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Can Physician De-Skilling Be Attributed To The Use Of EMRs?

Turns out there is an unintended consequence of many of the current efforts to standardize the way doctor’s practice medicine.  It is called de-skilling.  De-skilling can occur when physicians and other providers try to adapt to standardized, new ways of doing things.  Examples of such standardization include clinical based care guidelines, electronic medical records (EMRs), Pay for Performance (P4P), Patient Centered Medical Home (PCMH) requirements and so on.

Examples of physician de-skilling were revealed in a recent study which consisted of in-depth interviews with 78 primary care physicians regarding EMR use.  EMRs are all about standardization – what data is captured and recorded, how data is reported, how data is used, and so on.

Over the course of the interviews, physicians in the study described significant examples of de-skilling behavior.  Most indicated  that Read more »

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

Physician Says New Model Of Patient Care Should Be Common Sense

There’s nothing new under the sun, or in medicine. I’m not talking about monoclonal antibody targeted chemotherapy; I’m talking about taking care of patients, and specifically about running a medical practice. Not even the incursion advent of all our fancy new electronics has (or should have) a fundamental effect on how we take care of our patients.  The latest thing to come down the pike is the so-called Patient Centered Medical Home, a collection of policies, procedures, and practice re-structuring (webinars, templates, guidelines, etc. all available at low, low prices, of course) that essentially makes large group practices function like a solo doc from the patient’s point of view.

Because the buzzword of this new model is “teamwork”, we’re all supposed to begin the day with a brilliant new concept called the “huddle“: Read more »

*This blog post was originally published at Musings of a Dinosaur*

Fragmented Care Requires Clarification Of Roles By Each Member Of The Medical Team

Jessie GrumanThe most important thing I learned was that different doctors know different things: I need to ask my internist different questions than I do my oncologist.”

This was not some sweet ingénue recounting the early lessons she learned from a recent encounter with health care.  Nope.  It was a 62-year-old woman whose husband has been struggling with multiple myeloma for the last eight years and who herself has chronic back pain, high blood pressure and high cholesterol and was at the time well into treatment for breast cancer.

Part of me says “Ahem.  Have you been paying attention here?” and another part says “Well of course!  How were you supposed to know this?  Have any of your physicians ever described their scope of expertise or practice to you?”

I can see clinicians rolling their eyes at the very thought of having such a discussion with every patient.  And I can imagine some of us on the receiving end thinking that when raised by a clinician, these topics are disclaimers, an avoidance of accountability and liability.

But all of us – particularly those receive care from more than one doctor – need to have a rudimentary idea of what each clinician we consult knows and does. Why is this clinician referring me to someone else? How will she communicate with that clinician going forward? How and about what does she hope I will communicate with her in the future?

Why does our clinician need to address these questions? Read more »

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

What Medical Condition Is The Most Costly To Employers?

Ok…here’s a brain teaser.  What medical condition is the most costly to employers?  I’ll give you a hint.  It is also a medical condition that is likely to go unrecognized and undiagnosed by primary care physicians.

If you guessed depression you are correct. If you mentioned obesity you get a gold star since that comes in right behind depression for both criteria…at least in terms of cost and the undiagnosed part.

Four out of every ten people at work or sitting in the doctor’s waiting room suffer from moderate to severe depression.  Prevalence rates for depression are highest among women and older patients with chronic conditions.  Yet despite its high prevalence and costly nature, depression is significantly under-diagnosed (<50%) and under-treated by physicians.

For employers, the cost of depression cost far exceeds the direct costs associated with its diagnosis and treatment    As the graphic above indicates, the cost of lost productivity for on the job depressed workers (Presenteeism) and lost time for depressed workers that are absent from the job (Absenteeism) far exceed the cost of cost of treatment (medical and medication cost).

Read more »

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

Adult Vaccines: Most Doctors Don’t Stock All Of Them

Less than one in three primary care practices offer all 10 recommended adult vaccines, citing a variety of financial and logistical reasons.

Researchers sponsored by the Centers for Disease Control and Prevention sampled 993 family physicians and 997 general internists. Of the respondents, 27 percent (31 percent of family practitioners and 20 percent of internists) stocked all 10. Results appear in the Feb. 17 issue of the journal Vaccine.

The 10 vaccines were hepatitis A; hepatitis B; human papillomavirus vaccine (HPV); combined measles, mumps, and rubella (MMR); meningococcal conjugate vaccine (MCV4); pneumococcal polysaccharide (PPSV23); tetanus diphtheria (Td); combined tetanus, diphtheria, and pertussis (Tdap); varicella; and zoster.

Of the responding practices, two percent plan to stop vaccine purchases, 12 percent plan to increase them and the rest had no plans to change their vaccination stocking habits. But physicians who identified themselves as their respective practices’ decision makers for stocking vaccines were more likely to decrease the number of different vaccines stocked for adults (11 percent vs. three percent; P=.0001).

The National Vaccine Advisory Committee, a group that advises the various federal agencies involved in vaccines and immunizations, arrived at even bleaker figures in 2009, reported the April 2009 issue of ACP Internist. For example, 62 percent of decision makers in practices said they had delayed purchase of a vaccine at some time in the prior three years due to financial concerns. And in the prior year, 16 percent of practice decision makers had seriously considered stopping vaccinations for privately-insured patients due to the cost and reimbursement issues. Read more »

*This blog post was originally published at ACP Internist*

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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