Category Archives: Doctors

Doctor yearns for a return to the time when physicians were ‘artisans’

Share

stethoscope doctor's bag chest x-rayBy Michelle Andrews
Kaiser Health News

In his recent book, “The Finest Traditions of My Calling,” Dr. Abraham Nussbaum, 41, makes the case that doctors and patients alike are being shortchanged by current medical practices that emphasize population-based standards of care rather than individual patient needs and experiences.

Nussbaum, a psychiatrist, is the chief education officer at Denver Health Medical Center and practices on the adult inpatient psychiatric unit there. I recently spoke with him and this is an edited transcript of our conversation.

Q. Your book is in some ways a lament for times gone by, when physicians were “artisans” who had more time for their patients and professional independence. But you’re a young doctor and you must have known at the outset that wasn’t the way medicine worked anymore. Why do you stick with it?

A. The first thing I’d say was that I didn’t know right away that medicine is no longer universally understood as a calling instead of a job. We are describing health as if it is just another consumer good, and physicians and other health practitioners as the providers of those goods. That is the language of a job. When you remember that being with the ill is a calling, then you remember that it is a tremendous privilege to be a physician. People trust you with their secrets, their fears and their hopes. They allow you to ask about their lives and to assess their bodies. So my lament is not for the loss of physician privilege — goodbye to that — but to the understanding of medicine as a calling. Continue reading

Share

Hospital safety software often fails to flag unsafe prescriptions, report

Share

Photo by Creativity103 under creative commons license.

By Shefali Luthra
Kaiser Health News

Medical errors are estimated to be the third-highest cause of death in the country.

Experts and patient safety advocates are trying to change that.

But at least one of the tools that’s been considered a fix isn’t yet working as well as it should, suggests a report released Thursday.

That’s according to the Leapfrog Group, a nonprofit organization known for rating hospitals on patient safety.

Almost 40 percent of potentially harmful drug orders weren’t flagged as dangerous by the systems.

Leapfrog, working with San Francisco-based Castlight Health, conducted a voluntary survey of almost 1,800 hospitals to determine how many use computerized-physician-order-entry systems to make sure patients are prescribed and receive the correct drugs, and that medications won’t cause harm.

The takeaway? While a vast majority of hospitals surveyed had some kind of computer-based medication system in place, the systems still fall short in catching possible problems.

(Photo by Creativity103 under creative commons license.)
Continue reading

Share

Patients’ assessment of their health gaining importance in treatment

Share

Stethoscope DoctorBy Michelle Andrews
Kaiser Health News

For Erin Moore, keeping her son’s cystic fibrosis in check requires careful monitoring to prevent the thick, sticky mucous his body produces from further damaging his lungs and digestive system.

Moore keeps tabs on 6-year-old Drew’s weight, appetite, exercise and stools every day to see if they stray from his healthy baseline. When he develops a cough, she tracks that, too.

It’s been nearly a year since Drew has been hospitalized; as a baby he was admitted up to four times annually. Erin Moore credits her careful monitoring, aided by an online data tracking tool from a program at Cincinnati Children’s Hospital Medical Center called the Orchestra Project, with helping to keep him healthy.

Clinicians have typically focused more on physical exams, medical tests and biological measures to guide patient care.

Erin Moore, center, tracks the cystic fibrosis symptoms of her 6-year-old son, Drew, far left, using an online data tracking tool from Cincinnati Children’s Hospital Medical Center. (Courtesy of Holly Burkholder Photography)

“Now I have a picture of what health looks like for Drew,” said Moore, 35. “Tools like Orchestra that allow patients to take a more active stance in managing our health are still really undervalued.”

That may be changing, according to a study in the April issue of the journal Health Affairs that examines the movement to incorporate “patient-reported outcomes” into clinical care.

It may seem like a no-brainer to include patients’ assessments of their physical and mental conditions and quality of life into medical care, but such patient-generated data has traditionally been confined to research rather than clinical settings.

Clinicians have typically focused more on physical exams, medical tests and biological measures to guide patient care.

