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Latest Posts

High Value Care: Getting The Maximum Health Benefit

The past few months have offered encouraging signs that physicians and physician organizations are belatedly recognizing the need to take an active role in controlling health care costs by emphasizing “high-value” care and minimizing the use of low-value interventions with high costs and few clinical benefits. On the heels of a best practice guideline issued by his organization, American College of Physicians Executive VP Steven Weinberger, MD recently called for making cost-consciousness and stewardship of health resources a required general competency for graduate medical education.

In light of a recently published estimate that the top 5 overused clinical activities in primary care specialties led to $6.7 billion in wasted health spending in 2009, Dr. Weinberger’s call comes none to soon. Below is an excerpt from my post on this topic from April 13, 2010. Read more »

*This blog post was originally published at Common Sense Family Doctor*

Did Previous Generations Of Physicians Have Better Bedside Manners?

How much are good bedside manners worth? Would you double your copay if you could be guaranteed an extra measure of TLC from your physician? Can we put price on a physician’s warm smile, an understanding nod or a reassuring hand on your shoulder? Do patients have to contract with a concierge medical practice to receive this treatment?

I agree that our bedside manners with patients need some rejuvenation. It’s not fair, however, to isolate this issue out of context. Physicians today are facing crunching pressures from various sources that we cannot always compartmentalize when we are facing our patients – even though we should. Most folks believe that the bedside manners of the prior generation of physicians were superior to ours. Were our predecessors simply more compassionate and caring human beings than we are? I don’t think so. I think the medical profession was a different beast then. I hypothesize that if these wizened physicians entered the profession today, that they would behave differently.

Context is so critical when examining any issue. Read more »

*This blog post was originally published at MD Whistleblower*

Can A Curriculum Cultivate Empathy In Med Students?

It seems that there are medical schools taking the initiative to help their students become more compassionate.  It’s a worthy goal but I don’t know if it’s possible.  We can teach individuals to act compassionate.  But that, of course, is different from being compassionate.  While there may be literature to support the cause, I don’t think that a curriculum can cultivate empathy.

Is it possible to change a student or doctor’s heart?  Of course, I see it all the time.  But not from role playing or small groups.  It’s human circumstances that drive change.  Personal loss and life experience tempered by introspection and humility change how we see those around us.  It’s only when we recognize our own vulnerability that we can begin to see it in others.  This doesn’t happen in a classroom. Read more »

*This blog post was originally published at 33 Charts*

iPhone Attachment Allows For Live View Of Eye Anatomy

There are a variety of tools available to help Ophthalmologists with eye examinations.  A new hardware and medical apps solution turns the iPhone into an ophthalmoscope.  Called the iExaminer, this simple iPhone 4 peripheral connects the popular Welch Allyn PanOptic ophthalmoscope to the iPhone 4, and then a native medical app helps you perform a fundus exams and share videos and images right from the iPhone.

Two key applications for this:

1) Teaching: For medical schools that are teaching eye examinations — instead of having to look at static pictures of eye anatomy, this “live view” could be an optimal and innovative way to teach. This could also be a great way for an ophthalmology attendings to save key eye pathology that they visualize in the mobile setting for teaching purposes.

2) Use in mobile clinics: This could be a good screening tool for various eye pathology — Read more »

*This blog post was originally published at iMedicalApps*

Are International Medical Students The Answer To The Looming Physician Shortage?

Howard Dean wrote an op-ed defending the use of foreign international medical graduates:

Today, young physicians with degrees from international medical schools face skepticism from some in the American medical community. That strikes me as misinformed thinking, given the large number of international medical school graduates practicing in the United States, alongside American medical school graduates, and given that the American medical system depends on them to fill the growing doctor shortage.

The federal Health Resources and Services Administration predicts there will be a shortage of approximately 55,000 physicians in the United States by 2020. We simply can’t build the capacity to meet our growing needs for skilled physicians — especially given budgetary constraints on schools receiving government subsidies. Even if the new medical schools now in the planning stages all come to pass, they won’t turn out enough primary care physicians to meet urgent needs in urban and rural communities.

I actually don’t have a lot to say about the IMG thing,  I have worked with and hired many IMG’s and their skill and quality vary as much as US graduates. But this whole argument seems to miss the central point regarding the projected physician shortage. The supply of new medical graduates is not the choke point, under the current state of affairs. The choke point is the number of residency training slots. Read more »

*This blog post was originally published at Movin' Meat*

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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