University of Massachusetts Medical School (my alma mater) have found that for a select population of individuals, listening to personal narratives helps control blood pressure. While the power of stories is old news, the connection to clinical outcomes is what’s newsworthy here. Read Dr. Pauline Chen’s nice piece in the New York Times. The implications for ongoing work in this area are mind boggling.

The Annals of Internal Medicine study authors sum it up nicely:

Emerging evidence suggests that storytelling, or narrative communication, may offer a unique opportunity to promote evidence-based choices in a culturally appropriate context.  Stories can help listeners make meaning of their lives, and listeners may be influenced if they actively engage in a story, identify themselves with the storyteller, and picture themselves taking part in the action.

This nascent field of narrative medicine caught my eye when I stumbled onto the work of Rita Charon and the concept of the parallel chart. Extrapolation to social media may be the next iteration of this kind of work.

*This blog post was originally published at 33 Charts*

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

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How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

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Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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