However, as patient-centered medical care has taken hold in recent years, there’s been a growing interest in finding ways to use outcomes reported by individuals to help guide care.

“How are you feeling?” is a pretty standard conversation starter during a doctor’s visit. Continue reading

Share

Amid public feuds, venerated medical journal finds itself under attack

Share

New-England-Journal-of-MedicineBy Charles Ornstein
ProPublica.

The New England Journal of Medicine is arguably the best-known and most venerated medical journal in the world. Studies featured in its pages are cited more often, on average, than those of any of its peers. And the careers of young researchers can take off if their work is deemed worthy of appearing in it.

But following a series of well-publicized feuds with prominent medical researchers and former editors of the Journal, some are questioning whether the publication is slipping in relevancy and reputation.

The Journal and its top editor, critics say, have resisted correcting errors and lag behind others in an industry-wide push for more openness in medical research. And dissent has been dismissed with a paternalistic arrogance, they say.

In a widely derided editorial earlier this year, Dr. Jeffrey M. Drazen, the Journal’s editor-in-chief, and a deputy used the term “research parasites” to describe researchers who seek others’ data to analyze or replicate their studies, which many say is a crucial step in the scientific process. And last year, the Journal ran a controversial series saying concerns about conflicts of interest in medicine are oversimplified and overblown.

“They basically have a view that 2026 they don’t need to change or adapt. It’s their way or the highway,” said Dr. Eric Topol, director of the Scripps Translational Science Institute and chief academic officer at Scripps Health in La Jolla, California.

Topol and another cardiologist were called out by Drazen and his co-authors last year after they wrote an opinion piece in The New York Times saying the data behind a groundbreaking study about blood pressure treatment should be made available to doctors right away 2014 not delayed for journal publication.

“Most people are afraid to say anything about the New England Journal because they’re afraid they won’t get something published there,” said Topol, whose last piece appeared in its pages in 2011. “That’s part of this oppression.” Continue reading

Share

By not discussing cost issues, doctors, patients may miss chances to lower out-of-pocket costs

Share

Twenty-dollar bill in a pill bottleBy Shefali Luthra
Kaiser Health News

Talking about money is never easy. But when doctors are reluctant to talk about medical costs, a patient’s health can be undermined. 

A study published in Monday’s Health Affairs explores the dynamics that can trigger that scenario.

Patients are increasingly responsible for shouldering more of their own health costs. In theory, that’s supposed to make them sharper consumers and empower them to trim unnecessary health spending. But previous work has shown it often leads them to skimp on both valuable preventive care and superfluous services alike.

Doctors could play a key role in instead helping patients find appropriate and affordable care by talking to them about their out-of-pocket costs. But, a range of physician behaviors currently stands in the way, according to the study. Continue reading

Share

How to use your new Marketplace health coverage

Share

From Healthcare.gov

Congratulations on enrolling in 2016 health coverage! Now that you’re covered, here are a few tips to help you stay healthy and get the care you need.

using-your-new-health-coverage

 

3 ways to use your health insurance to stay healthy

  • Find a doctor and get medical care: If you don’t have a doctor, check your plan to find one in your network. If you get medical services from a provider in your plan’s network, you’ll pay lower prices than you would without insurance. That can save you hundreds of dollars per year, even if you don’t meet your deductible.
  • Learn about your prescription benefits: Health plans help pay the cost of certain prescription medications. Some plans offer reduced prices on generic drugs even before you’ve met your deductible.
  • Stay healthy with preventive benefits: All health plans sold through the Marketplace cover a set of preventive services at no cost to you when delivered by a network provider. These include some screenings, check-ups, patient counseling, and wellness services.

If you’ve never had health insurance or if it’s been a while, you can get more information about using your coverage and improving your health using our Roadmap to Better Care and a Healthier You (PDF).

