November 24th, 2010 by Shantanu Nundy, M.D. in Better Health Network, Health Policy, Opinion, True Stories
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This past September, a group of medical residents at my institution began seeing primary care patients at a free clinic down the street from our tertiary academic medical center (“hospital clinic”). Far from my expectations, the care we are able to provide at our free clinic is in many ways better than our hospital clinic. Somewhat paradoxically, the experience has given me a taste of what the practice of medicine is like in single-payer healthcare systems like Canada’s.
When I volunteered to start seeing patients at a nearby free clinic, I had little idea what I was signing up for. The term “free clinic” conjured up memories as a medical student in East Baltimore tending to patients at a local homeless shelter with severe frostbite or at a student-run clinic rummaging through the storage room for anti-hypertensive medications. I expected our patients to be terribly poor, the clinic to be little more than a warehouse, for supplies and medications to be few and far between, and for the care we provided to be more about putting out fires than delivering high-quality primary care.
But the place I have come to cherish working at is none of these things. A surprising number of our patients have stable lives and regular jobs — it’s just that their jobs don’t offer health insurance (including some who work in healthcare!) Patients call for appointments. When they arrive they are triaged by a nurse who takes their vitals and asks about their chief complaint before putting them in an exam room. We provide comprehensive primary care complete with routine lab tests for cholesterol and diabetes, age appropriate vaccinations, and referrals for mammograms and colon cancer screening. Read more »
*This blog post was originally published at BeyondApples.Org*
November 24th, 2010 by Davis Liu, M.D. in Better Health Network, Health Policy, News, Opinion, True Stories
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A recent medical error of a wrong-site surgery that occurred in one of the country’s best hospitals, Massachusetts General, reminded me why doctors need to be less like Chuck Yeager and more like Captain Sullenberger.
Growing up, I always wanted to be a fighter pilot, years before the movie “Top Gun” became a part of the American lexicon. My hero was World War II pilot Chuck Yeager, who later became one of the country’s premier test pilots flying experimental jet and rocket propelled planes in a time when they were dangerous, unpredictable, and unreliable.
Much like the astronauts in the movie “The Right Stuff,” Yeager and his colleagues literally flew by the seat of their pants, made it up as they went along, and never really knew if their maiden flight in a new aircraft might be their last. They were cowboys in the sky wrangling and taming the heavens.
Fast forward to January 2009, when shortly after takeoff, a one-in-a-million chance, a double-bird strike completely disabled a US Airways jetliner. Captain Chesley Sullenberger, with the help of his co-pilot Jeff Skiles, ditches the aircraft in the Hudson River in under four minutes even as the nation surely expected a tragedy. But not on that day. Not with that pilot. Read more »
*This blog post was originally published at Saving Money and Surviving the Healthcare Crisis*
November 24th, 2010 by BarbaraFicarraRN in Better Health Network, Health Tips, Opinion
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Do you feel patients are the most important part of the medical (healthcare) team?
In a recent post on Health in 30, “When Doctors and Nurses Work Together,” I wrote about the team-based approach for caring and treating patients, and it addressed the relationship between nurses, doctors, patients and the importance of a multidisciplinary, team-based approach to patient care.
The healthcare team is comprised of a diverse group of specialized professionals, and the most important part of the medical team is the patient.
Subsequent to publishing this post, I received an email from an author and patient advocate stating that patients are not the most important member of the medical team. I value and respect this comment, however I politely and passionately disagree. As a registered nurse and consumer health advocate, I emphatically say that patients are the most important part of the medical team. Read more »
*This blog post was originally published at Health in 30*
November 24th, 2010 by DrRob in Better Health Network, Health Policy, Opinion, True Stories
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Hey there, big, smart, good-looking doctor…
Are you tired of being snubbed at all the parties? Are you tired of those mean old specialists having all of the fun?
I have something for you, something that will make you smile. Just come to me and see what I have for you. Embrace me and I will take away all of the bad things in your life. I am what you dream about. I am what you want. I am yours if you want me…
Seduce: verb [trans.] attract (someone) to a belief or into a course of action that is inadvisable or foolhardy : they should not be seduced into thinking that their success ruled out the possibility of a relapse. See note at “tempt.”
(From the dictionary on my Mac, which I don’t know how to cite.)
If you ever go to a professional meeting for doctors, make sure you spend time on the exhibition floor. What you see there will tell you a lot about our system and why it is in the shape it is. Besides physician recruiters, EMR vendors, and drug company booths, the biggest contingent of booths is that of the ancillary service vendors.
“You can code this as CPT-XYZ and get $200 per procedure!”
“This is billable to Medicare under ICD-ABC.DE and it reimburses $300. That’s a 90 percent margin for you!”
This is an especially strong temptation for primary care doctors, as our main source of income comes from the patient visit — something that is poorly reimbursed. Just draw a few lab tests, do a few scans, do this, do that, and your income goes up dramatically. The salespeople (usually attractive women, ironically) will give a passing nod to the medical rationale for these procedures, but the pitch is made on one thing: Revenue. Read more »
*This blog post was originally published at Musings of a Distractible Mind*
November 20th, 2010 by KevinMD in Better Health Network, Health Policy, News, Research
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Hospitals have recently been stepping up their infection control procedures, in the wake of news about iatrogenic infections afflicting patients when they are admitted. Doctors are increasingly wearing a variety of protective garb — gowns, gloves, and masks — while seeing patients.
In an interesting New York Times column, Pauline Chen wonders how this affects the doctor-patient relationship. She cites a study from the Annals of Family Medicine, which concluded that,
fear of contagion among physicians, studies have shown, can compromise the quality of care delivered. When compared with patients not in isolation, those individuals on contact precautions have fewer interactions with clinicians, more delays in care, decreased satisfaction and greater incidences of depression and anxiety. These differences translate into more noninfectious complications like falls and pressure ulcers and an increase of as much at 100 percent in the overall incidence of adverse events.
Hospitals are in a no-win situation here. On one hand, they have to do all they can to minimize the risk of healthcare-acquired infections, but on the other, doctors need to strive for a closer bond with patients — which protective garb sometimes can impede. Read more »
*This blog post was originally published at KevinMD.com*
