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Some Things About Medicine Will Never Change

I just can’t imagine life today as a medical student. Every medical publication in the palm of your hand. The capacity to create an audience and publish at your own will.  Real-time dialog between students, faculty, anyone. Global reach from your phone. It’s mind-boggling really.

This is in stark contrast to my experience. My world was centered on index cards, textbooks and pens with different colors. We communicated via Post-it notes on the door of the student lounge. There were no apps and our only game was foozball. As a first year I scheduled time to compose H&Ps on the library’s only Macintosh II computer. This was plugged into the new Apple LaserWriter with WYSIWYG. Hi tech we were. We thought.

Being distractible and restless, I’m going to guess that if I had access to the communication platforms and tools available to today’s students, I might not have made it through. The inputs must be staggering and I imagine that discipline with personal bandwidth has become a critical key to survival. Read more »

*This blog post was originally published at 33 Charts*

Why Doctors Should Be Less Like Chuck Yeager And More Like Captain Sullenberger

A recent medical error of a wrong-site surgery that occurred in one of the country’s best hospitals, Massachusetts General, reminded me why doctors need to be less like Chuck Yeager and more like Captain Sullenberger.

Growing up, I always wanted to be a fighter pilot, years before the movie “Top Gun” became a part of the American lexicon. My hero was World War II pilot Chuck Yeager, who later became one of the country’s premier test pilots flying experimental jet and rocket propelled planes in a time when they were dangerous, unpredictable, and unreliable.

Much like the astronauts in the movie “The Right Stuff,” Yeager and his colleagues literally flew by the seat of their pants, made it up as they went along, and never really knew if their maiden flight in a new aircraft might be their last. They were cowboys in the sky wrangling and taming the heavens.

Fast forward to January 2009, when shortly after takeoff, a one-in-a-million chance, a double-bird strike completely disabled a US Airways jetliner. Captain Chesley Sullenberger, with the help of his co-pilot Jeff Skiles, ditches the aircraft in the Hudson River in under four minutes even as the nation surely expected a tragedy. But not on that day. Not with that pilot. Read more »

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

Why Government Healthcare Is Your Best Bet

A friend who works with the unemployed called me up the other day huffing with indignation. The local charity clinic, apparently overwhelmed, had changed its policies so that her unemployed uninsured would no longer be able to seek care there.

“Someone has to do something!”

Um, what exactly would that be? I’d love to help, but I have bills to pay (as do charity clinics) so I can hardly provide medical care without seeking payment. I understand her desperation (and that of the people she so valiantly helps) but who, exactly, is supposed to do what, precisely?

Things are going to get worse before they get better, I fear. The unemployment issue goes way beyond a devastating economic downturn. It’s a reflection of the most basic economic principle of supply and demand. Wages are the “price” of labor — prices go down when supply goes up. In the case of labor, it’s when you have large numbers of people willing to accept lower wages. Can you say “outsourcing?” Watch as the jobs flow overseas while we’re still left with all these people, but not enough jobs to support themselves. In the meantime they all still need healthcare, but can’t pay for it.

Someone has to do something!

Guess what? It just so happens that we really do have a healthcare infrastructure in this country. Between the Veterans Administration (VA) and public healthcare clinics, we have rather a good start at building a truly national healthcare system. Perhaps now is the time to expand it. Read more »

*This blog post was originally published at Musings of a Dinosaur*

“Roadmap For New Physicians”: How To Avoid Fraud And Abuse

In October, the Office of Inspector General (OIG) issued a report on Fraud and Abuse Training in Medical Education, finding that 44 percent of medical schools reported giving some instruction in the anti-kickback statute and related laws, even though they weren’t legally required to do so. (As an aside, do we really live in such a nanny state? Over half of all medical schools don’t teach their students anything about this issue — because nobody’s making them — even though it is an issue that looms large in the practice of medicine.)

On a more positive note, about two-thirds of institutions with residency programs instruct participants on the law, and 90 percent of all medical schools and training programs expressed an interest in having dsome instructional materials on the subject of the anti-kickback statute, physician self-referrals (Stark) rules and the False Claims Act.

So in November, the OIG released a Roadmap for New Physicians – A Guide to Avoiding Fraud and Abuse, available on line and as a PDF. It’s a good 30-page primer on the subject. While some of the examples given are specific to newly-minted physicians, anyone in the health care industry would benefit by reading it. The document offers a window into the thinking of the OIG, its perspective on the wide range of issues summarized within, and is a good touchstone for any individual or organization seeking to structure a relationship that needs to stay within the bounds of these laws. Read more »

*This blog post was originally published at HealthBlawg :: David Harlow's Health Care Law Blog*

Medical Schools: Why Do Some Do Primary Care Better?

A new study published in the Annals of Internal Medicine, ACP’s flagship journal, finds that medical schools vary greatly in producing more primary care physicians and getting them into underserved communities.

- “Public schools graduate higher proportions of primary care physicians” than private schools.

- “The 3 historically black colleges and universities with medical schools (Morehouse College, Meharry Medical College, and Howard University) score at the top” in training primary care physicians who then go on to practice in underserved communities. (Click here for an interview with two recent graduates of historically black colleges and with Wayne Riley, MD, FACP, who is the president and CEO of Meharry Medical College in Nashville, Tennessee and a regent of the American College of Physicians.)

- “The level of NIH support that medical schools received was inversely associated with their output of primary care physicians and physicians practicing in underserved areas.” Read more »

*This blog post was originally published at The ACP Advocate Blog by Bob Doherty*

Latest Interviews

Caring For Winter Olympians In Sochi: An Interview With Team USA’s Chief Medical Officer Dr. Gloria Beim

I am a huge fan of the winter Olympics partly because I grew up in Canada where most kids can ski and skate before they can run and partly because I used to participate in Downhill ski racing. Now that I m a rehab physician with a reconstructed knee I…

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How Do Hospital Executives Feel About Locum Tenens Agencies And Traveling Physicians?

I recently wrote about my experiences as a traveling physician and how to navigate locum tenens work. Today I want to talk about the client in this case hospital side of the equation. I ve had the chance to speak with several executives some were physicians themselves about the overall…

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Latest Book Reviews

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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Unaccountable: A Book About The Underbelly Of Hospital Care

I met Dr. Marty Makary over lunch at Founding Farmers restaurant in DC about three years ago. We had an animated conversation about hospital safety the potential contribution of checklists to reducing medical errors and his upcoming book about the need for more transparency in the healthcare system. Marty was…

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