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

Latest Posts

Saving Primary Care: What Will It Take?

“Bold changes are needed in how the United States delivers and pays for primary care if the key goals of national health reform are to be achieved,” according to the health policy journal Health Affairs, which has released a thematic issue devoted entirely to the crisis in primary care.

(The complete articles are available only to subscribers, but Health Affairs’ blog has a good summary.)

I have spent much of the day reading the journal — 47 articles, and a combined 300 pages of text. Here are my “take-home” messages from the articles. Read more »

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

Why Primary Care Doctors Are So Busy

There’s been a lot of commentary on a recent article from the New England Journal of Medicine, detailing the undocumented tasks that a typical primary care physician performs.

For those who haven’t read the piece, entitled, What’s Keeping Us So Busy in Primary Care? A Snapshot from One Practice, it’s available free at the NEJM website. I highly recommend it.

To summarize, primary care doctors are responsible for much more than seeing patients in the exam room. In the cited practice, which has a fairly typical makeup, physicians were responsible for an average of over 23 telephone calls and 16 e-mails per day. Many practices don’t engage their patients over e-mail, so it’s conceivable that the number of telephone calls is lower than average here. Read more »

*This blog post was originally published at*

Does Group Health’s “Medical Home” Leave The Poor Behind?

Group Health has published two papers recently, one in Health Affairs and the other in JAMA, both extolling the virtues of its Medical Home. These follow their brief report last fall in the NEJM and the lengthy description of their model in the American Journal of Managed Care. Their model has been promoted by the Commonwealth Fund, and it is cited in the currrent issue of Lancet.

The big news is that costs were a full 2% lower than conventional care, hardly a great success –- it wasn’t even statistically significant. But was even this small difference due to the Medical Home, or was it because the Medical Home patients were less likely to consume care? Read more »

*This blog post was originally published at PHYSICIANS and HEALTH CARE REFORM Commentaries and Controversies*

Relational Medicine: The Joy Of Primary Care

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*

9 Tips To Improve Patient Satisfaction

Some interesting points were raised at a recent Society of Hospital Medicine (SHM) session by Winthrop Whitcomb and Nancy Mihevc on patient satisfaction. To improve satisfaction scores:

1. Review the patient’s chart before you go in the room. It makes a big difference if the patient perceives you know what’s going on without having to bury your face in a chart.

2. Patients are often confused about who they are supposed to see after discharge. This, of course, is a safety issue as well as one that affects patient satisfaction.

3. Sit down when you are visiting a patient. Patients are happiest when they perceive you’ve spent enough time with them, and they are more likely to perceive this if you are sitting than standing with your hand on the doorknob. Read more »

*This blog post was originally published at ACP Hospitalist*

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 »