Share

Now there’s proof: Docs who get company cash tend to prescribe more brand-name meds

Share

Twenty-dollar bill in a pill bottleBy Charles Ornstein, Ryann Grochowski Jones and Mike Tigas, ProPublica

Doctors have long disputed that the payments they receive from pharmaceutical companies have any relationship to how they prescribe drugs.

There’s been little evidence to settle the matter until now.

A ProPublica analysis has found for the first time that doctors who receive payments from the medical industry do indeed tend to prescribe drugs differently than their colleagues who don’t.

And the more money they receive, on average, the more brand-name medications they prescribe. Continue reading

Share

Doctors ponder delicate talks as Medicare pays for end-of-life counseling

Share

ekg-tracingBy Phil Galewitz
Kaiser Health News

JUPITER, Florida — She didn’t want to spend the rest of her days seeing doctors, the 91-year-old woman confessed to Dr. Kevin Newfield as he treated a deep wound on her arm.

“You don’t have to, but you have to tell me what you do want,” Newfield replied.

“I’m not afraid of dying. I’m afraid of being 106,” she told the surgeon and her daughter, who was in the room with them.

The woman’s spontaneous admission in Newfield’s south Florida office that January day triggered a 20-minute discussion about living wills, hospice and other end-of-life issues, Newfield said.

An orthopedic surgeon who sometimes performs amputations, Newfield is comfortable having those conversations.

Many doctors are not, but a Medicare policy, known as advance care planning, that took effect in January could help change that. Continue reading

Share

It’s not just doctors and nurses, patients need to wash their hands, too

Share

Hygiene. Cleaning Hands. Washing hands.

By Shefali Luthra
Kaiser Health News

Encouraging doctors and nurses to wash their hands frequently has always been considered an easy and effective way to curb the spread of infection in hospitals and other health facilities.

But a new research letter published Monday in JAMA Internal Medicine points to another key group of people who aren’t always keeping their hands so clean and, it turns out, probably should: patients.

Researchers focused on inner-city Detroit and examined patients who went from hospitals to post-acute care facilities — places like rehabilitation centers, skilled-nursing facilities, hospice and long-term care hospitals.

They found that almost one in four adults who left the hospital had on their hands a superbug: a virus, bacteria or another kind of microbe that resists multiple kinds of medicine. While in post-acute care, about 10 percent of patients picked up another superbug. Of those who had superbugs, 67 percent still had them upon being discharged, even if they hadn’t gotten sick.

These findings add to a growing body of research about hand hygiene and the patient’s role in infection transmission, and speak to an underlying problem with health care facilities — they can increase the odds of getting sick. The paper’s authors suggest it highlights a potential, so far underused strategy for addressing that concern: getting patients to wash their hands. Continue reading

Share

Retail clinics add convenience but also hike costs, study

Share

minuteclinicBy Chad Terhune
KaiserHeatlhNews

Retail clinics, long seen as an antidote to more expensive doctor offices and emergency rooms, may actually boost medical spending by leading consumers to get more care, a new study shows.

Rather than substituting for a physician office visit or trip to the hospital, 58 percent of retail clinic visits for minor conditions represented a new use of medical services, according to the study published Monday in the journal Health Affairs.

There are more than 2,000 in-store clinics nationwide, and they handle about 6 million patient visits annually.

Those additional visits led to a modest increase in overall health care spending of $14 per person per year.

“This challenges the conventional wisdom that retail clinics save the health care system money,” said Dr. Ateev Mehrotra, a co-author of the study and an associate professor of health care policy at Harvard Medical School. “The increase in spending from new utilization trumps the savings we saw from replacing doctor visits and the emergency department.”

There are more than 2,000 in-store clinics nationwide, and they handle about 6 million patient visits annually, the study said.

They are popular with many consumers who like strolling in for care with no appointment, as opposed to waiting hours elsewhere, and they are open seven days a week.

