December 13th, 2011 by Dinah Miller, M.D. in Opinion
Tags: Complications, Confidentiality, Double life, Medication Histroy, Open, Past treatment, Privacy, Psychiatry, Psychology, secrets, Thoughts, Xanax
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In yesterday’s post on e-prescribing, the issue of patient confidentiality came up in the context of doctors being able to see a patient’s full medication history in an electronic program, and one commenter brought up that she doesn’t necessarily want to tell her shrink about a yeast infection, perhaps because she finds it embarrassing. The writer of the post, a guest blogger, suggested that this might lead to useful information that should be addressed in therapy, for example the patient’s sexual life.
Years ago, I remember being a bit taken back when a patient brought up some rather problematic (to him) sexual issues in his marriage. It wasn’t the nature of the issues that surprised me (I spent more than a decade consulting to a sexual behaviors unit and I spent several months of residency training on an inpatient sexual disorders unit: it takes a lot to shock me). What surprised me was that this was the first I was hearing about this issue after seeing the patient for 5 years of psychotherapy. He had a secret life.
There’s not really much to do about this. One can only Read more »
*This blog post was originally published at Shrink Rap*
December 12th, 2011 by Michael Kirsch, M.D. in Health Policy, Opinion
Tags: CMS, Hospitals, Medical Quality, Medicare, Never Events, Pay For Performance, Unfair
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This blog has tried to support the virtue of personal responsibility. If you smoke, don’t blame Joe Camel. If you surrender to Big Mac attacks, don’t go after Ronald McDonald. If you love donuts, and your girth is steadily expanding, is it really Krispy Kreme’s fault? And, if you suffer an adverse medical outcome, then…
Medicare aims to zoom in on hospitals, suffocating them with a variation of the absurd pay-for-performance charade that will soon torture practicing physicians. Of course, a little torture is okay, as our government contends, but pay-for-performance won’t increase medical quality, at least as it currently exists. It can be defended as a job creator as several new layers in the medical bureaucracy will be needed to collect and track medical data of questionable value.
Medical quality simply cannot be easily and reliably measured as one can do with a diamond, an athlete or a wine. Most professions resist being graded or claim that the grading scheme is a scheme. Teachers, for example, refute that testing kids is a fair means to measure their teaching performance. Conversely, any individual or profession who scores well on any quality review program will applaud the system’s worth and fairness. Shocking.
Under the government’s new program, hospitals could be financially responsible for the cost of medical care that a patient requires for up to 90 days after discharge. Read more »
*This blog post was originally published at MD Whistleblower*
December 12th, 2011 by Bryan Vartabedian, M.D. in Opinion
Tags: Doctor, Doximity, Hospitals, Image, LinkedIn, Marketing, Online Reputation, Physician, PR, Reputation, Social Media
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I spoke to a group of academic physicians recently. Afterward I was and asked, “Shouldn’t my hospital be responsible for my digital footprint? I don’t have time to look after that sort of thing. And wouldn’t it make sense for them to promote my research?”
4 thoughts:
1. Online reputation management of academic physicians should be an individual, not institutional, responsibility. The question reflects a belief that your reputation is the job of “the marketing people.” No institution will ever be as invested in your future as you are. While there are hospitals that do a good job supporting their faculty and staff, you can’t assume it to be the case. No one looks after you like you.
2. Dig your well before you’re thirsty. That’s the name of a brilliant pre-digital book written by Harvey Mackey. He suggested that the time to invest in relationships is before you need them. Medicine is changing fast and you’ll never know how long you’ll be where you’re at. Better yet, you never know what opportunities could come your way when people find you. And if you want to experience the land before time when people used colored pencils, Rolodexes, and rotary phones, read Dig Your Well. Read more »
*This blog post was originally published at 33 Charts*
December 12th, 2011 by John Mandrola, M.D. in Health Policy, Opinion
Tags: Access, Health Care Reform, Parallax, Salaried Physicians, Work Hours
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My last post centered upon the funny-sounding word, ‘parallax.’ I was using it to describe how middle-age athletes see their sport.
But it seems to me that parallax relates to healthcare policy.
First, the definition:
Parallax: an apparent change in the position of an object resulting from a change in position of the observer.
Here goes…(in less than 360 words!)
As America and its government grapple with how much austerity can be tolerated, the cost of healthcare consumption holds center stage.
And…
Everyone knows a portion of the rising costs of healthcare stem from paying doctors a fair wage. (Worry not; I’m not prepping you for a rant about declining reimbursement and higher regulatory costs. This would be too fatiguing. Plus, doctors’ wages lie way beyond the scope of a clinician’s blog.)
Let me tell you a real-life story about a recent situation? It’s meant to illustrate one of the many healthcare policy conundrums. And it shows how one’s views of healthcare policy may depend–on the position of the observer. (ie, parallax) Read more »
*This blog post was originally published at Dr John M*
December 11th, 2011 by Jessie Gruman, Ph.D. in Health Policy, Health Tips, Opinion
Tags: Accountable Care Organizations, ACO, CMS, EHR, Electronic Medical Records, EMR, Geriatrics, Group Health Cooperative, Home Health Care, Jessie Gruman, LinkedIn, medicaid, Medicare, Nursing Home, remote monitoring, Telehealth
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Did you know that every nursing home resident in the U.S. must be asked every quarter whether she wants to go home, regardless of her health or mental status? And if she says yes, there is a local agency that must spring into action to make that happen.
This is the result of a 2010 Center for Medicaid/Medicare Services regulation aimed at helping keep older people in their (less expensive) homes rather than institutional settings. A New York Times article notes that the nursing home exodus, while modest to date, is building. This means the number of people with serious chronic conditions like congestive heart failure, diabetes and chronic obstructive pulmonary disease who draw heavily on community-based primary care services will grow.
These returnees are joining their peers and the blossoming crowd of us Baby Boomers who intend to resist living in nursing homes with as much spirit as our parents did, while the consequences of our plump and sedentary lifestyles arrange themselves into a constellation of diabetes, congestive heart failure and COPD similar to the one that plagues our elders.
Much has been written about Read more »
*This blog post was originally published at Prepared Patient Forum: What It Takes Blog*
In yesterday’s post on e-prescribing, the issue of patient confidentiality came up in the context of doctors being able to see a patient’s full medication history in an electronic program, and one commenter brought up that she doesn’t necessarily want to tell her shrink about a yeast infection, perhaps because she finds it embarrassing. The writer of the post, a guest blogger, suggested that this might lead to useful information that should be addressed in therapy, for example the patient’s sexual life.
