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How An Empowered Patient Finds A New Doctor

What if the average patient (person) knew what healthcare insiders, providers and expert patients know?

Take the process of looking for a new personal physician. Conventional wisdom tells people that when looking for a new physician they need to consider things like specialty, board certification, years in practice, and geographic proximity. Online services like Health Grades allow you to see and compare the satisfaction scores for prospective physician candidates.

But industry insiders know different. Consider those patient satisfaction scores for physicians. In reality, “one can assume that the quality of care is actually worse than surveys of patient satisfaction would seem to show,” according to a 1991 lecture by Avedis Donabedian, M.D.:

“Often patients are, in fact, overly patient; they put up with unnecessary discomforts and grant their doctors the benefit of every doubt, until deficiencies in care are too manifest to be overlooked.”

Given the constant drumbeat about the lack of care coordination and medical errors, it would seem that some people (patients) are beginning to reach the breaking point alluded to by Dr. Donabedian. The empowered among us are starting to compare physicians (and the hospitals that employ them) to a higher standard — a higher standard that reflects the nature and quality of the medical services physicians actually provide. Empowered patients today are “being taught to be less patient, more critical, and more assertive.” Read more »

*This blog post was originally published at Mind The Gap*

From “Winnie The Pooh”: Edward Bear And Primary Care

Here is Edward Bear, coming downstairs now, bump, bump, bump, on the back of his head, behind Christopher Robin. It is, as far as he knows, the only way of coming downstairs, but sometimes he feels that there really is another way, if only he could stop bumping for a moment and think of it. 

— From A.A. Milne’s “Winnie the Pooh and the House at Pooh Corner.”

Internists, I expect, will identify with Edward Bear.

Richard Baron’s study in the NEJM on the amount of work he and his colleagues do outside of an office visit — the “bump, bump, bump” of a busy internal medicine (IM) practice — has resonated with many of his colleagues.

Jay Larson, who often posts comments on this blog, did a similar analysis for his general IM practice in Montana, and found that for every one patient seen in the office, tasks are done for 6 other unscheduled patients. Jay writes: “So really there [are] internists [who] are managing about 130 patients per day. Not much consolation when they only get paid for 18 per day.” Read more »

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

Life Line Screening Promotes Unnecessary Medical Tests

A patient brought in a flyer for Life Line Screening, where for $129 an individual can have their carotid (neck) and peripheral (leg) arteries screened for blockage, their abdominal aorta screened for aneurysm (swelling), and be tested for osteoporosis. The advertisement claims that “we can help you avoid a stroke,” and their logo notes “Life Line Screening: The Power of Prevention.”

Are these tests worth your money? Short answer: No.

Although the flyer correctly indicates that 80 percent of stokes can be prevented, the National Stroke Assocation does not recommend ultrasound as a screening test. Preventing stroke includes quitting smoking, knowing your blood pressure and cholesterol numbers, drinking alcohol in moderation (if already doing so), exercising regularly, and eating a low-sodium diet. Their is no mention of an ultrasound test. Why? Because there is NO evidence that it helps save lives in individuals who are healthy and have no symptoms (except for the following situations). Read more »

*This blog post was originally published at Saving Money and Surviving the Healthcare Crisis*

Heart Disease And Working Overtime

The European Heart Journal studied 6,000 British civil servants and followed them for 11 years. They found that working an extra 3 to 4 hours a day is associated with increased coronary heart disease.

The researchers controlled and adjusted for lifestyle, cardiac risk factors, and other factors that would skew the results, and still found that people who worked 3 to 4 extra hours a day had a 60 percent increase in risk for heart disease. Read more »

*This blog post was originally published at EverythingHealth*

Recent Readings On Social Media In Medicine

Here are a few papers and publications focusing on how social media can be used in medicine, healthcare and science. These represent the evidence-based approach in social media:

Google docs: a better method than a paper clinical schedule. Kippenbrock T, Holloway E, Moore DD. Comput Inform Nurs. 2010 May-Jun;28(3):138-40.

How to get the most from the medical literature: keeping up to date in nephrology. Cullis J, Webster AC. Nephrology (Carlton). 2010 Apr;15(3):269-76.

Twitter: consider the possibilities for continuing nursing education. Billings DM, Kowalski K, Bristol TJ. J Contin Educ Nurs. 2010 May;41(5):199-200.

Literature search on risk factors for sarcoma: PubMed and Google Scholar may be complementary sources. Mastrangelo G, Fadda E, Rossi CR, Zamprogno E, Buja A, Cegolon L. BMC Res Notes. 2010 May 10;3(1):131.

Effect of visual media use on school performance: a prospective study. Sharif I, Wills TA, Sargent JD. J Adolesc Health. 2010 Jan;46(1):52-61.

Patients’ Evaluations of Health Care Providers in the Era of Social Networking: An Analysis of Physician-Rating Websites. Lagu T, Hannon NS, Rothberg MB, Lindenauer PK. J Gen Intern Med. 2010 May 13.

Tweeting science and ethics: social media as a tool for constructive public engagement. Regenberg AC. Am J Bioeth. 2010 May;10(5):30-1.

*This blog post was originally published at ScienceRoll*

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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