Category: Uncategorized

Has Med School Changed For the Better?

Dec 30, 2014• 9

By KARAN CHHABRA

Every third-year has heard it.

“…When I was in your position, I was taking 24-hour calls every other night. If my resident was there, I was there….”

We’re regaled about the glory days, without shelf exams, without phlebotomists, and—by god—without those work-hour restrictions. The days when medical students wouldn’t dare ask their residents for help, or residents their chiefs, or chiefs their attendings, and so on. I hear a bit of romance: the heroism of providing total patient care, exactly when the patient needed it, unfettered by handoffs or outside interference. I envy the skill required to practice medicine almost-literally in one’s sleep.

As the veteran doc continues his (yes, usually his) soliloquy, he may admit that it wasn’t the safest model for patients, or the most humane for trainees. He may today be a better doctor for it, but he’s a bit ambivalent about whether it should remain exactly the same today. Presumably he wasn’t alone, because since the good ol’ days, the third year of medical school has morphed into something barely recognizable.

HIT Newser: Massachusetts Modifies Meaningful Use Mandate

Dec 30, 2014• 1

By MICHELLE RONAN NOTEBOOM

New Life for ACOs

CMS announces that 89 new organizations were selected to participate in the Medicare Shared Savings program, bringing the total number of participating ACOs to 424. The announcement comes on the heels of a recently released proposed rule that reflects an increased focus on primary care and improved incentives for participation. Were the pundits who predicted an early death for ACOs wrong?

Massachusetts Modifies Meaningful Use Mandate

The Massachusetts Board of Registration modifies a provision requiring providers to attest to Meaningful Use in order to retain their medical licenses. The final regulations establish multiple ways in which physicians can demonstrate proficiency using EHRs, including taking a three-hour continuing education class on EHR or registering with the state’s HIE.

Do We Need Patient Relationship Management (PRM) Systems?

Dec 29, 2014• 5

By JORDAN SHLAIN MD

As a primary care doctor in San Francisco and Silicon Valley, I have been searching for the holy grail of patient engagement for over 15 years. My journey began with alpha-numeric pager and a medical degree. I shared my pager number with my patients along with a pledge to call them back within 15-minutes, 24-hours a day. My communications evolved into email and texting, with the predicate that by enhancing communication, I could carefully guide my patients down the byzantine corridors of healthcare – with a high probability we could avoid mistakes – if they would agree to share the ownership of their treatment plan. My life’s work has been where the rubber meets the road; where doctors interface with patients: office, hospital, home or smartphone.

Technology has washed over almost every industry and transformed it, radically. Healthcare is on the precipice of destiny. The wave is here.

Over the past three decades healthcare has lurched from one existential crisis to another; often manifested by an acronym solution: HMO, ACO, PCMH, P4P, PQRS; each a valiant attempt to reign in costs and solve for aligning incentives. However, we can’t have hospitals, doctors, health systems and payers accountable to healthy outcomes if the 300,000,000 people (patients) are not paramount to the equation.

If you haven’t been paying close attention, ‘patient engagement’ is a white-hot topic in healthcare these days. It wasn’t sexy 5 years ago. In fact, at the keynote speech at HIMSS 13 (the national Health IT conference), it was announced that the “The blockbuster drug of the 21st century is Patient Engagement”.

Stories You Won’t Read In 2015

Dec 29, 2014• 3

By PAUL KECKLEY

The headlines and their storylines that you’re not likely to read in 2015:

Physicians optimistic about their future. They’re wildly enthusiastic about the mandate to use electronic medical records to coordinate patient care more effectively, and see the shift away from volume to value as positive trend for the industry. Increased penalties about unnecessary care and report cards about their clinical performance are welcomed as physicians embrace transparency. NOT!

Facts: Trust in physicians remains high but has slipped in recent years. Their compensation remains high relative to overall population at 5.8:1, but physician discontent is palpable. And the visibility given their business dealings vis a vis the Physician Sunshine Act and Medicare Physician database is unwelcome and discomforting.

The Affordable Care Act repealed. Overcoming a President veto, the Senate and House approved repeal. The newly insured in Medicaid and health exchanges will be easily absorbed into the current insurance system so the ranks of the uninsured will not swell. NOT!Continue reading…

Zen and the Art of Antibiotics

Dec 29, 2014• 2

By HANS DUVEFELT, MD

Jacques Johndreau did not look like his usual self when I saw him in the office a few weeks ago. He looked part retired bank manager and part Disney cartoon chipmunk.