These small clinics are typically run by nurse practitioners and treat infections, mild sprains and handle other preventive care such as immunizations. Continue reading

Share

Pediatricians offer a ‘medical home’ for your child

Share

Pediatricians Know Children’s Medical History Well and Provide Comprehensive Care

McCabe_Liana_2014Guest column by Liana McCabe, MD
Contributing writer

As the mother of two young children and a pediatrician, I understand and appreciate how challenging it can be to coordinate health care for a child, especially for parents who also work outside the home or have other responsibilities. To make caring for children and their families easier, we strive to provide comprehensive pediatric services and have our office be your child’s ‘medical home.’

Your pediatrician can do it for you

Aided by an electronic medical record, which includes your child’s allergies, medical history and immunization records, a pediatrician is able to provide the most informed, safe and effective treatment options, unlike a clinic that may not be able to easily obtain your child’s personal health information.

Consistency is also key to proper health care

The importance of a long-term relationship with a pediatrician from the newborn years until adulthood – both for the patient and for the parent who is looking for guidance in navigating the sometimes challenging world of parenting – cannot be understated.

With every visit, phone call or secure email, the pediatrician is learning about your child’s health care needs, enabling the physician to make decisions with complete knowledge and information. This is why children’s health care is ideally delivered or coordinated through the child’s ‘medical home,’ the office of the primary-care pediatrician.

Pediatricians provide comprehensive care

Continue reading

Share

The stethoscope: Timeless tool or relic?

Share

Some doctors say clinicians can now get much more information from newer technology than they can get from a stethoscope. Clinging to the old tool isn't necessary, they say. (Kimberly Paynter/WHYY)

By Taunya English, WHYY
Kaiser Health News

To hear a patient’s heart, doctors used to just put an ear up to a patient’s chest and listen. Then, in 1816, things changed.

Lore has it that 35-year-old Paris physician Rene Laennec was caring for a young woman who was apparently plump, with a bad heart and large breasts.

Dr. George Davis, an obstetrician at East Tennessee State University who collects vintage stethoscopes, said the young Dr. Laennec didn’t feel comfortable pressing his ear to the woman’s bosom.

Kidney specialist Steven Peitzman, a professor at Drexel University College of Medicine, says physicians who are now in their 60s and 70s used to get praise if they had the 'ear' to hear and interpret subtle sounds through a stethoscope. (Kim Paynter/WHYY)

Kidney specialist Steven Peitzman, a professor at Drexel University College of Medicine, says physicians who are now in their 60s and 70s used to get praise if they had the ‘ear’ to hear and interpret subtle sounds through a stethoscope. (Kim Paynter/WHYY)

“So he took 24 sheets of paper and rolled them into a long tube and put that up against her chest, listened to the other end and found that not only could he hear the heart sounds very, very well, but it was actually better than what he could hear with his ear,” Davis said.

Or, maybe it was poor 19th century hygiene — lice and the smell of an unwashed body — that kept Laennec from getting too close to his patient.

Either way, he went home and crafted a wooden cylinder with a hole down the middle and that became the first stethoscope. Continue reading

Share

Insurers and Medicare agree on measures tracking doctors’ quality

Share

By Jordan Rau
KHN

The federal government and the insurance industry released on Tuesday an initial set of measures of physician performance that they hope will reduce the glut of conflicting metrics doctors now must report.

doctorqualityratings

The measures are intended to make it easier for Medicare, patients, insurers and employers to assess quality and determine pay. Continue reading

Share

Administration will continue to push Obamacare expansion, HHS chief says

Share

HHS Sec. Burwell says ‘beat goes on’ as agency seeks to expand health law’s influence

By Mary Agnes Carey
KHN

Official portrait of the Secretary of Health & Human Services Sylvia Mathews BurwellDepartment of Health and Human Services Secretary Sylvia M. Burwell on Friday hailed the health law’s 2016 enrollment gains and said the department was already beginning to gear up for the next enrollment period.

In addition to the health law, Burwell’s agency is juggling many other priorities these days, including coordinating her agency’s response to the emerging threat of the Zika virus, President Barack Obama’s “Moonshot on Cancer” initiative and the growing epidemic of opioid abuse.

“The beat goes on,” she said during a briefing with reporters at HHS headquarters. Continue reading

Share