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Latest Posts

Dr. Don Berwick’s “Patient-Centered” Medicine

There’s been a bit of buzz in the health blogs over President Obama’s decision last week to use the mechanism of a recess appointment to be the director of the Centers for Medicare and Medicaid Services (CMS).

Recess appointments, for those who may not be aware, allow a President to put a nominee in place when Congress is in recess in order to have him in place without the messy process of having him approved by the Senate. True, the Senate still has to approve a recess appointment by the end of its term, or the seat goes vacant again, but it’s an excellent way to avoid having nasty confirmation fights during election years. Of course, both parties do it, and the reaction of pundits, bloggers, and politicians tend to fall strictly along partisan lines.

If you support the President, then a recess appointment is a way to get around the obstructionism of the other party. If you don’t support the President, it’s a horrific abuse of Presidential power. And so it goes. Either way, I don’t really care much about the politics of how such officials are appointed so much as who is being appointed.

The man who was appointed last week to head CMS is Donald Berwick, M.D., CEO of the Institute for Healthcare Improvement. His being placed in charge of CMS will likely have profound consequences not just for how the recent health care/insurance reform law is implemented, but for how the government applies science-based medicine to the administration of the this massive bill. Read more »

*This blog post was originally published at Science-Based Medicine*

Medical Receptionist Extinction?

Medical receptionists beware — your days are numbered.

This little gizmo was placed in one of our facility’s lobbies this week. (No, it’s not being used to get your boarding pass at the airport, but it’s amazing the parallels healthcare is taking with the airline industry.)

Instead, it’s used to check in patients presenting to have their blood drawn for prothromin times. Just swipe your credit card, confirm your appointment, sign your name, and away you go!

On seeing this, one doctor exclaimed: “But INR checks are my patients’ only chance to get out and socialize!”

Fortunately for now there are still human assistants there to help patients learn how to use the new device.

-WesMusings of a cardiologist and cardiac electrophysiologist.

*This blog post was originally published at Dr. Wes*

Dr. Val Tells Lee Aase (At Mayo Clinic) About Her Innovative Primary Care Practice

valabcThanks to my friends at #HCSM (a Twitter group created to spark discussion about healthcare and social media) for inviting me as a guest speaker on their 1 year anniversary. We had a special Blog Talk Radio event, moderated by Lee Aase (Mayo Clinic’s social media guru) and Dana Lewis. Tom Stitt and Meredith Gould were also critical in coordinating programming and technical arrangements.

The goal of the show was to discuss how social media and healthcare intersect – with a diverse group of 8 speakers (from patients, to physicians, to industry and insurance stakeholders). I’ve edited my clip for your listening pleasure (please excuse the technical glitch near the end – you’ll know it when you hear it). The full 2 hour show may be downloaded from Blog Talk Radio.

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For more information about my practice, check out Read more »

The House Special

During the past several weeks, I have diagnosed several patients with novel H1N1 influenza infection with my diagnostic opinion occasionally backed by a positive flu swab. When my wife, an ER doctor, fell ill I suggested she had novel H1N1 infection and went on to advise some of my family, friends, and neighbors of the likelihood that they too had H1N1. Yet when it was my turn to suffer with fever, body aches, headache, sore throat, and malaise one word seemed best able to convey how I really felt: swine.

My symptoms began four days after having the H1N1 shot and almost immediately after putting my children to bed following a fun but rainy Halloween night. It would have been nice to blame the rain or the flu shot for my suffering but I knew better. Unable to sleep I found myself ruminating over an aphorism I first heard as a third year medical student, spoken by a man who lives in my heart as my mentor. Read more »

Welcome To The Information Age, Primary Care

For 18 years, primary care providers steadily have been eclipsed by “specialists.”  It is no longer rare to hear calls for these competent generalists to drive straight to the scrap heap in order to be refitted as procedural, money-making Humvees.  What may be implied by this scenario is that primary care providers are selling out so as to allow nurse practitioners to be a more economical, efficient and smarter primary care provider. In fact, such ideas are not impossible if primary care doesn’t take control of their own destiny and invest in their own future. Technology will prove such a pivotal investment.

In my June 10 post, I discussed the five cornerstones of 21st century medical care as presented by a book published by the Institutes of Medicine entitled Crossing the Quality Chasm: A New Health Systems for the 21st Century.  The first cornerstone presented a communication-centered medical practice and abandoned the traditional brick-and-mortar idea that “the answers to all medical questions must be delayed until the patient is seen in the office.” Rather than the doctor being the last person to know what’s happening to a patient, a communication-centered model puts doctors at the front of the office, answering phones, emails and internet-generated questions through the day, allowing the practitioner to be the first ones to know what’s happening with our patients. This model could eliminate up to 66% of today’s office visits while simultaneously improving speed of delivery of care, convenience, access, quality and reduce costs.

The second cornerstone that primary care needs to invest in and build is an advanced information management system, which still does not exist.  An electronic medical record (EMR) that replaces a paper chart does not adequately explain the real potential of a tool that could transform the generalist.

Information in the communication-centered practice is managed differently than in traditional models.  The health care provider, surrounded by phones and computers, is linked to a powerful network with electronic medical records, health information databases,  sensitivity-specificity measurements, medical literature, and information about local facilities such as laboratories, pharmacies  x-rays, and consultants and their costs, just to name a few linkages.

Imagine information no longer limited by what is in the doctor’s head, but rather, doctors who can access and find the answer to any medical question within seconds by having bookmarks that extend through an entire medical library, and searching for answers would be as easy as:  The evidence based guidelines treatment for this problem is “click”… The differential diagnosis for night sweats is “click”… The medicines known to cause “weird smells” as a side effect are “click”… The cost of that test is “click”… The three labs closest to your home where I could fax the order are “click”…The sensitivity and specificity for this test or that symptom or that physical finding to be associated with lupus is “click”…The recommended treatment for this fracture is “click”…The three best articles for helping patients manage and educate themselves about their cholesterol are “click”… The telephone number to arrange setting up the test is, “click”… The facts and comparison for this medicine is… “click” The video link demonstrating the Canalith repositioning maneuvers is in your email box… “click.” Primary care providers help patients work through this information, discerning what is of utmost importance to their medical situation and issue. As it is said, “The role of the expert is to know what to ignore.”

Excellent primary health care requires continuous communication between doctors and patients so as to respond through the evolving and unpredictable twists and turns of illness and treatment . Doctors likewise need connection to the highest quality information and recording systems so as to actualize the science of best “healers”. The idea that doctors should always know the answer to a problem by using memory alone is as misguided as insisting mathematicians return to pencil and paper calculations to prove that they are “real” mathematicians.    Despite the potential, primary health care has remained timid to challenge the unexamined assumptions behind the limits of  Hippocrates medical practice. Were Hippocrates to return today I imagine him asking, “What have you done?”

Our patients need doctors to step up to the plate and go to bat for them. We as doctors need it too.

Until next week, I remain yours in primary care,

Alan Dappen, MD

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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