He spoke with hardly any facial movements:

“Holy Boys, my wife said to me this morning, you look like you’ve got the mumps again!”

I was aware that Jacques had an atrophic testicle from catching the mumps as a teenager. This time, it was not likely the mumps, but a bacterial parotitis. He was afebrile, and could open his mouth when asked to. I could not palpate a stone in Stensen’s duct and he didn’t experience any worsening of pain when eating acidic foods, so I wasn’t so sure he had a stone.

This was an early, mild case of parotitis and I thought he had a good chance of beating the infection with oral antibiotics. The majority of these infections are caused by staphylococci, but sometimes gram-negative bacteria are the culprit. Whatever I chose, I needed to consider that Jacques takes a blood thinner, warfarin, which interacts with many antibiotics, particularly ones with gram negative coverage.

I e-prescribed a high dose of Ceftin, or cefuroxime, a second generation cephalosporin with good coverage for both staph and gram-negatives and no effect on warfarin.

Why I’m Starting a Radically Different Kind of Medical Practice

Dec 29, 2014• 52

By ROBIN BERZIN, MD

We hear a lot about how US medicine is broken, from how much we spend annually ($4 trillion) for unimpressive outcomes, to the growing epidemic of obesity and diabetes, to problematic financial models, to the growing malaise amongst doctors.

Across US health care, a lot of smart people are crafting solutions to these problems, but in my view the reality is that many of them are generating efficiencies on top of a broken product.

The real problem is that conventional primary care as it’s practiced today no longer serves the needs of most people, be they wealthy or under-served, be they patient or provider.

I am starting Parsley Health, a new kind of medical practice that directly addresses these problems, first by providing something called Functional Medicine rather than traditional primary care, and second by providing functional medicine in a tech driven, modern and affordable way.

What is Functional Medicine?

I became a functional medicine doctor because early on I recognized two major limitations of the conventional medicine.

The Trouble with Home Health Care & Care Coordination

Dec 28, 2014• 11

By LESLIE KERNISAN, MD

Home health care is in many ways a fantastic service, especially for those Medicare beneficiaries who are essentially home bound due to frailty or illness.

But it often feels surprisingly hard to synergize with home health care.

The main problem, as I see it, is that home health care agencies have set themselves up to provide only administratively required communication with the ordering doc. (There are rules governing home health care, you know!)

Now, what I need is clinically relevant communication. As in, how is the patient clinically doing, so that you and I can coordinate our efforts together. This has apparently not been built into the home health care workflow.

And things get even more complicated when it’s a patient in assisted living, because then you have the facility nurse who should be kept in the loop as well.

Right now, I am trying to follow up on an elderly woman who lives in assisted living and has paid in-home aides (which are provided by a separate company).

I referred her to home health care a few weeks ago for help managing her skin. On one hand, she was starting to develop a pressure sore from sitting too much in the same position. And on the other hand, she had a fungal rash in her groin, under her incontinence brief.

I prescribed an antifungal cream to be used twice a day for two weeks.

Now it’s been three weeks, and the pharmacy is requesting a refill.

Well…what’s going on with that rash?

What I want to do is send an email to everyone who is involved and might know something.

Rediscovering Medical Professionalism

Dec 26, 2014• 2

By MARTIN SAMUELS, MD

I am a doctor today because of Dr. J.W. Epstein, my pediatrician in Cleveland in the 1950s. An immigrant from the Nazi terror in Europe, he had trained in Vienna and spoke English with a Germanic accent. His house calls are etched permanently in my memory. His visits were heralded by a fury of activity, led by my mother. “The doctor is coming! Put on clean underwear. Clean the house.” Water would be set to boil on the stove, in case the doctor should need to sterilize a needle for an injection. Up would drive his broken-down jalopy, which he would park directly in front of the house. No need to worry about getting a ticket. The police knew his car and would never issue a citation to The Doctor. No one – not the mayor, not the governor, not even Al Rosen, the venerated third baseman for the Indians – would have received such a royal welcome.

In he would come, wearing a suit and hat, carrying a worn black doctor’s bag. “Mudder, ver is da boy?” ”He’s in his room upstairs with a rash and sore throat.” He would put down his bag, sit on my bed, and ask me if the teacher had sent home the homework. He wouldn’t want me falling behind in my school work.

