August 11th, 2010 by KevinMD in Better Health Network, Health Policy, News, Opinion
Tags: Bridging Care, Dr. Jesse Pines, Dr. Zachary Meisel, Emergency Medicine, Healthcare reform, Hospital Bouncebacks, Hospital Discharge, Hospital Re-Admissions, Improved Followup, Patient Noncompliance, Primary Care, Recently Discharged Hospitalized Patients, Shorter Hospital Stays, Slate, Transition Care Clinics
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In their most recent piece at Slate, emergency physicians Zachary F. Meisel and Jesse M. Pines tackle the issue of bouncebacks — that is, the re-admission of recently-discharged hospitalized patients. They bring up good some good points, and point out that until recently hospitals really didn’t have any incentive to reduce bouncebacks:
…hospitals have never had a compelling reason to try to prevent bouncebacks. Hospitals are typically paid a flat sum for each inpatient stay — shorter stays equal higher profits. When patients bounce back, hospitals can charge the insurance company twice for the same patient with the same problem. Many hospitals also view bouncebacks as out of their control: If a patient boomerangs back because she doesn’t follow doctor’s orders, it’s not the hospital’s fault.
With health reform, however, things are changing. In an effort to reduce bouncebacks, hospitals are paid less for re-admissions, and they must publish their bounceback rates. Read more »
*This blog post was originally published at KevinMD.com*
August 11th, 2010 by Davis Liu, M.D. in Better Health Network, Health Tips
Tags: Accurate Diagnosis, Bedside Manner, Doctor-Patient Communication, General Medicine, How To Talk To Your Doctor, Patient-Doctor Relationship, Primary Care
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As a practicing primary care doctor, I continue to work incredibly hard on making my bedside manner even better so that patients feel heard. The other reason is because as most doctors learned in medical school 90 percent of getting the right diagnosis comes from taking a good history from a patient.
Unfortunately with shorter doctor office visits and doctors interrupting patients within 23 seconds of starting, you need to know how to get your concerns across. While I don’t believe this is the responsibility of patients, the reality is not everyone has access to doctors with great bedside manner.
How to talk to your doctor is quite easy if you follow three simple steps. Read more »
*This blog post was originally published at Saving Money and Surviving the Healthcare Crisis*
August 11th, 2010 by Bryan Vartabedian, M.D. in Better Health Network, News, Opinion, Research
Tags: Academic Fraud, Annals Of Internal Medicine, Blogosphere, Brigham and Women's Hospital, Cut-And-Paste, Digital Reverberation, General Medicine, Harvard University, Medical Residency, Medical Students, New Generation of Doctors, Plagiarized Content, Residency Applicants, Technology and Medicine, Unethical Academic Conduct, When Young Doctors Lie
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This is something: A study published in the July 20, 2010 Annals of Internal Medicine finds that 5 percent of residency applications contain plagiarized content. The study from Boston’s Brigham & Woman’s Hospital is based on the personal statements of nearly 5,000 residency applicants that were matched against a database of published content.
The authors comment that the study is limited, among other things, by the fact that it was done in just one institution. It makes me wonder if the number is artificially high or potentially too low.
So why would medical students lie? Read more »
*This blog post was originally published at 33 Charts*
August 11th, 2010 by RyanDuBosar in Better Health Network, Health Policy, News, Research
Tags: Baby Boomers, CDC, Centers For Disease Control and Prevention, Chronic Conditions, Coronary Atherosclerosis, Diabetes, ED, Emergency Department, Emergency Medicine, Emergency Room, ER, Family Medicince, General Medicine, Hypertension, Internal Medicine, medicaid, Middle Aged Patients, National Center for Health Statistics, National Hospital Ambulatory Medical Care Survey, Office Visits, Older Adults, Older Patients, Primary Care, SCHIP, State Children's Health Insurance Program
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Office-based practices are focusing increasingly on patients 45 and older, reports the Centers for Disease Control and Prevention.
In 2008, those 45 and older accounted for 57 percent of all office visits, compared to 49 percent in 1998. Prescriptions, scans and time spent with the doctor also became increasingly concentrated on those middle aged and older, according to data from the CDC’s National Center for Health Statistics.
Also, physician visits increasingly concentrated on medical and surgical specialists and less on care provided by primary care practitioners for those ages 45 and older. Furthermore, for patients ages 65 and older, the percentage of visits to primary care specialists decreased from 62 percent to 45 percent from 1978 to 2008, while the percentage of visits to physicians with a medical or surgical specialty increased from 37 percent to 55 percent. Read more »
*This blog post was originally published at ACP Internist*
August 11th, 2010 by Lucy Hornstein, M.D. in Better Health Network, Health Policy, Health Tips, Opinion
Tags: Dr. Rob Lamberts, Family Medicine, Family Practice, General Medicine, Housecalls, Internal Medicine, Internist, Med-Peds, Medical Residency, Medical School, Medical Training, Musings of a Distractible Mind, Obstetrics And Gynecology, Pediatrician, Pediatrics, Primary Care
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I like Dr. Rob, the one with the “distractible mind.” And although I thoroughly agree with the stance he takes in his recent post against cholesterol screening in kids, I must take issue with his opening statement:
I have a unique vantage point when it comes to the issue universal cholesterol screening in children, when compared to most pediatricians. My unique view stems from the fact that I am also an internist who deals with those children after they grow up on KFC Double Downs.
From Dictionary.com:
“Unique: existing as the only one or as the sole example; single; solitary in type or characteristics.”
Your med-peds training allows you to follow patients from birth to death (but no obstetrics or gynecology). You can care for all organ systems and all stages of disease (but without as much training in psychiatry). Congratulations! You’ve just (re)invented family practice (except for the above shortcomings). Oh, wait — that’s already a recognized specialty with its own residency programs, boards and everything like that, forty years now.
This misuse of the word “unique” is one of my pet peeves. “Unique?” I don’t think that word means what you think it means. After twenty years in practice, I agree that there probably isn’t much difference between what Dr. Rob does and what I do. After twenty years, I’m not even sure how much relevance remains from our “training.” Still, there remains a great deal of confusion about the very real differences between family practice and med-peds residencies. Read more »
*This blog post was originally published at Musings of a Dinosaur*
