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Latest Posts

Are The Quality Metrics For Neurologists Reasonable?

Quality and safety metrics that will specifically affect neurologists/neurohospitalists are coming in the next few years, and neurohospitalists need to be involved in the discussion of what those metrics are, warned S. Andrew Josephson of USCF during a neurohospitalists session at the Stroke 2010 conference yesterday.

He urged the audience to consider the current metric of “time to antibiotics administration for pneumonia,” which seems like a reasonable quality metric on the surface. To get compliance rates up, many hospitals give antibiotics to anyone with a little sputum, a cough, a fever, etc., as soon as he/she arrives at the ED. Thus, resistance rates have risen along with administration rates, because people are getting the drugs when they have things like bronchitis, not just pneumonia. Read more »

*This blog post was originally published at ACP Hospitalist*

Board Certification May Not Be A Good Proxy For Quality Care In Emergency Medicine

The American Board of Emergency Medicine (ABEM) describes itself as:

Welcome to the American Board of Emergency Medicine (ABEM) public website.  ABEM certifies qualifying physicians who specialize in Emergency Medicine and is a member board of the American Board of Medical Specialties (ABMS).  ABMS certification is sought and earned by physicians on a voluntary basis. ABEM and other ABMS member boards certify only those physicians who meet high educational, professional standing, and examination standards.  ABEM and other ABMS member boards are not membership associations.

The thing I’d like to bring your attention to is that it’s a Voluntary organization.  For a voluntary organization they’re adding lots of requirements without asking members… Read more »

*This blog post was originally published at GruntDoc*

Patients Value Personal Recommendation Over Online Doctor Ratings

The organizations that rate hospitals and doctors have proliferated as the internet has become mainstream over the past 5 years. I’m sure you have seen some of these: U.S. World & News Reports, Consumer Reports Health, Health Grades, Leapfrog, Hospital Compare, Americas Best Doctors and 100 Best Hospitals. My local magazine lists the “top doctors” along with full page paid ads and promos that are very compelling. The questions is, do consumers care? Are these rating agencies really steering people toward top quality in health care?

Each of these agencies and organizations that “rate” have different measurements and criteria for their choices. The top rankings do not necessarily relate to quality outcomes. The Medicare data are two years old. Different treatments and conditions are judged, so a “top” hospital in one area may be a loser in another. Read more »

*This blog post was originally published at EverythingHealth*

New Hospital Policy Leaves Cancer Patient In Tears

cryingpatientA dear friend of mine (let’s call her Amanda) has metastatic breast cancer. She’s far outlived her life expectancy, thanks to advances in targeted chemotherapy, but is beginning to need more medical care. She’s the divorced mom of two teens, with a loving extended family who keeps a close eye on her.

When Amanda was recently admitted to her local hospital with abdominal pain, a new policy resulted in some unintended consequences. While she was still in the Emergency Department, a nurse came by to ask if Amanda wanted to be an organ donor. The family members – keenly aware of her grave prognosis – assumed that the nurse knew about the cancer, and was asking this question because it had been determined that Amanda was about to die.

Tearful sobs ensued. Amanda’s sister called me the next day to tell me the news. Read more »

Pay More, Get Less – The Certain Future Of Healthcare

Even with healthcare reform, Americans will increasingly be burdened with high deductibles, more financial responsibility, and less satisfaction with their health insurance for the foreseeable future. Why? Because the healthcare system is unable to transform its services in a manner that other industries have done to improve quality and service while decreasing costs. The two biggest culprits are the mentality of healthcare providers and the fee for service reimbursement system.

Doctors and patients haven’t altered the way they communicate over the past hundred years. Except for the invention of the telephone, an office visit is unchanged. A doctor and patient converse as the physician scribbles notes in a paper chart. Despite the innovations of cell phones, laptop computers, and other time saving devices, patients still get care through face to face contact even though banking, travel, and business collaboration can be done via the internet, webcams, and sharing of documentation. As Dr. Pauline Chen noted in a recent article, doctors are not willing to use technology to collaborate and to deliver medical care better, more quickly and efficiently. Mostly it is due to culture resistant to change. Partly it is due to lack of reimbursement. Both are unlikely to be addressed or fixed anytime soon. Read more »

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

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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