May 5th, 2010 by KevinMD in Better Health Network, Health Policy, Opinion, Research
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Doctors often have a communication disconnect with their patients. A recent piece from the New York Times encapsulates the issue, citing a recent New England Journal of Medicine perspective.
According to oncologist Ethan Basch, “Direct reports from patients are rarely used during drug approval or in clinical trials. If patients’ comments are sought at all, they are usually filtered through doctors and nurses, who write their own impressions of what the patients are feeling.”
There are a variety of reasons for this. Some doctors feel they have a better sense of the patient’s symptoms than the patient himself. Biases can affect how doctors and nurses perceive symptoms. Read more »
*This blog post was originally published at KevinMD.com*
May 5th, 2010 by DrRob in Better Health Network, Health Policy, Opinion, True Stories
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I was happy when I looked at [the day’s] schedule. Two husband-and-wife pairs were on my schedule, both of whom have been seeing me for over 10 years. Their visits are comfortable for me — we talk about life and they are genuinely interested in how my family is doing. They remember that I have a son in college, and want to know how my blog and podcast are doing. I can tell that they not only like me as a doctor — they see me, to some degree, as a friend.
Another patient on the schedule is a woman from South America. She has also been seeing me for over 10 years. I helped her through her husband’s sudden death in an accident. She brings me gifts whenever she goes on her trips, and also brings very tasteful gifts for my wife. Today she brought me a Panama hat.
I know these people well. I know about their past illnesses and those of their children. I know about their grandchildren, having hospitalized one of them over the past year for an infection. I know about the trauma in their lives as well as what they take joy in. They tell me about their trips and tell me their opinions about the healthcare reform bill.
I spend a large part of their visits being social. I can do this because I know their medical situation so well. I am their doctor and have an immediate grasp of the context of any new problems in a way that nobody else can. Read more »
*This blog post was originally published at Musings of a Distractible Mind*
April 28th, 2010 by RyanDuBosar in Better Health Network, Health Policy, News, Opinion, Research
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Two new surveys take the temperature of the primary care working environment.
In the first, a collaboration between the Medical Group Management Association and the Association of Staff Physician Recruiters, recruiters took a median of six months to fill positions for internal medicine or family practice physicians, according to the In-House Recruitment Benchmarking Survey: 2010 Report Based on 2008 Data.
Among the findings:
— It cost less to recruit specialists, due to the economic downturn and a 30% rise in the use of Internet job boards as a primary recruitment method.
— It takes longer to fill a position in non-metropolitan areas, where the impact of the primary care shortage is greatest. Read more »
*This blog post was originally published at ACP Internist*
March 25th, 2010 by KevinMD in Better Health Network, News, Opinion
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It’s well known that the use of imaging scans, like CTs, MRIs and PET scans, have been growing at an alarming rate. But a recent study provides some stark numbers. According to a recent CDC report, “MRI, CT or PET scans were done or ordered in 14 percent of ER visits in 2007.” That’s four times as often as in 1996. Although a physician called that growth “astounding,” it’s really no surprise.
Emergency departments are becoming more crowded, and with patient satisfaction scores becoming more influential in financial incentives for physicians, sometimes just ordering a test is the path of least resistance. Factor in the spector of defensive medicine which, according to a survey from the Massachusetts Medical Society, accounts for up to 28 percent of tests ordered, it’s a wonder that more scans weren’t ordered.
Imaging scans are a clear cost driver in healthcare, contributing $12 billion to Medicare’s bill. But costs won’t resonate with patients requesting the tests or the doctors ordering them. One encouraging sign is the recent trend of publicizing the harms of scans, like radiation from CTs. I’m finding that patients are becoming increasingly aware of the risk, and making a more informed decision after I explain it to them. It’s a small step forward.
*This blog post was originally published at KevinMD.com*
October 7th, 2009 by Happy Hospitalist in Better Health Network, Health Policy, Opinion
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Some put the figure for defensive medicine at 10% of medical expenses a year. That’s $250 billion dollars. Others claim it to be 2-3% per year or about $60 billion dollars a year.
Now ask any physician what it is. I’d say it’s closer to 30% a year. That’s $750 billion dollars a year. Why? Because I know what is going through the minds of physicians when they put the pen to the paper. In America, we strive to exclude the long tail diagnosis. Why? Because getting sued for 67 million dollars because you treated a torn aorta when all the evidence pointed to an emergent MI has a way of making doctors evaluate the possible, instead of focusing on the probable.
Defensive medicine is not about losing a lawsuit. It’s about getting sued and the lack of boundaries that protect a physician from having bad outcomes with competent medicine, even if that competent medicine was the wrong medicine for the wrong patient at the wrong time, a fact known only after the fact when a bad outcome occurs. Read more »
*This blog post was originally published at A Happy Hospitalist*
