Better Health: Smart Health Commentary Better Health (TM): smart health commentary

Latest Posts

Emergency Medicine Dilemma: Risk Malpractice Or Overtesting?

Emergency physicians are in a dilemma. Risk missing a diagnosis and be sued, or be criticized for overtesting.

Regular readers of this blog, along with many other physicians’ blogs, are familiar with the difficult choices facing doctors in the emergency department.

The Associated Press, continuing its excellent series on overtesting, discusses how lawsuit fears is a leading driver of unnecessary tests. Consider chest pain, one of the most common presenting symptoms in the ER:

Patients with suspected heart attacks often get the range of what the ER offers, from multiple blood tests that can quickly add up in cost, to X-rays and EKGs, to costly CT scans, which are becoming routine in some hospital ERs for diagnosing heart attacks …

… and the battery of testing may be paying off: A few decades ago insurance statistics showed that about 5 percent of heart attacks were missed in the emergency room. Now it’s well under 1 percent, said Dr. Robert Bitterman, head of the American College of Emergency Physicians’ medical-legal committee.

“But you still get sued if you miss them,” Bitterman added.

The American Medical Association’s idea of providing malpractice protection if doctors follow standardized, evidence-based guidelines makes sense in these cases. Furthermore, it can also help reduce the significant practice variation that health reformers continually focus on. Read more »

*This blog post was originally published at KevinMD.com*

Too Much Testing And Treatment? Try Superb Primary Care

The Associated Press has been running a fantastic series of must reads with the latest article highlighting the consequence of too many imaging studies, like X-rays and CT scans, which are the biggest contributor to an individual’s total radiation exposure in a lifetime. Americans get more imaging radiation exposure and testing than people from other industrialized countries.

Reasons for doing too many tests include malpractice fear, patient demands for imaging, the difficulty in obtaining imaging results from other doctors or hospitals, as well as advanced technologies, like coronary angioplasty, which have increased radiation but avoid a far more invasive surgery like heart bypass. Read more »

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

Overtreatment: When Less Is More In Medicine

The Associated Press recent article “Overtreated: More medical care isn’t always better” reiterated a commonly known fact which is not understood by the public. This problem of doing more and yet getting little in return is a common issue which plagues the U.S. healthcare system and was illustrated quite convincingly by Shannon Brownlee’s book. Americans get more procedures, interventions, imaging, and tests but aren’t any healthier.

In fact they are often worse off. Too many unnecessary back surgeries. Too many antibiotics for viral infections, which aren’t at all impacted by these anti-bacterial therapies. Too many heart stents which typically are best used when someone is actually having a heart attack. Research shows that those that are treated with medications do just as well. As all patients with cardiac stents know, they also need to be on the same medications as well.

Eliminating unnecessary treatments is a good thing, particularly when it is based on science. Read more »

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

Cutting Healthcare Costs Means Saying “No” To Patients

Let’s face it, the best way to cut healthcare costs is to say “no.” That means denying unnecessary tests that most patients in the United States are accustomed to having.

The New York Times‘ David Leonhardt has the best take on this issue that I’ve read. He acknowledges the difficulty of telling the American public “no,” and cites examples ranging from the breast cancer screening controversy to the managed care backlash in the 1990s:

This try-anything-and-everything instinct is ingrained in our culture, and it has some big benefits. But it also has big downsides, including the side effects and risks that come with unnecessary treatment. Consider that a recent study found that 15,000 people were projected to die eventually from the radiation they received from CT scans given in just a single year — and that there was “significant overuse” of such scans. Read more »

*This blog post was originally published at KevinMD.com*

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…

Read more »

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…

Read more »

See all interviews »

Latest Cartoon

See all cartoons »

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…

Read more »

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…

Read more »

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…

Read more »

See all book reviews »

Commented - Most Popular Articles