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“The Hot Spotters”: Is Better Care For The Neediest Patients The Answer To Lower Healthcare Costs?

Author-physician Dr. Atul Gawande has done it again with a well-written article in The New Yorker magazine entitled, “The Hot Spotters.” It deals with the fact that 5 percent of people with chronic illness make up over 50 percent of all healthcare costs.

If we can zero in on providing better preventive care for those people, we can finally get our arms around runaway healthcare costs. How great that you don’t even have to have a New Yorker subscription to read it. Here are a few cliff notes until you get to it:

– In Camden, New Jersey, one percent of patients account for one-third of the city’s medical costs. By just focusing attention on the social and medical outpatient needs of those people, they not only got healthier but costs were cut in half.

– Our current system is unable to reign in costs. We need to completely re-design and fund how we do primary care.

– Charging high co-payments to people with health problems just backfires. They avoid preventive care and end up hospitalized with expensive and life-threatening illnesses that are much worse and more costly. Read more »

*This blog post was originally published at EverythingHealth*

What If All Patients Were This Engaged In Their Health?

This video is an excellent testimony of what a truly engaged and knowledgable patient with diabetes looks and sounds like. Kudos to the Mayo Clinic for sharing this wonderful piece about shared decision making.

Pay particular attention to the fact that the patient in the video was treated for diabetes by her primary care physician for eight years before being referred to a clearly “patient-centered” endocrinologist. Also note her belief that a patient-centered approach to chronic disease management probably results in shorter, more productive visits in the long run.

*This blog post was originally published at Mind The Gap*

November Is American Diabetes Month

November is American Diabetes Month, and in the video below I talk with a local TV news reporter about risk factors, complications, and ways to prevent diabetes. The interview was only about two minutes and there’s much more to be covered, so check out the American Diabetes Association’s website for more information.

If you find this video helpful, I invite you to view more of my TV interviews on my YouTube channel. Happy November!

*This blog post was originally published at Doctor Anonymous*

Diabetes Lessons

As doctors, sometimes the biggest lessons that we learn about disease pathology are those that we learn from the people that have that disease. Diabetes is one such disease.

I recently gave a show-and-tell lecture about insulin pumps to the new interns and residents as well as the 3rd-year medical students on their pediatric clerkship with the inpatient endocrine service. We discussed different types of pumps (point A on the picture) and they got to push the buttons and send a bolus or change a basal rate. They also looked at real time CGM (Continuous Glucose Monitors, points C and D on the picture) sensors used to check glucoses levels every five minutes. Read more »

Who’s Really Overcrowding The ER?

If you think the overcrowding in emergency rooms across the country is because of the uninsured, think again.

A new study in the Annals of Emergency Medicine reports that of patients who are frequent users (over 4 times a year) of emergency departments (ED), the uninsured represent only 15 percent of those frequent users.

Also, the frequent ED users were more likely than occasional users to have visited a primary care physician in the previous year.

They also found that most patients who frequently use the ED have health insurance and the majority of users (60 percent) were white. These findings contradict the widely held assumption that frequent users are minorities or illegal immigrants without insurance. Read more »

*This blog post was originally published at EverythingHealth*

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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