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Patient-Centered Outcomes Research Institute: Just Another AHRQ?

If you want to grow the expense of health care delivery in America very quickly, then create two government agencies to do the same job.

From the 28 September 2011 issue of the New England Journal of Medicine, we read about a small paragraph in our new health care law that created the Patient-Centered Outcomes Research Institute (PCORI). From that same article, here’s the PCORI’s mission:

PCORI responds to a widespread concern (eds note: emphasis mine. Really? What about the internet?) that, in many cases, patients and their health care providers, families, and caregivers do not have the information they need to make choices aligned with their desired health outcomes.

PCORI funding is set at a total of $210 million for the first 3 years and increases to approximately $350 million in 2013 and $500 million annually from 2014 through 2019. With more than $3 billion to spend between now and the end of the decade, PCORI will support many studies encompassing a broad range of study designs and outcomes that are relevant to patients, aiming to assist people in making choices that are consistent with their values, preferences, and goals.

We should recall that Read more »

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

Following The Rules: Is The Patient Really Yours?

I had a patient with non-valvular atrial flutter denied dabigatran (Pradaxa®) by their insurer recently. The patient had diabetes, hypertension and has had a heck of a time maintaining therapeutic blood thinning levels (prothrombin times).

But those are the rules, you see. Only patients with non-rheumatic atrial fibrillation can get dabigatran, I was told. Dabigatran was never approved for atrial flutter, only atrial fibrillation. Never mind the stroke risk in non-rheumatic atrial flutter, like atrial fibrillation, has been found to be significant.

For my patient, dabigatran would have been the perfect solution.

But increasingly I’m finding the patient is not mine, they’re Read more »

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

Is The Million Hearts Campaign All About The Money?

I don’t know what I was thinking with my last post about the Health and Human Services’ Million Hearts initiative. I thought the whole point of this program was to save money. At the time, I was less than optimistic that the government could acurately reach their goal given the problems with many of the principles behind their program. For instance, maybe it was just me, but how typing on an electronic medical record system would save those lives was lost on me.

But at the time, I had no idea this whole campaign was based on fear.

Watch this introductory video I found on the brand new Million Hearts website, all paid for (of course) with your tax payer dollars: Read more »

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

Medical Security Breaches Are A Common Occurrence

It was kind of funny reading this recent article from the New York Times that focuses on a relatively small health data breach from Stanford Hospital’s emergency room:

A medical privacy breach involving Stanford Hospital in Palo Alto, Calif., led to the public posting of data for 20,000 emergency room patients, including names and diagnosis codes, on a commercial Web site for nearly a year, the hospital has confirmed.

Since discovering the breach last month, the hospital has been investigating how a detailed spreadsheet made its way from one of its vendors, a billing contractor identified as Multi-Specialty Collection Services, to a Web site called Student of Fortune, which allows students to solicit paid assistance with their schoolwork.

Gary Migdol, a spokesman for Stanford Hospital and Clinics, said the spreadsheet first appeared on the site on Sept. 9, 2010, as an attachment to a question about how to convert the data into a bar graph.

Although medical security breaches are not uncommon, the Stanford breach was notable for Read more »

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

Nurses With “Do Not Disturb” Signs: Government-Directed Health Care

It was supposed to be one of a series of “measures to improve safety, reliability, patient experience, staff satisfaction and efficiency of medicine management.” Instead, the wearing of red “tabards” by nurses that read “Do Not Disturb” while they distributed medications has proven to be the straw that broke the camel’s back in England. While the “Do Not Disturb” message on the tabards was replaced with a message that reads “Drug Round in Progress,” isn’t the message the same?

Directive Number 99365.23a: “In the Name of Safety, Do Not Bother Me While I Hand Out Medications.”

It seems almost too incredible to believe and yet, this is how it’s playing out now in England’s National Health Service. Read more »

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

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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