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Why Physician Ratings Aren’t Quite Adequate Yet

“Most physicians are competent and able to take care of most of the problems patients present with.  The standards for getting into medical school are high and for getting out are higher.  I think this call for patients to become experts in picking their doctors is overstated.”  – David Rovner, MD, Professor Emeritus, Michigan State University

Most?  What does “most” mean?  Can most doctors treat me for the flu?  How about pancreatic cancer? Must I conduct the same type of research to choose a doctor to set my broken arm that I do to find one to treat my mom’s congestive heart failure?   Is the same level and type of research necessary to find a good surgeon as for a primary care clinician? Read more »

*This blog post was originally published at Prepared Patient Forum: What It Takes Blog*

No Single Intervention Can Cure Poor Medication Adherence

Jessie GrumanYou are sick with something-or-other and your doctor writes you a prescription for a medication.  She briefly tells you what it’s for and how to take it.  You go to the pharmacy, pick up the medication, go home and follow the instructions, right?  I mean, how hard could it be?

Pretty hard, it appears.  Between 20 percent to 80 percent of us – differing by disease and drug – don’t seem to be able to do it.

There are, of course, many reasons we aren’t.  Drugs are sometimes too pricey, so we don’t fill the prescription. Or we buy them and then apply our ingenuity to making them last longer by splitting pills and otherwise experimenting with the dosage.

Some drugs have to be taken at specific times or under specific conditions, posing little challenge when you are taking only one.  But it can be devilishly difficult to coordinate the green pill half an hour before breakfast, the yellow ones on an empty stomach four times a day and the orange one with a snack between meals.  It’s complicated; we don’t understand.  We’re busy; we forget. We’re sick; it’s confusing.

Some drugs produce uncomfortable side effects while others set off an allergic reaction. Every single day, we have to decide if the promised outcomes are worth the discomfort.

Kate Lorig, the developer of the Chronic Disease Self-Management Program, has listened to thousands of people talk about the challenges they face in taking their medications as prescribed.  “One of the reasons that folks do not take their meds is that they think they are not doing anything,” Lorig says. “This is especially true of medications that replace something that you no longer produce like thyroxin or medications for chronic conditions that help you get worse more slowly.   The trajectory of a disease is not something one can usually sense, and people start feeling that their drugs are not making them better. Another problem is that people expect drugs to work at once like aspirin and antibiotics.   Many drugs take days, weeks or even months for people to feel better.  They lose patience.” Read more »

*This blog post was originally published at Prepared Patient Forum: What It Takes Blog*

Judging Illness Severity And The Financial Implications Of Dialing 911

Nora misjudged the height of the stair outside the restaurant, stepped down too hard, jammed her knee and tore her meniscus.  Not that we knew this at the time.  All we knew then was that she was howling from the pain.

There we were on a dark, empty, wet street in lower Manhattan, not a cab in sight, with a wailing, immobile woman.  What to do?  Call 911? Find a cab to take her home and contact her primary care doctor for advice?  Take her home, put ice on her knee, feed her Advil and call her doctor in the morning?

Sometimes it is clear that the only response to a health crisis is to call 911 and head for the emergency department (ED).  But in this case – and in so many others we encounter with our kids, our parents, our co-workers and on the street – the course of action is less obvious, while the demand for some action is urgent.

The question “which action?” has become more complicated of late because:

  • In some communities, there are alternatives to an ambulance or a drive to the nearest ED, such as Urgent Care centers.
  • Disincentives exist for going the route of the ED: in many cash-strapped municipalities we are charged for the cost of ambulance ride; we risk not having our ED visit covered by insurance if we make the wrong decision or fail to notify our health plan in a timely manner.  Or we don’t have insurance and the ED care is expensive.
  • Some of us have a number of clinicians who could guide us about ED versus self care on any urgent health matter, plus our health plan may have a nurse advice line that could do the same.  Which among them to call?  How long will it take to get an answer in the middle of a busy workday or a late night?
  • Many of us have no primary care clinician to call. Read more »

*This blog post was originally published at Prepared Patient Forum: What It Takes Blog*

7 Reasons Why Doctors Should Use LinkedIn

LinkedIn logoI recently wrote about why doctors don’t use LinkedIn. While the post intended to break down why doctors weren’t inclined to use LinkedIn, I never meant to suggest that it can’t be helpful for practicing physicians.

Enough people messaged me and commented that I feel I should address the issues of doctors and LinkedIn with a broader perspective. So how could LinkedIn be important for the average physician?

1. Dig your well before you’re thirsty. I remember reading Harvey Mackey’s book back in the day which suggested that you should always have options lined up in the event that things don’t work out. Times are definitely changing. Different practice environments and models of care may favor those with an unusual element to their background. The evolution of the healthcare environment may force you to change what you do. Think about your skill sets and what you’ve accomplished — how does that define you? LinkedIn is a good place to showcase that part of you. 

2. LinkedIn is one element of your digital footprint that you control. Too many physicians are not concerned with their professional digital footprint. That is, the record of stuff that appears when you conduct a vanity search on Google or Bing.  In fact, it’s been suggested that Google has replaced the CV. When I search myself I find interviews and keynotes long forgotten that never made my CV. And unlike other searchable sources, the information on LinkedIn in in your control. Think about LinkedIn as home plate for your personal brand. If you don’t think of yourself as a personal brand, perhaps you should. LinkedIn will force the issue for you. Read more »

*This blog post was originally published at 33 Charts*

What’s The Future Of Social Health Media?

So you’re probably wondering what I’m doing blogging about social networking when this is a blog about health and medicine and medical writing. Well, just consider:

  • Thousands of tweets are sent every hour about health/medical issues. Want a cool way to follow them? Check out Health Tweeder.
  • Thousands of health care professionals, medical organizations and healthcare facilities have Facebook pages.

And I’m sure that’s only the beginning. Those, together with Linked In, are the only social networking sites I currently use so that’s all you get for now. Read more »

*This blog post was originally published at A Medical Writer's Musings on Medicine, Health Care, and the Writing Life*

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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