That might interfere with my becoming a doctor. Then came the ritual of the examination. Say aah; schtick out your tongue; take some deep breaths. “Gut… gut…zounds normal” as he listened with his stethoscope, feeling gently on my belly and then finally tap on some reflexes with his tomahawk hammer. “Mudder, it’s da measles, plenty of fluids, back to school in a few days.” “Veel zee you in da office next fall for da usual checkup.” “Mudder; don’t vorry, it isn’t polio.” No time for a cup of tea today; too many other house calls for this afternoon and off he would go. The enormous feeling of relief, transmitted from my mother to me, had me on the mend in no time.

This is what I wanted to do: be the agent of relief, the repository of medical knowledge, the most respected figure in the community. Some years later, as a teenager, I was waiting in Dr. Epstein’s office for my annual checkup before school started in September. I was surrounded by little babies and I realized that I might be growing out of Dr. Epstein. As he was tapping on my back in the usual reassuring fashion, I said to him, “How long can you see me as a patient?” “ Until you’re a doctor.” How could I fail him?

Fact vs Fiction – Navigating the Health Care Marketplace with Consumer Reports

Dec 23, 2014

At Health 2.0 WinterTech: The New Consumer Health Landscape speakers and sponsors are exploring the platforms that empower the informed consumer movement by providing objective reviews of consumer products. Senior Director, of Health Impact and Consumer Reports, Tara Montgomery will be joining the event to speak to their research on the health products, prescriptions, and providers that contribute to the changing consumer health landscape.

Health 2.0: Tara can you start by speaking to what really pushed this expansion into research and advocacies surrounding health products and when you sort of saw this started shifting?

Tara Montgomery: Yes. Well, actually, you might not know, but we have been in health since day one, and it was actually in our charter back in 1936 to look out for the well-being of all consumers. We started in our very first issue of our magazine and we rated Alka-Seltzer and said that its claims vanish — like gas bubbles in the air. So that was our first foray into health, but that was in a small scale, and I think it was typical of the kinds of health products being advertised to consumers earlier in the 20th century, but over the decades, we covered health lightly. And then, really, about 10 years ago, we saw the shift in healthcare where the consumer’s role really was shifting much more consciously from a compliant patient to a need to be a more savvy health consumer. That was a real call to action for us because our role in helping consumers out in the world is really to give people savvy information about value, and everything we’ve done in washing machines and cars and toasters has been about helping people evaluate the benefits, their satisfaction, and the value for money of the products and services they choose. When the burden of health costs started to shift towards consumers, and you know that definitely has been more intense in the past couple of years, we’ve needed to rise to the occasion and helpconsumers navigate that new role. So, that was a moment for us along with transparency, because when we wanted to rate healthcare products and services more than 10 years ago, the data wasn’t available, and obviously, you can’t look at health the same way as we look at cars and washing machines and bang — our national lab.Continue reading…

Health is All Around Us : How Our Environment Informs Our Health

Dec 23, 2014• 1

As Health 2.0 gears up for Health 2.0 WinterTech, January 15th in San Francisco, their reporters sat down with Environmental Working Group Executive Director, Heather White to discuss the many pathways consumer health advocacy takes and the barriers that continue to keep many of us in the dark about the relationship between our health and our environment.

Health 2.0: To get things started, Heather, I wanted to talk with you a little bit about some of the insight you’ll be providing at WinterTech, which is in relation to the Skin Deep App. From what I’ve researched, it offers ratings on over 70,000 products. I was hoping you could share your thoughts on how you and your team envisioned this app and the way it’s changing how consumers shop for skin products, and what has been the response thus far?

Heather White: Yeah. Well, it definitely has been making waves in the market for a pretty long time. Our site was developed 10 years ago, but we launched our app last year. So far, we’ve had about 300,000 downloads on iPhone and about 95,000 on Android, so close to 400,000 consumers have downloaded the app and are able to make decisions on safer cosmetics and personal care products right at the store. So, we’ve gotten a lot of response and support from our community, but we’re also finding that our brand is reaching a much broader audience. It’s really exciting for us because EWG is all about making sure people make this connection between our health and the environment and really start thinking about the environment as something that they connect to everyday. It’s not just that place you go on vacation, but it also incorporates the chemicals that you buy and that you put on your skin and the chemicals that you buy and then you bring into your home. Skin Deep is trying to really push the market for safer cosmetics and we’ve really seen a lot of consumers make more switches to safer alternatives and we’re also seeing each day new brands coming onto the markets that are less toxic. So, there’s been a tremendous response so far. It’s a free app. It’s available both on the Android and iPhone and our supporters and people who are interested in this issue have really welcomed it.